Limitaciones de los Ensayos Clínicos Aleatorizados para la práctica y la investigación en psicoterapia: Una perspectiva constructivista de los pacientes como agentes

Randomized Clinical Trials (RCTs) are the reference for the research and practice of psychotherapy in approaches related to Empirically Supported Treatments and the philosophy of Evidence-Based Medicine. In psychotherapy, RCTs study protocolized treatments designed to be applied unidirectionally by the therapist in an identical manner on each occasion, analogous to a drug. However, the proposal of a psychological treatment usually happens in an at least bidirectional interview framework and the properties and effects of psychological treatments are mediated by the use that the patient makes of them. Although we try to influence the patient, his actions are ultimately not under our control. For this reason, it is advisable to reduce faith in the strict following of protocols, techniques and treatment proposals, assuming that their modification and adaptation is not an error but rather an inherent characteristic of their implementation through the patient's action. The strict application of treatment protocols responds to the need to increase the methodological rigor of research, but can be counterproductive in clinical practice. The nature of the psychological and the patient as agent reduces the centrality of both the RCT approach and its findings for the clinical application of psychological treatments.