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As we all know to our sorrow by this time, the design and implementation of studies of psychotherapy (other than those of brief, time-limited treatment of outpatients) are fraught with methodological difficulties. The authors set forth the flaws in each of five major projects which had concluded that the treatment of choice for schizophrenias was medication rather than psychotherapy.
The major pitfalls of the previous studies were (1) judging outcome on the basis of the hospital behavior of patients rather than their ability to live productively outside a hospital; (2) assigning therapists who lack experience in doing psychotherapy with schizophrenic patients, and failing to supervise them systematically; (3) ignoring the importance of sociocultural factors; (4) ignoring motivational factors in research therapists as a determinant of therapeutic effectiveness; (5) failing to do blind ratings of progress and outcome; (6) failing to assess outcome with testing procedures that adequately addressed the central issue of thought disorder.
In the Karon and Vandenbos project, the supervisors were senior therapists with at least ten years' experience doing psychotherapy with schizophrenic patients from the Black, inner city subculture from which the project cases were drawn. Trainees received systematic initial didactic training and ongoing supervision. All trainees were volunteers, chose their supervisors because they valued their skills and viewpoints, and were paid for the extra time invested in the project.
Twelve Patients (Group A) were assigned to a supervising psychotherapist