Obstacles to a randomised controlled trial of intensive dynamic psychotherapy: an account of the New South Wales Section of Psychotherapy outcomes project

Objective: This paper examines the obstacles to a randomised controlled tri al (RCT) of intensive dynamic psychotherapy (IDP) by reference to the fate of the New South Wales Section of Psychotherapy outcomes project. Method: Planning was complete and the final research protocol was about to be implemented when funding difficulties led to suspension of the project. The opinions of the research subcommittee regarding the main obstacles to t he ultimate success of the project are now analysed in the expectation that better research strategies will follow. Results: With hindsight, six of the eight members of the research subcommit tee reported that the project was not feasible. By choice of questionnaire items they identified the greatest threats to a successful trial as: standa rdisation of the procedures, termination at 24 months, the availability of funding and the choice of treatment procedures. The most frequently volunte ered concerns related to the enlistment and cooperation of the trial therap ists (5), standardisation of the experimental therapy (3), probable shortfa ll in trial subjects (3) and the availability of funding (2). Conclusions: The most powerful general obstacles to success of the project related to the standardisation of procedures and the failure to maintain su fficient cooperation of trial therapists. The protocol required IDP therapi sts to terminate procedures at 24 months, which contradicted their usual pr actices and led to some alienation from the project. Amendments to the prot ocol might improve the possibility of a successful trial. However, one migh t also conclude that it is premature to attempt a naturalistic RCT of IDP.