Conceptual, methodological, and ethical problems of placebo groups in psychotherapy research

Psychotherapy researchers have long recognized the need to control for expectancy effects, therapist contact, and therapist attention and have generally subsumed these therapeutic factors under the placebo effect rubric. The authors suggest that the need to control for such factors must be distinguished from the necessity for a placebo group. A psychotherapy placebo group that meets the classic criteria (i.e., a theoretically inert procedure without specific activity for the condition being treated) may be unethical, impractical, or methodologically unsound in psychotherapy research of moderate or greater length. The authors suggest that the term placebo group be abandoned and that alternatives, such as "best available" therapies, component control conditions, neutral expectancy controls, and counterdemand manipulations, be used. The necessity for wait-list controls in psychotherapy research is discussed. (26 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).