Counselling Psychology QuarterlyVol. 24, No. 1, March 2011, .docx

Counselling Psychology Quarterly
Vol. 24, No. 1, March 2011, 43–53
How special are the specialties? Workplace settings in
counseling
and clinical psychology in the United States
Greg J. Neimeyer
a*, Jennifer M. Taylor
a
, Douglas M. Wear
b
and
Aysenur Buyukgoze-Kavas
c
a
Department of Psychology, University of Florida, P.O. Box
112250, Gainesville, FL
32611, USA;
b
Psychology and Community Counseling Clinic, Antioch
University Seattle,
Seattle, WA 98121, USA;
c
Department of Educational Sciences, Division of Psychological

Counseling and Guidance, Middle East Technical University,
Ankara, Turkey
(Received 1 February 2010; final version received 18 February
2011)
How special are the specialties? Although clinical and
counseling psychol-
ogy each have distinctive origins, past research suggests their
potential
convergence across time. In a survey of 5666 clinical and
counseling
psychologists, the similarities and differences between their
workplace
settings were examined during early-, mid-, and late-career
phases to
explore the distinctiveness of the two specialties. Overall,
clinical and
counseling psychologists reported markedly similar workplace
settings.
However, some significant differences remained; a greater
proportion of
counseling psychologists reported working in counseling
centers, while a
greater proportion of clinical psychologists reported working in
medical
settings. In addition, during late-career, substantially more
counseling and
clinical psychologists worked in independent practice contexts
than in
community mental health centers, medical settings, academia, or
university
counseling centers. Findings are discussed in relation to the
ongoing
distinctiveness of the two specialties and the implications of

this for training
and service in the field of professional psychology.
Keywords: clinical psychology; counseling psychology;
workplace settings
Introduction
Recognized as distinct specialties by the American
Psychological Association,
clinical and counseling psychology each have distinct histories,
intersecting appli-
cations, and longstanding concerns regarding their continuing,
or diminishing,
differences. This article explores these issues and examines the
contemporary
similarities and differences between these two specialties as
reflected in their
workplace settings. Workplace settings are examined at early,
mid, and late career
in order to determine whether differences vary by cohort in a
way that might reflect
either on their enduring or diminishing differences over time.
Enduring or diminishing differences?
Historically, the specialties of clinical and counseling
psychology have developed
from different origins and formed distinctly different
trajectories as a result
*Corresponding author. Email: [email protected]
ISSN 0951–5070 print/ISSN 1469–3674 online
� 2011 Taylor & Francis
DOI: 10.1080/09515070.2011.558343

http://www.informaworld.com
(Munley, Duncan, McDonnell, & Sauer, 2004). Clinical
psychology drew heavily
from the mental health movement that emphasized
psychological dysfunction,
disability, and rehabilitation (McFall, 2006). Its alignment with
the medical model,
which places a premium on assessment, diagnosis, and treatment
within a broad
range of hospital and community contexts, reflects a coherent
extension of the
specialty across time (Tipton, 1983). Counseling psychology, by
contrast, derived
largely from the vocational guidance movement that emphasized
the productive
matching of a person to his or her work environment in the
interest of optimizing
performance and satisfaction (McFall, 2006; Munley et al.,
2004). Counseling
psychology’s enduring commitment to vocational psychology,
personal adjustment,
multiculturalism, and social justice (Neimeyer & Diamond,
2001; Tipton, 1983) can
be seen as an ongoing testament to the person–environment fit
that animated its
origins over a century ago (Whiteley, 1980).
These historical differences are reflected in a range of
contemporary distinctions
between the two specialties, as well (Munley et al., 2004).
Longstanding literatures
have addressed the enduring distinctions between clinical and

counseling psychology
training programs in relation to their theoretical commitments
(Norcross &
Prochaska, 1982; Ogunfowora & Drapeau, 2008) and their
training models
(Korman, 1974; Norcross, Kohout, & Wicherski, 2005), and
have sought to see
whether these differences translate into differential internship
placements (Brems
& Johnson, 1996; Neimeyer & Keilin, 2007; Neimeyer, Rice, &
Keilin, 2009;
Shivy, Mazzeo, & Sullivan, 2007) or workplace experiences
(Owens, Moradi, &
Neimeyer, 2008).
Early work concerning their theoretical preferences noted
substantial differences
between clinical and counseling psychology. Some of the most
preferred orientations
within the field of counseling psychology, such as Rogerian,
humanistic and existen-
tial, were among the least preferred orientations within clinical
psychology (Norcross
& Prochaska, 1982; Watkins, Lopez, Campbell, & Himmell,
1986). By contrast,
behavioral and psychodynamic theories have been found to be
preferred within
clinical training programs (Bechtoldt, Norcross, Wyckoff,
Pokrywa, & Campbell,
2001). These theoretical differences have been noted among
students and practi-
tioners (Cassin, Singer, Dobson, & Altmaier, 2007), as well as
among the
training directors in these respective specialties (Norcross,
Sayette, Mayne, Karg,
& Turkson, 1998).

Other work, however, has suggested diminishing differences
between the
specialties in this regard over time (Zook & Walton, 1989). The
majority of students
and professionals within both of these specialties recently have
been found to identify
themselves as eclectic, integrative, or cognitive-behavioral
(Bechtoldt et al., 2001),
for example, with only modest differences in relation to
identification with
psychoanalytic, behavioral, or humanistic orientations. The
recent work of
Ogunfowora and Drapeau (2008) reported no significant
differences between the
two specialties in relation to any of the theoretical orientations
they studied,
including humanistic, psychodynamic, behavioral, or biological
approaches.
In addition to exploring potential theoretical differences,
research on the
distinctiveness of clinical and counseling psychology has also
noted increasing
distinctions in relation to their underlying training models.
Historically, both clinical
and counseling psychology positioned themselves beneath the
scientist–practitioner
training model (Norcross, Castle, Sayette, & Mayne, 2004).
With its distinctive
emphasis on the integration of science and practice, the Boulder
Model (1949)
44 G.J. Neimeyer et al.

dominated the field professional of training within both
specialties until the
introduction of the Scholar–Practitioner model that arose from
the Vail conference
(1973). The scholar–practitioner model was introduced as an
alternative to the
scientist–practitioner model (Korman, 1974), placing primary
emphasis on profes-
sional training and on the interpretation and application of
research, rather than its
generation or dissemination.
The scholar–practitioner model of training has proliferated
rapidly within clinical
psychology, but not within counseling psychology (Norcross et
al., 2005). Today, the
modal degree conferred in the field of clinical psychology is a
Psy.D. degree, which
serves as a strong testament to the appeal of the scholar–
practitioner model within
the field of clinical psychology. By contrast, counseling
psychology has retained its
longstanding commitment to the scientist–practitioner training
model, viewing it as
core to its identity as a specialty (Stoltenberg et al., 2000).
Unlike clinical psychology,
counseling psychology has only two Psy.D. programs, for
example, and has regularly
reaffirmed its longstanding commitment, the Boulder training
model (Meara et al.,
1988; Murdock, Alcorn, Heesacker, & Stoltenberg, 1998).
A number of researchers have sought to explore the implications
of these
differences between clinical and counseling psychology and to

determine whether
or not they translate into differential outcomes. Taylor and
Neimeyer (2009), for
example, found qualitative differences in mentoring between
clinical and counseling
psychology training programs. Students in counseling programs
were generally more
satisfied and reported higher levels of socioemotional
mentoring, but somewhat
lower levels of research productivity. Brems and Johnson
(1996) studied the
internship placements of clinical and counseling students and
found that more
clinical students were placed in health science centers than were
counseling students,
whereas more counseling students were placed in university
counseling centers, and
these findings were supported in a 30-year retrospective of
internship placements
within the field of counseling psychology in the United States
(Neimeyer & Keilin,
2007). The recent work of Neimeyer et al. (2009) extends these
findings.
In comparing the internship placements for an entire cohort
group of clinical and
counseling psychology students, they found differences that
mirrored previous
findings; against a background of considerable similarity,
clinical psychology
students nonetheless were significantly more likely to obtain
internships in hospital
and medical center contexts, whereas counseling psychologists
more commonly were
placed within counseling center contexts.
Some provisional evidence also supports the idea that these

differences may
translate into workplace differences, as well. Watkins et al.
(1986), for example,
found that counseling psychologists were more often employed
in counseling centers
and academic departments, whereas clinical psychologists were
more often found in
private practice and medical settings (see also Watkins,
Schneider, Cox, & Reinberg,
1987), findings that were largely replicated by the subsequent
work of Zook and
Walton (1989) and Brems and Johnson (1996). Likewise,
Bechtoldt et al. (2001)
found that clinical psychologists were more likely to be
employed in private practice,
hospitals and medical schools, while counseling psychologists
were more likely to be
employed in counseling centers, differences that have been
noted in more recent
research, as well (Mogan & Cohen, 2008).
Despite these differences, however, there is longstanding
concern that counseling
psychology may be losing ground in relation to preserving the
distinctiveness of its
specialization. The sometimes subtle differences in theoretical
orientations within
Counselling Psychology Quarterly 45
counseling and clinical, for example, occur against the
background of substantial
theoretical similarity (Cassin et al., 2007). And, while
differences in training models

clearly persist, a number of researchers have asked, ‘‘Does the
model matter?’’ and
some concluded that it may not (cf. Neimeyer et al., 2007;
Rodolfa, Kaslow, Stewart,
Keilin, & Baker, 2005).
The convergence of the specialties is reflected most clearly,
perhaps, in the
recognition that most counseling psychology graduates do not
emphasize their
distinctiveness. Instead, they refer to themselves generically as
‘‘clinical practi-
tioners’’ (Watkins et al., 1986), a finding that raises additional
concerns about the
diminishing distinctiveness of the specialties in the professional
marketplace. In fact,
Mosher (1980) and Fitzgerald and Osipow (1986) suggest that
may either become extinct or simply become absorbed into
clinical psychology, most
notably because psychologists from both camps are
experiencing a convergence
in terms of their workplace settings. The purpose of this
research was to examine the
workplace settings of clinical and counseling psychologists for
the evidence of this
convergence or of their continuing distinctiveness. By
examining these workplace
differences within early- mid- and late-career professionals, we
hoped to determine
whether any differences between the specialties have increased
or decreased across
the various cohort groups.
Methods

Participants
In cooperation with the State, Provincial and Territorial
Psychological Associations
(SPTAs), an Internet survey of psychologists was conducted
across North America.
Executive Directors of the Associations were solicited through
the Council of
Executives of State and Provincial Psychological Associations
(CESPPA). Those
who agreed to participate were provided with an email to
forward to their
memberships that described the nature of the study and included
a link to the
informed consent and survey, which could be completed and
submitted online. This
survey was part of a larger study that examined broader
perceptions of professional
development (Neimeyer, Taylor, & Wear, 2009), which included
a range of
demographic questions, such as the area of one’s degree type
(clinical or counseling
psychology), workplace setting (Community Mental Health
Center, Hospital or
Medical Setting, Independent Practice, University Academic
Department, University
Counseling Center or Mental Health Service, or Other), and the
year the highest
degree was conferred, among other demographic questions.
A total of 5666 psychologists (clinical n¼4182; counseling
n¼1484) responded
to the survey. Fifty-four of the 58 licensing jurisdictions were
represented, for a
participation rate of 93.1% of the jurisdictions. The overall
membership of the

SPTAs is approximately 40,000 members, meaning that the
current sample
represented approximately 14.2% of the total population of the
collective member-
ships. In all, 58.5% of the participants were women and 41.5%
were men. The mean
age of participants was 52.7 (SD¼11.79), which closely
approximates the mean age
of APA members (54.3 years). The majority of the sample
reported their ethnicity as
White/Caucasian (91.7%), followed by Hispanic (2%), African
American (1.7%),
Asian (1.2%), two or more races (1.0%), Other (0.8%),
American Indian or Alaskan
(0.2%), or Native Hawaiian (0.2%); 1.1% declined to report
their ethnicities.
The percentages of ethnic minorities in the sample closely
approximate the
percentages of psychologists represented in the membership of
APA, where 2.1%
are Hispanic, 2% are Asian, 1.8% are African American, and
0.2% are American
Indian, and 0.4% are multiracial (Center for Psychology
Workforce Analysis and
Research, 2007). In terms of workplace setting, the majority of
participants described
themselves as working in independent practice (56.6%),
followed by hospital/medical
settings (15.0%), community mental health settings (7.6%),
academic settings
(6.9%), university counseling center settings (5.0%), or other

(8.9%). Participants
represented a relatively experienced sample of psychologists,
with the median date
of licensure being 1989 (SD¼10.97). Approximately 16.4% of
participants (n¼926)
were considered in their ‘‘early career’’ phase (0–7 years post-
highest degree), 39.1%
of participants (n¼2210) were considered in their ‘‘mid-career’’
phase (8–20 years
post-highest degree), and 44.5% of participants (n¼2518) were
considered in their
‘‘late career’’ phase (21 or more years post-highest degree).
Procedures
Participants were asked to read the Informed Consent describing
the study. After
indicating their consent to participate, individuals were linked
to the survey.
Participants completed and submitted their surveys online
anonymously. The survey
included questions regarding specialty (clinical or counseling)
and current workplace
setting.
Results and discussion
Chi-square statistics were conducted to determine if there were
significant differences
in workplace settings across the career phases of those who
graduated from clinical
and counseling psychology programs. Pearson Chi-square
statistics indicated
significant differences between the two specialties in relation to
workplace settings
in early career, �2(5, N¼907)¼27.77, p 5 0.001, in mid-career

�2(5, N¼2175)¼
65.72, p 5 0.001, and in late career, �2(5, N¼2461)¼67.50, p 5
0.001, phases. These
differences emerged against the backdrop of substantial
similarities between the
workplace profiles of the two specialties, however.
As illustrated in Figure 1, the profiles of workplace settings for
clinical and
counseling psychologists were generally quite similar at each
career stage. For
example, within community mental health centers (CMHCs),
13.7% of clinical
psychologists and 14.8% of counseling psychologists in the
early career phase
reported working in this setting. Likewise, in mid-career, 7% of
clinical psychologists
and 8.3% of counseling psychologists worked in this setting,
percentages that
diminished somewhat during late career both for the clinical
(5.6%) of clinical
psychologists work in CMHCs, and counseling psychologists
(4.9%).
Unlike CMHC’s, however, more substantial workplace
differences occurred in
relation to hospital or medical settings, particularly in early
career. At early career,
nearly one-quarter (24.4%) of clinical psychologists reported
working in hospitals
or medical settings, compared with 17.7% of the counseling
psychologists. At mid-
career, the percentages were comparable for clinical (16.8%)
and counseling (17.3%).
At late career, both groups showed a substantial decline, though
the decline within

clinical psychology (13.2%) was greater than the decline within
counseling
psychology (9.5%).
For both clinical and counseling psychologists, independent
practice was the
predominant workplace setting across all stages of the career.
However, unlike all
other workplace settings, the percentage of clinical and
counseling psychologists
in independent practice appears to have increased, rather than to
have decreased,
from early to late career. Nearly twice as many clinical
psychologists in late career
(66.4%) reported working in independent practices when
compared to clinical
psychologists working in independent practices in earlier stages
of their career
(38.7%). Similar findings are observed with counseling
psychologists, where 60% of
late career counseling psychologists reported working in
independent practices,
compared with only 35.4% of early career counseling
psychologists. It is noteworthy,
however, that a higher percentage of clinical psychologists
reported working in
independent practice settings during each of the three career
stages.
Regarding academic setting, similarities between clinical and
counseling psy-

chologists were again found. In the early career stage 7.7% of
the clinical
psychologists reported working in an academic setting,
compared with 5.7% in
mid-career and 6.7% in late-career. For counseling
psychologists, the percentage
of academic work settings was similarly consistent across early
(7%), mid (7.2%),
and late (9%) career phases though, as reported by Cassin et al.
(2007), a larger
percentage of counseling psychologists were employed in
academic settings overall
(Watkins et al., 1987).
Perhaps, the most striking differences between clinical and
occurred in relation to university counseling center settings,
where counseling
psychologists predominated at each career stage. In each phase,
the percentage of
counseling psychologists working in counseling center contexts
was more than three
times that of clinical psychologists. Counseling psychologists in
early (16.0%), mid
(11.6%), and late (8.2%) phases of their careers were
consistently more strongly
represented in this work setting compared to clinical
psychologists (5.6% in early,
3.2% in mid, and 1.8% in late career), though both groups
showed a decline
in workplace representation from early to late career.
100
Early Career Clinical
80

90
,
Mid-Career, Clinical
Late Career, Clinical
60
70
Early Career, Counseling
Mid-Career, Counseling
40
50
Late Career, Counseling
20
30
0
10
Hospital or Academic SettingCommunity
Mental Health
Center
Medical Setting

Independent
Practice
University
Counseling
Center
Figure 1. Workplace differences by specialty across career
trajectories.
The overall pattern of these results provides qualified support
for the distinc-
tiveness of clinical and counseling psychology in relation to the
workplace settings
of the professionals within those fields. Against a backdrop of
substantial similarity,
the differences that did emerge were consistent with the
distinctive values of the
respective specialties. Clinical psychologists, for example, were
more strongly
represented in medical and hospital settings, at least early in
their careers, and
counseling psychologists were more heavily represented in
counseling center settings
throughout their careers.
This profile of workplace settings may help inform students
who seek graduate
training in professional psychology. This could prove valuable

given the recent work
of Cassin et al. (2007) which suggests that students’
anticipations regarding their
future employment may diverge substantially from the actual
settings in which
graduates find employment. Cassin et al. (2007), for example,
found that 33% of
counseling psychology graduate students anticipated academic
careers, whereas the
data from this study indicate that in early career, only 5.7% of
counseling
psychologists had academic placements. Likewise, only 7.7% of
early career clinical
psychologists were in academic contexts, compared with 20.1%
of the clinical
students who anticipated academic careers (Cassin et al., 2007).
By contrast, in
relation to independent practice, the picture is reversed. Fewer
counseling students
(24.2%) and clinical students (26.6%) anticipate going into
independent practice
than are represented in early career, where 35.4% of the
and 38.7% of the clinical psychologists find employment. Thus,
this study suggests
that students may benefit from gaining a more realistic sense of
their workplace
probabilities and, perhaps, even utilize this information in their
decision making
regarding the particular specialty they prefer to pursue. For
aspiring graduate
students who want to work within a counseling center setting,
for example, it may be
useful to know that counseling psychologists are
disproportionately employed by
counseling centers, and this may provide useful information

when considering which
graduate schools to apply to.
It is important to emphasize, however, that clinical and
are represented in each of the workplace settings included in
this study, so
employment opportunities are available to both across all of
these workplace
contexts. Moreover, with few distinctions, the profiles of
workplace settings were
quite similar for clinical and counseling psychologist across the
various cohort
groups. Although clear cohort-related shifts occurred, with more
professionals in
independent practice in late career (cf. Zook & Walton, 1989),
these shifts did not
appear to vary by specialty. In short, there was no evidence that
the differences
between clinical and counseling psychology were either
substantially greater or lesser
in early than in late career. Evidence of stronger late career
differences, but
diminishing mid and early career differences, might have been
consistent with
the idea that the differences between the specialties are
diminishing across time
(Fitzgerald & Osipow, 1986). However, no such evidence was
found within this
study. To the contrary, the patterns of workplace settings for
clinical and counseling
psychologists were largely consistent across cohort groups.
Overall, the results of this study provide qualified support for
the distinctiveness
of clinical and counseling psychology, as reflected in the

workplace settings of their
practitioners. While substantial differences were the exception,
rather than the rule,
those differences that did emerge clearly conformed to
stipulated differences between
the specialties and seemed to endure across cohort groups.
It is important to underscore, though, that the examination of
workplace settings
provides only a global indicator of possible workplace
differences. As Owens et al.
(2008) have demonstrated, clinical and counseling psychologists
within the same
workplace setting can have strikingly different experiences and
they fulfill different
functions (Tipton, 1983), as well. Within the same setting the
duties that are fulfilled
and the orientations that are expressed by clinical and
may be markedly different (Osipow, 1980). Zook and Walton
(1989), for example,
found that while clinical psychologists more often approached
their work from a
psychodynamic approach, counseling psychologists commonly

utilized a humanistic
approach toward their work. Importantly, these differences
would be masked in this
study where only differences in the workplace setting itself
were examined, rather
than functions and orientations and perspectives expressed
within that workplace.
For this reason, the results of this study are best regarded as
providing a conservative
picture of the differences between the two specialties, leaving it
to future work to
develop a more detailed picture of the distinctions between the
specialties, not only in
relation to the places of their employment, but also in relation
to the duties,
functions, and orientation that each brings to its workplaces.
In addition, it is important to underscore that the cohort
differences examined
in this study do not necessarily reflect developmental
differences. The fact that
substantially more clinical and counseling psychologists appear
in independent
practice contexts during late career, for example, could reflect a
movement across the

career trajectory away from other workplace settings and toward
independent
practice. Alternatively, it may simply reflect a cohort effect,
with more late-career
individuals spending their entire careers in independent practice
contexts, while early
career individuals have taken positions in more diverse
occupational contexts.
Although cohort differences between clinical and counseling
psychology were
not evident in this sample, it nonetheless remains for future
longitudinal efforts to
address any genuine developmental differences between the
specialties that may have
occurred across time.
A final caveat has to do with the rapid internationalization of
counseling
psychology (Munley et al., 2004; Takooshian, 2003). As the
specialty of counseling
psychology makes systematic progress toward its international
development (Leong
& Ponterotto, 2003; Leung, 2003), this development will likely
register its effects on
workplace settings associated with professionals within this
field, as well. A number

of researchers and scholars have noted important variations as a
function of the
cultural adaptation of the specialty to a range of international
contexts (Kavas,
Taylor, & Neimeyer, 2010; Pelling, 2004; Takooshian, 2003),
and these may well be
reflected in workplace settings, as well, as the field continues
its process of
globalization. Indeed, the rapid globalization of the specialty,
as well as its quest to
embrace cultural diversity and variation, may become a further
feature that
distinguishes it as a specialty (Neimeyer & Diamond, 2001).
Within the context of these considerations, however, this study
provides
provisional evidence regarding the continuing differences
between clinical and
counseling psychology training programs in relation to one of
their principal
outcomes: the workplace settings of the professionals they train.
Future work that
clarifies the nature and implications of these differences may
contribute to a better
understanding of the contemporary distinctions between these

specialties. And these
distinctions may, in turn, serve as the basis for more informed
and effective decision
making on the part of students whose career interests may be
shaped by the
knowledge of the contexts in which they might eventually work.
Notes on contributors
Greg J. Neimeyer received his PhD in counseling psychology
from the University of Notre
Dame. He is professor of psychology in the Department of
Psychology at the University of
Florida and Director of the Office of Continuing Education and
Psychology at the American
Psychological Association. A fellow of the American
Psychological Association, he is also a
member of the Department of Community Health and Family
Medicine where he conducts his
clinical practice. His areas of research include professional
development, epistemology and
psychotherapy, constructivism, social influence in clinical
contexts, and relationship
development and disorder.
Jennifer M. Taylor received her MS in counseling psychology
from the University of Florida.
She is currently a PhD candidate in the University of Florida
counseling psychology program.
Her research focuses on professional development and

competencies, continuing education,
and mentoring.
Douglas M. Wear received his PhD in clinical psychology from
the University of Wyoming.
He is the president of Wear & Associates, Inc., executive
director of the Washington State
Psychological Association, director of Antioch University
Seattle Psychology and Community
Counseling Clinic, chair of the APA Continuing Education
Committee, and past chair of APA
Council of Executive Directors of State and Provincial
Psychological Associations. His
research and professional interests include professional
development, supervision, manage-
ment, consulting, and coaching.
Aysenur Buyukgoze-Kavas is a research assistant and PhD
student at Middle East Technical
University, Psychological Counseling and Guidance program.
She is part of the Scientific HR
Development Program, which aims to train future academicians
of Turkey. As a part of this
program, she worked as a visiting research scholar at University
of Florida, Department of
Psychology from February 2009 to October 2009. She is a
member of the Turkish
Psychological Counseling and Guidance Association and
American Psychological
Association Division 17. Her major research interests are career
decision-making, career
indecision, counseling supervision, mentoring and job
satisfaction.
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The Narrowing of Theoretical Orientations in Clinical
Psychology Doctoral Training
Laurie Heatherington, Williams College
Stanley B. Messer, Rutgers University
Lynne Angus, York University
Timothy J. Strauman, Duke University

Myrna L. Friedlander, University at Albany
Gregory G. Kolden, University of Wisconsin
The focus of this article is the increasingly narrow range
of therapeutic orientations represented in clinical
psychology graduate training programs, particularly
within the most research-oriented programs. Data on
the self-reported therapeutic orientations of faculty at
“clinical science” Ph.D. programs, Ph.D. programs at
comprehensive universities in clinical and in counseling
psychology, Psy.D. programs at comprehensive universi-
ties, and Ph.D. or Psy.D. programs at freestanding spe-
cialized institutions reveal a strong predominance of
faculty with cognitive-behavioral orientations at the
more science-focused programs, and a narrower range
of orientations than in the more practice-focused pro-
grams. We discuss the implications of this trend for the
future development of clinical psychology and provide
suggestions for addressing the attendant concerns.

Key words: CBT hegemony, clinical training and
research, theoretical orientation. [Clin Psychol Sci Prac
19: 362–374, 2013]
The growth of our knowledge is the result of a process closely
resembling what Darwin called ‘natural selection’; that is, the
natural selection of hypotheses: our knowledge consists, at
every moment, of those hypotheses which have shown their
(comparative) fitness by surviving so far in their struggle for
existence; a competitive struggle which eliminates those
hypotheses which are unfit.
Karl Popper (1979)
The best way to have a good idea is to have a lot of
ideas.
Linus Pauling
Doctoral training in clinical psychology is clearly in a
state of evolution. The scientist–practitioner (“Boul-
der”) model that characterized the training landscape
since 1949 has been challenged by several strong ideo-
logical and sociological forces and developments. Argu-

ments for the value of more practice-focused doctoral
training led to the development of Psy.D. programs,
beginning in the 1970s. Subsequently, market forces
have resulted in the explosive growth of large, prac-
tice-focused doctoral training programs at freestanding
institutions, dubbed “specialized institutions not offer-
ing comprehensive education beyond psychology or
counseling” by Sayette, Norcross, and Dimoff (2011,
p. 4), and hereafter referred to as “specialized institu-
tions,” as well as a crisis in the oversupply of applicants
relative to the availability of doctoral internships
(Munsey, 2011; Vasquez, 2011). Controversies about
standards for doctoral training programs, especially with
regard to the need to teach evidence-based treatments
(Bray, 2011; Calhoun, Moras, Pilkonis, & Rehm,
Address correspondence to Laurie Heatherington, Ph.D.,
Department of Psychology, Williams College, Williamstown,
MA 01267. E-mail: lheather[email protected]

© 2013 American Psychological Association. Published by
Wiley Periodicals, Inc., on behalf of the American
Psychological Association.
All rights reserved. For permission, please email:
permissionsuk.wiley.com 364
1998; Davison, 1998; Eby, Chin, Rollock, Schwartz,
& Worrell, 2011), continue. And most recently, the
assertion by some that current American Psychological
Association (APA) accreditation standards and practices
are undermining the science of clinical psychology has
resulted in the creation of alternative accreditation stan-
dards that emphasize research and clinical training
focusing on empirically supported treatments and
assessment (Baker, McFall, & Shoham, 2009; McFall,
2007). The outcomes of this evolution in training are
difficult to predict, and the relative merits of the vari-
ous training models are a matter of widely diverging
opinions and beyond the scope of this article.
However, a recent study of APA-accredited clinical

Ph.D. programs (Sayette et al., 2011), including the
Academy of Psychological Clinical Science (APCS,
2012)
1
and non-APCS programs in regular (“compre-
hensive”) university settings and in specialized universi-
ties, but excluding Psy.D. and counseling psychology
Ph.D. programs, demonstrated a number of significant
differences in acceptance rates, numbers of applicants
admitted, admissions credentials, extent of financial aid,
student demographic characteristics, and program fea-
tures (e.g., research funding, internship acceptance
rates). The study also found stronger faculty allegiance
to a cognitive-behavioral orientation in APCS pro-
grams (80%), as compared with non-APCS programs
(67%) and programs in the specialized institutions
(37%), as well as stronger allegiances to psychodynamic
and humanistic/existential orientations in non-APCS
versus APCS programs.

This article expands and critically discusses the latter
finding. We argue that the finding regarding theoretical
orientation reflects a feature of the evolving training
landscape that is central to the future of clinical psy-
chology but which has received little formal attention,
that is, the increasingly restricted range of therapeutic
orientations that clinical graduate students are expected
to draw upon in their professional work. We contend
that an unfortunate effect of some otherwise positive
developments in promoting clinical psychology as a sci-
ence is the danger of a monoculture of ideas about the
nature of psychotherapeutic change—specifically, a
hegemony of cognitive-behavioral theory and therapy.
Furthermore, this effect is moderated by the nature of
the doctoral training program. That is, the more
research-based, science-focused programs tend to offer
the narrowest range of theoretical orientations, whereas
the more practice-focused programs present the widest
ones. In this article, we present data suggesting that this

divide is evident within doctoral programs at compre-
hensive universities, especially in clinical psychology
(but not counseling psychology) programs. The divide
is particularly evident when comparing clinical
programs at comprehensive universities versus programs
at freestanding professional schools of psychology.
Following the presentation of data supporting this
assertion, we discuss the dangers of these divides.
First, however, consider the following thought exer-
cise. Imagine that you are the mentor of a talented
undergraduate who is beginning the clinical psychology
doctoral application process. She has a strong liberal
arts preparation, with a range of psychology courses in
both clinical and nonclinical areas, and good research
experience. She plans a career that includes psychother-
apy research and theory development, and she wants
solid clinical training as well. She is compiling an initial
list of programs and is particularly interested in family

systems theory and therapy. As her mentor, you consider
programs with core faculty (those who supervise theses
and dissertations, that is, excluding adjuncts, off-site
practicum supervisors, faculty in departments of psychi-
atry that do not offer doctoral degrees) who publish
research in addition to providing clinical training.
Now, repeat the exercise with humanistic, experiential or
existential theory/therapy, with psychodynamic theory/ther-
apy, and with interpersonal theory/therapy. Having done
this exercise ourselves and having mentored students
like this one, we are aware of the difficulty in coming
up with programs to suggest; indeed, these lists are
likely to be very short.
The data presented below bear out these personal
observations. We undertook a systematic study of theo-
retical orientations represented in clinical and counsel-
ing doctoral training programs of various types, using
published sources. The Insider’s Guide to Graduate

Programs in Clinical and Counseling Psychology (Sayette,
Mayne, & Norcross, 2010) provided information on
self-reported theoretical orientations of program faculty
in six categories, that is, Psychodynamic, Behavioral,
Family Systems, Cognitive Behavioral, Humanistic/
Existential, and Other; the guide allows for faculty to
THEORETICAL ORIENTATIONS � HEATHERINGTON ET
AL. 365
indicate one or more orientations. The APA’s 2010
Graduate Study in Psychology (APA, 2010) education/
accreditation web site (http://apa.org/ed/accreditation/
programs/index.aspx) and the list of member programs
published by the Academy of Psychological Clinical
Science (http://acadpsychclinicalscience.org/members)
provided designations of various program types. As
needed, Internet searches of individual programs were
used to confirm their statuses as (a) Ph.D. programs at

comprehensive universities, (b) Ph.D. programs at
comprehensive universities that are designated as clini-
cal science programs, (c) Psy.D. programs at compre-
hensive university programs, and (d) Psy.D. or Ph.D.
programs at freestanding, “specialized” institutions. We
included programs in the 50 U.S. states and Canada.
Although the APA is phasing out accreditation of
Canadian programs as of 2015, our concern is not with
credentialing issues, but rather with training and con-
tinued development in psychotherapy theory and
research, which has been and no doubt will continue
to be significantly influenced by Canadian psychology.
For this same reason, we also included counseling psy-
chology, but treated it separately, as virtually all coun-
seling psychology doctoral programs are at
comprehensive universities and because there are some
historical and current differences between counseling
and clinical psychology. Moreover, we excluded the

eight APA-accredited “combined” (e.g., school/clini-
cal, school/counseling) programs.
Table 1 presents the mean percentages of faculty in
various types of clinical psychology doctoral programs
who self-report particular theoretical orientations.
2
The
comparison is striking. In the clinical science programs,
fully 80% of faculty claim a cognitive-behavioral orien-
tation, and 89% claim either a behavioral or cognitive-
behavioral orientation, whereas small percentages of
faculty claim either a psychodynamic or a humanistic/
existential orientation. Fewer than half of the faculty in
Psy.D. programs at comprehensive universities and in
Psy.D. or Ph.D. programs in freestanding universities
claim a CBT orientation, with noticeably higher per-
centages of faculty (28% and 29%, respectively) claim-
ing a psychodynamic orientation. Interestingly, the
least variation across programs was found in the per-

centages of faculty claiming a family systems orienta-
tion, close to 20% of faculty in each type of program.
Table 2 presents the mean percentages of faculty in
counseling psychology doctoral programs who self-
report particular theoretical orientations. These data
reveal a wider range of orientations, with fewer than
half claiming a behavioral or cognitive-behavioral ori-
entation and nearly a third claiming a humanistic/exis-
tential orientation. Explanations for this variation will
be advanced shortly.
Some elaboration and qualifications of these data are
in order. First, in the Insider’s Guide, programs could
also designate faculty with “other” orientations. These
data were sparse and often unique to individual pro-
grams or individual faculty and thus are not included in
the table, but rather summarized as follows. Of the 54
clinical science programs, only two cited one or more
“other” orientations. These (and the number of pro-

grams that cited them) were neuropsychology (1),
community (1), interpersonal (1), motivational inter-
Table 1. Therapeutic orientations of faculty in clinical
psychology doctoral training programs
Program Type Psychodynamic (%) Behavioral (%)
Family
Systems (%) Humanistic/Existential (%)
Cognitivea
Behavioral (%)
Ph.D. programs designated as
“clinical science”b programs (n = 54)
7 9 17 4 80
All other Ph.D. programs at
comprehensive universities (n = 116)
19 11 20 24 67
Psy.D. programs at comprehensive
universities (n = 31)
28 5 16 12 48
Psy.D. and Ph.D. programs at
freestanding professional
schools (n = 37)
29 6 22 15 32

Ms 21 8 19 14 57
a Source: Sayette et al. (2010).
b Source: Academy of Psychological Clinical Science
(http://acadpsychclinicalscience.org/index.php?page=members).
CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE � V19
N4, DECEMBER 2012 366
viewing (1), child (1), and eclectic (1). Of the 116
other clinical Ph.D. programs at comprehensive univer-
sities, 15 listed faculty with “other” orientations: health
(1), integrative (3), community (1), clinical neuropsy-
chology (3), eclectic (1), interpersonal or interpersonal/
ego relations or cognitive/interpersonal (5), develop-
mental psychopathology (1), feminist (2), cognitive (1),
narrative/personal construct (1). Of the 31 Psy.D. pro-
grams at comprehensive universities, only one listed an
“other” orientation: integrative/transtheoretical. Of the
38 programs at freestanding professional schools, four
listed “other” orientations: research (1), integrative (2),
cultural diversity focus (1). And of the 66 doctoral

counseling programs, 13 listed “other” orientations:
eclectic (1), integrative (1), interpersonal (7), feminist/
multicultural or feminist or multicultural (13), con-
structivist (2), relational/process (1), narrative (1),
developmental systems (2).
Second, the data on orientations in the Insider’s
Guide were only available as percentages. We do not
know how many actual faculty are represented in these
percentages; “20%” of faculty claiming a family systems
orientation could refer to one or two individuals in
smaller programs, but several individuals in programs
with larger faculties. Although the APA Graduate Study
guide lists numbers of faculty, it was not possible (given
changing faculty sizes, variability in the recency of the
data in each source) to accurately compare the data in
these two sources to derive the raw numbers of faculty.
Nevertheless, this issue is of obvious importance,
because it speaks to the actual availability of mentors

and supervisors representing particular orientations, as
well as the viability of training and research from the
particular theoretical orientation at any given program.
Adding the percentages for each program, however,
provides a rough index of the extent to which faculty
at a particular program claim more than one allegiance,
that is, eclectic orientations. That is, in programs at
which each faculty member claims a single orientation,
the mean percentages for each orientation total to
100%. For programs in which faculty members claim
more than one orientation, the percentages total to
more than 100%, with higher totals representing more
faculty claiming multiple allegiances. The total percent-
ages averaged across the different program types are the
following: Ph.D. programs at comprehensive universi-
ties, M = 129%, Ph.D. programs at comprehensive
universities that are designated as clinical science pro-
grams, M = 107%, Psy.D. programs at comprehensive
university programs, M = 110%, Psy.D. or Ph.D. pro-

grams at the freestanding, “specialized” institutions,
M = 105%, and counseling psychology doctoral pro-
grams, M = 114%. Interestingly, the modal and median
percentage totals were the same (each 100%) for every
program type.
SO WHAT? IMPLICATIONS FOR TRAINING, RESEARCH,
THEORY, AND PRACTICE
The data revealed two major divisions: between the
types of theoretical orientations in which current stu-
dents/future clinical psychologists are being trained and
between the theoretical orientations predominant in
the more research-focused and more practice-focused
programs. These divides are potentially dangerous for
the field and the future development of psychotherapy
theory and research.
It should be noted as well that the data revealed a
third divide, between clinical and counseling psychol-
ogy programs, which is noteworthy in that it provides
some context for the current concern. The broader

theoretical focus in counseling psychology can be
explained by differences in its history and training phi-
losophies. Although counseling psychology training
programs have required curricula and training experi-
ences that are similar to those of clinical psychology
programs, counseling psychology has different roots in
Table 2. Therapeutic orientations of faculty in counseling
psychology doctoral training programs
Psychodynamic
(%)
Behavioral
(%)
Family
Systems (%)
Humanistic/
Existential (%)
Cognitivea
Behavioral (%)
Ph.D. programs at comprehensive
universities (n = 67)
19 1 18 31 42

a Source: Sayette et al. (2010).
AL. 367
group career counseling, vocational rehabilitation of
WWII veterans (Gelso & Fretz, 1992), and counseling
of “normal” individuals with developmental difficulties
or life problems (Friedlander, Pieterse, & Lambert,
2012). This history dovetails with the fact that the pre-
dominant training model in counseling psychology for
the last 45 years has focused on relationship-oriented
and microcounseling skills (Egan, 2007; Hill, 2004;
Ivey & Ivey, 2007; Ridley, Kelly, & Mollen, 2011). In
practicum training, the preferred supervision approach
is to foster trainees’ experience with a range of theoret-
ical approaches, always being guided by clients’ indi-
vidual problems and needs. Most counseling
psychology programs do not hire faculty members
based on theoretical orientation; rather, the prevailing

preference seems to be a faculty that represents a broad
range of approaches. Further, reflecting the de-empha-
sis on the medical model (matching treatment to diag-
nosis) and the preferred emphasis on relationship skills
and common factors, counseling psychology researchers
have traditionally focused more on explicating thera-
peutic change factors than on comparing client out-
comes by treatment approach. Indeed, some of the
historically most influential lines of psychotherapy pro-
cess research were conducted by counseling psycholo-
gists, for example, Edward Bordin, Charles Gelso,
Leslie Greenberg, Adam Horvath, Clara Hill, Laura
Rice, and Stanley Strong.
Returning to the two major divides, regarding the
first, we would argue that the increasing dominance of
CBT, while derived in part from the early body of
research (Chambless et al., 1996) examining and sup-
porting its efficacy, is not optimal for the continued

development of psychotherapy specifically, and clinical
psychology more generally. In particular, we suggest
that it is highly limiting to have the field dominated by
any single theory of change. If CBT were the only
effective treatment, this would not be problematic. But
converging evidence indicates that CBT is not in fact
the only effective treatment, as demonstrated by the
Dodo verdict; the fact that, typically, only a small per-
centage of outcome variance is accounted for by treat-
ment approach (Wampold, 2001); the demonstration of
therapist effects and especially (as discussed shortly) the
current research evidence that a number of treatments
from other theoretical approaches are also efficacious,
especially for the treatment for depression (APA Task
Force on Psychological Interventions’ 2012 list, http://
www.div12.org/PsychologicalTreatments/disor-
ders.html). We suggest that an impartial reading of the
psychotherapy efficacy literature would not inevitably

lead to such a narrow focus on a single theoretical ori-
entation. We also suggest that such a narrow focus is
very unlikely to encourage and facilitate the research
that is sorely needed on other treatment orientations.
The evolution of theory, research, and practice
requires a diversity of ideas and perspectives, and, as
Pauling noted, “lots” of them. Indeed, our current
major theoretical perspectives evolved from a combina-
tion of mutually enriching, sometimes competing, per-
spectives. For CBT, these have included behavioral,
psychodynamic, personal construct, social learning, and
other perspectives. Messer (2004), in a discussion of
“assimilative integration” (i.e., incorporation of tech-
niques from other types of treatment into one’s
“home” therapy), cited Keane and Barlow’s (2002)
observation that Freud and Janet most influenced the
use of exposure and anxiety management—now con-
sidered central features of CBT—in the treatment for
PTSD. More recently, we have seen the experiential

tradition influencing the evolution of CBT in its new
emphasis on affective experience, and the meditative
tradition helping to shape Dialectical Behavior Therapy
(Linehan,1993) and variations of cognitive-behavioral
treatments for generalized anxiety disorder (Roemer,
Erisman, & Orsillo, 2008). Additionally, integrative
approaches to treating addictions and associated mental
health issues, such as motivational interviewing, draw
heavily on the client-centered model of therapeutic
practice (Angus & Kagan, 2009).
Why is the current dominance of a single theoretical
perspective potentially problematic? A generation of
students trained to think from only one perspective will
become theorists, teachers, researchers, and practitio-
ners whose creativity, intellectual flexibility, and ability
to create new treatments for changing times, troubles,
and client populations are likely to be diminished.
Further, a generation of students trained (implicitly or

explicitly) to trust in only one perspective will become
a generation that is less willing to be open to different
ideas and most importantly, less able to meet the
emerging mental health needs of the future.
John Stuart Mill, a strong advocate of empirical
methods in scientific procedure in the 19th century
and a philosophical progenitor of behaviorism, argued
that a plurality of views is needed in science (Cohen,
1961). Mill’s reasons are as appropriate for training in
clinical and counseling psychology as they are for sci-
entific advancement, including the fact that a problem-
atic view may contain some portion of the truth.
Moreover, as the prevailing view is never the whole
truth, it is only by collision with contrary opinions that
the remainder of the truth has a chance of being recog-

nized. One point of view that is wholly true, but not
subjected to challenge, will be held as a prejudice
rather than derived from a rational basis, and someone
holding a particular point of view without considering
alternative perspectives will not really understand the
meaning of the view he or she holds. Citing Mill and
framing this argument in a positive form, Safran and
Messer (1997) argued that science and practice flourish
in an atmosphere of confronting and discussing differ-
ence, noting that “to the extent that confronting alter-
nate therapeutic paradigms and techniques flips us into
a ‘world-revising mode’ … there is the possibility of its
leading to a dialogue which can truly deepen our
understanding of the human change process” (1997,
p. 142). In the clinical realm as well, there are atten-
dant implications for the ways in which we think
philosophically about human nature and human
change. It has been argued that exposing psychology
students to different theories and visions of reality

(Messer & Winokur, 1984) enriches their understand-
ing of clients and ways to treat them, including the
possibility of shifting from one perspective to another,
thereby encompassing more of the complexity of
human behavior (Messer, 2006).
Paradoxically, having both understanding of and
competence with two or more treatment orientations
may help clinicians use particular treatment protocols
with greater fidelity, when that is their goal. There is
mounting evidence that the actual therapeutic
interventions of clinicians who believe they are follow-
ing manualized treatment protocols often do not accu-
rately reflect the core treatment principles of that
approach (Shoham, 2011). A proposed remedy, training
students to understand the difference between going
“off-manual” versus practicing “flexibility within
fidelity” (Kendall, Gosch, Furr, & Sood, 2008; Sho-
ham, 2011), requires a deep understanding of what is

and what is not a prototypical intervention in the
approach at hand. And the latter, we suggest, is facili-
tated by knowing more than one therapeutic approach
well because the distinguishing features between cate-
gories of interventions help define them. For example,
students who truly understand interpretation but who
are following a CBT protocol and attempting to frame
cognitive restructuring interventions will be more
likely to do so with integrity because they understand
the differences between these similar yet distinct con-
structs at a core level.
Finally, we are concerned that the trend shown in
these data is likely to beget more of the same over
time. The programs most likely to produce our future
academic clinical psychologists—comprehensive Ph.D.
programs, perhaps especially those designated as clinical
science programs—are the ones with the narrowest
range of orientations. Not only will this trend limit the
vision and sources of ideas for current students, but also

their students will be even less likely to have professors
and clinical supervisors who represent other orienta-
tions, and consequently less likely to have research
mentors who are engaged in serious research on psy-
chotherapy from other orientations. We hasten to note
that there is no implied criticism here of the core
emphasis of clinical science training programs on the
need for data regarding the development and validation
of treatment approaches. In fact, one of our goals in
this commentary is to emphasize and support the asser-
tion that any treatment model worth learning must
have compelling data that support its efficacy and effec-
tiveness (and in fact, as noted earlier, a range of treat-
ment approaches do). Rather, the concern is that we
may inadvertently be training a generation of students
who equate a particular orientation with “good sci-
ence” and, by implication, other orientations for which
compelling data in fact exist, with “bad science” or

“no science.”
Finally, inasmuch as the growth and development of
treatments is facilitated by ongoing exchanges between
researchers and practicing clinicians, these divides are
dangerous. There is currently considerable distance
between the kinds of treatments that practitioners
know and use, on the one hand, and the type of
AL. 369
treatment that has come to dominate the research-
based treatment development landscape, that is, CBT,
on the other. A 2008 APA survey of 5,051 certified
Psychology Health Service Providers in the United
States revealed the following “primary theoretical
orientations,” in descending order: cognitive behavioral
(38.9%), psychodynamic/psychoanalytic (15.6%), inte-
grative (14.6%), “other,” which was primarily “eclec-

tic” (6.1%), cognitive (5.1%), humanistic/existential
(4.1%), behavioral (2.9%), systems (2.8%), and less than
2% each of biological, developmental, and family
(APA, 2008, http://www.apa.org/workforce/publications/
08-hsp/index.aspx).
Yet, feedback about the clinical realities of imple-
menting treatments as well as (ideally) the input of
practitioners into treatment development at early stages
is critical. A laudable collaborative project between
APA’s Division 12 (Clinical Psychology) and Division
29 (Psychotherapy) solicited clinicians’ feedback about
their experiences using various cognitive-behavioral
approaches for social phobia, generalized anxiety disor-
der, and panic (Goldfried, 2010, 2011). This kind of
exchange advances intelligent development and refine-
ments of our treatments, but it will be less and less
likely to happen among, for example, family therapy,
psychodynamic, and experiential researchers and practi-

tioners, given the shrinking numbers of academics ask-
ing such questions from these perspectives.
LIMITATIONS AND POSSIBLE COUNTERARGUMENTS
There are some limitations in the data themselves.
Only allegiances to the categories of therapeutic orien-
tation included by the Insider’s Guide were assessed;
also, objections may be raised to the ways in which the
approaches are categorized in that book, for example,
separating behavioral and cognitive behavioral, and cat-
egorizing all psychodynamic approaches as one. Other
orientations (e.g., Interpersonal Therapy [IPT], group,
eclectic) are missing altogether. An “integrative” choice
would have been particularly relevant to the current
questions. As it is not included in the Insider’s Guide,
we have no way of knowing whether faculty “orienta-
tion” refers to an orientation with regard to one’s clini-
cal practice (and indeed, how many faculty are engaged
in active clinical practice), personal theoretical prefer-

ence, research domain, or some combination. Further,
the focus of these categories on treatment orientations
does not capture allegiance to training orientations that
focus on aspects of the therapeutic relationship, which
transcend treatment type, but which are also critically
important not only for treatment outcome but also for
theory development and research (Norcross, 2011). On
the other hand, we note that our sample itself is
broader and more representative of psychologists cur-
rently engaged in training than other surveys of theo-
retical orientation, for example, surveys restricted to
members of APA’s Division 12 (Clinical Psychology;
Norcross, Karpiak, & Santoro, 2005).
The data also cannot reveal how the current state of
affairs applies to the actual coursework and practicum
training offered within the various types of training pro-
grams, nor do the percentages include part-time and
adjunct faculty who are hired to teach practical and who

are sometimes involved in supervising theses and disser-
tations at Psy.D. and professional school programs, and
thus have some influence on doctoral students’ outlooks.
We would argue, however, that the impact of their
research mentorship may not be as strong as that of core
faculty, who are engaged in research and predominantly
shape the intellectual ethos of the program.
In the spirit of the Popper quote, a counterargument
to ours may be mounted, namely, that the evolution
we described is precisely what is best for the field. The
strongest stance would be that it is no longer accept-
able to use—or to train students to use—psychological
treatments that have not been empirically supported as
efficacious for specific psychological disorders in rigor-
ous randomized clinical trial research. On the other
end, there are stances that allow for evidence-based
practice and training (Levant & Hasan, 2008) that in
addition to basing practice on findings from random-
ized clinical trials, more explicitly recognize the role of

clinical expertise, client values and preferences, and
other forms of research evidence (Messer, 2004). There
are a variety of opinions about the standards by which
the acceptability of evidence for a treatment should be
decided. We will not hash out the empirically sup-
ported treatments debate here as it has been thoroughly
discussed in the literature, but we acknowledge that
individuals’ and programs’ stances on what constitutes
acceptable evidence of treatment effectiveness/efficacy
are a key factor in training policies.
We agree that training students in a diversity of
poor or wholly untested treatments for the sake of hav-
ing a variety of options makes no sense and that dis-
credited theories and treatments (cf. Castonguay, 2010;
Lilienfeld, 2007), as well as those for which no one

seems to be willing or able to mount research programs
to evaluate, should be “eliminated as unfit.” But we are
a long way from the claim that only cognitive-behav-
ioral treatments are empirically supported. As Messer
(2004) noted, the literature also reveals a number of
what Wampold (2001) defined as “bonafide” therapies:
those with a firm theoretical base, an extensive practice
history, and a research foundation, even if the treat-
ment does not meet the “empirically supported” crite-
ria as defined by the Task Force (Wampold, Minami,
Baskin, & Tierney, 2002; Wampold et al., 1997).
Indeed, as noted earlier, the updated APA Division 12
list of research-supported treatments for depression
now goes far beyond the narrow range of treatment
approaches originally identified and includes 12 differ-
ent empirically supported treatments for depression that
are based on humanistic, psychodynamic, interpersonal,
and cognitive therapy models (http://www.div12.org/

PsychologicalTreatments/disorders.html). Yet, the increas-
ing lack of opportunity for serious graduate study and
research on the full range of evidence-based approaches
risks creating a situation in which their development
will fall increasingly behind, widening these divides.
POSSIBLE SOLUTIONS AND FUTURE DIRECTIONS
First, preparing students to think in an integrative man-
ner may help. It has been demonstrated that the funda-
mental tenets of one theory also explain client change
from other theoretical perspectives. Consider operant
conditioning, a hallmark of CBT, which Castonguay,
Reid, Halperin, and Goldfried (2003) found to occur
in psychodynamic as well as humanistic therapies.
Contrariwise, there are features of CBT that are bor-
rowed, knowingly or not, from psychodynamic therapy
and that are correlated with change in CBT (Shedler,
2010). The psychotherapy integrationist movement has
a long history, which includes Dollard and Miller’s

(1950) comparative analysis of behaviorism and
psychoanalysis, Frank’s (1961) description of curative
factors in healing across cultures, and Lazarus’s (1967)
technical eclecticism and multimodal therapy. The
growing trend toward integration came from major
theorists who recognized the complexity of the change
process and the shortcomings of many unimodal theo-
ries. In his 2010 presidential address to the Society for
Psychotherapy Research, Castonguay predicted that
psychotherapy integration will continue to grow and
that the four major systems of therapy will be
improved based on research that emphasizes common
and contextual factors with diverse client populations.
According to him, as we narrow the division between
research and clinical practice, integrative psychotherapy
is likely to become the gold standard, even if it is not
superior to a “pure form” approach. In our data set,
there were a few programs that were clearly integra-

tionist evidenced by both a variety of orientations rep-
resented and a total number of orientations listed that
was well over 100%. Furthermore, a substantial body
of efficacy research indicates that successful treatment is
accounted for by individual client differences, individ-
ual therapist effects, and common factors (expectancy,
alliance, etc.) more so than by techniques specific to
any particular theoretical orientation (Wampold, 2001).
Thus, truly integrative thinking requires training in
these research and theoretical bases as well.
Second, the training of top-notch future psychother-
apists, psychotherapy theorists, and psychotherapy
researchers needs to include an understanding of the
latest clinical science in related domains of knowledge
such as developmental psychopathology and affective
neuroscience. For example, attachment, emotion regu-
lation, autobiographical memory specificity, and per-
ceptual-cognitive biases, among many other topics, are

highly relevant to therapy; not only will this under-
standing enrich the pool of ideas that inform the study
of change process mechanisms, but also it will enhance
entry-level clinicians’ ability to think broadly and
deeply about how and when to use the tools they
have. It is erroneous to assume that one orientation is
more compatible with basic science than another, the
current data notwithstanding. The challenge, of course,
is to be true to the intent of training models—to actu-
ally expose students to science, teach them how to
understand it (and in some cases, how to engage in it),
and most importantly, help them to integrate emerging
findings in behavioral and clinical science into their
practices.
AL. 371
Third, we suggest that monocultures, or near mono-
cultures, tend to reproduce themselves in both subtle

and less subtle ways without deliberate attention to
intellectual diversity. The chance to talk with col-
leagues from other theoretical orientations as well as
from related disciplines is affected by program infra-
structure, from the seemingly mundane (office and lab-
oratory placements, research group assignments, habits
of colloquia invitations and attendance) to the less
mundane (faculty hiring and graduate student admission
practices, tenure and promotion pressures that foster
not straying too far from colleagues’ beliefs or prevail-
ing department culture). Professional conferences, with
a few exceptions (Society for Psychotherapy Integra-
tion, Society for Psychotherapy Research), have
become increasingly balkanized, top-ranked doctoral
programs tend to admit students whose prior training
and attitudes about theoretical orientation are fairly set
and mirror that of their potential advisor, and grant
pressures (which currently favor the predominant treat-

ment approach) help keep students fairly narrowly
focused from the time they enter their doctoral pro-
grams. Our field needs to think collectively about the
implications of such practices. Finally, it bears repeating
that advocates of promising treatment approaches that
are not widely available for training at present and that
do still require stronger empirical evidence need to
continue their research efforts and to be better sup-
ported in doing so. It is interesting and hopeful in this
regard that those doctoral programs in comprehensive
universities not designated as clinical science programs,
and the doctoral programs in counseling psychology,
had the highest mean percentages of multiple orienta-
tions claimed, 129% and 114%, respectively.
It will be interesting to see whether or not future psy-
chotherapy training continues to be organized around
broad umbrella “orientations” or organized more
around some other features of treatments. We note, for

example, that CBT now represents a highly diverse cate-
gory of evidence-based protocols (EBPs), which are
quite different from each other in underlying theories of
change (e.g., exposure in Prolonged Exposure [PE],
cognitive restructuring in Cognitive Processing Therapy
[CPT]), structures (90-min sessions in PE, 60-min ses-
sions in CPT), and techniques/procedures (in-session,
repeated imaginal exposures in PE, use of written narra-
tives in CPT). In fact, the United States Department of
Veterans Affairs (VA) purports to provide training and
dissemination of specific EBPs for clinicians providing
mental health services to veterans (Karlin et al. 2010).
The VA’s list of these includes the following: CBT for
depression, Acceptance and Commitment Therapy
(ACT) for depression, IPT for depression, CPT for
PTSD, PE for PTSD, Social Skills Training (SST) for
severe mental illness, Integrative Behavioral Couple
Therapy (IBCT), and Family Psychoeducation.

Should graduate psychotherapy training programs
aspire to training models that de-emphasize a focus on
particular theoretical orientations and focus more than
at present on training in a broad range of evidence-
based protocols? On the one hand, it would be a way
for students to acquire knowledge earlier in a range of
efficacious treatments so that internship and postdoc-
toral psychotherapy training could be organized around
providing more advanced training and supervision.
(Currently, many internship and postdoctoral training
sites can only provide introductory exposure to evi-
dence-based protocols from approaches other than
CBT, due to students’ very limited [if any] exposure to
these approaches during graduate training.) Further, it
might be expected that with experience and supervi-
sion, trainees in EBPs naturally evolve toward integra-
tion and adaptation of EBPs according to the unique
characteristics of individual patients. On the other

hand, it could be argued that this kind of training strat-
egy, especially at the graduate (vs. internship or extern-
ship) level, would be atheoretical, too narrow and too
focused on specific protocols. Rather, students should
be trained in the broader theoretical outlooks and non-
specific relationship skills, and only then in the specific
EBPs, which will lead naturally to an integrative
approach informed by a deeper understanding.
In another vein, Follette and Beitz (2003) offer
some sensible suggestions for creating a curriculum that
teaches students to think in a broad and rigorous scien-
tific manner about empirically supported treatments.
Specifically, these suggestions call for more attention to
mechanisms of psychotherapeutic change, which is by
definition a multitheoretical or even pantheoretical
enterprise, at least. In addition, programs seeking to
build strength in training for more than one orientation
should “put their best foot forward” by highlighting

the available data, exposing students to the theoretical
and empirical base that justifies training in a particular
orientation.
In sum, healthy evolution in our field, as in all
fields, requires new ideas that derive from varying per-
spectives. As clinical science progresses, this kind of
flexibility, which transcends singular allegiances to one
theoretical orientation versus another, will become
increasingly important in the development of theory,
research, and practice.
ACKNOWLEDGMENTS
We gratefully acknowledge the able research assistance of
Laura Christianson and Joshua Wilson, and very helpful com-
ments from Marlene Sandstrom, Catherine B. Stroud, and an
anonymous reviewer.
NOTES

1. These are programs that have been determined to meet
the criteria outlined by the Academy of Psychological Clini-
cal Science and thus designated by that body as “clinical sci-
ence” programs. See http://acadpsychclinicalscience.org/
members.
2. The raw data, including a list of programs in each cate-
gory, are available upon request.
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Received February 5, 2012; accepted October 2, 2012.
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