For those of you who read my fall column, you may remember that I continued with Laura Carstensen's theme from last spring about having glimmers of hope for the future of scientific clinical psychology. Well it's spring again, and we all know that hope springs eternal in the spring. So let me tell you some of the reasons why it does this spring. As I mentioned in the fall, the Task Force on Psychological Intervention Guidelines had submitted its final draft to the APA Board of Directors in December so that they could approve it before it being sent for adoption to the APA Council of Representatives in February. This document details generic criteria for how to evaluate the effectiveness of new and existing treatment interventions, and should set the stage for other task forces to be formed that will generate state-of-art guidelines for treatment of specific disorders. Although there had been some objections to its contents by some officers of APA divisions devoted to humanistic and psychoanalytic psychotherapy, it received strong support at the APA Council meeting in February. Indeed, a number of individuals who know APA Council meetings very well were stunned at how little discussion and controversy it generated, and that it passed with nearly unanimous support! I am confident that this document was so well received because the time is ripe given current concerns about health care reform. With the overwhelmingly positive vote at Council (on which practitioners are heavily represented), we seem to have evidence that practitioners are indeed more willing than in the past to listen to guidelines telling them about which treatments work best. This is obviously good news for SSCP members! We can only hope now that the momentum will keep up and that some of the specific task forces for different disorders will be formed soon.
I also mentioned in the fall that I was pleased with the responsiveness of Ray Fowler to the objections of a few of us to a pamphlet on "How to choose a psychotherapist" that had been written by the Public Interest Directorate of APA. The pamphlet as it was written was withdrawn from circulation, and it has now been revised with the editorial help of the three of us who objected so strongly to the earlier version of it (me, Laura Carstensen, and Jerry Davison). I have also been assured that mechanisms are being put into place that should prevent such pamphlets from being drawn up in the future without significant input from scientists.
On another front, you may remember that we voted at the APA business meeting last summer to affiliate with APS. Perhaps as a consequence of this, we now have Alan Kraut, APS Executive Director, working on our behalf with NSF. The issue concerns NSF's refusal to give fellowships to any students in clinical psychology training programs, or to give research grants to any clinical scientists that do research relevant to clinical problems. At present the policy is absolute and it does not matter how much the research involves "basic science" issues in clinical psychology. He has written several convincing letters to NSF officials about the arbitrariness of their policy and about why it should be changed. His latest letter included quotations from a good number of SSCP Perspectives continued on p. 2 Perspectives continued members who responded to a posting he made on the SSCPnet about this topic. Who knows whether Alan will ultimately succeed in getting NSF to change their policy on this, but we certainly wish him luck and will be endlessly grateful it he does succeed.
Finally, I wanted to endorse Jack Blanchard's comments elsewhere in this newsletter about the excellent program that Michelle Craske has put together for SSCP at APA in New York in August. Not only do we have two excellent symposia, but we will also have an award address from Andrew Mathews, who is our 1995 Distinguished Scientist Award winner.
Susan Mineka, President
Seligman Task Force on Treatments that Work
Past-president Marty Seligman reported on progress in arranging publication of the work of the task force he appointed (Peter Nathan, Chair) to write a book on treatments that work, based on a series of scholarly reviews. Legal counsel at APA had impeded progress in Div. 12's signing a contract with Oxford U. Press on the basis of their belief that such a book came perilously close to constituting treatment guidelines and therefore required line-by-line legal review. To break this log jam, Dr. Seligman arranged for the contract to be signed by Dr. Nathan as an individual, and it will not be published under the aegis of Div. 12, although the royalties will be donated to Div. 12. Board members were distressed by APA's intrusion into the publication of a scholarly work and later approved SSCP- formulated recommendations that Div. 12's council representatives will introduce when the new APA bylaws are considered. These recommendations call for APA to specifically disavow the right to review scholarly works and task force reports that are not intended to be guidelines. It is important that any SSCP members who are council reps support these amendments when they come before council.
SSCP's Affiliation with APS
SSCP Rep. Chambless responded to the Div. 12 board's request (Oct. 1994 meeting) that SSCP investigate whether it had acted against any section, division, or APA bylaws when it elected to affiliate with the American Psychological Society. Chambless's report that she had investigated and had found no violations did not satisfy those SSCP members on the board who were unhappy that the section had voted to affiliate with APS without advance notice and at a poorly attended meeting. Although this vote was in keeping with SSCP bylaws, Chambless reported that the SSCP executive committee had agreed to put this matter to a vote of the entire membership, along with a set of housekeeping changes to the bylaws.
Plans proceed for the celebration of the centennial of the founding of clinical psychology with a conference to be held in Oct. 1996 in Philadelphia. At least two clinical psychologists will receive awards for lifetime contributions to the field.
In light of the expected large budget deficit, the board voted to seek a dues increase of $8 per annum. Approval of division members will be required. In addition to meeting current expenses, the increased revenue will help fund the centennial celebration, the expanded number of issues of the new division journal (Clinical Psychology: Science and Practice), and membership recruitment efforts.
Task Force on Promotion & Dissemination of Psychological Procedures
Chambless reported on the progress of the implementation committee for the recommendations of the SSCP-sponsored task force. Considerable progress has been made, and the work of this group will be continued by the Task Force on Psychological Interventions, also chaired by Chambless. SSCP members wishing a copy of the progress memo on the task force's recommendations may request one from me at CHAMBLE@AMERICAN.EDU.
The board approved recommendations from the nominations committee for appointment to various APA committees and boards. There are, no doubt, many SSCP members who might have been so nominated and who would have ably represented our interests. It would be helpful to have a pool of potential nominees to suggest to the nominations committee. SSCP members who, in the future, are willing to be considered for such a nomination are asked to inform Rep. Chambless and indicate on what type of board or committee they would like to serve.
Next Board Meeting
The next meeting of the Div. 12 board will be held September 9-10, 1995. SSCP members wishing to have issues raised at the meeting should contact Rep. Chambless at least a month in advance of the meeting. Postal address: 42 Old Gulph Road, Wynnewood, PA 19096-1219.
The Executive Board of SSCP met at the Mid-Winter meeting of Division 12 of APA in Santa Fe on January 13-15. The Executive Board consists of Susan Mineka, President, Laura Carstensen, Past-President; Ian Gotlib, President-Elect; Jack J. Blanchard, Secretary/Treasurer; and Diane Chambless, Representative to the Division 12 Board. A number of issues were addressed at the meeting and I will provide a brief review of some of these discussions.
1995 SSCP AWARDS: Andrew Mathews was selected as the recipient of the 1995 Distinguished Scientist Award. The winner of the SSCP Dissertation Award was Drew Erhardt. Drew completed his dissertation work under the supervision of Stephen P. Hinshaw at the University of California, Los Angeles. Congratulations to Andrew and Drew!
1995 APA SSCP PROGRAM: As the 1995 APA Program Chair for Section III, Michelle Craske has done an outstanding job of organizing an impressive list of speakers for the 1995 APA Convention. In addition to the Distinguished Scientist Award Address presented by Andrew Mathews there will be two symposia sponsored by SSCP: "Cognitive vulnerabilities, stress and depression" and "Emotion excesses and deficits in psychopathology". The speakers for the symposium titled "Cognitive vulnerabilities, stress and depression" will include Constance Hammen (Interpersonal vulnerability and the generation of stress), Clive Robins (Life stress and personality in depression: Interactive and reciprocal influences), David A. Clark (Selfhood processes in sociotropy and autonomy: Understanding individual differences in the appraisal of stressful life experiences), Gerald Metalsky (Cognitive -vulnerability: A test of the hopelessness theory of depression), and Lyn Abramson (Cognitive-vulnerability to depression: The Temple- Wisconsin project). For the symposium titled "Emotion excesses and deficits in psychopathology" the speakers will include Peter Lang (Emotional and motivational priming), John Neale (Emotion in schizophrenia), Chris Patrick (Emotion and temperament in psychopathology), Gregory Miller (Emotional processing in depression), and Don Fowles (Emotional deficits in psychopathology as reflected in the electrodermal response). Full details regarding the times and locations of the 1995 SSCP program will appear in the summer issue of Clinical Science.
BUDGET: SSCP has continued to grow with yet another increase in membership this year. The budget is healthy and we are able to meet all of our current and anticipated expenses. The growth and vitality of SSCP is in part attributable to the relevance of this organization's goals in an environment of real and threatened changes in psychology as well as the active participation of SSCP's members on SSCPnet.
STATE LICENSURE: An issue that was originally raised at last year's Mid-Winter meeting was the concern about State Licensing requirements for the clinical practice of psychology. In particular, licensure requirements that may be difficult, if not impossible, for clinical psychologists working primarily in academic settings to satisfy. Laura Carstensen has drafted a letter that will be appropriate to send to State Licensing Boards. This letter outlines the issues and concerns and indicates opposition to licensure requirements that adversely impact clinical psychologists in academic settings. Laura indicated that Division 12, the Board of Scientific Affairs, and APS will sign on. It was noted that State Boards may be most responsive to letters originating from individuals from within their state. Thus Laura and Sue suggested that the letter from be sent along with a personal letter from an individual within the state such as a Director of Clinical Training.
INTERNSHIP DIRECTORY: SSCP's internship directory has enjoyed increased attention; however, the Board discussed a number of ways that we might better improve awareness about this resource. Ideas that will be pursued are direct mailings to student members of SSCP, advertisements placed in appropriate professional journals, posting information regarding the directory to other e-mail networks in addition to SSCPnet, and a brief empirical paper based on data collected in the Directory to be submitted to an appropriate APA publication. If you have not already ordered your copy of the Directory please contact Graywind Publications at 518-438- 3231 (see the accompanying note in this newsletter for full details regarding ordering).
APS AFFILIATION: As many of you know SSCP voted at the 1994 APA Business Meeting to affiliate with the American Psychological Society (APS). Laura Carstensen discussed the advantages of such an affiliation which include: 1) allowing clinical science to become a larger part of APS and 2) the opportunity to appeal to a wider membership who share the concerns and goals of SSCP. An additional factor discussed was that the impact of SSCP could be broadened with two national organizations (APA and APS) seeking to support clinical science.
PRESCRIPTION PRIVILEGES: The Executive Board voted for SSCP to be a signatory of the AAAPP letter which opposes prescription privileges for psychologists. After much discussion the Board believed that taking a position on this issue, was consistent with the mission of SSCP to support the science of clinical psychology.
BYLAW CHANGES: The Board reviewed SSCPs bylaws and drafted several small changes. There will be a mailing regarding these suggested changes which will be put to a vote by the membership of SSCP.
SSCPnet: The Executive Board was enthusiastic about the continued success of SSCPnet. The net has served to provide a forum for a wide range of compelling topics and has provided a meaningful method of keeping our membership in touch and informed. The Board acknowledged with gratitude Michael Bailey's efforts at keeping the SSCPnet functioning and credits SSCPnet with the continued growth of SSCP's membership.
CENTENARY: The Centenary of Clinical Psychology will be achieved in 1996. This milestone will be observed next year in Philadelphia on October 18-20. Marty Seligman discussed this major event with the Board and outlined the plans of Division 12. SSCP will have two hours of time at APA's program. Ian Gotlib will be requesting suggestions for how SSCP might best use this time on this historic occasion.
Remember that the process of applying for clinical psychology internship programs is just around the corner! The SSCP Internship Directory (just published in the fall of 1994) is a great resource for identifying programs that best meet a students training goals. Information on each of the 155 internship programs in the Directory includes data on 1) where past interns have come from (i.e., clinical, counseling or school psychology programs and the accreditation status of graduate programs), 2) a listing of training provided for 25 empirically validated treatments, 3) a description of the research activities of internship faculty, 4) the research productivity of past interns (the number of conference presentations and publications authored by interns over the past four years), 5) facilities,, and support provided to interns (e.g., whether computers are available or if interns have secretarial support), and 6) the job placements of interns over the past four years (e.g., the. number of interns taking positions that were primarily clinical/service, academic/research faculty appointments, or postdoctoral fellowships). To order SSCP's Directory of Research Opportunities for Clinical Psychology Interns send $15.00 plus $3.50 shipping and handling ($18.50 total) to: Graywind Publications Incorporated, Stuyvesant Plaza, Executive Park Drive, Albany, NY 12203 (Phone: 518-438-3231).
Please note that SSCP membership fees for 1995 were due last December. There will be a notice mailed in the upcoming weeks reminding those of you have who have not yet paid your 1995 dues. Please be sure to renew your membership in SSCP. If 1995 dues are not paid this will be the last newsletter received and access to SSCPnet will be discontinued.
In an upbeat inaugural article, President Susan Mineka (1994) pointed to several hopeful signs of breakthrough by the voices of clinical science. Particularly encouraging to us was her indication that APA's Task Force on Psychological Intervention Guidelines, of which she is a member, is progressing toward a report emphasizing controlled trials as a primary source of evidence for therapeutic efficacy. Although this may seem to scientific psychologists to be the most rudimentary of confessions, such recognition could indeed signal a significant and long overdue movement of APA toward science-based practice.
We began to ponder the likely impact of such a victory for clinical science. Suppose - just suppose - that APA were actually to adopt the radical policy that therapies should be judged (and reimbursed) according to their documented efficacy in properly designed clinical trials, and that "practitioners are going to need to be able to show that they are using scientifically validated treatments" (Mineka, 1994, p. 2). We believe that we have already seen a glimpse of this future.
Behind Closed Doors
If therapists were required to use science-based treatments, how would one know that they were doing so? Pertinent here is the experience of those who have trained therapists to provide such services within clinical trials. In such conditions of relatively high control, the (re)training of therapists is rather fully under the influence of the project director and clinical supervisor, and continued employment of a therapist on the project is contingent upon proper performance of the requisite treatment (e.g., Project MATCH Research Group, 1993). Our research team has had extensive experience in such training, particularly through a decade-long series of trials of Azrin's (1976) community reinforcement approach (CRA; Meyers & Smith, in press). In our earliest research, therapists received extensive training and regular face-to-face supervision in CRA strategies, but performed the services behind closed doors without direct audio or video recording. The supervisor's knowledge of what transpired was thereby limited to weekly verbal accounts and verbatims from the therapists. Our follow-up interviews with clients suggested that therapists, despite their verbal descriptions, were actually practicing a wide range of old behaviors, and might be inconsistently implementing CRA procedures. In a completely different project with a new set of therapists we therefore had all sessions audiotaped for later analysis, although these tapes were not used in ongoing supervision. In subsequent content analyses of these tapes, coders had considerable difficulty distinguishing between experimental and control sessions, and the actual rate of delivery of CRA-appropriate therapist behaviors was distressingly low despite explicit training, a structured procedures manual, and ongoing supervision sessions. In all current clinical studies, therefore, we require videotaping of sessions, with regular monitoring of tapes by clinical supervisors (e.g., Project MATCH, 1993). This, in fact, has allowed us to achieve high rates of treatment-specific therapist behaviors.
The distressing part of this situation is that under ordinary practice conditions, there would not even be the level of monitoring that was present in our earliest research. There may be no specific training in new procedures, no standard therapy manual, and no qualified supervisor who oversees practice. Independent practitioners are independent. Even if the National College of Psychology succeeds in implementing specialist competency standards that require specific training in procedures, what guarantee would there be that therapy subsequently delivered by these specialists would in any way resemble science-based practice?
A Placebo by Any Other Name
This reminded us of a second experience that may presage the post-victory era. For two decades Miller and Hester (1980, 1986) have been reviewing the outcome literature on alcoholism treatment approaches. One product of this endeavor has been an evolving list of recommended treatment methods that are most strongly supported by clinical trials. The top of the current list (Miller et al., 1995) looks like this: brief intervention, social skills training, motivational interviewing, community reinforcement approach, and behavior contracting.
Both of us are from time to time invited to speak to clinical audiences on this topic, and this research summary is integrated into the regular training of new alcohol/drug counselors in New Mexico. One local psychiatric hospital a few years ago sponsored a large clinical addiction conference to which this list of effective treatments was presented. Some weeks later we received in the mail a new brochure from the hospital's addiction treatment program. It announced that the program was now based on the community reinforcement approach, social skills training, and other elements from our list of scientifically-supported methods. As indicated above, the retraining of clinical staff in such specialized procedures is no simple matter. We inquired of hospital program staff how they had learned these new procedures, and found no one who could identify when, where, or by whom any such training had been delivered.
This mirrors another common reaction that we have experienced when presenting the outcome literature to audiences of providers: "We already do that!" Stanton Peele refers to this as "the Prego defense," alluding to the pasta sauce commercial in which the proprietor responds to a list of desired ingredients by assuring for each one, "It's in there!" Social skills training? We do that. Family therapy? You bet. Community reinforcement approach? Yes, we offer that. Behavior contracting? No problem! Practice goes on as usual, but under a new name and description. In a recent survey of 28 agencies providing alcohol treatment services in the Albuquerque area, half claimed to be offering the community reinforcement approach, and 57% to be offering social skills training (Miller & C'de Baca, 1994).
Whence Cometh Our Help?
Such experiences cause us to despair at times of the prospects for retraining and reshaping the practice of clinicians already wedded to clinical lore and overpracticed methods. It is unlikely in the extreme that any health care delivery system would achieve the kind of monitoring and accountability necessary even to determine that appropriate methods were being delivered properly. Psychosocial treatments are harder to detect than surgeries. How would one establish that a clinician had committed malpractice or defrauded the public by proposing to offer a scientifically-proven therapy but failing to do so with sufficient specificity? In this same light, what will prevent treatment programs from declaring that their offered services encompass any list of appropriate treatment modalities? Although one can imagine check procedures like pseudoclients or the screening of sample tapes, the costs and practicalities of widespread implementation of such quality monitoring would be prohibitive.
Our hope, then, would seem to lie in better control of the training of psychologists - a function long overseen by APA. The practice behaviors of clinicians are likely strongly determined by early training and experience. Once a therapist's schemas are in place, they are notoriously difficult to modify even with persuasive corrective feedback. It would seem therefore that if we genuinely desire that psychologists of the future will engage in science-based practice, APA should add at least two stringent standards with regard to clinical training. First, APA-approved programs should teach, as core approaches, only those treatment methods that are soundly supported by properly designed outcome research. This in itself is insufficient preparation, however, for a lifetime of practice within a rapidly evolving science. It is also thus necessary for the training of all psychologists to include thorough indoctrination in scientific rigor and skepticism. Currently new treatment fads (we think at the moment of procedures like eye movement desensitization and reprocessing) sweep rapidly into widespread practice in the absence of (and sometimes despite) scientific evidence. Controls on such entrepreneurial practice are at least somewhat tighter in medicine. When we reach the point that all psychologists in training learn science-based clinical practice and are taught to apply rigorous scientific skepticism as the first test of new procedures, we will have come much closer to the realization of psychology as a clinical science.
Azrin, N.H. (1976). Improvements in the community- reinforcement approach to alcoholism. Behaviour Research and Therapy, 14, 339-348.
Meyers, R.J. & Smith, J.E. (in press). Community reinforcement approach: A clinical guide for treating substance abuse. New York: Guilford Press.
Miller, W.R., Brown, J.M., Simpson, T.L., Handmaker, N.S., Bien, T.H., Luckie, L.F., Montgomery, H.A., Hester, R.K., & Tonigan, J.S. (1995). What works? A methodological analysis of the alcohol treatment outcome literature. In R.K. Hester & W.R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives (2nd ed.). New York: Allyn & Bacon.
Miller, W.R., C'de Baca, J. (1994). New Mexico alcohol/drug program directory. Albuquerque: University of New Mexico. Miller, W.R., & Hester, R.K. (1980). Treating the problem drinkers: Modern approaches. In W.R. Miller (Ed.), The addictive behaviors: Treatment of alcoholism, drug abuse, smoking, and obesity (pp. 11-141). Oxford: Pergamon Press.
Miller. W.R., & Hester, R.K. (1986). The effectiveness of alcoholism treatment methods: What research reveals. In W.R. Miller & N. Heather (Eds.), Treating addictive behaviors: Processes of change (pp. 121-174). New York: Plenum Press.
Mineka, S. (1994). Presidential perspectives. Clinical Science, Fall, 2-3.
Project MATCH Research Group (1993). Project MATCH: Rationale and methods for a multisite clinical trial matching patients to alcoholism treatment. Alcoholism: Clinical and Experimental Research, 17, 1130-1145.
WANT A CHANCE TO SHOW OFF YOUR WORK?
JOIN US AT THE Society for a Science of Clinical Psychology 5th ANNUAL STUDENT POSTER SESSION
WHERE: APA convention in New York
WHEN: August 11-15, 1995
HOW: Become a student member of SSCP (if you aren't one already)
by submitting an application and $5.00 membership fee. Submit three (3) copies of a 500 word abstract (double spaced) describing the study to be presented. Abstracts should include title, author(s), and affiliation. Also include any tables and/or figures that will appear on the poster.
Mail your submission and one self-addressed stamped envelope to: Howard Berenbaum Society for a Science of Clinical Psychology APA Division 12, Section III Department of Psychology, 603 East Daniel Street University of Illinois Champaign, IL 61820
Posters will either be accepted or returned with a request for revisions. If your submission is received by MAY 31, 1995, you will have the opportunity to revise and resubmit. You may resubmit until the FINAL SUBMISSION DATE, JUNE 30, 1995. Students whose posters have been selected will be notified in writing. An award will be presented to the author of the best poster.
If you have any questions, contact Ernestine Briggs or Sharon Lambert at: Department of Psychology, 603 East Daniel Street, University of Illinois, Champaign, IL 61820 We may also be reached by electronic mail: Ernestine, firstname.lastname@example.org, Sharon , email@example.com