The Effectiveness of Psychotherapydoi: 10.1037/0003-066X.50.12.965pmid: N/A
Consumer Reports (1995, November)published an article which concluded that patients benefited very substantially from psychotherapy, that long-term treatment did considerably better than short-term treatment, and that psychotherapy alone did not differ in effectiveness from medication plus psychotherapy. Furthermore, no specific modality of psychotherapy did better than any other for any disorder; psychologists, psychiatrists, and social workers did not differ in their effectiveness as treaters; and all did better than marriage counselors and long-term family doctoring. Patients whose length of therapy or choice of therapist was limited by insurance or managed care did worse. The methodological virtues and drawbacks of this large-scale survey are examined and contrasted with the more traditional efficacy study, in which patients are randomized into a manualized, fixed duration treatment or into control groups. I conclude that the Consumer Reportssurvey complements the efficacy method, and that the best features of these two methods can be combined into a more ideal method that will best provide empirical validation of psychotherapy.
The Reflective Educatordoi: 10.1037/0003-066X.50.12.975pmid: N/A
Since the Boulder conference on training in clinical psychology in 1949, at least 13 national conferences have been convened to examine issues in training for practice in psychology, all based on the assumption that extensive training is required to develop professional skills in psychotherapy, psychodiagnosis, and related professional functions. This assumption is challenged by a large body of research that fails to show any relationship between training and efficacy in common forms of practice. Educators of professional psychologists are urged to heed the challenge closely and examine its implications critically. At the same time, educators of researchers in psychology are encouraged to examine common assumptions about the nature of practice in psychology and to consider conceptions of professional work that emphasize reflection in action and disciplined inquiry, rather than psychotherapy and psychodiagnosis, as defining features. Education for practice is neither science nor art, but a profession in itself. When the educational process is approached from this vantage point, novel opportunities for systematic investigation emerge. Decisive studies of the appropriate kind have yet to be done.
Bridging Scientist and Practitioner Perspectives in Clinical Psychologydoi: 10.1037/0003-066X.50.12.984pmid: N/A
Literature suggests that a complex and often hostile relationship exists between the science and practice of clinical psychology. Contributors to this conflict of viewpoints are reconsidered within the proposition that there are different roads to discovery and that there may be good reasons to keep the science and practice of clinical psychology somewhat separate. Results of a national survey of 325 psychologists are reviewed that support the view that psychological practitioners value research and consider their practices to be augmented by scientific findings. However, they are in need of vehicles of communication that will help them translate scientific findings into practice. Results suggest that practitioners do more to understand scientific findings than scientists do to understand the problems that face clinical practitioners. Ways to facilitate communication between and among these groups are considered.
The Local Clinical Scientistdoi: 10.1037/0003-066X.50.12.995pmid: N/A
The local clinical scientist brings the attitudes and knowledge base of the scientist to bear on the problems that must be addressed by the clinician in the consulting room. The problems of inadequate generalizability are reduced by a recognition of the value of local observations and local solutions to problems. However, these observations and solutions benefit by the scientific attitude of the clinician and are subjected to the same need for verifiability that greets all scientific enterprises. The clinical setting is viewed as analogous to a scientific laboratory, and, by doing so, the scientist–practitioner model is enacted.
The Destructiveness of Perfectionismdoi: 10.1037/0003-066X.50.12.1003pmid: N/A
Reports in the public media indicate that intense perfectionism and severe self-criticism played a role in the suicide of three remarkably talented individuals. The role of perfectionism in these suicides is consistent with recent extensive investigations of aspects of perfectionism as well as further analyses of the NIMH Treatment of Depression Collaborative Research Program (TDCRP), indicating that intense perfectionism interfered significantly with therapeutic response in the various brief treatments for depression. Self-critical individuals, however, made substantial improvement in long-term intensive treatment. These findings suggest the value of considering psychopathology, especially depression, from a psychological rather than a symptomatic perspective; that different patients may be differentially responsive to various types of therapy; and that more extensive therapy may be necessary for many highly perfectionistic, self-critical patients.
Focusing on Society's Real Needsdoi: 10.1037/0003-066X.50.12.1022pmid: N/A
Professional psychology has the obligation and opportunity for contributing significantly to society. The prescription privilege agenda is a case example. During the past decade, considerable support has developed within the field, particularly among practitioners, for obtaining this clinical responsibility. The federal sector has demonstrated that our profession can prescribe competently and safely and that viable training modules can be developed at the postdoctoral level. There is a clear and pressing need for ensuring that psychotropic medications are used in a safe and effective manner. Nevertheless, at both the state and national levels, those psychologists involved in seeking this privilege have experienced intense opposition from organized psychiatry. It is crucial that the profession control its own destiny.