POSITION PAPER ON FUNDING FOR PSYCHOTHERAPY RESEARCH
(approved March 7, 2006)

The APA Division of Psychotherapy is committed to advancing psychotherapy training, research, and practice within the profession of psychology. At this time, programmatic psychotherapy research is confronted with obstacles that endanger its continued contribution to the health and welfare of the populace. Psychotherapy researchers are increasingly alarmed by sociopolitical policies and funding priorities.

Background

Over 5,000 empirical studies and 300 meta-analyses have established the clinical and cost effectiveness of psychotherapy in reducing symptoms, restoring work performance, and improving quality of life for the vast majority of those who seek treatment. The research demonstrates that 75% of people who enter psychotherapy evidence meaningful improvement. Moreover, research consistently indicates that psychotherapy produces favorable results when compared to psychoactive medications and when assessed for cost effectiveness.

Three Problems and Recommended Solutions

Problem 1: The limited funds available for psychotherapy research are largely devoted to randomized clinical trials (RCTs). While RCTs are valuable designs for establishing the causal effectiveness of treatments, they are incomplete in explicating the reasons for such effectiveness and in translating science into service.

Recommended Solutions: Fund an array of methodological designs for psychotherapy research. These include:
a. Process research is a primary method of conducting basic research and understanding the mechanisms of change.
b. Qualitative and single-case designs are necessary to study important aspects of process research, such as participant moment-by moment responsiveness and the therapist-patient relationship.
c. Effectiveness research examines psychotherapy as it is commonly practiced and such critical parameters as patients at risk for negative outcomes, and the generalization of treatments validated in the laboratory to routine clinical practice.
d. Practice-based research networks enhance collaboration between researchers and clinicians and facilitate technology transfer.

Problem 2: The limited funds available for psychotherapy research are largely allocated to investigating the efficacy of manualized treatments. These are valuable studies but incomplete as the research repeatedly demonstrates that the therapeutic relationship, patient contributions, and therapist effects account for as much, if not more, of patient success than particular treatments.

Recommended Solutions: Fund psychotherapy research that investigates more than manualized treatments. These include:
a. Adaptation of treatments to patient characteristics (e.g., stages of change, preferences for treatments, ethnic diversity) is necessary for predicting outcome and customizing the most effective treatment for individual patients.
b. Sub-threshold disorders and comorbid disorders are more common than in medicine and are frequently excluded from funding consideration because they fail to meet diagnostic criteria for randomized clinical trials.
c. Long-term treatment studies can determine which treatments are most clinically and cost effective.
d. Research on psychotherapy with marginalized clients, such as members of ethnic/racial minorities and the physically disabled.
e. Couples and family therapy are treatments of choice for many relationship problems with public health implications. Yet, psychotherapy research on couples and family processes is rarely identified or funded.
f. Therapist-focused research investigates the impact of therapists' personal characteristics, relational style, and training on their effectiveness and are critical to understanding why some therapists are more effective than others.
g. Application of psychological research to physician-patient relationships contributes to health-care outcomes given the increasing attention in the medical literature to the treatment relationship.

Problem 3: The criteria for evaluating grant proposals in psychotherapy research are frequently inadequate and the reviewers are expert in only efficacy designs.

Recommended Solutions:
a. The criteria for evaluating research proposals should be appropriate for the area of investigation, stage of inquiry, and state of knowledge. When recommending criteria revision, psychotherapy researchers are often referred to the NIMH R34 program, a standing program for many of the types of studies requested. These are "early" studies proposing new models or developing new treatment approaches.
b. Reviewers should be peers of the applicants and knowledgeable about the relevant areas of psychotherapy research. Panels should be composed of established psychotherapy researchers with experience in the kinds of research questions being reviewed and the methodologies being employed.
c. Federal grant office staff should included individuals with experience in psychotherapy research in order to provide adequate consultation to grant applicants and to initiate conferences addressing relevant research issues.
d. Membership on special task forces is essential for psychotherapy researchers in that these working groups produce documents that set priorities for future funding.