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Clinical researchers have recently begun to explore differences between psychotherapy outcome studies that focus on efficacy and those that focus on effectiveness. The authors provide concise descriptions of these research models, followed by more extended consideration of the most important conceptual and empirical distinctions between the two. Research on the efficacy/effectiveness distinction is then put into context: The common treatment variables that also influence treatment outcomes are reviewed. Fifty years of research on psychotherapy outcomes are next considered; contemporary research on the efficacy and effectiveness research models is emphasized. A description and evaluation of current efforts to heighten the value of technique-focused research to clinicians follow. The authors conclude by anticipating some promising future directions in this research domain.

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Efforts to identify empirically supported psychological treatments over the past half century have been strongly influenced by the development of more potent treatments and more effective outcome research methods. Practice guidelines incorporating empirically supported treatments proposed by the Agency for Health Care Policy and Research, the American Psychiatric Association, and the Division of Clinical Psychology of the American Psychological Association are described and critically assessed. Advocates for practice guidelines assert that they promote therapeutic accountability and motivate adoption of the best current practices; critics question their empirical bases, diverse standards of proof and potential to constrain clinical decision making. These claims are critically examined, and when appropriate, solutions are suggested. It is clear, however, that the one solution that will not work is a return to the preguideline era.Editor's note. Samuel M. TUrner served as action editor for this article.