FAIR TESTS OF CLINICAL-TRIALS - A TREATMENT IMPLEMENTATION MODEL

We propose a psychotherapy treatment implementation model whereby adeq uate levels of independent treatment components (delivery, receipt, an d enactment) are prerequisite to asserting whether a valid clinical tr ial has been conducted. The delivery component refers to the accuracy of treatment presentation. receipt refers to the accuracy of the clien t's comprehension of treatment, and enactment refers to the extent of out of session application initiated by the client. Clinical scientist s regularly address one or two of these components, but rarely all thr ee, according to a survey we report. Sources and effects of model defi cits, i.e., inadequate levels of treatment components, as well as meth ods of component assessment and induction, are discussed. We conclude that faults in any one of the components drain validity proportional t o the degree of deficit, and that clinical trials have often incorrect ly been considered fair tests, resulting in biased efficacy judgments.