Therapy–An “Unconscionable Embarrassment?”

I am not a clinician–I’d never in a million years be able to master the non-judgmental thing–but clinical practice has always been an essential part of our field. We have had some success, as outlined by Martin Seligman in his entertaining talk for TED. We can provide some quality of life for about 2/3 of patients with schizophrenia, for which there were no effective treatments 60 years ago. But as Seligman warns us in his lecture, psychology remains “not good enough.”

In a new report published in Psychological Science in the Public Interest, clinicians Timothy Baker (U. Wisconsin-Madison), Richard McFall (Indiana) and Varda Shoham (Arizona) point out that there is a strong disconnect between what has been learned in psychological science and what practitioners offer. For example, even though cognitive behavioral therapy (CBT) has been scientifically demonstrated to be efficacious in treating posttraumatic stress disorder (PTSD), fewer than 30% of practicing psychologists are trained in these techniques, and fewer than half of those trained actually use them to treat PTSD. Not good enough.

How Often Are Therapies Based on Psychological Science?

In his editorial introducing Baker et al., Walter Mischel describes his own challenges with the training programs at Stanford, and characterizes the disconnect between psychological science and practice as an “unconscionable embarrassment.” Fortunately, Baker et al. and Mischel offer a solution–a complete revamp of the clinical accreditation programs. You can follow the progress of the proposed Psychological Clinical Science Accreditation System (PCSAS) here.

What is interesting to me about this issue is that psychology is not alone in facing academic versus practioner dilemmas. When I was a college student in southern California, UCLA had the reputation of being “theoretical” while USC was more “hands on,” pretty much across the board, whether you considered law, business, or medicine. Here at Cal Poly, we follow the “practioner” theme, branding ourselves as “learn by doing.”  My daughter, Karen, has investigated the academic-practitioner issue in her own field of expertise–public relations, and won a top paper aware at last summer’s AEJMC conference. The paper generated a lot of interest among faculty who were concerned that their current curricula were not preparing students for jobs in the 21st century of social media.

This science-practitioner issue strikes me as another one of those no-win battles, like nature-nurture. We know that nature-nurture doesn’t work as an either or, and I’m guessing that science-practitioner doesn’t either. Clearly, the scientist should ask some questions that have useful applications, and the practitioner needs a solid grounding in science to provide the best treatment. Artificial divisions between the two do not serve anybody well. It reminds me of a Jane Austen novel–if people would only talk together, the novel would be two pages long.