This tool presents therapeutic modalities alongside their research evidence. Evidence is organized into five tiers:
TIER 1 Guideline-Recommended — Endorsed by major bodies (NICE, VA/DoD, WHO, APA) for specific conditions. This is the strongest institutional endorsement.
TIER 2 Multiple RCTs / Meta-Analyses — Substantial controlled research exists but may not yet be in major guidelines.
TIER 3 Emerging / Limited RCT — Some controlled research, often small studies or single RCTs. Promising but not yet established.
TIER 4 No Controlled Research — No published RCTs. This does not mean ineffective — it may reflect epistemological differences, practical barriers, or simply that research hasn't been conducted.
TIER 5 Framework — Not a manualized treatment protocol; an organizing framework that informs clinical practice but cannot be directly tested as a standalone intervention.
Key distinctions students should understand:
Empirically Supported Treatments (ESTs) — Specific therapies shown effective for specific disorders in RCTs. The APA Div. 12 list. Narrow, disorder-specific.
Evidence-Based Practice (EBP) — Integration of best available research with clinical expertise and patient values/context (APA, 2006). Broader than ESTs.
Practice-Based Evidence — Effectiveness data from real-world clinical settings, case studies, and naturalistic research. Ecological validity over internal validity.
Clinical Consensus — Widely practiced and endorsed by training communities without RCT support. Common in psychodynamic, somatic, and humanistic traditions.
Not everything that matters can be randomized. The absence of RCT evidence is information about the state of research, not a verdict on clinical value.