Paradigms in current psychotherapy research: a critique and the case for evidence-based psychodynamic psychotherapy research

Psychotherapy research that compares one treatment with another has resulted in anomalies. First, treatments appear to be equivalent and second, therapist effects appear to be stronger than treatment effects. In order to make progress these anomalies need to be addressed. The ways in which research is proceeding can be conceptualised as following different paradigms, each one having convictions about what are the rules and standards for scientific practice. In particular, efficacy researchers advocate the gold standard to be the randomised controlled trial. Alternative and emerging paradigms for psychotherapy research are identified and briefly outlined. The problems and pitfalls of each one are summarised. It is argued that one of the paradigms, which is centered on understanding psychotherapy process and referred to in the paper as “back to the phenomena”, offers the greatest potential for evidence-based psychotherapy practice. It is argued that future psychotherapy research should be based on theory-based process research. Psychodynamic psychotherapy process research is well established and examples of the findings of this type of research and their relevance to future research and practice are provided