Defining empirically supported therapies.

A scheme is proposed for determining when a psychological treatment for a specific problem or disorder may be considered to be established in efficacy or to be possibly efficacious.The importance of independent replication before a treatment is established in efficacy is emphasized, and a number of factors are elaborated that should be weighed in evaluating whether studies supporting a treatment's efficacy are sound.It is suggested that, in evaluating the benefits of a given treatment, the greatest weight should be given to efficacy trials but that these trials should be followed by research on effectiveness in clinical settings and with various populations and by cost-effectiveness research.In this special section, the authors of review articles have been asked to evaluate the psychological treatment research literature in their area of expertise to identify empirically supported treatments' (ESTs).Briefly, we define ESTs as clearly specified psychological treatments shown to be efficacious in controlled research with a delineated population.Thus, following Kiesler (1966), we suggest that practitioners and researchers will profit from knowing which treatments are effective for which clients or patients.That psychological treatments (undefined) benefit the majority of clients or patients (undefined) is already well established (see, e.g., M. L. Smith & Glass, 1977).Furthermore, our particular emphasis is on the effects of the treatments as independent variables.This is not to deny the importance of other factors such as the therapeutic alliance, as well as client and patient variables that affect the process and outcome of psychological therapies (see, e.g.,