Psychotherapy Outcomes in Naturalistic Settings: A Reply to Hansen, Lambert, and Forman

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A recent article by Hansen, Lambert, and Forman (2002) comparing outcomes in naturalistic settings and clinical trials was based on the assumption that these samples are comparable. However, up to 50% of patients in naturalistic settings are either in the normal or mild ranges whereas no patients in clinical trial samples are in the normal range. When Hansen's data are analyzed controlling for initial level of severity, outcomes in clinical trial samples and naturalistic samples are roughly comparable. Thus, Hansen's conclusion that patients in naturalistic settings do not receive adequate exposure to psychotherapy is unsupported. Rather, the Hansen data suggest that adequate outcomes can be achieved with far less exposure to psychotherapy than that suggested by consensus clinical trial data.

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