Meta analysis as an advancement in methodology.

I was surprised to know that the idea of gauging which therapy is effective, by seeing “what treatment by whom, is most effective for this individual, under what set of circumstances(Paul, 1967, cited in Ellis(1999)) had a such long history. Paul’s statement is in line with what exactly ESTs are aiming for with empirical evidences. Then, I am more surprised to see that still little has been known and achieved in term of the outcome research of psychotherapy, compared to the long history of the idea. Was it because of lack of knowledge in methodologies to address it? Or our professionals’ propensity to stick with “anecdotal impressions”? Probably combinations of many other reasons.

That’s why I was delighted by reading two articles, Engels, Garnefsk & Diekstra(1993) and Butler, Chapman, Forman & Beck(2006). At least it was obvious that scientific approach with a focus on rigorous methodology was one of desirable advancements made in the area of outcome research. Compared to Engels, Garnefsk & Diekstra(1993), Butler, Chapman, Forman & Beck(2006) employed more sophisticated ways of reviewing meta-analyses. For example, to resolve an issue of obscurity caused by the practice of aggregating the outcomes for all treatments across all disorders into one meta-analysis(p.18), Butler, Chapman, Forman & Beck(2006) breaks down the comparison of research outcomes into 13 disorders, starting with depression to chronic pain. This approach enables me to have a clearer and more extensive understating on the efficacy and effectiveness of CBT on specific disorders covered in this article. In addition, I also find the introduction of concept and interpretation of those concepts, categorization of effect sizes as “controlled” vs. “uncontrolled” and “U3”, very informative. I was aware of the ways of conducting meta-analysis, like by effect sizes, but did not have a concrete knowledge on how they were calculated and what would they mean. And therefore, it was amusing to get to know how to read figures in meta analysis and apply the knowledge to research I need to be familiar to or will carry out later on.

In spite of the strengths in methodologies in reviewing meta analyses and rigorous research efforts, it is still striking that not many of evidences do exist, telling us what therapies work for better on what disorders with what patients. Consider Butler, Chapman, Forman & Beck(2006) calls for comparing CBT with other forms of therapy in search for the answers to the question. And Engels, Garnefsk & Diekstra(1993) ends with a question “which particular type of client receives the greatest benefits from RET?” The research on this topic is challenging, but frustrating at the same time because I’m amazed with innovative methods of handling problems in research, but still they are considered not good enough in some ways.