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July 24, 2004. I would like to congratulate the editors, particularly Stuart Hauser, for the outstanding section on research in JAPA 52/2. Sidney Blatt and Golan Shahar's “Psychoanalysis—with Whom, for What, and How?” is an impressive contribution to that section. I greatly appreciated the authors' careful explanation of their statistical results, an exercise that rendered the numbers they presented intelligible to the general reader.
I would like to encourage both the editors and the authors to take their presentation a step further. In a study that is not randomized, it is possible that various factors may be distributed unequally among the groups being compared. Blatt and Shahar provide an example of a possible confounding factor in their Figure 10. That figure shows that patients in the supportive-expressive psychotherapy group had a lower number of Rorschach responses than patients in the psychoanalysis group. Any difference between the treatments may be explained, at least in part, by the difference in the patient populations before treatment. The Menninger Psychotherapy Research Project began with a two-week evaluation. The MPRP data on these patients included education level, socioeconomic class, presence or absence of substance disorder, and IQ. In the APA Grand Rounds Online (2/19/2004)—“From Science to Practice: How to Critically Evaluate the Literature”—S. Nassir Ghaemi states that “it is the responsibility of investigators to think about and examine such potential confounders.… The first table should generally be a comparison of clinical and demographic variables in the groups being studied to see if there are any differences, which then might be confounders” (). It would refine and deepen your presentation to include a discussion of these possible confounding factors, as well as any others the authors may have information about.