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Placebo buster.

Placebo buster

There is a growing chorus of scientific criticism that brands psychotherapy research as inadequate because, unlike behavior therapy and drug treatments, the benefits of psychotherapy have not been compared with those of inactive, "placebo' treatments. But this argument, responds psychologist Morris Parloff of American University in Washington, D.C., should be bronzed and shelved with other outdated psychotherapy research techniques.

"In the field of psychotherapy, the term placebo is both conceptually grotesque and operationally infeasible--or nearly so,' writes Parloff in the February JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY.

One problem, he argues, is that the medical concept of a placebo--an inactive medication prescribed to placate a patient rather than treat a real disorder--is exceedingly difficult to apply to a host of psychotherapies. Since there is no consensus on the active ingredients of each therapy, he says, designing a placebo treatment is an exercise in futility. Specific techniques are not a good benchmark, says Parloff; patients tend to be reassured by the expertise of therapists who emphasize techniques and procedures, thus encouraging inadvertent placebo effects. In any case, he adds, many therapists are more concerned with nonspecific factors, such as the quality and strength of the relationship with a patient. And unlike drug researchers, therapists would know if they were dispensing a placebo or experimental intervention. The enthusiasm of placebo therapists, and the confidence of their patients, would inevitably suffer.

If not placebo controls, then what? Psychotherapy studies already have shown that many types of therapy can have positive effects, points out Parloff, but the myth has flowered that each treatment is equally effective for all kinds of disorders. He proposes that researchers now compare treatments with different types of interventions (say, instructing patients on how to think about problems in new ways versus fostering emotional expression and psychological insight) and see what works best for specific problems. The patient-therapist relationship, treatment length and other nonspecific variables could be held largely constant across therapies.

"I am not sanguine that the doubts nurtured by psychotherapy's most intense and imaginative critics will be appeased [by new placebo studies],' notes Parloff. "But the placebo challenge, as proposed, is ill-conceived.'
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Title Annotation:argument against use of placebo controls in psychotherapy research
Publication:Science News
Date:Mar 29, 1986
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