Seligman M E
Department of Psychology, University of Pennsylvania, Philadelphia 19104, USA.
Am Psychol. 1996 Oct;51(10):1072-9. doi: 10.1037//0003-066x.51.10.1072.
Well-founded criticisms of the Consumer Reports (CR; 1995) study of psychotherapy include possible bias of the CR sample; limitations of self-report; and the limitations of cross-sectional, retrospective data. Poorly founded criticisms concern "consumer satisfaction" and the claim that the remarkably good effects of long-term therapy resulted from spontaneous remission, that psychotherapy effects were small, and that nondoctoral providers did as well as doctoral-level providers. Both the experimental method (efficacy) and the observational method with causal modeling (effectiveness) answer complementary questions, and they both do so by eliminating alternative possible causes. Efficacy studies, however, cannot test long-term psychotherapy because long-term manuals cannot be written and patients cannot be randomized into two-year-long placebo controls, so the "empirical validation" of long-term therapy will likely come from effectiveness studies. Such studies of long-term therapy, of qualifications of providers, and of clinical judgment versus case management are urgently needed as practice confronts managed care.
对《消费者报告》（CR；1995年）关于心理治疗研究的有充分根据的批评包括CR样本可能存在的偏差；自我报告的局限性；以及横断面回顾性数据的局限性。缺乏依据的批评涉及“消费者满意度”，以及长期治疗效果显著良好是自发缓解的结果、心理治疗效果微小以及非博士级从业者与博士级从业者表现相当的说法。实验方法（疗效）和带有因果模型的观察方法（有效性）回答互补性问题，而且二者都是通过排除其他可能原因来做到这一点的。然而，疗效研究无法测试长期心理治疗，因为无法编写长期治疗手册，且患者也不能被随机分配到为期两年的安慰剂对照组中，因此长期治疗的“实证验证”可能将来自有效性研究。随着实践面临管理式医疗，迫切需要对长期治疗、从业者资质以及临床判断与病例管理进行此类研究。
