Many compelling cases have been made both for and against the use of randomized control trials (RCTs) in psychotherapy research. Many of these cases will be explored throughout this article. In light of the existing literature, I believe that randomized control trial (RCT) designs are essential in psychotherapy research and the advancement of empirically supported treatments (EST). However, I do not believe that 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. (2004a) presents one of the most convincing and controversial articles in the literature addressing the use of RCTs in psychotherapy research; Westen and colleagues' article addresses some of the major problems with RCT designs and advocates the use of alternative measures for psychotherapy research. I will begin by addressing issues related to RCT designs as discussed in Westen et al. (2004a), primarily the set of assumptions on which the RCT methodology is believed to rely, as well as responses to the allegations. I will then go on to discuss issues related to internal and external validity, as well as some advantages and disadvantages of RCT designs, and close with a recommendation for the use of RCTs in the future. Westen et al. (2004a), makes some interesting accusations regarding the use of RCTs. Some of which are widely shared, others which appear to be nothing more than erroneous accusations. The argument against the use of RCT designs by Westen et al. (2004a) is based on the belief that for RCT methodologies to validate ESTs it is necessary to satisfy a certain set of assumptions, and it is obviously argued that these assumptions are not well validated and not widely applicable. I will touch on three of the hypotheses put forward in the Westen et al. study. (2004a) article: malleability
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