Getting Scientific With Psychotherapy

When it comes to choosing a therapist, we may have more options than we can make sense of. There are psychologists, psychiatrists, physicians, social workers, counselors, and more. Of course, the choice matters — we’re likely to give them not only an abundance of personal information, but also an abundance of money.

So, how do you trust your therapist will provide you with scientifically proven, cost-effective treatment? Unfortunately, some suggest, you can’t.

In a report that was published in the November 2009 issue of Psychological Science in the Public Interest, three top clinical scientists — Timothy Baker of the University of Wisconsin in Madison, Richard McFall of Indiana University in Bloomington, and Varda Shoham of University of Arizona in Tucson — argue the current practice of clinical psychology is inefficient in delivering the best possible treatment to patients.

Their solution: a new accreditation system. The board of directors of the new system, which is titled the Psychological Clinical Science Accreditation System, or PCSAS, started evaluating applications from clinical psychology training programs in November 2009. Their goal is to award accreditation to only those programs that offer more science-focused training, which they believe would improve the practice of clinical psychology in the field.

“It is a sorry state of affairs that a public that deserves the best-possible treatment is not getting it,” said McFall, who serves as the executive director of PCSAS. “Though we have made major scientific improvements in clinical psychology over the last 50 years, they have not reached the public.”

In just one of many examples offered by the authors, the report points out the failure to use cognitive behavioral therapy, or CBT, in treating post-traumatic stress disorder, or PTSD, despite research showing it to be the best long-term treatment.

A 2004 study conducted at Trinity University in Texas, for instance, showed that only 30 per cent of psychologists were trained to use CBT to treat the disorder, and only half of those trained to use it actually did. This suggests that only about one in seven patients with PTSD are getting the best possible treatment. PTSD affects eight per cent of the US population, or about 24 million people.

One explanation for the apparent underuse of science-based treatment is that many clinicians don’t adhere to a particular type of treatment. “It’s more just a little of this and a little of that,” says Baker. “These people might all be baking bread, but they’re doing it without a recipe.”

Baker and his colleagues suggest the solution is to put greater emphasis on more science-focused training than already exists. Their reasoning is quite simple: there is “tremendous supportive evidence” that suggests certain science-based techniques and treatments, such as CBT, are more efficient than other, more outdated methods. With the new accreditation system in effect, patients will be able to choose psychotherapists from those programs who emphasize these newer techniques, ensuring that they will get the best possible care.

Currently, the only major accrediting body for clinical psychology PhD and doctorate of psychology, or PsyD, programs is the American Psychological Association. APA has been in existence since 1948 and now has accredited 234 of the nation’s clinical psychology programs.

To McFall, this poses a problem. “Currently, accreditation is being awarded to programs that don’t agree on the philosophy behind the role of science in clinical practice,” said McFall. This makes it difficult for the public to differentiate those programs that emphasize more science-focused training from those that do not.

As for Susan Zlotlow, director of the accreditation program at APA, the science of psychology is indeed a critical part of clinical psychology training, but she does not believe there is a true need for practicing psychologists to be able to produce science. “Some of the things that work in the lab don’t generalize to people that well,” she said. “It’s not that simple.”

As such, there is a certain amount of skepticism among those in the APA and some accredited programs as to whether or not a new accrediting system is truly warranted.

By implementing the new system, two types of accreditation — APA and PCSAS — will be in effect for the foreseeable future. If all goes as planned, the PCSAS accreditation will serve to create a “different brand” of clinical psychology training programs, as Robert Levenson, clinical psychologist at University of California in Berkeley, put it. He warned, however, that the existence of two brands could prove costly if the divide is not eventually resolved.

“It is important that we take this first step towards a new accreditation system,” said Levenson. “However, the second step — to reconcile the two opposing sides — is even more important. If we let two systems last, it won’t look good for our field.”