Are RCT designs in psychotherapy research essential and uniquely necessary to advance ESTs? In the literature Westen et al. They appear to produce one of the most convincing articles addressing the problems with RCT designs and advocating the use of alternative measures for psychotherapy research. Westen et al. Bringing some serious concerns to light. The issues brought to light in the Westen et al paper will be addressed, as will the response to the allegations. RCT designs in psychotherapy research are essential in psychotherapy research to advance ESTs, however, I do not believe they are exclusively necessary for their advancement. RCTs are one of the most important components of psychotherapy research, but not the only one. Westen et. al., makes some interesting allegations regarding the use of RCTs. Some of which are widely shared, others which appear to be nothing more than erroneous accusations. Westen et. al., makes some interesting allegations regarding the use of RCTs. Some of which are widely shared, others which appear to be nothing more than erroneous accusations. Westens Argument Malleability (short-term) – explain what it says – and then explain how this is not true (give an example) Westen's promotion of long-term therapies appears to ignore issues of cost and patient compliance patient (Haaga, 2004). A heavy cost burden and the ability to maintain patients in long-term studies should be important considerations when comparing long-term therapies and shorter therapies (Haaga, 2004). - Discourage inclusion criteria other than those that a normal doctor would exclude in the everyday context (Thompson-Brenner, 2004). Comorbidity  Inclusion criteria – excluded patients are more challenging than enrolled patients (Haaga, 2004). Isolation of Personality Characteristics Problem with Using the DSM Thinking categorically