UCCs and EBPs?

[The Cinnabon]

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Hey everyone, lowly first year PhD student here who is applying for external pracs. Something I've noticed when looking at some UCC pracs (and internships) is the diverse "range" of modalities that staff practice under. I consider myself pretty CBT and EBP oriented, but I'm also pretty interested in getting training at a UCC as I think it could be interesting to work with emerging adults.

I guess my main question is why are UCCs very hit or miss as far as EBPs go compared to other sites such as the VA? I'm definitely at a cross roads between picking a population I'm interested in versus other sites that seem more grounded in empirically supported treatments, which is training I obviously want.

 

[summerbabe]

There’s likely a variety of factors:

- UCCs generally employ more/predominantly masters levels therapists including those who won’t get exposure to EBP focused training

- You’re more likely to find UCC clinicians aligned with Yalom/Rogers than Beck

- Traditionally, UCCs did not treat a lot of intense psychopathology and instead focused on things like general adjustment issues so there was less utility for EBPs

 

[The Cinnabon]

There’s likely a variety of factors:

- UCCs generally employ more/predominantly masters levels therapists including those who won’t get exposure to EBP focused training

- You’re more likely to find UCC clinicians aligned with Yalom/Rogers than Beck

- Traditionally, UCCs did not treat a lot of intense psychopathology and instead focused on things like general adjustment issues so there was less utility for EBPs

Thanks so much for the response, and yeah this clears a lot up!

Yeah, at least for now, I'm leaning towards some state hospital work for my prac as they really highlighted their strong CBT emphasis. UCC work around here is the quickest way to work with SGM populations (one of my big interests), but I don't know if it's wise to prioritize population above all else.

 

[PsyDr]

Yeah, at least for now, I'm leaning towards some state hospital work for my prac as they really highlighted their strong CBT emphasis. UCC work around here is the quickest way to work with SGM populations (one of my big interests), .....

Assuming SGM means "sexual and gender minority":

If you think UCCs have better SGMs exposure than state hospitals, I think you have been highly misinformed about state hospitals. UCCs might have higher functioning populations, but...

 

[psych.meout]

There’s likely a variety of factors:

- UCCs generally employ more/predominantly masters levels therapists including those who won’t get exposure to EBP focused training

- You’re more likely to find UCC clinicians aligned with Yalom/Rogers than Beck

- Traditionally, UCCs did not treat a lot of intense psychopathology and instead focused on things like general adjustment issues so there was less utility for EBPs

Agreed and another issue related to your third point is availability of services for a population with more severe mental health problems than what was traditionally seen and treated in that setting. Some UCCs may not be able to see students as often as would be indicated because they are so inundated with students in need of services, so they end up doing more supportive therapy or a watered down version of whatever EBP they would do in ideal circumstances.

 

[The Cinnabon]

Assuming SGM means "sexual and gender minority":

If you think UCCs have better SGMs exposure than state hospitals, I think you have been highly misinformed about state hospitals. UCCs might have higher functioning populations, but...

When you put it that way I feel like an idiot for not realizing I almost certainly can get said experiences at the state hospital. I'm glad I checked in here for the reality check, thanks!

 

[PsyDr]

When you put it that way I feel like an idiot for not realizing I almost certainly can get said experiences at the state hospital. I'm glad I checked in here for the reality check, thanks!

All part of learning. I’ve been there, you’ve been there, the next person will get there too.

 

[R. Matey]

Hey everyone, lowly first year PhD student here who is applying for external pracs. Something I've noticed when looking at some UCC pracs (and internships) is the diverse "range" of modalities that staff practice under. I consider myself pretty CBT and EBP oriented, but I'm also pretty interested in getting training at a UCC as I think it could be interesting to work with emerging adults.

I think you'll be pretty frustrated at a UCC as many do not do the CBT. This is ground zero for Rogers' humanistic counseling movement so the pressure to do some form of attachment/relational/psychodynamic can be intense. It varies though and there could be net gains. I had the chance to learn IPT and TLDP at my UCC practicum and internship, which are useful if I get the feeling that the patient won't tolerate CBT for whatever reason. Also, the TD at my UCC internship practiced CBT so there were still opportunities to me to further my skills so YMMV UCC to UCC.

so they end up doing more supportive therapy or a watered down version of whatever EBP they would do in ideal circumstances.

It depends on the issue: EDs beyond dysfunctional eating behavior, severe PTSD, and severe panic disorder likely cannot be addressed in at the UCC using EBPs because of the time constraints. Problems like adult ADHD, depression, GAD, social anxiety, and adjustment disorder can be. What was frustrating was being side-eyed for doing cognitive/CBT therapy for these problems rather than whatever de-colonized relational therapy was in vogue with the progressive narrative atm.

One other point I want to make about this is that you can and do get some pretty acute stuff in UCC. Think first encounters with psychosis, plenty of SI/SA and NSSI. Some of the patients that I've seen benefit the most from cognitive therapy have been depressed college students who are exceedingly grateful to have names and procedures to handle their streams of consciousness. Again, what pissed me off the most about this setting was not that it couldn't be done, but rather that the culture of university counseling would often make providing good care unnecessarily difficult.

 

[cara susanna]

I still remember at our grad school orientation when our UCC was presenting, they mentioned EMDR and how great it was, and my entire clinical psych cohort just all glanced at each other.

 

[psych.meout]

I still remember at our grad school orientation when our UCC was presenting, they mentioned EMDR and how great it was, and my entire clinical psych cohort just all glanced at each other.

Lol, that takes me back. So many proseminars where all the students gave each other side eye based on the bonkers stuff from the presenters.

 

[sammytheslug1200]

I really do not understand the dragging of UCCs on this thread...

Any agency is going to have individuals who practice from non-manualized treatment approaches. Also non-manualized does not equate to non-evidence based. Using solely RCTs to determine what constitutes EBPs reinforces circular logic because of course if the experimental design of RCTs are more conducive toward studying manualized EBPs, then results of RCT studies are of course going to favor manualized EBPs. Other forms of evidence exist for determining quality of psychotherapy interventions, see: Levitt, H. M., Hamburger, A., Hill, C. E., McLeod, J., Pascual-Leone, A., Timulak, L., ... & Tuval-Mashiach, R. (2024). Broadening the evidentiary basis for clinical practice guidelines: Recommendations from qualitative psychotherapy researchers. American Psychologist.

Similar criticisms could also be made in the opposite direction toward sites like VAs/Hospitals where one could make the argument that they attend to individual client specific characteristics (e.g., multicultural factors, client communication style, client affective expression) in performative/superficial ways because the training is preoccupied with doing what is in the manual. In fact, I had many clients on internship who shared their negative experiences of CBT/ACT interventions at the local IOP and hospital, but found UCC care a lot more suitable for their needs.

Both training philosophies have their purpose, but let's not **** on one to praise the other....

 

[The Cinnabon]

I really do not understand the dragging of UCCs on this thread...

Any agency is going to have individuals who practice from non-manualized treatment approaches. Also non-manualized does not equate to non-evidence based. Using solely RCTs to determine what constitutes EBPs reinforces circular logic because of course if the experimental design of RCTs are more conducive toward studying manualized EBPs, then results of RCT studies are of course going to favor manualized EBPs. Other forms of evidence exist for determining quality of psychotherapy interventions, see: Levitt, H. M., Hamburger, A., Hill, C. E., McLeod, J., Pascual-Leone, A., Timulak, L., ... & Tuval-Mashiach, R. (2024). Broadening the evidentiary basis for clinical practice guidelines: Recommendations from qualitative psychotherapy researchers. American Psychologist.

Similar criticisms could also be made in the opposite direction toward sites like VAs/Hospitals where one could make the argument that they attend to individual client specific characteristics (e.g., multicultural factors, client communication style, client affective expression) in performative/superficial ways because the training is preoccupied with doing what is in the manual. In fact, I had many clients on internship who shared their negative experiences of CBT/ACT interventions at the local IOP and hospital, but found UCC care a lot more suitable for their needs.

Both training philosophies have their purpose, but let's not **** on one to praise the other....

This feels like two separate points.

I think psychologists practicing evidence-based care utilizing tried and true treatment manuals should also be tailoring treatment to the individual. I agree that multicultural concerns in psychotherapy are huge and can effect the fidelity of a treatment ... but why can't the focus be on the development of formal adaptations to EPBs to service whatever the population of focus is on? That seems like the most grounded approach rather than opening the flood gates to treatments developed using spurious evidence/claims.

 

[psych.meout]

I really do not understand the dragging of UCCs on this thread...

Any agency is going to have individuals who practice from non-manualized treatment approaches. Also non-manualized does not equate to non-evidence based. Using solely RCTs to determine what constitutes EBPs reinforces circular logic because of course if the experimental design of RCTs are more conducive toward studying manualized EBPs, then results of RCT studies are of course going to favor manualized EBPs. Other forms of evidence exist for determining quality of psychotherapy interventions, see: Levitt, H. M., Hamburger, A., Hill, C. E., McLeod, J., Pascual-Leone, A., Timulak, L., ... & Tuval-Mashiach, R. (2024). Broadening the evidentiary basis for clinical practice guidelines: Recommendations from qualitative psychotherapy researchers. American Psychologist.

This is strawman.

No one here has said only RCTs should be used to determine EBP or ESTs (which you seem to be erroneously conflating), nor has anyone said that there is no value in qualitative research or other methodologies.

Similar criticisms could also be made in the opposite direction toward sites like VAs/Hospitals where one could make the argument that they attend to individual client specific characteristics (e.g., multicultural factors, client communication style, client affective expression) in performative/superficial ways because the training is preoccupied with doing what is in the manual.

Can you provide any data that substantiates these "criticisms" that individual differences are only being attended to in "performative/superficial ways?"

Also, this is a misunderstanding of what manualized treatment is, i.e., it is not a "cookbook," sticking to the manual and ignoring individual patient characteristics.

In fact, I had many clients on internship who shared their negative experiences of CBT/ACT interventions at the local IOP and hospital, but found UCC care a lot more suitable for their needs.

Both training philosophies have their purpose, but let's not **** on one to praise the other....

Ok, but I can similarly point to many of my patients who have had negative experience at UCCs and in other settings of doing supportive therapy, IFS, and other forms of therapy for years and not getting demonstrably better in any sense before coming to see me. This is the inherent flaw of anecdotes, they are not data and can easily be countered by other anecdotes. That's why we need data and empirical research, quantitative and qualitative.

 

[R. Matey]

Any agency is going to have individuals who practice from non-manualized treatment approaches. Also non-manualized does not equate to non-evidence based. Using solely RCTs to determine what constitutes EBPs reinforces circular logic because of course if the experimental design of RCTs are more conducive toward studying manualized EBPs, then results of RCT studies are of course going to favor manualized EBPs. Other forms of evidence exist for determining quality of psychotherapy interventions, see: Levitt, H. M., Hamburger, A., Hill, C. E., McLeod, J., Pascual-Leone, A., Timulak, L., ... & Tuval-Mashiach, R. (2024). Broadening the evidentiary basis for clinical practice guidelines: Recommendations from qualitative psychotherapy researchers. American Psychologist.

It's not circular logic as much as it's study design. An RCT tells you that on average, x set of procedures works for y problem. Whether a stronger within-person design using something like DSEM would be a better approach is current coversation in the literature. And whether it needs to be in that specific order or certain procedures can be left out is why mechanistic, meta-analytic, and dismantling studies exist. I think most psychologists inside and outside the ivory tower know that psychotherapy has to respect individual differences in the real world.

Also, there are studies that support interpersonal/psychodynamic approaches too using similar methods. Would you discredit these approaches based on so-called circular logic? The issue I had with university counseling is that many (again, not all) eschew these methods on illogical grounds. Science is fine for biases and climate change, but somehow irrelevant when psychotherapy becomes involved. Are RCTs perfect designs? No. But they do provide a framework on how to intervene. My clinical experience is that humanistic counseling is not enough, which is a conclusion that is supported by the literature.

And the problem with qualitative evidence is that lacks generalizability meaning that while x procedure for y condition may work for some, it may not work for others. This is a problem of scope. Interviewing hundreds or thousands of people to determine what intervention worked specifically for them is not feasible, not to mention that many qualitative designs do employ some kind of statistics so similar logic (e.g., intervention x works for this number of people) would be employed to arrive a conclusion.

Similar criticisms could also be made in the opposite direction toward sites like VAs/Hospitals where one could make the argument that they attend to individual client specific characteristics (e.g., multicultural factors, client communication style, client affective expression) in performative/superficial ways because the training is preoccupied with doing what is in the manual. In fact, I had many clients on internship who shared their negative experiences of CBT/ACT interventions at the local IOP and hospital, but found UCC care a lot more suitable for their needs.

idk, mate. I sure got tired of hearing how much I was oppressing people by providing cognitive therapy, which is a critique which really only ever came from certain staff. I was lucky enough to have a great TD who fended off these criticisms and supported my practice. When the UCC sent out feedback surveys, I, as an intern, was the one of the three most highly rated providers in the clinic. It turns out that if you respect people enough to offer them the best that science has to offer for their condition while making an effort to tailor it to their personal situation, they feel respected and cared for. Weird I know.

 

[MCParent]

My experience was that there was a wide range of practices at many UCCs, and that the range also varied widely by site. I was matched with a cbt supervisor for my UCC prac and it went great. Some other folks had supervisors who were surprised that students consulted literature at all about presenting concerns. Then the prac reorged and I think was pretty decently good evidence based. I didn’t find that absolute craziness was tolerated (one time I wrote in a note that I planned to discuss past life experiences w a client, badly worded I know; sv who was not super evidence based made sure I didn’t mean “past-life” experiences 🤣).

I do know some people who seem to have been UCC-trained only in some kind of twist of supportive therapy that was really just agreeing with the client about everything they said. I don’t think they’re modal but they stand out.

I felt like my UCC internship site was pretty good about evidence based practice though.

 

[cara susanna]

I really do not understand the dragging of UCCs on this thread...

Any agency is going to have individuals who practice from non-manualized treatment approaches. Also non-manualized does not equate to non-evidence based. Using solely RCTs to determine what constitutes EBPs reinforces circular logic because of course if the experimental design of RCTs are more conducive toward studying manualized EBPs, then results of RCT studies are of course going to favor manualized EBPs. Other forms of evidence exist for determining quality of psychotherapy interventions, see: Levitt, H. M., Hamburger, A., Hill, C. E., McLeod, J., Pascual-Leone, A., Timulak, L., ... & Tuval-Mashiach, R. (2024). Broadening the evidentiary basis for clinical practice guidelines: Recommendations from qualitative psychotherapy researchers. American Psychologist.

Similar criticisms could also be made in the opposite direction toward sites like VAs/Hospitals where one could make the argument that they attend to individual client specific characteristics (e.g., multicultural factors, client communication style, client affective expression) in performative/superficial ways because the training is preoccupied with doing what is in the manual. In fact, I had many clients on internship who shared their negative experiences of CBT/ACT interventions at the local IOP and hospital, but found UCC care a lot more suitable for their needs.

Both training philosophies have their purpose, but let's not **** on one to praise the other....

I mean, I overall agree with your point, but you're also repeating anti-EBP talking points that imo don't really hold up and just perpetuate myths about EBPs.

 

[WisNeuro]

I mean, I overall agree with your point, but you're also repeating anti-EBP talking points that imo don't really hold up and just perpetuate myths about EBPs.

As we know with the anti-EBP crowd, facts and reality are of little concern.