In Reply We appreciate the issues raised by Fountoulakis and Tohen, many of which are common in critiques of psychotherapy trials. As the title of our article implies, the comparison of interest was psychotherapy plus treatment as usual (TAU) vs TAU alone. Treatment as usual consisted of standard medication management with routine psychiatric care. The effect sizes for brief psychoeducation are based almost entirely on pairwise comparisons with family and conjoint therapy; brief psychoeducation was compared directly with cognitive behavioral therapy and interpersonal therapy in only 1 trial. We see no evidence that TAU performed worse than placebo, which would require asserting that patients in these trials would have been better off with placebos than with standard pharmacotherapy for bipolar disorder.