Toward a more clinically valid approach to therapy research.

Despite the advances in psychotherapy outcome research, findings are limited because they do not fully generalize to the way therapy is conducted in the real world. Research's clinical validity has been compromised by the medicalization of outcome research, use of random assignment of clients without regard to appropriateness of treatment, fixed number of therapy sessions, nature of the therapy manuals, and use of theoretically pure therapies. The field needs to foster a more productive collaboration between clinician and researcher; study theoretically integrated interventions; use process research findings to improve therapy manuals; make greater use of replicated clinical case studies; focus on less heterogeneous, dimensionalized clinical problems; and find a better way of disseminating research findings to the practicing clinician.