SCIENCE AS AN ALLY OF PRACTICE

Well-founded criticisms of the Consumer Reports (CR; 1995) study of ps ychotherapy include possible bias of the CR sample; limitations of sel f-report; and the limitations of cross-sectional, retrospective data. Poorly founded criticisms concern ''consumer satisfaction'' and the cl aim that the remarkably good effects of long-term therapy resulted fro m spontaneous remission, the psychotherapy effects were small, and tha t nondoctoral providers did as well as doctoral-level providers. Both the experimental method (efficacy) and the observational method with c ausal modeling (effectiveness) answer complementary questions, and the y both do so by eliminating alternative possible causes. Efficacy stud ies, however, cannot test long-term psychotherapy because long-term ma nuals cannot be written and patients cannot be randomized into two-yea r-long placebo controls, so the ''empirical validation'' of long-term therapy will likely come from effectiveness studies. Such studies of l ong-term therapy, of qualifications of providers, and of clinical judg ement versus case management are urgently needed as practice confronts managed care.