Matching treatments to client problems not diagnostic labels: a case for paradigmatic behavior therapy

The present article critically analyzes the current approach to treatment outcome research and the uncritical use of treatment packages. Comparing various combinations of treatments with groups of clients randomly assigned to these conditions has led to the neglect of individual differences between persons falling into broad diagnostic categories. The inconclusive results of such studies say little about the efficacy of a particular treatment for an individual client and are also not very useful in helping clinicians to decide which specific treatment to use for a given client. Although treatment packages may be attractive and at times helpful to clinicians, their simplistic use is antithetical to the original and unique approach of behavior therapy and no substitute for treatment individualization. Using the example of agoraphobic problems we show how a conceptual understanding of the processes involved in a given clinical problem and the development of an integrative paradigmatic behavioral model may guide the researcher/clinician toward more effective treatment planning. Conceptually derived treatments can be individualized more easily and therefore take better account of individual differences between clients suffering from a seemingly similar problem. Treatment outcome studies should specifically compare the efficacy of matching particular types and constellations of dysfunctional processes with different procedures which specifically target those dysfunctions.