[New directions for psychotherapy research: an evaluation of a research protocol and a methodological and technical framework proposal]

Abstract

Introduction: A recent report of the French research institute INSERM, based on a comprehensive review of the work done on the evaluation of psychotherapies Psychothérapies: trois approches évaluées, has shown the lack of research in France on this topic, notably in psychodynamic psychotherapy. The development of such research is needed. The first part of the paper deals with the limits of the third generation of studies on psychotherapy (medical model, use of RCT, DSM...) on which the INSERM report is based and reviews the existing propositions for a fourth generation of research in the field. METHODOLOGICAL FINDINGS: In the second part, a process-outcome research protocol developed by the authors, according to these new proposals as well as several on-going researches [J Clin Psychol, 27 2 (1998) 217-26, J Pragm Case Stud 3 (2000)(2), Arch Gen Psychiatry 59 (2002) 505-10, Psychother Res 12 3 (2002) 251-72 and Br J Psychiatry 165 (1994) 4-8] is presented. The proposed methodology is based on controlled single case studies. Quantitative and qualitative data are associated for the definition of the diagnosis, as well as initial, intermediate and final measures. Process analysis is used to describe the main characteristics of the on-going psychotherapy at different moments in time. It is thus possible to gain access to what is really done during the therapy and not only to what is supposed to be done, based on a manual or even on the name of the theory used by the therapist.

Design of the study: This methodology was tested during a one-year pilot study, in true conditions of psychotherapy with outpatients. The different phases of the analysis are presented: several tools dedicated to the observation, formalisation and data analysis are integrated in a coherent iterative process during the whole therapy. The interests and limits of each tool (ESM, DSM, PPQS, Hoglend, CORE...) are described together with the first results of the pilot study.

Discussion: The overall architecture of a database designed to collect, search and analyse data is provided in the last part of the paper.

Conclusion: This framework offers two possibilities at the same time: it provides therapists with the ability to follow the evolution of their cases and to compare them with similar cases. It provides researchers with the ability to drive true comparative analysis, based on psychotherapies conducted in real situations and on detailed-enough descriptions to obtain significant outcomes.