A Response to Baker, McFall & Shoham (2009) from Dr. David N. Elkins

A Brief Response to an Article that Stigmatizes PsyD Programs, the Practioner-Scholar Model of Training, the APA Accreditation System, Traditional Psychotherapies, Most Practicing Clinicians, and the Profession of Clinical Psychology Itself

By
David N. Elkins, Professor Emeritus of Psychology, Graduate School of Education and Psychology, Pepperdine University
Core Faculty, University of the Rockies

Baker, McFall, and Shoham (2009) recently published a major article on the need for reform in clinical psychology. According to the authors, the field of clinical psychology is in a prescientific state similar to the state of medicine before the early 1900s when certain leaders began to insist that science – not intuition or personal experience -- must be the foundation of medical training and practice. The authors criticize PsyD programs, the practitioner-scholar model of training, traditional psychotherapies, and even the APA accreditation system. They insist that most clinical psychologists are poorly trained and have little respect for science. To support this indictment, they point out that most practicing clinicians refuse to use scientifically supported interventions despite their availability. The authors propose two major reforms which, in their opinion, might save the profession: (a) the exclusive use of scientifically supported interventions in psychotherapy and (b) the establishment of a new accrediting agency to recognize programs that are scientific and to stigmatize programs that are not.

We believe all clinical psychologists should be deeply concerned about an article that attempts to stigmatize PsyD programs, the practitioner-scholar model of training, the APA accreditation system, traditional psychotherapies, thousands of practicing clinicians, and the profession of clinical psychology itself. To accuse the profession of being "prescientific" -- similar to medicine before the early 1900s --simply because the vast majority of clinical psychologists refuse to endorse the narrow agenda the article promotes steps over the line. The authors marginalize the extensive research that undermines their position on interventions (i.e, that only "scientifically supported" interventions should be used). Thus, it would appear that it is a political war disguised as a scientific one. What the scientific research on psychotherapy actually shows is that all bona fide therapeutic systems are robustly effective. The research does not support the privileging of one therapeutic system – such as BT or CBT – over other systems. Nor does it support the privileging of so-called “scientifically supported” interventions over other interventions. In fact, extensive scientific research – in the form of analyses and meta-analyses of thousands of psychotherapy studies -- shows that contextual factors – not techniques -- are the primary determinants of therapeutic outcome (see Wampold, 2001; Elkins, 2007; Elkins, 2009; Hubble, Duncan, Wampold, & Miller, in press). Thus, although the article is filled with appeals to science and criticizes the profession as being “prescientific,” the truth is, the article marginalizes the extensive scientific research that undermines their position on therapeutic interventions.

If the agenda promoted in this article were to succeed (and there are indications that it could), it would mean the public stigmatizing (and possibly the eventual end) of practioner-scholar training programs, most PsyD programs, PhD programs that do not subscribe to the Boulder Model, the APA accreditation system, and all traditional psychotherapies. In addition, it would stigmatize all clinicians as lacking respect for science if they refused to use the so-called "scientifically supported" interventions espoused by the authors. Of course, if science truly supported the agenda promoted in the article, we should all do obeisance and acknowledge that we are in a dark, prescientific state, that we obviously and wrongfully have lacked respect for science, and that this article has shown us the error of our ways, and called us to repentance and reformation of our professional lives. On the other hand, if we believe this article stepped over the line and is scientifically unfounded, that our training programs are based on scientific foundations, that traditional psychotherapies are robustly effective (as the research shows), that clinical psychology is not in a "prescientific" state, and that we deeply respect science -- including the science that undermines the agenda promoted in the article -- then we should do everything possible to stop this movement in its tracks – by contacting our Division leaders at APA, by putting out the word to all psychology organizations, by contacting the leaders of PsyD training programs to tell them their programs may be at risk, and by contacting APA to insist that our national organization address such attempts to stigmatize and undermine our profession.

References

Baker, T. B., McFall, R. M., & Shoham, V. (2009). Current status and future prospects of clinical psychology: Toward a scientifically principled approach to mental and behavioral health care. Association for Psychological Science: A Journal of the Association of Psychological Science, 9(2), 2009.

Elkins, D. N. (2007). Empirically supported treatments: The deconstruction of a myth. Journal of Humanistic Psychology,47 (4), 474-500.

Elkins, D. N. (2009). Humanistic psychology: A clinical manifesto: A critique of clinical psychology and the need for progressive alternatives. Colorado Springs, Colorado: University of the Rockies, Press.

Hubble, M.A., Duncan, B. L., Wampold, B.E., Miller, S. D. (Eds.), (in press). The heart & soul of change: Delivering what works. Washington, DC: American Psychological Association.

Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum Associates.

Wampold, B. E. (2005). Do therapies designated as ESTs for specific disorders produce outcomes superior to non-EST therapies? Not a scintilla of evidence to support ESTs as more effective than other treatments. In J. C. Norcross, L. E. Beutler & R. F. Levant (Eds.), Evidence-based practices in mental health: Debate and dialogue on the fundamental questions (pp. 299-308, 317-319). Washington, DC : American Psychological Association.

Author's e-mail address:
davidnelkins@hotmail.com