Psychotherapy Volume 36/Spring 1999/Number 1 TREATMENT GUIDELINES: THE GOOD, THE BAD, AND THE UGLY GEORGE STRICKER Adelphi University NANCY C. BOLOGNA Park Nicollet Clinic ELIZABETH A. ROBINSON Robinson/Nedelman Psychological Associates Treatment guidelines for psychotherapy describe a set of best practices based in part on scientific evidence. There have been several sets of such guidelines published recently by governmental, professional, and health services organizations. The adequacy of such guidelines, which perforce reduce the variability of professional services, depends on the adequacy of the scientific evidence with respect to both efficacy and clinical utility. The American Psychological Association formed a Task Force to develop a Template for Developing Guidelines in order to evaluate the scientific evidence for these Preparation of this manuscript was supported by the Ameri- can Psychological Association under the auspices of the Board of Professional Affairs Template Implementation Work Group, of which the first five authors were members. We would like to thank Ivan Miller, who joined the group after the initial draft of the article was prepared, for his helpful comments and participation in the discussion of the manu- script. Correspondence regarding this article should be addressed to George Strieker, The Denier Institute, Adelphi University, Garden City, NY 11530. Electronic correspondence can be sent to STRICKER@PANTHER.ADELPHI.EDU DANIEL J. ABRAHAMSON Traumatic Stress Institute STEVEN D. HOLLON Vanderbilt University GEOFFREY M. REED Practice Directorate American Psychological Association guidelines. This article describes the Template and then applies it to a set of recently promulgated guidelines. The Template was able to demonstrate the strengths and weaknesses of the various documents. Sunshine Is the Best Disinfectant Historically, psychotherapy was considered to consist of a two-person contract between the therapist and the patient, with all financial deci- sions made between these two parties and all communications considered confidential except where disclosure was mandated by law (e.g., child abuse). This began to change about 30 years ago with the adoption of mental health benefits within indemnity contracts, whereby a third-party payer provided a contractually deter- mined portion of the payment, requiring little more than a diagnosis in return. Within the past decade, with the growing prominence of orga- nized systems of healthcare, the third party now often sets the fee and, in return for the payment, requires considerable information and dictates other parameters of the treatment, such as the length and goals of care. This has led to a con- troversy between the insurance industry and many practitioners, with disagreement as to whether the management of care is for or against the best interests of the patient, and with clear and impassioned statements expressing both points of view. At one extreme, some psycholo- gists accept the potential benefits of managed 69