Psychological snake oil?
This from today’s issue of Science magazine:
Shrinking the Shrinks
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.
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Why are the PsyD degrees so popular? Less time/school/expensive to attain? Where do MSWs and CSWs fit into this? Many of them work as therapists. Do you think limiting all practicing psychologists to admission through a Phd is a good idea? I can see it for research, but for clinical practice?
PsyD programs are less selective (dozens in each class vs fewer than 10 in most good PhD programs).They are easier, because most don’t require a lot of difficult science courses. They are actually more expensive, and don’t give nearly as much financial aid; enough people are willing to pay their own freight. The point of the new report is that consumers have a right to know if their therapist has been trained in rigorous science-based practice, or something else (art, craft, intuition?). The new accredidation system would accredit only scientifically grounded PhD programs (which is not all PhD programs either). The hope is that the worst programs of all kinds will close down, but some will continue, and consumers will be able to choose a therapist based on training. Right now, if someone with a serious emotional or mental disorder walks into a psychologist’s consulting room at random, he/she has no idea if that therapist will be offering treament based on plausible ides about human behavior, or voodoo. I will post the link to the entire report, which also spells out the therapies that have been scientifically tested and found effective, including: CBT for depression and PTSD, exposure therapy for OCD, family therapy for schizophrenia, couples therapy for addictive disorders, and so on. MSWs can also choose to offer these tested interventions, but this program doesn not deal with MSW trining.
In response to another comment. See in context »I understand the need to control credentialling, but we both know (?) that even the most-degreed therapists can still offer atrocious treatment if they’re book-smart but unethical or not very helpful. I hate to admit it, but I’ve met some doozies over the years, and great ones remain rare, bless ‘em.
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As a practicing clinical psychologist, and a psychoanalyst to boot, there is much to like and dislike about this development. A Flexner Report for psychology would be terrific. Grad schools are clearly sending out far too many graduates. I think last year there were only enough internships for about 70% of applicants. But before we get an actual Flexner Report both researchers and practitioners need to do a much better job working together. As you quote (t)herapists’ “lack of adequate science training … leads them to value personal clinical experience over research evidence.” At the same time, researchers lack of clinical experience leads them to overestimate the value and generalizability of the work they do.
One of my first jobs was working for a “hard science” schizophrenia researcher. My job was to visit all the wards at several hospitals and interview patients for inclusion in the study. Maybe 1 in 100 who had all the necessary symptoms also did not have any history of alcohol, drugs, domestic violence, child abuse, and other exclusionary criteria. It is likely most clinicians would never see a schizophrenic patient who fit the criteria for this research.
I’m looking forward to reading the report and seeing what the APS proposes.