ON CLINICAL PRACTICE
Scientific clinical psychology is the only legitimate and acceptable
form of clinical psychology. This first principle seems clear and
straightforward to me ‑ at least as an ideal to be pursued without
compromise. After all, what is the alternative? Unscientific clinical
psychology? Would anyone openly argue that unscientific clinical
psychology is a desirable goal that should be considered seriously as
an
alternative to scientific clinical psychology?...
Where there are lots of unknowns ‑ and clinical psychology
certainly has
more than its share ‑ it is all the more imperative to adhere as
strictly as possible to the scientific approach. Does anyone seriously
believe that a reliance on intuition and other unscientific methods is
going to hasten advances in knowledge?...
Understandably, the prospect of publicly exposing the questionable
practices of fellow psychologists makes most of us feel uncomfortable.
Controversy never is pleasant. Public challenges to colleagues'
activities certainly will anger those members of the clinical
psychology
guild who are more concerned with image, profit, and power than with
scientific validity. However, if clinical psychology ever is to
establish itself as a legitimate science, then the highest standards
must be set and adhered to without compromise. We simply cannot afford
to purchase superficial tranquillity at the expense of integrity....
Most of us have become accustomed to giving dispassionate, objective,
critical evaluations of the scientific merits of journal manuscripts
and
grant applications; now we must apply the same kind of critical
evaluation to the full spectrum of activities in clinical
psychology....
Clinical psychologists cannot justify marketing unproven or invalid
services simply by pointing to the obvious need and demand for such
services, any more than they could justify selling snake oil remedies
by
pointing to the prevalence of diseases and consumer demand for cures.
ON TRAINING
...(S)cientific training must be the sine qua non of graduate
education
in clinical psychology....
Everyone seems to have opinions about what makes for effective
scientific training, but such views seldom are backed by sound
empirical
evidence. Even where evidence exists, it may exert little influence on
the design of clinical training programs. It ought to be otherwise, of
course; those who train scientists should be reflexive, taking a
scientific approach themselves toward the design and evaluation of
their
training programs. Unfortunately, the structure and goals of graduate
training in clinical psychology tend to be highly resistant to change.
Institutional, departmental, and personal traditions, alliances, and
empires are at stake, and these tend to make the system unresponsive
to
logical, empirical, or ethical appeals.
Training program faculty members need ... to stop worrying about the
particular jobs their students will take and focus instead on training
all students to think and function as scientists in every aspect and
setting of their professional lives....
Too much emphasis has been placed on the acquisition of facts and the
demonstration of competency in specific professional techniques, and
too
little emphasis has been placed on the mastery of scientific
principles;
the demonstration of critical thinking; and the flexible and
independent
application of knowledge, principles, and methods to the solution of
new
problems. There is too much concern with structure and form, too
little
with function and results....
ON PROGRAM EVALUATION
The ultimate criterion for evaluating a program's effectiveness is how
well its graduates actually perform as independent clinical
scientists.
Thus, program evaluations should focus on the quality of a program's
products ‑ the graduates ‑ rather than on whether the program
conforms
to lists of courses, methods, or training experiences.
...(F)or clinical psychology to have integrity, scientific training
must
be integrated across settings and tasks. Currently, many graduate
students are taught to think rigorously in the laboratory and
classroom,
while being encouraged ‑ implicitly or explicitly ‑ to check
their
critical skills at the door when entering the practicum or internship
setting....
ON 'BREAKING AWAY'
In my more cynical moments, I sometimes suspect that many
psychologists
view serious proposals for scientific standards in practice and
training
as a betrayal, rate busting, or breaking away from the pack. ...
Inevitably, a breakaway will come. Some groups of clinical
psychologists
will become obsessed with quality, dedicated to achieving it. These
psychologists will adopt as their manifesto something similar to the
one
I have outlined here. When this happens, the rest of clinical
psychology
‑ all those who said that it couldn't be done, that it was not the
right
time ‑ will be left behind in the dust.