by Michael D. Anestis, M.S.
At 3:20pm eastern time today on NPR's "Science Friday" program, Richard McFall, Bruce Wampold, and Dianne Chambless will be guests and will be discussing the current state of clinical psychology and the role of science in guiding treatments. We have discussed this topic at great length on PBB and will continue to cover it, but we hope that readers will take the time to listen to this particular radio program - either live or after the fact, which you can do online at this site - in order to hear the issues discussed by some of the folks most directly involved in the process.
Richard McFall is one of the authors of the paper that set off this most recent round of debate on the issue (see our initial coverage of the article here and here)
Bruce Wampold is the author of several papers disputing the validity of the empirically supported treatments movement (see our coverage of his work here)
Dianne Chambless is the author of several influential studies on empirically supported treatments (ESTs) and one of the individuals responsible for developing the criteria that determine whether or not a treatment is to be considered "empirically supported" for a particular diagnosis (see of coverage of some of her work here)
Without question, we at PBB are supportive of the EST movement. Like anyone, we are not without our personal opinions and philosophical stances. This position, however, is not based upon a gut feeling, but rather mountains of empirical evidence. That being said, there are many who disagree with our viewpoints. Here is a sampling of the articles that have come out on this topic in the past two months, some of which support Baker et al.'s conclusions and some of which do not:
- Washington Post article by Baker, McFall, and Shoham
- Psychology Today coverage
- American Psychological Association discussion of their accreditation system
- Society for a Humanistic Psychology article by David Elkins
- Current Psychiatry article by Henry Nasrallah examining whether psychiatrists are evidence-based in their practices
- Los Angeles Times coverage
- Newsweek coverage
Importantly, as you listen to the NPR program and read these articles, keep in mind one often overlooked point: what people say and what the data tell us are often very different from one another. This, of course, is not a problem exclusive to clinical psychology. We see this transpire in politics, economics, sports, and countless other areas of life. With respect to clinical psychology, some of the common erroneous claims you will hear include:
Randomly controlled trials, the sole basis for claims of ESTs, are flawed because they are not representative of actual clinical practice. In other words, "real" clients are excluded.
- In reality, exclusive RCTs are only the first step in establishing empirical support for a treatment. In such studies, we want to ensure that the treatment is having a specific impact on specific symptoms. These trials are referred to as efficacy studies. Effectiveness studies, in which efficacious treatments are tested in "real world" clinical settings, are completely supportive of the results from the more exclusive trials. See some of our coverage on this issue here, here, and here.
Research shows that all treatments work equally well for all problems.
- This idea, known as the "Dodo Bird Hypothesis," has been debunked on numerous occasions. More often than not, it is based upon meta-analyses conducted by Bruce Wampold, who will be a guest on today's NPR program. You can see our discussion of Wampold's work here (link) and another example of a published critique of this research here (link). Again, make sure to actually read the documents before taking anyone's opinion as fact (and that includes mine), otherwise this becomes a game of manipulation, not a scientific endeavor based upon facts.
Researchers don't see patients and therefore don't know what they are talking about.
- I encounter this one a lot and, quite frankly, it's insulting. Researchers are often highly accomplished clinicians as well. Consider the work of David Barlow, Robert Leahy, Aaron Beck, and Thomas Joiner for example.
Therapeutic alliance is what really accounts for change in therapy. Specific techniques are not a real mechanism of change.
- This is another common comment, again often based upon the work of Wampold, but again it is based upon incredibly flawed data. What most studies show is a correlation between alliance and outcome, which is equally supportive of the idea that getting better in therapy causes clients to say they have a good alliance with their therapist (or therapists to say they have a good alliance with their clients). Longitudinal measures that examine whether alliance or symptom changes come first paint a very different picture. In therapies that emphasize alliance, such as psychodynamic therapy and CBASP, alliance has been shown to precede symptom change, but in other therapists, such as cognitive therapy, the opposite is true. Here again, people need to be sure to actually look at the data before reciting another individual's conclusion on the matter. You can read our extensive coverage of this issue here.
We are all individuals, so group data is useless in helping us learn what to do for an actual patient. Besides, everyone responds differently to different things.
- There is some good and some bad in this, and I think it mostly rests upon a misunderstanding of what we, as scientists, are doing and saying. Group data tells us information about the probability that an individual will respond in a certain way to a certain treatment in a particular environment. No scientist believes that all people are the same or that everyone responds equally to a particular treatment. We do, however, believe that some treatments are effective more often than others for particular diagnoses and that some treatments are particularly effective in particular ways. Fortunately, there are simple statistical tests call moderation analyses that help us determine if particular sets of people are more or less likely to respond like most others. When we simply guess who will and will not respond, we end up running into a lot of trouble. Nobody is advocating that only one form of treatment be available for particular mental illnesses. Scientists are simply advocating that the treatments with the most empirical support be used first and then, if a client does not respond to such approaches, alternatives should be considered. Those alternatives, however, should be subject to testing to ensure that they actually produce reliable effects. You can read our coverage of the importance of group data here.
Ultimately, today's show should be very interesting. NPR is doing the public a great service by bringing in prominent individuals from multiple perspectives to discuss the topic in a public forum. Hopefully we will all be able to learn from this program and the conversation will continue to expand. We're looking forward to hearing your thoughts.
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If you would like to learn more about the topics discussed on Psychotherapy Brown Bag, we hope that you will consult our online store for scientifically-based psychological resources.
Mike Anestis is a doctoral candidate in the clinical psychology department at Florida State University
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