Greenspan S I, Sharfstein S S
Arch Gen Psychiatry. 1981 Nov;38(11):1213-9. doi: 10.1001/archpsyc.1981.01780360029002.
Economic pressures and "value" judgments both compel and contaminate the current debate on the efficacy of psychotherapy. Too often, complex clinical trial outcome studies ignore the clinical or treatment process, as well as personality or contextual variables. Thus, they fail to build the foundations of a clinical science that makes possible the development of individually tailored treatment approaches and outcome predictions for specific patients with unique personalities, symptoms, and life circumstances. The real challenge, therefore, is for each psychotherapeutic approach to delineate its "process steps" and relate these steps to different outcomes. The "process" is the "final common pathway" for a number of patient, therapist, technique, and contextual variables. The capacity to predict the relationship between process and outcome at each stage in a therapeutic procedure is the relevant clinical test of "efficacy."
经济压力和“价值”判断既推动又干扰了当前关于心理治疗疗效的辩论。复杂的临床试验结果研究常常忽视临床或治疗过程，以及个性或情境变量。因此，它们未能奠定临床科学的基础，而这种基础对于为具有独特个性、症状和生活状况的特定患者制定个性化治疗方法和结果预测是必不可少的。因此，真正的挑战在于每种心理治疗方法都要明确其“过程步骤”，并将这些步骤与不同的结果联系起来。“过程”是许多患者、治疗师、技术和情境变量的“最终共同路径”。在治疗过程的每个阶段预测过程与结果之间关系的能力是“疗效”的相关临床检验。
