communicative value, and the richness of description of particularly complex unconscious interactive processes between analyst and patient. There is no generally accepted format for these reports and the information included tends to be quite variable (e.g. Spence, 1994) which undermines generalisation. Attempts have been made to systematise such qualitative reports (e.g. Klumpner & Frank, 1991) but these have not met with general approval. In comparison to descriptive accounts of single treatments, quantitative reports undoubtedly lack richness and depth but are more generally accepted because of the greater ease with which the reliability of the observation can be assessed. Within this latter group some are naturalistic reports of outcome or quasi-experiments (Cooke & Campbell, 1979), while others are reports of the experimental manipulation of interventions. In cases where appropriate baseline measures are taken, or where treatments are applied and withdrawn in a controlled manner, the patient acts as his/her own control. This methodology has been widely used by behavioural and cognitive-behavioural researchers (Morley, 1987; 1989), but is equally applicable to psychodynamic investigators (e.g. Fonagy & Moran, 1993) and to the investigation of process factors in therapy (e.g. Parry, 1986). Single-case studies have a number of attractive features. They can be combined with the routine clinical practice of private practitioners, they do not (necessarily) require the research apparatus and personnel normally associated with group based research and can be conducted fairly quickly. While of great importance in the demonstration or refinement of clinical technique and especially in treatment innovation, the results of single case studies can be difficult to generalise to the broader clinical population (indeed the design is not intended for such a purpose). Patients are often highly selected (necessarily so where studies are aiming to show the effectiveness of a technique for particular clients). More fundamentally, however, interpretation of results is limited by the fact that (as will become evident in the body of this report) therapeutic interventions have both general and specific impacts on the welfare of patients. A contrast intervention is required in order to be clear that any demonstrated benefits are attributable to specific therapeutic techniques – a strategy adopted in the randomised control trial. 52*&)9$60&!8)*(%)<<0&!"%$2<6![58"6^! In contrast to the single case study, RCTs explicitly ask questions about the comparative benefits of two or more treatments. Patients are randomly allocated to different treatment conditions, usually with some attempt to control for (or at least examine) factors such as demographic variables, symptom severity and levels of functioning. Attempts are made to implement therapies under conditions which reduce the influence of variables likely to influence outcome – for example by standardising factors such as therapist experience and ability, and the length of treatments. The design permits active treatments to be compared, or their effect contrasted with no treatment, a waiting list or a “placebo” intervention. Increasingly, studies also ensure that treatments are carried-out in conformity with their theoretical description – for example, ensuring that psychoanalytic treatments do not include cognitive-behavioural or supportive elements. To this end many treatments have been “manualised” (a process which specifies the techniques of the therapy programmatically), and therapist adherence to technique is monitored as part of the trial. There are obviously major problems in the manualisation of psychoanalytic treatment (Clarkin, 1998) but some progress has already been made on this front (e.g. Clarkin et al., 1999; Fonagy, Edgcumbe, Target, Moran, & Miller, in press; Kernberg et al., 1989; Luborsky, 1984). Though this design has the potential to distinguish the impact of treatments (and to provide a control for the effects of spontaneous remission), there are inherent limitations to this approach. '#"MB%$(&"!&?"+,#"B&L#">:(&
Although the ideal design of a treatment would be to contrast treatment to no-treatment, it is rarely the case that this is either ethically or practically possible. The alternative of offering a placebo treatment
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