The concept of Empirically Supported Treatment occupies a contested and generative position within the depth-psychology corpus. At its procedural core, the designation — systematized most influentially by Chambless and Hollon (1998) — establishes tiered criteria by which psychological interventions earn the designation ‘efficacious’: independent replication, adequate sample sizes, manualized protocols, and clinically as well as statistically meaningful effect sizes. The framework emerged from APA task force deliberations and carries explicit normative weight, reshaping training, reimbursement, and professional legitimacy. Yet the corpus is equally populated by voices that complicate, contest, or quietly circumvent this scaffolding. Shedler (2010) marshals meta-analytic evidence to demonstrate that psychodynamic therapies — long excluded from or marginalised within EST lists — achieve effect sizes comparable to those of treatments actively promoted under the EST banner, and that their gains endure where others decay. Schwartz’s IFS literature reveals that therapeutic modalities from outside the behavioural mainstream are increasingly subjected to EST-style trials precisely to establish parity. Norcross presses further, arguing that the relational substrate of therapy — demonstrably effective in its own right — receives inadequate institutional recognition alongside technique-centred EST frameworks. The deeper tension, never fully resolved, concerns whether the randomised controlled trial paradigm can adequately capture what depth-psychological traditions understand as therapeutic action.
A scheme is proposed for determining when a psychological treatment for a specific problem or disorder may be considered to be established in efficacy or to be possibly efficacious.
Chambless and Hollon articulate the foundational classification scheme for empirically supported treatments, establishing the evidentiary standards — including independent replication and efficacy trials — that anchor the entire EST enterprise.
, Defining Empirically Supported Therapies, 1998thesis
Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as ‘empirically supported’ and ‘evidence based.’
Shedler directly challenges the exclusion of psychodynamic therapy from EST recognition, presenting meta-analytic evidence that its effect sizes match those of designated empirically supported treatments.
, The Efficacy of Psychodynamic Psychotherapy, 2010thesis
Only when a treatment has been found efficacious in at least two studies by independent research teams do we consider its efficacy to have been established and label it an efficacious treatment.
Chambless and Hollon specify that independent replication across investigatory teams is the decisive criterion distinguishing ‘established’ from merely ‘possibly efficacious’ treatments.
, Defining Empirically Supported Therapies, 1998thesis
It is not enough for treatment effects to be statistically significant; they also need to be large enough to be clinically meaningful.
The framework insists on clinical significance as a necessary supplement to statistical significance, requiring that treatment effects meet a threshold of practical meaningfulness for practitioners.
, Defining Empirically Supported Therapies, 1998thesis
The benefits of other (nonpsychodynamic) empirically supported therapies tend to decay over time for the most common disorders.
Shedler argues that the durability advantage of psychodynamic therapy over time undermines the assumption that designated empirically supported therapies represent an unambiguous standard of efficacy.
, The Efficacy of Psychodynamic Psychotherapy, 2010thesis
The response among the advocates of the more traditional psychotherapies has all too often been to dismiss the need for controlled clinical trials. We think that such a strategy is short sighted.
Chambless and Hollon directly challenge traditional psychotherapy’s resistance to controlled trial methodology, framing such resistance as professionally untenable in the current evidence climate.
, Defining Empirically Supported Therapies, 1998supporting
It is useful to consider the extent to which evidence from efficacy trials is relevant to the kinds of patients actually seen in clinical practice.
Chambless and Hollon acknowledge the external validity problem — the gap between RCT populations and real-world clinical patients — as a standing limitation on the direct applicability of EST findings.
, Defining Empirically Supported Therapies, 1998supporting
Any given therapy tends to do better in comparison with other interventions when it is conducted by people who are expert in its use than when it is not.
Investigator allegiance is identified as a systematic confound in EST research, meaning that comparative efficacy findings are partly a function of researcher expertise and preference rather than treatment properties alone.
, Defining Empirically Supported Therapies, 1998supporting
Meta-analyses do not eliminate the need to make informed judgments about the quality of the studies reviewed.
Chambless and Hollon caution that quantitative synthesis methods cannot substitute for substantive critical evaluation of study quality in determining treatment efficacy.
, Defining Empirically Supported Therapies, 1998supporting
A significant portion of college students do not benefit from the existing empirically supported treatments, which they list as ‘antidepressant medication, cognitive-behavioral therapy (CBT), and interpersonal psychotherapy (IPT).’
IFS research situates itself against the limits of established empirically supported treatments, positioning itself as a necessary alternative for populations underserved by the current EST canon.
, Internal Family Systems Therapy, 1995supporting
The American Psychological Association has supported a succession of task force investigations… the development and maintenance of the therapeutic relationship is a primary curative component of successful therapy.
Flores contextualises APA’s EST task force work within an attachment framework, arguing that the therapeutic relationship — not technique alone — constitutes the primary mechanism of therapeutic change.
, Addiction as an Attachment Disorder, 2004supporting
Mental health organizations as a whole are encouraged to educate their members about the improved outcomes associated with using evidence-based therapy relationships, as they frequently now do about evidence-based treatments.
Norcross advocates for institutional parity between evidence-based therapy relationships and evidence-based treatments, challenging the technique-centric framing of the EST movement.
, Evidence-Based Therapy Relationships: Research Conclusions and Clinical Practices, 2011supporting
When, in an otherwise sound study, investigators have a sample size of 25-30 per condition… the treatments may be considered equivalent in efficacy.
Chambless and Hollon propose a practical equivalence standard for comparative EST trials, acknowledging that much of the comparative treatment literature rests on null rather than superiority findings.
, Defining Empirically Supported Therapies, 1998supporting
Psychological treatments have long been presumed to have more stable effects than pharmacotherapy, either because they redress underlying propensities that contribute to risk or because patients acquire stable skills.
The framework raises the question of durability as a dimension of efficacy, noting growing evidence that cognitive-behavioural interventions may produce more enduring change than pharmacotherapy.
, Defining Empirically Supported Therapies, 1998supporting
Empirically supported treatments, 6–7, 340–344.
Shapiro’s index entry situates EMDR explicitly within the empirically supported treatment literature, signalling the text’s concern with establishing EMDR’s legitimacy within EST classification frameworks.
, Eye Movement Desensitization and Reprocessing (EMDR): Basic Principles, Protocols, and Procedures, 2001aside
Behavioral skill training approaches continue to dominate the remainder of the top 10 list of treatment methods supported by controlled trials.
Miller and Wilbourne’s methodological ranking of alcohol treatment trials demonstrates the dominance of behavioural approaches in the EST literature, with implications for which modalities receive institutional sanction.
, Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders, 2002supporting
For a constructive critique of empirically supported psychotherapies, see D. Westen, C. M. Novotny, and H. Thompson Brenner, ‘The empirical status of empirically supported psychotherapies: Assumptions, findings, and reporting in controlled clinical trials.’
Kandel’s citation of Westen et al.’s critique flags the methodological assumptions embedded in controlled clinical trials as a live controversy within the broader literature on EST validity.
, In search of memory the emergence of a new science of mind, 2006aside
Most patients typically prefer psychological treatment over drugs in the treatment of depression, even though there is little empirical basis for choosing between them.
Chambless and Hollon acknowledge the discrepancy between patient preference and empirical evidence, raising the ethical and practical challenge of integrating patient values within an EST-driven treatment selection framework.
, Defining Empirically Supported Therapies, 1998aside
The strong positive findings of this study contribute to the already rich body of qualitative and quantitative research on sandplay, further establishing sandplay therapy as an evidence-based treatment.
Wiersma et al. deploy EST-adjacent language to claim evidence-based status for sandplay therapy, illustrating how depth-oriented and expressive modalities increasingly orient themselves toward empirical legitimation.
, A Meta-Analysis of Sandplay Therapy Treatment Outcomes, 2022aside