Fair tests of clinical trials: A treatment implementation model

We propose a psychotherapy treatment implementation model whereby adequate levels of independent treatment components (delivery, receipt, and enactment) are prerequisite to asserting whether a valid clinical trial has been conducted. The delivery component refers to the accuracy of treatment presentation, receipt refers to the accuracy of the client's comprehension of treatment, and enactment refers to the extent of out of session application initiated by the client. Clinical scientists regularly address one or two of these components, but rarely all three, according to a survey we report. Sources and effects of model deficits, i.e., inadequate levels of treatment components, as well as methods of component assessment and induction, are discussed. We conclude that faults in any one of the components drain validity proportional to the degree of deficit, and that clinical trials have often incorrectly been considered fair tests, resulting in biased efficacy judgments.