Despite the likelihood that certain forms of therapy, including most manualized therapies, will be favoured in research, there is actually little evidence that these particular forms of therapy are superior to a clinically significant degree. One interpretation of the research could therefore be that these forms of therapy are actually inferior to therapies that do not attempt to fit into research biases.
The issue of assessing therapies by organizing study groups only by DSM diagnoses also needs to be questioned. Let's look at this issue a bit further. In other fields of medicine, the type of studies done in psychiatry and the results achieved would likely not be considered to be acceptable. For example: prior to the antibiotic era, for a diagnosis like pneumonia, the etiology could not be firmly established and treatment would be mostly supportive. Under these conditions, one would find that treatments would be better than placebo, but that the difference would not be that pronounced. As diagnostic methods improved and increasingly specific antibiotics were developed, the difference between placebo and medication response would increase greatly. In psychotherapy research, despite a new diagnostic system and twenty-five years of research attempting to respond to policy makersí requests that specific therapies be developed for specific diagnoses, research has not indicated substantial change in efficacy of therapy modalities. This could indicate that there is a problem in how the issue of psychiatric diagnoses and treatment is being approached. This does not mean that the research to date has not been valuable. It does mean that the research needs to be interpreted carefully.
What can we learn from psychotherapy research? The research may indicate some problems with less structured forms of therapy. Some research has indicated that although therapists in the field may define themselves by a certain model, that frequently their approach may not meet the basic requirements for that model. In open-ended therapies, which may be more financially beneficial for therapists, it is possible to let the therapy drift without as much consistent attention to short-term issues. There may be aspects of research models that can lead to increased effectiveness of treatment. One way of looking at research models is to inquire into the commonalities of these models that may have a positive impact on efficacy. It does seem as more of these models are developed, that there are certain aspects in common. One clinical interpretation of these factors is described here as the 5 C's of competent psychotherapy.