Applying empirically supported treatments to complex cases: Ethical, empirical, and practical considerations

Among the factors contributing to the underutilization of empirically supported treatments (ESTs) are practitioners' concerns about the appropriateness of ESTs for complex patients who are thought to differ in significant ways from the samples in clinical trials. Such patients may challenge our best available treatments and may raise important ethical, practical, and empirical questions. The present article reviews features that may make a case complex and considers influences on the clinician's decision to provide, modify, or abandon an EST with such cases. Given a dearth of data to inform this decision, we highlight several questions faced by clinicians that are in need of investigation. We suggest avenues for future work that may enhance efforts to disseminate and effectively provide ESTs.