Also, just in case anyone is curious, here's what I told Constance Holden at Science about the report (excerpted below). Holden had a very brief blurb on it too in this week's Science.
Her brief piece in Science is immediately below, followed by my (much) more extended comments to her. Cheers....Scott Shrinking the Shrinks (Constance Holden, Science) Many training programs for clinical psychologists in the United States should be scrapped, an organization of psychologists says. In a report to be released this month, the Association for Psychological Science (APS) calls for more scientific rigor in psychotherapy. "Clinical psychology resembles medicine at a point in its history when practitioners were operating in a largely prescientific manner," it says. Therapists' "lack of adequate science training ... leads them to value personal clinical experience over research evidence." The report lambastes the American Psychological Association (APA)-which comprises mainly clinical psychologists-for lax accreditation standards and proposes a new mechanism for certifying Ph.D. training programs. Psychologist Scott Lilienfeld of Emory University in Atlanta praises the report, saying, "Far too many practitioners are administering unsubstantiated or untested intervention." But he worries that its proposals would freeze out Psy.D. programs, nonresearch degrees begun in the 1970s, which now turn out about half of the nation's clinical psychologists. Jeffrey Zeig, a clinical psychologist and director of the Milton H. Erikson Foundation in Phoenix, says psychotherapy is much too diverse to be constrained by APS definitions. "There are more than 1,000,000 therapists in the U.S., and only a fraction" have Ph.D.s, says Zeig, who predicts the report "will have as much effect as a breeze has on a leaf." But report co-author Timothy Baker of the University of Wisconsin School of Medicine and Public Health in Madison predicts that it "will ultimately reshape clinical psychology just as the [1910] Flexner Report reshaped medicine," leading to the closure of almost half the nation's medical schools. My full comments to Holden: The report, I suspect, is destined to become a classic. It is a magisterial and hard-hitting examination of the current state of mental health practice and what is wrong with it. The authors are right on the mark that the present state of much of graduate education in mental health today resembles that of medicine in the early 20th century. Surveys demonstrate that far too many practitioners are administering unsubstantiated or untested interventions, and not nearly enough are administering interventions that have been shown to be efficacious or promising. The authors are also correct that scores of programs accredited by the American Psychological Association are doing an inadequate job of teaching their students to think and practice scientifically. Just as medicine sorely needed Flexner to clean house, our field sorely needs reforms to place graduate training in clinical psychology and allied disciplines on surer scientific footing. This report goes part-way to doing so (but see below). Ironically, Zeig's defensive comments illustrate the problem and inadvertently help to make precisely the point that Baker and colleagues are making. Like many (but by no means all) practitioners in the field, Zeig wishes to privilege subjective personal experience above rigorous scientific data when it comes to adjudicating questions of what treatments to administer, ignoring hundreds of studies demonstrating that raw intuition and subjective experience are subject to a host of biases to which we're all prone. Zeig's remarks ignore the crucial point of the PSPI monograph: Scientific methods, like randomized controlled designs, are the best safeguards we have against a myriad of sources of human error. These research designs are the very embodiment of epistemic modesty, as they are an explicit admission we need systematic protections against our all too natural tendency to see what we want to see. Zeig is factually incorrect that scientific findings have not informed psychotherapies; much of the work on efficacious behavioral interventions, which have helped tens of thousands of individuals with autism, phobias, obsessive-compulsive disorder, bulimia, and many other conditions, derived largely from basic scientific research in the laboratory. Certainly, Zeig is right that clinically-inspired innovations have sometimes emerged without the benefit of formal scientific findings, and I don't anyone who disputes that. But how have we ascertained whether these innovations are efficacious? Through controlled scientific research. All that said, I am disappointed by one aspect of the report, namely the new accreditation system. I voiced my concerns at a meeting of the Academy of Psychological Clinical Science a few years ago, and am disappointed to see them unaddressed. Put simply, the authors' diagnosis is accurate, but their prescription is incomplete. Regrettably, the new accreditation system will only certify programs that produce clinical researchers, not practitioners. As a consequence, programs that do an excellent job of training scientifically-minded psychotherapists - those who rigorously trained to scientifically evaluate the research literature on the effectiveness of interventions and trained to apply evidence-based interventions - will not be eligible for accreditation. Indeed, the accreditation principles (see http://www.pcsas.org/principles.html) explicitly state that "Programs with a chief mission of training psychologists for specialized careers in applied clinical work-no matter how science-based such applied training may be-are not appropriate candidates for PCSAS accreditation." This decision is, in my view, deeply misguided, as it sends a clear message that the authors aren't interested in helping to reform programs whose principal mission is to train practitioners. As a consequence, the authors missed a golden opportunity to narrow the scientist-practitioner gap, as they forfeited the chance to place their stamp of approval on programs that specialize in training scientifically-minded practitioners - those who are good critical thinkers and apply the best available research evidence to their clinical work. Yet as the authors themselves note, these are precisely the practitioners whom we sorely need. They are also, I should note, the practitioners who have the potential to best disseminate evidence-based interventions to the clinical community. In all of these respects, the analogy to the Flexner report is not entirely accurate, as the Flexner report revamped the practice training of physicians. In contrast, the present report leaves practice-oriented clinical programs in the dust and more or less gives up on them, focusing instead on training clinical researchers. As a consequence, it is unlikely to exert much impact on the scientific training of most psychotherapists, which is regrettable. It also risks widening, not narrowing, the scientist-practitioner gap by confusing "clinical scientists" with "clinical researchers." In my view, clinical scientists are not limited to clinical researchers; they are individuals who apply scientific approaches to whatever they do, whether it be research, psychotherapy, assessment, teaching, and the like. The report could have made a powerful statement by recognizing and endorsing clinical scientists who are operating on the front lines of everyday practice, but it elected to ignore them. -----Original Message----- From: Dr. Bob Wildblood [mailto:drb...@rcn.com] Sent: Sunday, October 04, 2009 11:43 AM To: Teaching in the Psychological Sciences (TIPS) Subject: Re: [tips] clinical workers and evidence Gerald Peterson wrote: >Here is an interesting article about the problems of evidence-based clinical >workers. I don't like them calling all therapists psychologists, nor the >subtitle of psychologists rejecting science, and it's a bit of >over-simplification, but might be of interest to some. See: >http://www.newsweek.com/id/216506 > Having been a counselor/therapist for 33 years, there is lots in this article to agree with. Many clinicians and physicians do rely more on intuition than on science in making decisions as to how to treat a client/patient with a particular disorder (taking into consideration that diagnosis is, itself, not very scientific in many cases, especially psychology/psychiatry). That being said, there are manhy of us who do rely on the use of "evidence based therapies" especially those which are supported strongly by research. In fact, our beloved insurance companies are beginning to know what kind of therapy is being used for what diagnosis, and I have heard (anecdotes, to be sure) that some people have been refused reimbursement if certain therapies are not used with certain diagnoses. Interestingly (to possibly start a firestorm here) one of the therapies which has as much or more research than any other is EMDR and its use in PTSD resulting from a multitude of causes, because! w! e don't know what sense there is behind it that can explain how it might work. Since I am an advocate of EMDR, have read the research, and have seen the results with my own clients starting with Vietnam veterans (in my experience since about 1994, not immediately after the conflict was finally abandoned) I submit that it is an evidence based therapy and as to how it works, I submit that we know as much about how it works as we do about how aspirin works. In sum, not a bad article although it is a bit simplified. Robert W. Wildblood, PhD Riverside Counseling Center and Adjunct at Germanna CC, Fredericksburg, VA drb...@rcn.com The soundest argument will produce no more conviction in an empty head than the most superficial declamation; as a feather and a guinea fall with equal velocity in a vacuum. - Charles Caleb Colton, author and clergyman (1780-1832) Not thinking critically, I assumed that the "successful" prayers were proof that God answers prayer while the failures were proof that there was something wrong with me. - Dan Barker, former preacher, musician (b. 1949) We have an obligation and a responsibility to be investing in our students and our schools. We must make sure that people who have the grades, the desire and the will, but not the money, can still get the best education possible. - Barack Obama, President of the United States of America --- To make changes to your subscription contact: Bill Southerly (bsouthe...@frostburg.edu) This e-mail message (including any attachments) is for the sole use of the intended recipient(s) and may contain confidential and privileged information. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this message (including any attachments) is strictly prohibited. If you have received this message in error, please contact the sender by reply e-mail message and destroy all copies of the original message (including attachments). --- To make changes to your subscription contact: Bill Southerly (bsouthe...@frostburg.edu)