Differential therapeutics: a guide to treatment selection.
Practical and scientific developments have recently focused attention on treatment selection in psychiatry. Based on the research literature, the opinions of leading practitioners, and the authors' clinical experience, tentative guidelines for treatment selection are offered. The indications, patient enabling factors, and relative contraindications that influence the choice of treatment format, orientation, and duration are outlined, as are indications for combining psychotherapy with psychotropic medication and for a prescription of no treatment. Critics of differential therapeutics might argue that the outcome of psychotherapy is influenced primarily by its nonspecific aspects and by patient characteristics, and that it may be premature to form guidelines given the incompleteness of the research. However, as outcome studies are more carefully designed, specific effects of different treatments may well emerge. Furthermore, treatment selection is a practical necessity, and a careful analysis of the available data and opinion helps to inform these choices and to identify areas for continued research.