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

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PEER REVIEWED




The need for empirically supported
psychology training standards
J O H N M A L O U F F 		




  The scie...
of the standards. Is it enough for          Fauth, Gates, Vinca, Boles, & Hayes         effect explains the results, it co...
Lutz, Leon, Martinovich, Lyons, &           no research findings to show that           of quality psychotherapy. However,...
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The need for empirically supported psychology training standards (psychotherapy in australia malouff 2012)

  1. 1. PEER REVIEWED The need for empirically supported psychology training standards J 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 agencies require 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 and psychology students with training in one, and that this advantage has been psychology students by current training empirically 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 when Council, 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 any Commission on Accreditation, 2009). training in empirically supported value. Thousands of researchers took Although this article focuses on treatment, but a basis can be found in up the call and collected a wealth of the 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 to of psychotherapists and counsellors many other fields of science. It would the training requirements imposed likewise require training programs be logical to suggest that psychology by accreditation agencies, one would to provide training in empirically training standards also should be based say that empirically supported supported 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 the and Psychotherapy (BACP), 2009; accrediting agencies must start to requirements lead to better outcomes Psychotherapy and Counselling apply the scientific method to their in the clients of students who were Federation of Australia, 2012). own professional decision making, trained in programs that meet the The minimal empirical support for just as they encourage psychology requirements. psychotherapy methods typically students to base decisions on evidence. Is there published evidence of includes evidence that the treatment Psychologists have issued calls for the efficacy of psychology training is more effective than no treatment. the collection of evidence about the standards? The search for empirical At higher levels, empirical support effects of psychology training (Carey, support of specific training standards includes evidence that the treatment Rickwood, & Baker, 2009; Gonsalvez begins with identification of the goals 28 PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012
  2. 2. of the standards. Is it enough for Fauth, Gates, Vinca, Boles, & Hayes effect explains the results, it could be students to demonstrate competence in (2007) to conclude that changes in that the training led to more effective specified skills or should the standards training are needed. treatment. It is unknown whether the lead to better outcomes for future Finally, two recent studies improvement in outcomes continued clients 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 support so it would be appropriate to measure of student therapists in a clinical for the idea that typical professional client benefit (O’Donovan & Dawe, doctorate program showed no training of psychologists leads to better 2002). This review focuses on effects of association with number of years outcomes for their psychotherapy training standards on psychotherapy outcomes. Other possible benefits of the standards relating to assessment Overall, research findings provide little per se and ethics are beyond the scope of this paper. support for the idea that typical professional Research findings training of psychologists leads to better Professional training in general With regard to client psychotherapy outcomes for their psychotherapy clients. outcome, there is relevant evidence about the value of formal training of training completed (Boswell, clients. standards. Meta-analyses of studies of Casonguay, & Wasserman, 2010). A somewhat related body of research treatments delivered to clients assigned However, a study of CBT training of has examined whether differences to either licensed psychologists or community psychologists over a year among psychotherapists lead to paraprofessionals 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 multilevel better outcomes or that the two groups training year than their clients the modeling is that therapist differences were equal in outcomes (Berman & year before (Simons et al., 2010). explain a modest amount of variance Norton, 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 of the studies used in prior meta-analyses found evidence of better outcomes for professional psychotherapists. The authors stated that only one included study was designed adequately to control for confounding influences. However, that one study, by Strupp and Hadley (1979), did not have random assignment of clients to therapists. The Strupp and Hadley study found the same therapy outcomes for paraprofessionals (university professors) and professional psychotherapists. A more recent study also showed equivalent therapy outcomes for paraprofessionals (self-help group members) and professionals (Bright, Baker, & Neimeyer, 1999). Studies such as the pre-post study of Bein et al. (2000) of mental health professionals receiving traditional psychotherapy training, including teaching and supervised experience, have shown no lasting benefit with regard to effectiveness with clients, leading Illustration: © Savina Hopkins, 2012. www.savinahopkins.com PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012 29
  3. 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 this that factors that affect therapists, client outcomes. Milne and James coursework leads to better outcomes for possibly 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 completion client outcomes. from 'cognitive-behavioral' therapist The next matter to address is to supervision, but the studies they cited Research completion has not been what extent specific training standards did not support that conclusion. For examined with regard to whether have evidence of efficacy for client instance, Parsons and Reid (1995), it contributes to more effective psychotherapy outcomes. Is it necessary cited as showing that supervision treatment by students, perhaps because to show that fifty hours of supervision benefitted clients, did not evaluate no one thinks that it would. This is better than thirty hours? Probably clients. One recent study (Bambling, requirement may be an anachronism not. It would be beneficial, however, King, Raue, Schweitzer, & Lambert, left from bygone days when earning to show that costly, time-consuming 2006) found that supervision directed a degree beyond undergraduate aspects of the training standards lead at developing a working alliance was supposed to make a person a to better client outcomes. These aspects include clinical experience, supervision, coursework, and research completion. There appears to be no evidence to suggest Experience that coursework and research completion, If one views psychotherapy as a skill, psychotherapy experience seems which make up a great deal of required likely to be beneficial for improving client outcomes. However, amount psychology training, have any value to future of professional experience usually does not correlate significantly with psychotherapy clients of the students. client therapy outcomes, according to a careful review (Christensen & with the client led to better outcomes scholar, or it may be an application Jacobson, 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 wrong Bridge, & Birmaher, 2000; Michael, lasted beyond the time of supervision. with training standards that serve Huelsman, & Crowley, 2005; Vocisano, This promising finding has not been purposes other than the well-being Klein, Arnow, Rivera, Blalock, & followed by anything similar. To of future psychotherapy clients of the Rothbaum, 2004), although it is warrant the requirement of supervised students. This is true as long as the possible to find studies that show an experience, one would want evidence overall training serves the well-being association (Beutler et al., 2004), and from multiple research groups that of those clients. Because there is so one older meta-analysis found a small compare students in training receiving little evidence of that, it would be but significant correlation between the typical levels of supervision versus less prudent for accrediting agencies to level of therapist experience and client supervision, with regard to their client focus on standards that have empirical outcomes (r = .11; Stein & Lambert, outcomes after completion of training. support for their benefit to consumers 1984). The meta-analyses which of psychological services. show that paraprofessionals, who had Coursework Relevant research methods virtually no psychotherapy experience, The requirement of specific training and possible studies had outcomes at least as good as those coursework seemingly would contribute of 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 involve et al., 1984; Weisz et al., 1987, 1995) coursework in psychology programs has assigning psychotherapists randomly suggest the possibility that professional nothing directly to do with treatment. to receive some required aspect of experience has no effect. Instead, it tends to focus on statistics, accredited training, or not, and psychopharmacology, and other topics then assessing their success with Supervision randomly assigned clients. These with, at most, slight connections to Psychologists tend to view helping others overcome psychological studies would be especially valuable supervision aspects of their training problems. Parts of training typically if they use validated measures to as 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 clients outcome 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 help Holloway and Neufeldt (1995) on psychotherapy methods, seem to balance any differences between concluded that there are virtually have direct relevance to the provision therapists in client drop-out rates 30 PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012
  4. 4. (see Atkins & Christensen, 2001). Conclusion available. This review presents several These studies could assign students This review has focused on methods of data collection for the randomly 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 that the same for both groups, and then in helping psychologists produce present training standards are based compare therapy client outcomes. positive treatment outcomes for their on the best available evidence, but For instance, researchers could assign psychotherapy clients. There appears the standards appear to be based on students 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, rather with supervision and then compare which make up a great deal of required than educated guesses helps a society outcomes in subsequent clients treated psychology training, have any value make progress. by the students. The study would to future psychotherapy clients of References not be easy to do. It might require the students. There is evidence with American Psychological Association multiple 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 accreditation differences 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.pdf method to assess outcomes (e.g., client supervision. The relevant evidence goal achievement) across different in total does not show empirical Australian Psychology Accreditation types of problems. Many outcome Council (2010). Rules of accreditation and support for the contribution of current accreditation standards for psychology studies 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. Australian for their client outcomes; of evidence-based practice, they Psychologist, 36, 122–130. 2) therapists in training could must produce evidence to support Baker, K. D., & Neimeyer, R. A. be assessed for psychotherapy their standards. Psychotherapy (2003). Therapist training and client outcome early in the training is an important part of work as a characteristics as predictors of treatment and near the end; psychologist, and this evidence response to group therapy for depression. 3) therapists could be assessed Psychotherapy Research, 13, 135–151. needs to show that existing training for outcomes before and after standards contribute to psychotherapy Bambling, M., King, R., Raue, P., some specific training; outcomes. Although this article focuses Schweitzer, & Lambert, M. (2006). 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. Psychotherapy carry a responsibility to show that Research, 10(2), 119–132. program versus those who have the training they provide has positive completed 3/4, could be assigned benefits for future clients of the Berman, J. S., & Norton, N. C. (1985). Does psychotherapy clients randomly, professional training make a therapist students. The government agencies more effective? Psychological Bulletin, 98, with everything else the same have their own duty to act in the public 401–407. for both groups of students, interest in light of available evidence. followed by a comparison Beutler, L. E., Malik, M., Alimohamed, S., The present argument also applies Harwood, T. M., Talebi, H., Noble, S., & of treatment outcomes. to psychotherapy and counselling Wong, E. (2004). Therapist variables. In M. Similar findings from different accreditation and training programs. J. 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  5. 5. health services. American Psychologist, Franklin, M. E., Abramowitz, J. S., Furr, Psychology, 39, 111–127. 54, 965–978. J. M., Kalsy, S., & Riggs, D. S. (2003). O’Donovan, A., & Dawe, S. (2002). A naturalistic examination of therapist Boswell, J. F., Casonguay, L. G., & Evaluating training effectiveness in experience and outcome of exposure and Wasserman, R. H. (2010). Effects of psychotherapy: Lessons for the AOD field. ritual prevention for OCD. Psychotherapy psychotherapy training and intervention Drug and Alcohol Review, 21, 239–245. Research, 13, 153–167. use on session outcome. Journal of Orlinsky, D. E., Botermans, J. F., & Consulting and Clinical Psychology, 78, Gonsalvez, G. J., & McLeod, H. J. (2008). Ronnestad, M. H. (2001). Towards 717–723. Toward the science-informed practice an empirically grounded model of of clinical supervision: The Australian Bright, J. I., Baker, K. D., & Neimeyer, R. A. psychotherapy training: Four thousand context. 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Effects Consulting Psychology, 16, 319–324. therapists produce better results? Journal of psychotherapy with children and Fauth, J., Gates, S., Vinca, M. A., Boles, of Child and Family Studies, 14, 223–236. adolescents revisited: A meta-analysis of S., & Hayes, J. A. (2007). Big ideas for treatment outcome studies. Psychological Milne, D., & James, I. (2000). A systematic psychotherapy training. Psychotherapy: Bulletin, 117, 450–468. review of effective cognitive-behavioral Theory, Research, Practice, Training, 44, supervision. British Journal of Clinical 384–391. 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.au 32 PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012

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