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RecognitionofPsychotherapyEffectiveness

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RecognitionofPsychotherapyEffectiveness
ApprovedAugust2012

Thisresolutionreportsonthegeneraleffectivenessofpsychotherapy.Inaddition,APAisintheprocessofcreatingclinicaltreatmentguidelines
(/about/offices/directorates/guidelines/clinicalpractice.aspx).Theseguidelineswillhelpidentifyspecifictreatmentswhicharemosteffectiveforparticularproblemsorpatients.

Introduction
CouncilvotedtoadoptasAPApolicythefollowingResolutionontheRecognitionofPsychotherapyEffectiveness1 :
WHEREAS:psychotherapyisrootedinandenhancedbyatherapeuticalliancebetweentherapistandclient/patientthatinvolvesabondbetweenthepsychologistandthe
client/patientaswellasagreementaboutthegoalsandtasksofthetreatment(Cuijpers,etal.,2008,Lambert,2004Karver,etal.,2006Norcross,2011Shirk&Karver,2003
Wampold,2007)
WHEREAS:psychotherapy(individual,groupandcouple/family)isapracticedesignedvaryinglytoprovidesymptomreliefandpersonalitychange,reducefuturesymptomatic
episodes,enhancequalityoflife,promoteadaptivefunctioninginwork/schoolandrelationships,increasethelikelihoodofmakinghealthylifechoices,andofferotherbenefits
establishedbythecollaborationbetweenclient/patientandpsychologist(AmericanGroupPsychotherapyAssociation,2007APATaskForceonEvidenceBasedPractice,2006
Burlingame,etal.,2003Carr,2009a,2009bKosters,etal.,2006Shedler,2010,Wampold,2007,2010)

Definitions
WHEREAS:evidencebasedpracticeinpsychologyis"theintegrationofthebestavailableresearchwithclinicalexpertiseinthecontextofpatientcharacteristics,cultureand
preferences"(APATaskForceonEvidenceBasedPractice,2006,p.273)
WHEREAS:aworkingdefinitionforPsychotherapyisasfollows:"Psychotherapyistheinformedandintentionalapplicationofclinicalmethodsandinterpersonalstancesderived
fromestablishedpsychologicalprinciplesforthepurposeofassistingpeopletomodifytheirbehaviors,cognitions,emotions,and/orotherpersonalcharacteristicsindirections
thattheparticipantsdeemdesirable"(Norcross,1990,p.218220)
WHEREAS:aworkingdefinitionforTreatmentisasfollows:Treatmentswhenusedinthecontextofhealthcare,refertoanyprocessinwhichatrainedhealthcareprovideroffers
assistancebaseduponhisorherprofessionalexpertisetoapersonwhohasaproblemthatisdefinedasrelatedto"health"or'illness."Inthecaseof"mental"or"behavioral"
health,theconditionsforwhichonemayseek"treatment"includeproblemsinliving,conditionswithdiscretesymptomsthatareidentifiedasorasrelatedtoillnessordisease,
andproblemsofinterpersonaladjustment.Thetreatmentconsistsofanyactorservicesprovidedbyabonafidehealthproviderintendedtocorrect,changeoramelioratethese
conditionsorproblems(Beutler,1983Frank,1973)

ResearchonEffectiveness
WHEREAS:theeffectsofpsychotherapyarenotedintheresearchasfollows:Thegeneraloraverageeffectsofpsychotherapyarewidelyacceptedtobesignificantandlarge,
(Chorpitaetal.,2011Smith,Glass,&Miller,1980Wampold,2001).Theselargeeffectsofpsychotherapyarequiteconstantacrossmostdiagnosticconditions,withvariations
beingmoreinfluencedbygeneralseveritythanbyparticulardiagnosesThatis,variationsinoutcomearemoreheavilyinfluencedbypatientcharacteristicse.g.,chronicity,
complexity,socialsupport,andintensityandbyclinicianandcontextfactorsthanbyparticulardiagnosesorspecifictreatment"brands"(Beutler,2009Beutler&Malik,2002a,
2002bMalik&Beutler,2002Wampold,2001)
WHEREAS:theresultsofpsychotherapytendtolastlongerandbelesslikelytorequireadditionaltreatmentcoursesthanpsychopharmacologicaltreatments.Forexample,in
thetreatmentofdepressionandanxietydisorders,psychotherapyclients/patientsacquireavarietyofskillsthatareusedafterthetreatmentterminationandgenerallymay
continuetoimproveaftertheterminationoftreatment(Hollon,Stewart,&Strunk,2006Shedler,2010)
WHEREAS:formostpsychologicaldisorders,theevidencefromrigorousclinicalresearchstudieshasshownthatavarietyofpsychotherapiesareeffectivewithchildren,adults,
andolderadults.Generally,thesestudiesshowwhatexpertsinthefieldconsiderlargebeneficialeffectsforpsychotherapyincomparisontonotreatment,confirmingtheefficacy
ofpsychotherapyacrossdiverseconditionsandsettings(Beutler,2009Beutler,etal.,2003Lambert&Ogles,2004McMain&Pos,2007Shedler,2010Thomas&Zimmer
Gembeck,2007Verheul&Herbrink,2007Wampold,2001).Incontrasttolargedifferencesinoutcomebetweenthosetreatedwithpsychotherapyandthosenottreated,different
formsofpsychotherapytypicallyproducerelativelysimilaroutcomes.Thisresearchalsoidentifieswaysofimprovingdifferentformsofpsychotherapybyattendingtohowtofitthe
interventionstotheparticularpatient'sneeds(Castonguay&Beutler,2006Miklowitz,2008Norcross,2011)
WHEREAS:comparisonsofdifferentformsofpsychotherapymostoftenresultinrelativelynonsignificantdifference,andcontextualandrelationshipfactorsoftenmediateor
moderateoutcomes.Thesefindingssuggestthat(1)mostvalidandstructuredpsychotherapiesareroughlyequivalentineffectivenessand(2)patientandtherapist
characteristics,whicharenotusuallycapturedbyapatient'sdiagnosisorbythetherapist'suseofaspecificpsychotherapy,affecttheresults(Castonguay&Beutler,2006
Livesley,2007Norcross,2011)
WHEREAS:instudiesmeasuringpsychotherapyeffectiveness,clientsoftenreportthebenefitsoftreatmentnotonlyendure,butcontinuetoimprovefollowingtherapycompletion
asseeninlargereffectsizesfoundatfollowup(Abbass,etal.,2006Anderson&Lambert,1995DeMaat,etal.,2009Grant,etal.,2012Leichsenring&Rabung,2008
Leichsenring,etal.,2004Shedler,2010)
WHEREAS:researchusingbenchmarkingstrategieshasestablishedthatpsychotherapydeliveredinroutinecareisgenerallyaseffectiveaspsychotherapydeliveredinclinical
trials(Minami,etal.,2008Minami,etal.,2009Minami&Wampold,2008Nadort,etal.,2009Wales,Palmer,&Fairburn,2009)
WHEREAS:theresearchevidenceshowsthatpsychotherapyisaneffectivetreatment,withmostclients/patientswhoareexperiencingsuchconditionsasdepressionand
anxietydisordersattainingorreturningtoaleveloffunctioning,afterarelativelyshortcourseoftreatment,thatistypicalofwellfunctioningindividualsinthegeneralpopulation
(Baldwin,etal.,2009Minami,etal.,2009Stiles,etal.,2008Wampold&Brown,2005)
WHEREAS:researchwillcontinuetoidentifyfactorsthatmakeadifferenceinpsychotherapy,andresultsofthisresearchcanthenbereportedtoclinicianswhocanmakebetter
decisions(Gibbon,etal.,2010Kazdin,2008)
WHEREAS:researcherswillcontinuetoexaminethewaysinwhichbothpositiveandpossiblenegativeeffectsofpsychotherapyoccur,whetherduetotechniques,client/patient
variables,therapistvariables,orsomecombinationthereof,inordertocontinuetoimprovethequalityofmentalhealthinterventions(Barlow,2010Dimidjian&Hollon,2010
Duggan&Kane,2010Haldeman,1994Wilson,Grilo,&Vitousek,2007)

EffectivenessRelatedToHealthCarePolicies
WHEREAS:theeffectsproducedbypsychotherapy,includingtheeffectsfordifferentagegroups(i.e.children,adults,andolderadults)andformanymentaldisorders,exceedor
arecomparabletothesizeofeffectsproducedbymanypharmacologicaltreatmentsandproceduresforthesamecondition,andsomeofthemedicaltreatmentsandprocedures
havemanyadversesideeffectsandarerelativelyexpensivevisavisthecostofpsychotherapy(Barlow,2004Barlow,Gorman,Shear,&Woods,2000Hollon,Stewart,&
Strunk,2006Imel,McKay,Malterer,&Wampold,2008Mitte,2005Mitte,Noack,Steil,&Hautzinger,2005Robinson,Berman,&Neimeyer,1990Rosenthal,1990Walkup,et
al.,2008Wampold,2007,2010)
WHEREAS:asubstantialbodyofscholarlywork(e.g.,Henggeler&Schaeffer,2010Roberts,2003Walker&Roberts,2001Weiszetal.,2005)havedocumentedthe
effectivenessofpsychotherapyacrossarangeofproblemsaffectingchildrenandadolescents
WHEREAS:largemultisitestudiesaswellasmetaanalyseshavedemonstratedthatcoursesofpsychotherapyreduceoverallmedicalutilizationandexpense(Chiles,Lambert,
&Hatch,2002Linehan,etal.,2006Pallak,Cummings,Dorken,&Henke,1995).Further,patientsdiagnosedwithamentalhealthdisorderandwhoreceivedtreatmenthadtheir
overallmedicalcostsreducedby17percentcomparedtoa12.3percentincreaseinmedicalcostsforthosewithnotreatmentfortheirmentaldisorder(Chiles,Lambert,&Hatch,
2002)
WHEREAS:thereisagrowingbodyofevidencethatpsychotherapyiscosteffective,reducesdisability,morbidity,andmortality,improvesworkfunctioning,decreasesuseof
psychiatrichospitalization,andattimesalsoleadstoreductionintheunnecessaryuseofmedicalandsurgicalservicesincludingforthosewithseriousmentalillness(Dixon
Gordon,Turner,&Chapman,2011Lazar&Gabbard,1997).Successfulmodelsoftheintegrationofbehavioralhealthintoprimarycarehavedemonstrateda2030percent
reductioninmedicalcostsabovethecostofthebehavioral/psychologicalcare(Cummings,etal.,2003).Inaddition,psychologicaltreatmentofindividualswithchronicdiseasein

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smallgroupsessionsresultedinmedicalcarecostsavingsof$10forevery$1spent(Lorig,etal.,1999)
WHEREAS:thereisstrongscientificevidencetosupportthelinksbetweenmentalandphysicalhealth,andagrowingnumberofmodelsandprogramssupporttheefficacyofthe
integrationofpsychotherapytreatmentwithintheprimaryhealthcaresystem(Alexander,Arnkoff,&Glass,2010Felker,etal.,2004RoyByrne,etal.,2003).Infact,earlymental
healthtreatmentsthatincludepsychotherapyreduceoverallmedicalexpenses,simplifiesandprovidesbetteraccesstoappropriateservicesandcaretothoseinneed,and
improvestreatmentseeking
WHEREAS:manypeoplepreferpsychotherapytopharmacologicaltreatmentsbecauseofmedicationsideeffectsandindividualdifferencesandpeopletendtobemore
adherentifthetreatmentmodalityispreferred(Deacon&Abramowitz,2005Paris,2008Patterson,2008Solomonetal.,2008Vocksetal.,2010).Researchsuggeststhatthere
areveryhigheconomiccostsassociatedwithhighratesofantidepressantterminationandnonadherence(Tournier,etal.,2009),andpsychotherapyislikelytobeamorecost
effectiveinterventioninthelongterm(Cuijpers,etal.,2010Hollon,etal.,2005Pyne,etal.,2005)

EffectivenesswithDiversePopulations
WHEREAS:thebestresearchevidenceconclusivelyshowsthatindividual,groupandcouple/familypsychotherapyareeffectiveforabroadrangeofdisorders,symptomsand
problemswithchildren,adolescents,adults,andolderadults(AmericanGroupPsychotherapyAssociation,2007Burlingame,etal.,2003Carr,2009a,2009bChambless,etal.,
1998Horrell,2008Huey&Polo,2008,2010Knight,2004Kosters,etal.,2006Lambert&Archer,2006Norcross,2011Pavuluri,Birmaher,&Naylor,2005Sexton,
Alexander,&Mease,2003Sexton,Robbins,Hollimon,Mease,&Mayorga,2003Shadish&Baldwin,2003Stice,Shaw,&Marti,2006Wampold,2001Weisz&Jensen,2001)
WHEREAS:thedevelopmentand/oradaptationofevidencebasedpsychotherapypracticesforeachagegrouphavefurtherdemonstratedeffectivenessinreducingsymptoms
andimprovingfunctioningacrossthelifespan.Specificchallengesthatemergewithageareaddressedbydevelopmentalresearchthatpinpointsthemostefficaciouscontent,
vocabulary,andtechniquesusedfordifferentages.Asaresult,substantialevidencesupportspsychotherapyasafrontlineinterventionforcommunitydwellingolderadults,
olderadultswithmedicalillnesses,whoarelowincome,ethnicminorityandhavecooccurringmildcognitiveimpairments.Inaddition,increasingevidencehasdocumentedthat
olderadultsrespondwelltoavarietyofformsofpsychotherapyandcanbenefitfrompsychologicalinterventionstoadegreecomparablewithyoungeradults.Furthermore,many
olderadultspreferpsychotherapytoantidepressants,andpsychotherapyisanimportanttreatmentoptionforolderadultswhoareoftenonmultiplemedicationsformanagement
ofchronicconditionsandaremorepronetotheadverseeffectsofpsychiatricmedicationsthanyoungeradults(Alexopoulos,etal.,2011APA,2004Aren,etal.,2005aAren,
etal.,2005bAren,Gum,Tang,&Unutzer,2007Aren,etal.,2010Arnold,2008Gum,Aren,&Bostrom,2007Cuijpers,vanStraten&Smit,2006Kazdin,etal.,2010
Kaslow,etal.,2012)
WHEREAS:researchersandpractitionerscontinuetodevelopculturallyrelevant,sociallyproactiveapproachesandmodalitiesthatwillallowpsychologiststoextend
psychotherapeuticservicestovulnerableandcurrentlyunderservedpopulationssuchasadults,children,andfamilieslivinginpoverty(Ali,Hawkins,&Chambers,2010Belle&
Doucet,2003Goodman,Glenn,Bohlig,Banyard,&Borges,2009Smith,2005,2010Smyth,Goodman,&Glenn2006)
WHEREAS:bothevidencebasedpsychotherapypracticeforthegeneralpopulationandculturallyadaptedinterventionsaregenerallyeffectivewithracial/ethnicminorities,
psychologistswhoworkwithmarginalizedpopulations,suchaspeoplelivinginpovertyand/orothersociallyexcludedgroups,canimprovetheeffectivenessoftheir
interventionsthroughawarenessofunintentionalage,race,class,and/orgenderbias.Theacquisitionofmulticulturalcompetenceandtheadaptationofpsychotherapy,whether
incontent,language,orapproach,canimproveclientengagementandretentionintreatmentandcanenhancedevelopmentofthetherapeuticalliance(Griner&Smith,2006
Horrell,2008Huey&Polo,2008,2010Miranda,etal.,2005Miranda,etal.,2006Vasquez,2007Whaley&Davis2007)
WHEREAS:theresearchcontinuestosupportthatpsychotherapy,bothgroupandindividualsmodelsofclinicalinterventions,iseffectivetreatmentforindividualswith
disabilities.Thestudiesalsoindicatethatpsychotherapyiseffectiveforavarietyofdisabilityconditionsincludingcognitive,intellectual,physical,visual,auditory,and
psychologicalimpairments.Theresearchsupportsthatpsychotherapyiseffectiveforindividualswithdisabilitiesoverthelifespan.Asampleoftheresearchreflectingthe
effectivenessoftherapywithindividualswithdisabilitiesinclude:Glickman(2009),Hibbard,Grober,Gordon,&Aletta(1990),Kurtz&Mueser(2008),Livneh&Sherwood(2001),
Lysaker,Glynn,Wilkniss,&Silverstein(2010),Olkin(1999),Perlman,Cohen,Altiere,Brennan,Brown,Mainka,&Diroff,(2010),Rice,Zitzelsberger,Porch,&Ignagni(2005),
Radnitz(2000),andVail&Xenakis(2007)
WHEREAS:researchindicatesthebeneficialeffectsofpsychotherapyasameansofimprovingmoodandreducingdepressionamongindividualswithacuteandchronichealth
conditions(e.g.,arthritis,cancer,HIV/AIDS)(Fisch,2004Himelhoch,etal.,2007Lin,etal.,2003)
WHEREAS:althoughsomeculturaladaptationsalreadyhavedemonstratedeffectivenessasmentionedabove,manyunderservedcommunitiescancontinuetobenefitfrom
specificadaptationsordemonstratedeffectivenessofevidencebasedpsychotherapypractice.Forexample,currentpsychotherapyresearchsuggeststhatracial/ethnic
minorities,thosewithlowsocioeconomicstatus,andmembersoftheLGBTcommunitymayfacespecificchallengesnotaddressedbycurrentevidencebasedtreatment.In
conductingpsychotherapy,practitionersaresensitivetothesechallengesandpursueappropriateadaptations(Butler,O'Donovan,&Shaw,2010Cabral&Smith,2011Gilman,
etal.,2001Smith,2005Sue&Lam,2002)
THEREFORE:BeItResolvedthat,asahealingpracticeandprofessionalservice,psychotherapyiseffectiveandhighlycosteffective.Incontrolledtrialsandinclinicalpractice,
psychotherapyresultsinbenefitsthatmarkedlyexceedthoseexperiencedbyindividualswhoneedmentalhealthservicesbutdonotreceivepsychotherapy.Consequently,
psychotherapyshouldbeincludedinthehealthcaresystemasanestablishedevidencebasedpractice.
BeItFurtherResolvedthatAPAincreaseitseffortstoeducatethepublicabouttheeffectivenessofpsychotherapysupportadvocacyeffortstoenhanceformalrecognitionof
psychotherapyinthehealthcaresystemhelpensurethatpolicieswillincreaseaccesstopsychotherapyinthehealthcaresystem,withparticularattentiononaddressingthe
needsofunderservedpopulationsandencourageintegrationofresearchandpracticeandsupportadvocacyforfunding.
BeItFurtherResolvedthatAPAencouragescontinuedandfurtherresearchonthecomparativeeffectivenessandefficacyofpsychotherapy.
1Whilestatementsabouttheeffectivenessofpsychotherapymustbeaccurateyetgeneralizedinapolicydocumentformat,researchstudieshavenotequitablyinvestigatedallfactorsthateither

enhanceordiminishpsychotherapyeffectiveness.Fullexplicationofthedifferentialstatusofanygivenvariableandthestateofresearchofanygivenfactorinthepracticeofpsychotherapyis
beyondthescopeofthisdocument.Theresearchcitationsthataccompanyeachstatementprovidespecificityofscope,limitations,andimplicationsforpsychotherapypracticeandidentifythe
therapeuticcircumstancesinwhichresearchhasdeterminedthatpsychotherapyissoundlyeffective.Examplesoftheseimportantmoderatingvariablesincludeclient/patientcharacteristics,clinician
characteristics,contextfactors,diagnosticclassificationandseverity,developmentalstatus,andfactorsrelatedtosuchhumanandculturaldiversityasrace,ethnicity,gender,sexualorientationand
disabilitystatus(Bernal,JimenezChafey,&DomenechRodriguez,2009Curry,Rohde,Simons,Silva,Vitiello,Kratochvil,etal.,2006Hinshaw,2007Kazdin,2007Kocsis,Leon,Markowtiz,
Manber,Arnow,Klein,&Thase,2009McBride,Atkison,Quilty,&Bagby,2006Miklowitz,Axelson,George,Taylor,Schneck,Sullivan,etal.,2009Ollendick,Jarrett,GrillsTaquechel,Hovey,&
Wolff,2008).

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