Treatment-as-usual for adolescent suicide attempters: implications for the choice of comparison groups in psychotherapy research.

Studied Treatment-as-Usual (TAU) in a sample of 63 adolescent suicide attempters. Randomized clinical trials (RCT's) with high-risk populations, such as suicidal patients, are difficult to conduct due to clinical and ethical concerns about control groups. Therefore, TAU comparison groups have been proposed as ethically defensible alternatives to control groups. However, TAU is rarely characterized in treatment trials. Following a suicide attempt, the adolescents in our sample reported attending 0 to 22 outpatient psychotherapy sessions, with an average of 7.0 sessions. Fifty-two percent of the adolescents reported attending six or fewer sessions. Supportive psychotherapy techniques were reported by three fourths of the sample, psychodynamic and cognitive techniques by one half of the sample, and behavioral techniques by one third of the sample. Results suggest that TAU with this population of adolescents is highly variable, both in terms of the number of sessions attended and type of treatment received. This variability makes interpretation of treatment results in clinical trials with TAU comparison groups tenuous. Given the attention paid to treatment attendance and fidelity in most RCTs, even less potent control groups in such trials may be both ethically and clinically as justifiable as TAU designs for high-risk populations.