The need for empirically supported psychology training standards (psychotherapy in australia malouff 2012)

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  • 1. PEER REVIEWEDThe need for empirically supportedpsychology training standardsJ O H N M A L O U F F The scientific method makes many important contributions to society. It is on this basis that psychology training standards require universities to teach empirically supported psychotherapy methods to students. A logical extension of this premise is to apply the scientific method to the standards themselves. This article describes the need for empirically supported psychology training standards supported by well-designed studies which can demonstrate that individuals who receive training based on specific standards are more effective in their subsequent work than individuals who do not receive the training. Relevant studies published so far do not support the efficacy of current psychology standards. Future studies could use a variety of research designs to evaluate specific training standards. The conclusions of this study extend to training standards in the fields of psychotherapy and counselling.I n general, national psychology- training accreditation agenciesrequire universities to provide is more effective than a placebo, that multiple sources of data show the effects, that the advantage is a lasting & McLeod, 2008), based on concerns about the large financial and other costs imposed on universities andpsychology students with training in one, and that this advantage has been psychology students by current trainingempirically supported psychotherapy found by multiple research groups standards (Michael, Huelsman, &methods. This is true in Australia (Chambless & Hollon, 1998). Crowley, 2005). Hans Eysenck (1952)(Australian Psychology Accreditation Psychology accrediting agencies threw down a similar challenge whenCouncil, 2010) and in the United States typically do not justify in their training he famously challenged researchers to(American Psychological Association standards the reason for requiring test whether psychotherapy had anyCommission on Accreditation, 2009). training in empirically supported value. Thousands of researchers tookAlthough this article focuses on treatment, but a basis can be found in up the call and collected a wealth ofthe training of psychologists, the many important successes of the supporting data (Lambert & Ogles,accreditation agencies for the training scientific method in psychology and in 2004). To apply these standards toof psychotherapists and counsellors many other fields of science. It would the training requirements imposedlikewise require training programs be logical to suggest that psychology by accreditation agencies, one wouldto provide training in empirically training standards also should be based say that empirically supportedsupported psychotherapy methods (e.g., on published data. They are not. requirements ought to have evidence,British Association for Counselling At some point, psychology from multiple research groups, that theand Psychotherapy (BACP), 2009; accrediting agencies must start to requirements lead to better outcomesPsychotherapy and Counselling apply the scientific method to their in the clients of students who wereFederation of Australia, 2012). own professional decision making, trained in programs that meet theThe minimal empirical support for just as they encourage psychology requirements.psychotherapy methods typically students to base decisions on evidence. Is there published evidence ofincludes evidence that the treatment Psychologists have issued calls for the efficacy of psychology trainingis more effective than no treatment. the collection of evidence about the standards? The search for empiricalAt higher levels, empirical support effects of psychology training (Carey, support of specific training standardsincludes evidence that the treatment Rickwood, & Baker, 2009; Gonsalvez begins with identification of the goals28 PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012
  • 2. of the standards. Is it enough for Fauth, Gates, Vinca, Boles, & Hayes effect explains the results, it could bestudents to demonstrate competence in (2007) to conclude that changes in that the training led to more effectivespecified skills or should the standards training are needed. treatment. It is unknown whether thelead to better outcomes for future Finally, two recent studies improvement in outcomes continuedclients of the students? The ultimate produced varying results. A study after the end of training. Overall,goal of standards is to benefit clients, of psychotherapy-session outcomes research findings provide little supportso it would be appropriate to measure of student therapists in a clinical for the idea that typical professionalclient benefit (O’Donovan & Dawe, doctorate program showed no training of psychologists leads to better2002). This review focuses on effects of association with number of years outcomes for their psychotherapytraining standards on psychotherapyoutcomes. Other possible benefits ofthe standards relating to assessment Overall, research findings provide littleper se and ethics are beyond the scopeof this paper. support for the idea that typical professionalResearch findings training of psychologists leads to betterProfessional training in general With regard to client psychotherapy outcomes for their psychotherapy clients.outcome, there is relevant evidenceabout the value of formal training of training completed (Boswell, clients. standards. Meta-analyses of studies of Casonguay, & Wasserman, 2010). A somewhat related body of researchtreatments delivered to clients assigned However, a study of CBT training of has examined whether differencesto either licensed psychologists or community psychologists over a year among psychotherapists lead toparaprofessionals show either that the showed that their depressed clients differences in client improvement.paraprofessionals had significantly that year improved more during the The usual estimate from multilevelbetter outcomes or that the two groups training year than their clients the modeling is that therapist differenceswere equal in outcomes (Berman & year before (Simons et al., 2010). explain a modest amount of varianceNorton, 1985; Durlak, 1979; Hattie, While it is possible that a Hawthorne (8% or so) in client outcomes (see e.g.,Sharpley, & Rogers, 1984; Weisz,Weiss, Han, Granger, & Morton,1995). A meta-analysis by Stein &Lambert (1995) using a subsample ofthe studies used in prior meta-analysesfound evidence of better outcomesfor professional psychotherapists. Theauthors stated that only one includedstudy was designed adequately tocontrol for confounding influences.However, that one study, by Struppand Hadley (1979), did not haverandom assignment of clients totherapists. The Strupp and Hadleystudy found the same therapyoutcomes for paraprofessionals(university professors) and professionalpsychotherapists. A more recent study also showedequivalent therapy outcomes forparaprofessionals (self-help groupmembers) and professionals (Bright,Baker, & Neimeyer, 1999). Studiessuch as the pre-post study of Bein et al.(2000) of mental health professionalsreceiving traditional psychotherapytraining, including teaching andsupervised experience, have shownno lasting benefit with regard toeffectiveness with clients, leading Illustration: © Savina Hopkins, 2012. www.savinahopkins.com PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012 29
  • 3. Lutz, Leon, Martinovich, Lyons, & no research findings to show that of quality psychotherapy. However,Stiles, 2007). Those findings suggest student supervision leads to better there is no evidence that any of thisthat factors that affect therapists, client outcomes. Milne and James coursework leads to better outcomes forpossibly including training standards, (2000) concluded that their review of future clients of the students.could have at best a modest effect on studies showed that clients benefitted Research completionclient outcomes. from cognitive-behavioral therapist The next matter to address is to supervision, but the studies they cited Research completion has not beenwhat extent specific training standards did not support that conclusion. For examined with regard to whetherhave evidence of efficacy for client instance, Parsons and Reid (1995), it contributes to more effectivepsychotherapy outcomes. Is it necessary cited as showing that supervision treatment by students, perhaps becauseto show that fifty hours of supervision benefitted clients, did not evaluate no one thinks that it would. Thisis better than thirty hours? Probably clients. One recent study (Bambling, requirement may be an anachronismnot. It would be beneficial, however, King, Raue, Schweitzer, & Lambert, left from bygone days when earningto show that costly, time-consuming 2006) found that supervision directed a degree beyond undergraduateaspects of the training standards lead at developing a working alliance was supposed to make a person ato better client outcomes. These aspectsinclude clinical experience, supervision,coursework, and research completion. There appears to be no evidence to suggestExperience that coursework and research completion, If one views psychotherapy as askill, psychotherapy experience seems which make up a great deal of requiredlikely to be beneficial for improvingclient outcomes. However, amount psychology training, have any value to futureof professional experience usuallydoes not correlate significantly with psychotherapy clients of the students.client therapy outcomes, accordingto a careful review (Christensen & with the client led to better outcomes scholar, or it may be an applicationJacobson, 1994) and subsequent studies with depression clients during of the scientist-practitioner model of(Franklin, Abramowitz, Furr, Kalsy, the supervision, but there was no training psychologists. One might& Riggs, 2003; Kolko, Brent, Baugher, examination of whether the effects argue that there is nothing wrongBridge, & Birmaher, 2000; Michael, lasted beyond the time of supervision. with training standards that serveHuelsman, & Crowley, 2005; Vocisano, This promising finding has not been purposes other than the well-beingKlein, Arnow, Rivera, Blalock, & followed by anything similar. To of future psychotherapy clients of theRothbaum, 2004), although it is warrant the requirement of supervised students. This is true as long as thepossible to find studies that show an experience, one would want evidence overall training serves the well-beingassociation (Beutler et al., 2004), and from multiple research groups that of those clients. Because there is soone older meta-analysis found a small compare students in training receiving little evidence of that, it would bebut significant correlation between the typical levels of supervision versus less prudent for accrediting agencies tolevel of therapist experience and client supervision, with regard to their client focus on standards that have empiricaloutcomes (r = .11; Stein & Lambert, outcomes after completion of training. support for their benefit to consumers1984). The meta-analyses which of psychological services.show that paraprofessionals, who had Coursework Relevant research methodsvirtually no psychotherapy experience, The requirement of specific training and possible studieshad outcomes at least as good as those coursework seemingly would contributeof professional psychologists (Berman to psychotherapy client outcomes. The best evaluation of the value& Norton, 1985; Durlak, 1979; Hattie However, much of the required of training standards would involveet al., 1984; Weisz et al., 1987, 1995) coursework in psychology programs has assigning psychotherapists randomlysuggest the possibility that professional nothing directly to do with treatment. to receive some required aspect ofexperience has no effect. Instead, it tends to focus on statistics, accredited training, or not, and psychopharmacology, and other topics then assessing their success withSupervision randomly assigned clients. These with, at most, slight connections to Psychologists tend to view helping others overcome psychological studies would be especially valuablesupervision aspects of their training problems. Parts of training typically if they use validated measures toas helpful (Orlinsky, Botermans, relate to psychological testing. collect outcome information from& Ronnestad, 2001). However, the Whether that has value to clients is multiple sources, such as clientsoutcome evidence regarding the value beyond the scope of this paper. Parts and observers (Chambless, 2001).of clinical supervision is limited. of coursework, such as those focusing Intention-to-treat analyses can helpHolloway and Neufeldt (1995) on psychotherapy methods, seem to balance any differences betweenconcluded that there are virtually have direct relevance to the provision therapists in client drop-out rates30 PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012
  • 4. (see Atkins & Christensen, 2001). Conclusion available. This review presents severalThese studies could assign students This review has focused on methods of data collection for therandomly to some aspect of required whether there is empirical support evaluation of training standards.training or not, keep everything else for psychology training standards One might make the argument thatthe same for both groups, and then in helping psychologists produce present training standards are basedcompare therapy client outcomes. positive treatment outcomes for their on the best available evidence, butFor instance, researchers could assign psychotherapy clients. There appears the standards appear to be based onstudents randomly to 10 training cases to be no evidence to suggest that supposition rather than on evidence.with supervision or 0 training cases coursework and research completion, Acting on the basis of evidence, ratherwith supervision and then compare which make up a great deal of required than educated guesses helps a societyoutcomes in subsequent clients treated psychology training, have any value make progress.by the students. The study would to future psychotherapy clients of Referencesnot be easy to do. It might require the students. There is evidence with American Psychological Associationmultiple research centres or multiple regard to the effects of experience and Commission on Accreditation (2009).years to have enough power to detect supervision, but the weight of evidence Guidelines and principles for accreditationdifferences in client outcome. It would at this point does not provide clear of programs in professional psychology.require either a large number of clients support of current training standards Retrieved from http://www.apa.org/ed/with similar problems, or a valid accreditation/about/policies/guiding- that relate to either experience or principles.pdfmethod to assess outcomes (e.g., client supervision. The relevant evidencegoal achievement) across different in total does not show empirical Australian Psychology Accreditationtypes of problems. Many outcome Council (2010). Rules of accreditation and support for the contribution of current accreditation standards for psychologystudies of types of psychotherapy have psychology training standards to courses. Retrieved from http://www.to overcome similar difficulties. positive outcomes for psychotherapy apac.psychology.org.au/Assets/Files/ Weaker, but less complicated, quasi- clients (see Bickman, 1999; Mahrer, APAC_Rules_for%20_Accreditation_analytic and correlational methods 1999). Whether the training standards and_Accreditation_Standards_for%20_could provide valuable supplemental Psychology_Courses_Ver_10_June_2010. contribute to some other important pdf.evidence. In these studies, for instance: outcome for the public is beyond the 1) therapists who have received scope of this paper. Atkins, D. C., & Christensen, A. (2001). Is professional training worth the bother? some aspect of standard-required For accrediting agencies to A review of the impact of psychotherapy training, or not, could be assessed operate in the realm of the principles training on client outcome. 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Clinical 4) the client success of therapists supervision: Its influence on client-rated on training standards set by psychology working alliance and client symptoms with different levels of some accredition agencies, the logic of the reduction in the brief treatment of major type of required training, such as argument applies also to psychology depression. Psychotherapy Research, 16, experience treating clients, could be training programs which operate under 317–331. assessed for client outcomes; and, the standards, and to government Bein, E., Anderson, T., Strupp, H., Henry, 5) students who are at different agencies that register or license W., Schacht, T., Binder, J., & Butler, S. levels of completion of a psychologists. Training programs that (2000). The effects of training in time- training program, e.g., those aim to be scientific in their orientation limited dynamic psychotherapy: Changes who have completed 1/4 of the in therapeutic outcome. 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Journal of adolescent depression: Do professional Granger, D. A., & Morton, T. (1995). EffectsConsulting Psychology, 16, 319–324. therapists produce better results? Journal of psychotherapy with children andFauth, J., Gates, S., Vinca, M. A., Boles, of Child and Family Studies, 14, 223–236. adolescents revisited: A meta-analysis ofS., & Hayes, J. A. (2007). Big ideas for treatment outcome studies. Psychological Milne, D., & James, I. (2000). A systematicpsychotherapy training. Psychotherapy: Bulletin, 117, 450–468. review of effective cognitive-behavioralTheory, Research, Practice, Training, 44, supervision. British Journal of Clinical384–391. AUTHOR NOTES JOHN MALOUFF, Ph.D., is Associate Professor of Psychology in the School of Behavioural, Cognitive and Social Sciences at the University of New England. His research interests include evaluating the efficacy of: methods of coping with stressors; types of psychotherapy; self-help materials for psychological problems; and, methods used to increase adherence to recommendations of health professionals. He also has an interest in researching methods for running organisational meetings and how to improve romantic relationships. Comments: jmalouff@une.edu.au32 PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012