Experts call for evidence-based clinical psychology, more science in education and practice.

Fascinating discussion about the science of clinical psychology on Science Friday this week: A group of practitioners is recommending a new accreditation system for training programs to ensure that the methods used by clinical psychologists are backed by scientific research. Advocates of evidence-based methods also claim that more practitioners need to provide evidence demonstrating that their methods work, backing up their claims that they are providing effective treatments.

It's time for some evidence. One of the Science Friday guests was Richard McFall, the Executive Director of pcsas.org, the Psychological Clinical Science Accreditation System. The group's mission is to "provide rigorous, objective, and empirically based accreditation of Ph.D. programs in psychological clinical science.... PCSAS was created to promote superior science-centered education and training in clinical psychology, to increase the quality and quantity of clinical scientists contributing to the advancement of public health, and to enhance the scientific knowledge base for mental and behavioral health care."

McFall is also a co-author of the report Prospects of Clinical Psychology: Toward a Scientifically Principled Approach to Mental and Behavioral Health Care [42-page pdf here]. "Clinical psychologists’ failure to achieve a more significant impact on clinical and public health may be traced to their deep ambivalence about the role of science and their lack of adequate science training, which leads them to value personal clinical experience over research evidence, use assessment practices that have dubious psychometric support, and not use the interventions for which there is the strongest evidence of efficacy. Clinical psychology resembles medicine at a point in its history when practitioners were operating in a largely prescientific manner."

A practical approach. In discussing the use of criteria for data-driven decision-making in mental health care, the report addresses efficacy; effectiveness and dissemination potential; costs and cost- effectiveness; and scientific plausibility. "[T]he future of clinical psychology will be dictated largely by what data show regarding the relative cost-effectiveness of psychosocial and behavioral interventions compared with other competing intervention options in mental health care. Before we can make sense of these data, however, we first must understand clearly the criteria by which such evaluative comparisons are made. Clinical psychologists must offer compelling evidence relating to these criteria if they expect their psychosocial and behavioral interventions to have a fair chance of gaining widespread support, to be adopted in the health delivery system, and to be funded via health coverage mechanisms.... However, there is considerable evidence that the data for the four classes of criteria we discuss... - efficacy, effectiveness, cost-effectiveness, and scientific plausibility - already significantly influence health care decisions."

The report also addresses the merits of psychosocial interventions and future prospects of clinical psychology, saying there's both good news (empirical support for psychosocial interventions) and bad news (psychology’s failure to develop as an applied science).

Diane Chambless of the Univ. of Pennsylvania offered great insights: She said psych students need to learn to infuse their treatments with science, becoming familiar with what's in the database, and what methods are shown to work. She remarked that practitioners need to gather empirical evidence in their practice so they can evaluate outcomes.

But one detractor said adoption of evidence-based methods doesn't make a big difference because they typically replace treatment techniques that were also effective, so the improvements are small. (Hmm... might want to study that empirically.)

Let's present the evidence more effectively. The report advocating evidence-based clinical psychology makes a very compelling case for scientifically supported, cost-effective treatments. I only wish the authors had made their information easier to dig through; they've fallen into the traditional trap of offering page after page of text, supplemented by long lists of references. The empirical evidence and examples they cite aren't easy to spot or grasp quickly. It would be great to see some reader-friendly charts, at-a-glance summaries of treatment specifics, details of training programs, and easy-to-read findings or other evidence.

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