I say “arbitrary definition” because the researchers make a weak case for explaining why they believe a good researcher equals a good psychotherapist. Stewart et al.’s (2007) survey of 591 psychologists found that while indeed most psychologists surveyed strongly said they relied largely on their own past clinical experiences, they also relied on treatment outcome research too (it wasn’t an “either/or” type of question). And cognitive-behavioral therapists, followed by those who used an eclectic approach, were more likely to do so than those who used other approaches like psychodynamic. Stewart et al. wrote, “Clinicians also indicated that they often use the following: treatment materials informed by psychotherapy outcome research findings, treatment materials based
on clinical case observations, and discussions with colleagues.” Does that sound like clinicians in the field today are ignoring or aren’t using the research?
Perhaps one of the reasons clinicians don’t use empirically supported treatments as often as some would like is because, as Stewart et al. (2007) note, the research supporting their use over treatment as usual is “in its infancy.” Is it really a wise idea to start retooling all of psychology training based upon a largely unproven area of psychology, one with many, many holes?
A New House of Cards
Baker et al. (2009) seem to be arguing from a position of elitism rather than the more basic question: How do we train top-notch clinicians that result in better and faster client outcomes? Their entire article centers around how to make graduate school programs more elite, in order to grant them yet another new credential (to add to the existing credential soup that already confuses most consumers and even many professionals).
Indeed, when you see the article for what it is — a sales pitch for the brand-new PCSAS accreditation process — you understand why the argument was crafted in the manner it was. This isn’t about training psychologists to become better psychotherapists, it’s about offering a new credential to training programs that train psychologists to meet the authors’ definition of what makes a good clinician.
Left out of the article (or at least the version I have) was any conflict of interest statement. Two of the three researchers work for the PCSAS organization, and the person who wrote the accompanying editorial praising the study (Walter Mischel) is on the PCSAS advisory board. Is it any wonder that the article finds that the solution to the “problem” is an organization two of the three authors work for?
The researchers’ belief is that if we just do a better job of training psychologists in research at the beginning of their careers, they are more likely to utilize said research throughout their careers. But if all of this were simply about reforming clinician psychologists “for the public good,” it seems haphazard to stop at just psychology. Wouldn’t the public, therefore, benefit from most therapists being trained in this manner? If this the best way to guarantee positive client outcomes more quickly, shouldn’t we be asking virtually all professions to train under this model?
The authors also make a false dichotomy argument — that there are only two possible roads on which to train good clinical psychologists: a greater research emphasis or the status-quo. That’s it. I would argue there are many other models of legitimate training for psychotherapists.
I also can’t help but wonder what happens if such accreditation becomes used amongst some new psychologists? Existing clinical psychologists will apparently be left out in the cold. And such a process would likely create a two-tiered system of mental health care. If you’re well off and can afford to see someone graduating from one of these elite training programs, you do. But if not, you’re stuck seeing the same old psychologist who doesn’t have the “elite” training. Yet another divide in an already fragmented profession and model of care.
I don’t think anyone will argue that being aware of and using more research-validated treatments (or empirically supported treatments, as some research call them) is a bad idea. But I also don’t believe that trying to create a two-tiered level of training programs is going to do much to help the profession. Instead of bringing more psychologists together and trying to bridge the gap between science and practice, it’s likely to drive an even greater wedge between those who support greater use and promotion of such treatments, and those who do not.
Baker, T.B., McFall, R.M. & Shoham, V. (2009). Current Status and Future Prospects of Clinical Psychology Toward a Scientifically Principled Approach to Mental and Behavioral Health Care. Perspectives on Psychological Science, 9(2).
Buchbinder R, Staples M, Jolley D. (2009). Doctors with a special interest in back pain have poorer knowledge about how to treat back pain. Spine, 15;34(11), 1218-26.
Hay MC, Weisner TS, Subramanian S, Duan N, Niedzinski EJ, Kravitz RL. (2008). Harnessing experience: exploring the gap between evidence-based medicine and clinical practice. J Eval Clin Pract., 14(5), 707-13.
Mischel, W. (2009). Connecting Clinical Practice to Scientific Progress. Perspectives on Psychological Science, 9(2).
Stewart, R.E., & Chambless, D.L. (2007). Does psychotherapy research inform treatment decisions in private practice? Journal of Clinical Psychology, 63, 267â€“281.
You can also read Newsweek’s uncritical take on the article, Why Psychologists Reject Science.