THE IMPORTANCE OF THE PRINCIPLE OF CLINICAL-SIGNIFICANCE - DEFINING SIGNIFICANT TO WHOM AND FOR WHAT PURPOSE - A RESPONSE TO TINGEY, LAMBERT, BURLINGAME, AND HANSEN

Tingey, Lambert, Burlingame, and Hansen (1996) argue that although the re are benefits and utility of clinical significance, extensions to th e concept proposed a decade ago (Jacobson, Follette, & Revenstorf, 198 4a) are necessary. The criticisms of the original paper and subsequent extensions are problematic and fail to appreciate the underlying prin ciple of clinical significance, namely defining for whom and for what purpose significant change would be identified. This paper responds to several of the criticisms outlined in Tingey et al. with regard to op erationalizing a comparison group, the perceived limitations of using two distributions, and the problems with their approach of specifying a method for determining whether groups are distinct. We then propose that there is a principle that underlies the concept of clinical signi ficance that should be appreciated. We conclude by describing under wh at conditions ''functional'' distributions may be supplemented by incl uding information to allow comparisons of outcomes with the current be st available treatment alternative, but offer a cautionary statement a bout the potential risks run by extensions such as Tingey et al.'s tha t can obscure the concept of clinical significance to the point that r esearchers are no longer discussing change in terms meaningful to the client.