Measuring Success: Debating Psychotherapy’s Value and the Role of RCTs in Assessing It

• In Event: Randomized Controlled Trials: The “Gold Standard” Between Theory and Practice

Abstract

This paper traces early debates about the efficacy of psychotherapeutic interventions and the methods for assessing it. I focus on the decades from 1950 to 1980 when discussions about controls, randomization, standardization, and quantification roiled the world of psychotherapy research. The paper asks: what are the main problems that researchers identified with their existing methods for assessing psychotherapeutic efficacy?, and what kind of solutions did they devise? To answer these questions, I rely on data from NIMH committee meetings and psychotherapeutic articles and books that include original research, reviews, as well as editorials and commentaries. The emerging themes evidence both narrow concerns with methods as well as larger questions about the relationship between research and the clinic, and between psychotherapy and the worlds of science and medicine. I place these conversations within the broader context of the time, defined by two related problems: first, the incipient pharmacological revolution in psychiatry and second, the dominance of psychoanalysis. This is a period during which randomized controlled trials are enshrined as gold standards in medical research (particularly after the 1962 Drug Amendments), laying the groundwork for a broader shift in the field of mental health. The push and pull of these influences—namely randomized controlled trials and psychoanalytic dominance—shapes the debates of the time and determines the research paths competing for legitimacy in the field. Previous scholarship has examined the emergence of new scientific methods and disciplines, showing how credible science is constructed and demarcated from non-science. Instead, I focus on how methods travel between fields, gain legitimacy in a relatively hostile context, and end up shifting the power relationships in the receiving epistemic community.

Author

• Mariana Craciun, Tulane University