R ecently the National Association of Social Workers (NASW) (O'Neill, 1999), citing federal statistics, reported that social workers provide more mental health services than do professionals from all other disciplines combined. A large percentage of these social work services consists of psychotherapy. Despite the widespread use of psychotherapy, consumers, researchers, and payers nonetheless question that it produces change. Indeed, in this era of managed care and diminishing financial support for mental health services, the issue of which therapies yield tangible results in treating specific clients with specific disorders is hotly contested. How this question is framed and tested may be viewed as fully adequate or as unduly narrow and limited, depending on one's stake and perspective on the issue.Psychotherapy researchers seek to "examine empirically both the process of the therapeutic encounter and the changes that result from participation in this process" (Lambert & Hill, 1994, p. 72). Such research may be quantitative or qualitative and may range from studies of single cases to hundreds of cases across multiple locations. Outcome researchers, who examine the results of psychotherapy, address immediate to long-term changes in the client and sometimes in the larger client system. Approaches to outcome research have diverged in recent years, with carefully controlled experimental efficacy studies offset by less well-controlled studies of the effectiveness of psychotherapy as practiced in "real world" settings with a wider mix of clients and broader qualitative methods (Maione & Chenail, 1999).
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