A: In the area of psychosocial interventions, it is tough to have a placebo control; this is a very important problem. A waiting list control is not good enough. A researcher has to show that some other program, similar in intensity to their treatment, is not as good. He or she has to show an effect of their active ingredient that is in addition to a good therapeutic relationship. If a less intense control is used, such as being on a waiting list, then any effect shown may be non-specific therapeutic factors at work.

A: "Treatment as usual" or TAU is fine, as long as it is similar in intensity to the treatment being studies.

A: This is a double-edged sword. As soon as I say that I have the answer, no dialogue is going on. If I try to convince the community of my treatment but don't try to understand their needs, then I may lose the patients so my effective treatment amounts to nothing. The attitude of "don't mess with my program" is a real dilemma for the field. We should design interventions from the start with flexibility. If therapists can't do the program exactly as written, are we telling them that they should do nothing? If developers haven't identified the active ingredient and dosage and the underlying theories, then it is a straw man. Efficacy researchers have to start in the real world, right at the beginning, and listen to what doctors and patients say would be helpful so that palatability and compliance are built in.