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Evaluative Research of Psychotherapies: Lights and Shadow – Dr. José Manuel Martínez Rodríguez

There is now a need for psychotherapy professionals to be able to answer questions from...

Last updated 23 July 2024
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There is now a need for psychotherapy professionals to be able to answer questions from users and health managers about the usefulness of the methods we use. This social demand comes, however, influenced by a health and social context in which treatment for specific mental disorders is sought. Anyway the consensus on which the Diagnostic Categories are based doesn´t reflects a psychopathological reality. It is a mere description of symptoms, which changes over time, being its primary goal to facilitate communication between professionals and institutions that reimburse expenses. Current classifications (DSM-V, CIE 10a) lack a psychopathological theory that supports diagnostic consensuses. This social demand, on the other hand, does not take into account that psychotherapy, as a generic method of treatment, goes far beyond mere symptomatic reduction.

Methods of evaluation of psychotherapies have followed the medical model of evaluation of treatments and have chosen as gold standard randomized controlled trials, assuming the challenge of showing that they have effective means to treat specific mental disorders. This creates an implicit competition with psychopharmacological treatments for specific disorders and between schools of psychotherapy. On the other hand, different schools implicitly assume a frame of reference in which what is validated by current evaluation methods is not the basic psychopathological construct but the techniques and methods that are effective for the treatment of specific disorders.

Current methods of evaluation of psychotherapies have privileged three dimensions to evaluate, effectiveness, effectiveness and efficiency in symptomatic reduction, regardless of other possible dimensions, such as improving self-knowlege, personal development, transformation of personality traits, improvement of quality of life, etc. On the other hand, funding entities in the evaluative research of psychotherapies are at risk of funding short forms of psychotherapy, easily replicable, but with little long-term follow-up, versus psychotherapeutic interventions of complex and prolonged mental disorders.

Almost all schools work implicitly with cognitive behavioral techniques that have been found effective in evaluation studies. It should therefore be noted that these procedures, common to most psychotherapy schools, are already an a priori indicator of their effectiveness. Research could then proceed to validate in a concerted manner the affective, behavioral, physiological and cognitive components that are effective present in different proportions throughout treatment in different schools.

Since the 1990s, a methodological corpus has been generated that has been refined in order to eliminate biases in research, improve causal inferences and improve statistical power of analysis. Today it is thought in terms of a hierarchy of evidence combining experimental, quasi-experimental and observational methods to inform the clinician. While this hierarchy of evidence is at the service of improving the decision-making of professionals, there is a risk that funding companies and health managers will use the evidence the wrong way as if the results of the research had a direct translation into improving care. Good results in researching the effectiveness of a treatment method may not follow well in clinical practice. On the other hand, there are patients who can improve with methods with which most do not improve.

Therefore, the results of the current evidence list should not be considered definitive, it should be used with caution without considering that techniques that do not currently have evidence are ineffective or useless. On the other hand, it is important that evaluative researchers of psychotherapies continue to establish their own evaluation methods, reflecting the depth of psychotherapies by differentiating them from the methods used to evaluate medical treatments.

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Evaluative Research of Psychotherapies: Lights and Shadow - Dr. José Manuel Martínez Rodríguez

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