The Troubled Marriage of Science and Art in the Practice of Psychotherapy

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Saturday, 06 March 2010 21:24 Last Updated on Saturday, 22 May 2010 17:38 Written by Cynthia Ezell

In a recent issue of Newsweek, (Ignoring the Evidence. Why do psychologists reject science? October 12, 2009), Sharon Begley opined about the analysis published in the November 2009 Perspectives on Psychological Science concerning the disparity between what science can prove about psychotherapy and what psychotherapists actually do. She was basing her article on a report that actually first appeared in 2008 in Psychological Science in the Public Interest, the journal of the Association for Psychological Science (APS), co-authored by Timothy Baker of the University of Wisconsin, accompanied by an editorial written by Walter Mischel. [Editor's Note: For the extremely curious, the 145-page pre-publication draft is available HERE.] In the original report, Baker states that many clinicians “fail to use the interventions for which there is the strongest evidence of efficacy." (Begley, 2009) Baker’s report and the attendant responses have set off a firestorm in the media about psychotherapy and psychotherapy training programs.

Two years ago, the APS established an accreditation system for graduate psychology programs that would stand in opposition to the current credentialing system maintained by the American Psychological Association (APA). Begley states that “if public shaming doesn’t help” (Begley, 2009) then perhaps the new credentialing system proposed by APS will “stigmatize ascientific training programs and practitioners.” (Baker, 2008) The intention seems clear—to draw a firm line between those who are deemed scientifically trained, and those who aren’t. Don’t stop reading here just because you are a master’s level psychotherapist and aren’t really concerned about doctoral training programs. This debate affects all of us.

Baker believes that psychologists spin the facts to cover up what they must surely fear—that their profession is a “charade." He says that psychologists are “deeply ambivalent about the role of science” and “lack solid science training”. A particular target of both Baker’s report and Begley’s article are Psy.D. programs, which focus more on the practice of psychotherapy than on clinical research. Begley deems these programs as “science-lite”. Might she deem a LSCW or a LMFT training program as “science-zero”?

There was an interesting discussion of the tension between science and practice in December on NPR’s Talk of the Nation, which I did not hear. Fortunately, Melinda Borthick, Ph.D., did hear it, and forwarded me the transcript. The host is Joe Palca, and the guests that day were Bruce Wampold from the University of Wisconsin, Richard McFall, executive director of the Psychological Clinical Science Association System, and Dianne Chambless from the University of Pennsylvania. Wampold made a comment which seemed to me to be obvious and central to this debate, but which seemed to have little impact on the other guests. Wampold said, “So becoming a therapist involves clearly being knowledgeable about what the science is, about the disorders and about treatment, but it also takes a great amount of effort and supervision to learn how to deliver these treatments. And so it may well be that the graduates of these (strictly scientific) programs actually have less therapy training and maybe wouldn’t be as qualified or as effective as therapists in other programs” (Wampold, 2009). Richard Almond likens the relationship of researchers to clinicians to “two populations living on continents that have drifted apart." He writes that researchers and clinicians now live in different social “ecosystems," having little in common organically besides their shared heritage. (Almond, 2006)