Table 1.

Features of RCTs and relative criticisms (source: Starcevic, 2003).

Features of RCTs	Criticisms of RCTs
‘‘Randomized controlled trials’’ (RCTs) are a methodological procedure that consists in the comparison of the group of patients in whom the usefulness of treatment is being examined (experimental group) with the group of patients who are receiving no active treatment (e.g., a placebo; control group);	In the psychotherapy studies there is no counterpart to a placebo that is used in the pharmacotherapy studies. The non-specific (and presumably placebo-like) psychological treatments, administered to patients in control groups, are not ‘neutral’ in the way that placebo is pharmacologically ‘neutral’ because they produce psychological effects, regardless of whether these are clinically significant.
RCTs focus on strict diagnostic homogeneity of the groups of patients and give emphasis on diagnostic precision;	Psychiatric diagnosis is usually not the main factor that determines the use of psychotherapy and diagnostic precision is not emphasized in psychotherapy. As a result, psychotherapy patients are not as diagnostically homogeneous as patients in RCTs and often have additional disorders that would exclude them from RCTs.
Another key feature is represented by the randomization into experimental and control groups of patients;	Randomizing patients in the psychotherapy usefulness studies is troublesome because clinical practice is not randomized; also, randomization creates an artificial situation because it ignores the fact that psychotherapy patients actively choose their own treatments.
It is important to carry on double-blind design of research;	A double-blind design is impossible in psychotherapy research. Patients cannot be blind as to what psychological treatment they are receiving because they actively participate in it; likewise, therapists cannot be blind because they know what treatments they administer.
Another ‘‘gold standard’’ of the RCTs procedure is the use of standardization of treatment procedures, so that all patients receive (or are presumed to receive) treatment in the same way.	Psychotherapy is extremely difficult to ‘standardize’ so that its procedures and techniques are used in the same way by all the therapists, regardless of their training and personality. Every encounter between the patient and the therapist has some unique features, with the potential of producing ‘something’ that cannot be predicted and entirely ‘standardized’.