Clinical Science APA Designation

[OneNeuroDoctor]

I am reading on some of the listserve that APA is proposing combination or discontinuance of designated programs that focus on either clinical or science claiming it is not a dichotomy. From what I am able to decipher is that APA does not want to have separate programs but that clinical and science are mandated in all psychology programs and it is a mistake to assume they are different.

I know there is the Boulder Model and the Vail Model and the new model of training would be the Clinical Science Model.

Some hostile exchanges among psychologist on the APA listserves focusing on APA accredited program being required to follow a Clinical Science Model. Some are emphasizing clinical psychologist leaving APA and forming their own association as APA is stressing academic/scientist over clinical/practitioner.

Primarily the Clinical Science model mandates evidence based practices in all of clinical psychology training in a Behavioral Science focus and Humanistic and Psychodynamic training would not be stressed in a Clinical Science model.

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[AcronymAllergy]

I'd honestly be shocked if most folks thought the APA was preferential toward clinical science over psychological practice, as a preference toward the latter is essentially what led to the creation of the "clinical scientist" training paradigm and the APS as a professional organization and accreditation body to begin with. The fact that folks might be upset that the APA is too "scientist-focused," unfortunately, makes me wonder if those members are simply completely removed from science and scientifically-informed practice.

I'd be interested to see the back-and-forth between the sides, but unfortunately, I'm not currently an APA member.

 

[WisNeuro]

I'm with AA, the APA has always been much more on the side of practice than research. I would find it odd that they would further alienate their paying base after hemorrhaging members in the past 2 decades.

 

[Ollie123]

As AA indicated, I've generally seen most of the push in the other direction, with people getting incredibly frustrated about APA's complete disregard for science and the role of science in psychological practice. Practitioners make up the vast majority of their member base and they do way more to advocate on their behalf (albeit in arguably ineffective ways) than they do to act on behalf of psychological scientists. Heck, that's the very reason PCSAS came about...if APA were legitimately going to push in that direction it would eliminate the need for them. Which I would actually applaud, but its been decades with absolutely no indication APA is going to take anything remotely approaching on a firm stance so I would be absolutely shocked to see it happen now.

I fully agree dividing into clinical and science is an artificial dichotomy. Both should be mandated for all clinical/counseling programs...I'm horrified to think of the idea that they might not be. I have no idea how or why that would preclude learning about humanistic or dynamic interventions, though it would force context into the discussion in lieu of the "I do therapy X because it 'speaks to me' more and I like it" approach we continue to allow.

 

[OneNeuroDoctor]

It seems that the psychologists arguing against a Clinical Science emphasis with requirement of evidence based practices is that humanistic and psychodynamic focused programs would not meet the APA accredited guidelines.

 

[WisNeuro]

There is an evidence base for some psychodynamic treatments. And, anyone who is arguing against requiring an evidence base for a delivered treatment deserves to have their license taken away.

 

[QAsPsych]

It's a dense debate. There are people who are opposed to evidence-based practice for reasons that boil down to "I've been in practice for 35 years and I've helped hundreds of people and how dare you ivory tower know-it-alls question what I do", and then there are people who regard the phrase "evidence based practice" as a cover phrase for "CBT (and certain variants)". Certainly I have met people who use it in the latter way, and refuse the idea that there could be evidence for humanistic or psychodynamic approaches. Some people, witnessing this, have legitimate concerns that their voices will be drowned out despite evidence, in favor of a narrow view of what "evidence based practice" means. Which is separate from the camp of psychologists who simply are not scientists and are not in favor of scientific inquiry into their methods.

On the other side of the debate you have some psychologists who do not believe that social sciences are legitimate science, which results in pushback. Saying "we want to be more scientific" is great, but if that means physics envy then, surprise, a lot of people are going to oppose it.

 

[Fan_of_Meehl]

To my mind (and in my experience) our focus on the application of (behavioral) science to human problems is the thing that makes our field distinctively useful. I have always tried to have one foot in the scientific literature and one foot in the clinic (balancing 'book/article-time' with 'patient-time' and this has been one of the aspects of a career in clinical psychology that I have found consistently rewarding through the years). I have always held the position that clinical psychologists who are averse to reading (professional materials) in the area that constitutes their daily practice don't belong in the field. Our field isn't here to promote/perpetuate 'pop' psychological principles or fads or perpetuate common myths about human behavior or neuroscience (e.g., 'we only use 10% of our brain..." -whatever that would even mean).

I work for a large federal organization and have had a supervisor pressure me to do 'drive-by' competency/capacity evaluations (i.e., we need this by the end of shift or approximately two hours from now, from record review, testing, interviewing and report-writing) that were more driven by random institutional political expediencies than pressing clinical need. It was a tense situation but I had to say 'no' (and this didn't earn me any points with my supervisor). Other colleagues who were pressured to do this were uncomfortable but did it anyway out of fear of reprisal. Basically, I found a way to politely/professionally make the point that, "I'm sorry, but I practice professional psychology"...that is, I don't just pull a capacity determination out of my butt on a moment's notice without checking out what best practices are and what the science says about reliably making a valid determination of competency. In my way of thinking, it's hard to decouple the need to be scientifically-informed about what we do from the moral/ethical responsibility to not harm patients. Sometime that harm is merely wasting everyone's time with an inert misguided approach to treatment but sometimes is as serious as haphazardly starting a process that ends with a patient being stripped of their rights to make their own medical decisions.

 

[OneNeuroDoctor]

Interesting the different viewpoints on the listserve as some are claiming that clinical psychology training has deteriorated since evidence-based training has been emphasized. Apparently evidence and science seem to be negatively viewed by some camps whereas they believe it has simplified psychology and watered down the true meaning of psychologist to uncover deep problem while engaging in years of therapy. One well known psychologist even claimed "psychologist eat their young."

 

[WisNeuro]

Evidence and science are negatively viewed? By who? People who still believe in humors, bloodletting, and trephination? And, if successful therapy is the one that is supposed to take years to complete, I'm glad to let those people walk. While some SMI may require that long-term type of care, it's ridiculous to expect that to be the norm, and in my opinion, unethical.

The "true meaning" of psychology these people want is a a consistent meal ticket who never really needs to get better for them to collect their fees.

 

[erg923]

Interesting the different viewpoint on the listserve as some are claiming that clinical psychology training has deteriorated since evidence based training has been emphasized. Apparently evidence and science seem to be negative viewed by some camps whereas they believe it has simplified psychology and watered down the true meaning of psychologist to uncover deep problem while engaging in years of therapy. One well known psychologist even claimed "psychologist eat their young."

While dishing up gossip from the various list serves maybe "interesting" to you, I think you can save the drama for momma in this case.

Obviously, the APA has a stake in not splintering the profession and, likely more importantly for them, not losing or ceding power. And of course they have a point there, if only one of self preservation. Everyone has their purist view of what the profession should look like. But, frankly, that's not really up to us anymore is it? No, we ****ed that up long ago. Like when we declined to be put on par physicians under medicare, and when we couldn't quite prove that our clinical work was superior to lesser trained individuals. Oh, and when we started producing professional school graduates who cant actually do clinical science (opting for Raven dissertations) and think a Chi Square is Greek life fundraiser.

 

[Ollie123]

Sadly, there is still a not-insignificant portion of the field that believes that thinks evidence is bad. Heck, Scott Lilienfeld has practically built his career off calling these folks out. They do seem to be dying out, albeit slowly. Though as erg indicated, I worry we are going to see a resurgence because of our inability/refusal to enact training standards.

 

[PsychBiker]

As an aside, I have a colleague doing her PsyD dissertation and only using archival data; she has an interesting topic, but could someone explain to me why a long lit review is considered acceptable as a dissertation?

Chi Square isn't a fraternity?

 

[Ollie123]

As an aside, I have a colleague doing her PsyD dissertation and only using archival data; she has an interesting topic, but could someone explain to me why a long lit review is considered acceptable as a dissertation?

Chi Square isn't a fraternity?

If it was, my respect for greek life would likely have been substantially higher!

Is it archival data or a lit review? The former I am okay with it if it is substantive, as it can sometimes be a massive undertaking. It also may be the only realistic way to address certain topics while a student (i.e. epi-type questions). That would be incredibly rare for these types of programs though. Usually it just seems to be something awful designed to meet only the loosest definition of "research" that one can muster up so they can push people through the system.

 

[smalltownpsych]

These arguments always seem to get framed in this way. One side saying empirically validated treatments using experimental method is essential to the profession and stating that the other side says that research and science are stupid. The other side says that the experimental method is not the only answer and that it is too reductionist and states that the other side ignores all of the research on other therapeutic factors in favor of cookie cutter treatments. The best way to make the other side seem irrational is to exaggerate their position. I forget what that technique is called but it happens all of the time around here. Psychologists seem to love to argue with each other. The Freudians vs. The Skinnerians must have been a fun one.

 

[PsychBiker]

Is it archival data or a lit review? The former I am okay with it if it is substantive, as it can sometimes be a massive undertaking. It also may be the only realistic way to address certain topics while a student (i.e. epi-type questions). That would be incredibly rare for these types of programs though. Usually it just seems to be something awful designed to meet only the loosest definition of "research" that one can muster up so they can push people through the system.

Its archival and its seemingly substantive, though I haven't looked at her work. From what I know, she chose this route to avoid IRB as well as not having to deal with testing - she essentially wants to get it over with... Meh, maybe it will take as much work or more than an experimental design, and maybe I am just biased.

 

[OneNeuroDoctor]

I gather that APA is specifying and enforcing standards requiring APA accredited programs to have uniformity of curriculum based on evidence-based practices. With the changes occurring in 2017 requiring APA program eligibility for APA accredited internship application, both programs and internships will be required to follow evidence-based practices. Depending on criteria, evidence-based could be broadly or narrowly described. As indicated in this thread already, psychodynamic therapy may be evidence-based for some mental health diagnosis whereas CBT may be evidence-based for different mental health diagnosis.

Apparently training programs, both PhD and PsyD will be mandated to have evidence-based training with both science and clinical focus rather than programs only having a science or clinical focus. All programs will need to have options for students to have breadth of training that is evidence-based. Currently, a number of program have primarily either a psychodynamic orientation or CBT orientation. My guess is programs that primarily focus on one type of orientation will need to justify their evidence-based to maintain APA accreditation.

 

[WisNeuro]

I doubt they'll come down on programs all that much. I'm not sure if they would risk all the money they get from the diploma mills. Especially in light of their declining membership.

As of now, it's open for public comment for another month. Also, I don't see them making any one program justify their evidence base if they are already teaching EBT's. I can't fathom them mandating that a school get some psychodynamic faculty to supplement their PE/ExRP/etc methods. You can teach evidence based practice easily, you don't have to have resources to teach every single best treatment available.