Models for the Graduate Curricula in Clinical Psychology
Prepared by the Division 12 Task Force on teaching evidence based practice in Clinical Psychology
J. Gayle Beck, Chair, Louis G. Castonguay, Andrea Chronis-Tuscano, E. David Klonsky, Lata K. McGinn, and Eric A. Youngstrom1
Although the field has embraced an evidence-based approach to the practice of Clinical Psychology, it still remains important to enhance Clinical Psychology doctoral training programs’ support of this emphasis. Given the value of grounding doctoral training in Clinical Psychology on empirical evidence, our goal is to develop cross-cutting principles and resources that can guide Clinical Psychology doctoral programs of all forms in the incorporation of evidence-based models of training2. Although a number of other groups are developing training guidelines for various forms of specialty training within Clinical Psychology (e.g., training for clinical scientists, training for cognitive-behavioral therapists, training for behavioral health practitioners), each of these guidelines rests on the assumption that doctoral students will receive foundational training in core areas (e.g., psychopathology, evidence-based assessment, evidence-based treatment) and will receive clinical supervision in the development of core clinical skills (e.g., case formulation, differential diagnosis, treatment/intervention conceptualization, ethics, sociocultural competence). This document delineates specific principles to guide the core doctoral training and foundational clinical supervisory experiences for Clinical Psychology programs, irrespective of the theoretical orientation of the faculty or the training mission of the program. In designing these principles, we are focusing on Clinical Psychology, which is appropriate given our individual and collective training experiences. It is possible that some or all of the principles outlined in this document can apply to training in broader health services psychology.
In working to develop these key principles, the committee combed the recent literature on evidence-based practice and training models across disciplines that reflect this approach (Bauer, 2007; Collins, Leffingwell, & Belar, 2007; Gray, 2004b; Guyatt & Rennie, 2002; Hunsley & Mash, 2007; Spring, 2007; Straus, Glasziou, Richardson, & Haynes, 2011; Thorn, 2007; Youngstrom, 2012). We also considered the policy statement on evidence-based practice issued by the American Psychological Association (APA) that was developed in 2005 (Appendix 1). This policy emphasizes the roles of research, clinical expertise, and patient values in the conduct of evidence-based practice. As noted in the policy, the definition used by APA is specific about how to operationalize research evidence but understandably ambiguous with respect to the nature and operationalization of clinical expertise and patient values. In particular, information about how and when clinical expertise and patient values should be integrated with research is lacking in this policy. The ambiguity is not a deficit of the APA policy so much as an accurate reflection of the state of knowledge in the field. Thus, our guidelines necessarily go beyond the APA statement in providing recommendations for teaching evidence-based practice in clinical psychology training programs.
Moreover, in drafting these principles, our task force recognizes that multiple epistemologies can be useful in undergirding training programs. Within the principles presented here, emphasis is placed on logical positivism (also known as logical empiricism) given the current advances within the field. The members of our task force believe that the phrase “evidence-based” should refer to empirically-grounded information (including but not restricted to EST), and should subsume both quantitative and qualitative sources of data. Although clinical expertise and patient values are regarded by our task force as essential elements in training students to conduct assessment, case formulation, treatment, and larger-scale clinical interventions, these perspectives at present are not grounded in scientific data. As the field continues to evolve and there is greater empirical knowledge about clinical expertise and patient values, including models for how to integrate these three literatures, these components could be integrated more fully into systematic training efforts.3
In order to facilitate the use of these principles, we provide numerous resources that programs may use flexibly to incorporate each principle into their existing curricula (Appendix 2).
Key Principles of Evidence-Based Doctoral Training
We believe that four key principles should guide doctoral training in Clinical Psychology. These principles are:
1. To determine authorship of this document, the chair of the committee was listed first; remaining authors were listed in alphabetical order. The opinions expressed in this document do not reflect any one individual’s but rather, have been reached through discussion among the task force.
2. Evidence-Based Training is the conscientious and explicit use of the best current evidence in the design of training programs. The evidence is the outcomes from well- designed research studies in the fields of psychology and evidence-based practice. The terms evidence-based training and practice do not indicate one specific instructional approach or one specific technique and do not favor one theoretical orientation over another. Often mistaken as the same, evidence based practice and training differs from manualized, empirically supported treatments. Rather, evidence based training is a general training approach designed to ensure that doctoral students become proficient in the skills, knowledge and behavior necessary for the study and practice of clinical psychology (Hoge, et al., 2003; Spring, 2007).
3. Feedback and recommendations related to a previous draft of this document were also sought and received from representative of various APA divisions and other professional organizations to ensure the relevance of these principles to different types of Clinical Psychology training programs/models.