Psychology graduate school training on interventions for child maltreatment.

This current study surveyed psychology programs' use of empirically supported treatments (ESTs) for children and their families with a history of child maltreatment. In May 2009, there were 599 graduate school programs listed by the Graduate Study in Psychology Online of the American Psychological Association (APA). Psychology graduate school department heads or directors of training were asked to complete an online survey about training offered in treatments for this population. Of the 599 psychology graduate school programs contacted, 201 (34%) responded. Of the 201 programs that responded, 140 provided training in treatments for children and their families with a history of child maltreatment. Results indicated that training in at least 1 EST was provided by 89% of the programs that provided training in treatments for this population. However, training in the treatment rated as meeting the highest standard of evidence, Trauma-focused cognitive–behavioral therapy, was provided in only 45% of the programs. Training in treatments that have been rated as not yet having sufficient research evidence to be labeled as supported were more likely to occur in non-APA accredited and non-PhD programs (i.e., terminal Master's, EdS, PsyD). As an important vehicle for the dissemination of ESTs in child maltreatment, considerable progress is needed to improve the training provided by psychology graduate programs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An exploratory survey on empirically supported treatments: Implications for internship training.

Is training in empirically supported treatments (ESTs) necessary for internship? Are all internship sites embracing EST training equally? An exploratory survey reports training practices and attitudes toward use of ESTs in internship sites accredited by the American Psychological Association. Training practices during an internship year varied across type of setting, but only 28% reported offering more than 15 hr of training. Lack of managed care demands, flexibility in session limits, and perceived mismatch between client needs and treatment options were reasons endorsed for not doing more training and supervision with ESTs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Provision of psychotherapy for a statewide population of Medicaid beneficiaries with schizophrenia.

This study uses 1,995 Medicaid-paid claims from Georgia to examine factors influencing the provision of psychotherapy services to patients with schizophrenia. Measures of services included individual and group psychotherapy and were derived using the Physician's Current Procedural Terminology, 4th edition (CPT-4) codes. Approximately one in four patients received psychotherapy during the study period. When controlling for other factors, psychotherapy use was less likely for African American than White patients and more likely for women, those with comorbid substance abuse, and those with severe physical comorbidities. Compared with those not treated with an antipsychotic, those being treated with typical antipsychotics did not differ in psychotherapy use, but those treated with atypical antipsychotics were significantly more likely also to be receiving psychotherapy. Among psychotherapy users, individual psychotherapy alone was most common. Compared with those receiving only individual psychotherapy, the probability of receiving additional group therapy or group therapy alone was elevated for African American patients, those in metropolitan areas, and those with comorbid substance abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Putting empirically supported treatment into practice: Lessons learned in a children's mental health center.

With the increasing focus on service accountability, there is an urgent need to identify empirically supported treatments (ESTs) and disseminate their use in the daily practice of mental health organizations. This article describes the authors' experiences of implementing an EST at a children's mental health center by involving the collaboration of clinicians, administrators, and innovator(s). Initially, a small group of clinicians voluntarily commit to pilot test the EST, with the intention of evaluating the adoption and integration of the treatment model into the organization's full-service delivery system. Using E. A Rogers's (1995) work on the diffusion of innovations, the current case study example suggests that ESTs can be flexibly and successfully implemented with integrity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bridging the Gap Between Posttraumatic Stress Disorder Research and Clinical Practice: The Example of Exposure Therapy.

There are notable challenges in translating empirically supported psychosocial treatments (ESTs) into general routine clinical practice. However, there may be additional unique dissemination and implementation obstacles for ESTs for trauma-related disorders. For example, despite considerable evidence from randomized clinical trials that attests to the efficacy of exposure therapy for posttraumatic stress disorder, front-line clinicians in real-world settings rarely use this treatment. Perceived and actual barriers that interfere with adoption include clinician misconceptions about what exposure entails and complex cases to which ESTs may not be readily applicable. Specific suggestions for bridging the science-into-service gap in trauma ESTs (in general) and in exposure therapy (in particular) are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Canadian professional psychology and empirically supported treatments": Commentary.

The impact on Canadian professional psychological treatment practices of the American Psychological Association's Division 12 (Clinical Psychology) Task Force's development of criteria and listings for empirically supported psychological treatments, along with other industrial efforts to standardize the identification of treatments with established efficacy is described in the article by J. Hunsley et al (see record 1999-01869-001). D. L. Chambless comments on the importance of having empirically supported treatments (ESTs) because many clients will not have the specific problems for which ESTs have been developed. In such cases, clinicians need to decide whether they are warranted in generalizing from the samples on which an EST is based, or whether they need to devise a novel approach. Also of importance is the therapeutic relationship or working alliance: a focus on ESTs should not be taken to mean that foundational issues such as the alliance can be forgotten. Training therapists should first learn basic therapeutic skills before learning more specialized ESTs. Other comments concern traditional training in Canada and a US trend of rejecting ESTs until more efficacy studies are completed of research-to-treatment generalizability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Workshop.

If the article by Kahn and Santostefano in the April issue of the American Psychologist (1962, 17, 185-189) can be taken as an indication, clinical psychologists are still very much interested and concerned with their professional role image or images. Discussions of this topic invariably get around to a discussion of training programs for clinical students and the pros and cons of various types of curricula and educational experience. Partially because of the lack of agreement among faculty and practicum personnel, discussions of professional identity by clinical graduate students are filled with uncertainty, confusion, and conflict surpassing even that which is evident in the discussions of their professional fathers. Questions concerning "professionalism," academic versus clinical training, and the relationships of clinical psychology to other professions are representative of the omnipresent topics of conservation. As a matter of fact, the workshop was so well received that we plan to hold a second workshop next year. But we thought that those individuals who live too far from us to be easily able to attend our meeting might want to try something similar in their areas. We are preparing a more thorough summary and commentary concerning the recent meeting and would be glad to forward a copy to interested individuals. A group of graduate students in the clinical program at the University of Oklahoma decided that it might, be quite worthwhile if they could assemble a number of students from other training settings and attempt to exchange ideas concerning their future roles as professional people. It was the contention of these students that graduate students in psychology, and particularly clinical students, seldom have an opportunity to freely exchange ideas about these problems in an atmosphere which is specifically designed for this purpose. Thus, what we think is quite a unique idea was born: that we might be able to provide graduate students from various training programs in clinical psychology with the opportunity to get together to discuss training, role conflicts, identity, and other professional problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Canadian graduate training in psychology.

As a result of a questionnaire sent to all Canadian graduate training schools in psychology, a tabulation was made of a) qualifications for admission to each programme, b) graduate training specialty in each department, c) broad numerical comparisons of size of university with number applying and accepted for study. Overall the results indicate that the minimum qualifications for entry are a B average in 7 or 8 undergraduate psychology courses including basic experimental psychology and statistics. Qualifying years are usually offered to those who do not reach these minima. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Promotion of Academic Careers in School Psychology: A Conceptual Framework of Impact Points, Recommended Strategies, and Hopeful Outcomes.

School psychology is facing a major shortage of faculty in graduate training and education programs. To deal with this shortage and the issues that surround it, we propose a conceptual framework that incorporates a number of impact points that graduate training programs can use to educate and sustain individuals in academic careers. The impact points include: selection of students, program-related training variables, post-program transition variables, and sustainability of academic careers. Each of these impact points is discussed within the context of the role that current faculty and practitioners in the profession can play in graduate education and training of academic scholars. Among the variety of potential solutions to the shortage, we introduce the concept of the "virtual university" to promote future education and sustainability of faculty within our graduate training programs. A case scenario from graduate students at the University of Wisconsin-Madison is presented as a context for the impact points raised in the article. We argue that those of us in the profession think systemically and lead the way into a new era of collaborative work across our graduate programs and among our colleagues in clinical, counseling, and related areas of applied and professional psychology graduate training. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

On Professionalization in Psychology.

This column comments on an article by Drevdahl in the January, 1956 issue of the "American Psychologist". In his article, Drevdahl offers an analysis of ABEPP in its relationship to graduate training programs in clinical psychology. His basic point seems to be that if ABEPP claims for itself the ability to judge what is "good" and "competent" in psychological practice then it ought to use this knowledge to improve professional training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Generic psychotherapy case formulation training improves formulation quality.

Psychotherapy case formulations written by 20 clinicians who received a 2-hr training session in case formulation were compared with those of 23 clinicians not receiving training. Formulations based on intake interviews conducted at a university-based psychiatric outpatient clinic, two to three per clinician, were reliably coded for quality and content. Clinicians in the training group produced formulations rated as higher in overall quality and as more elaborated, comprehensive, complex, and precise. These formulations were also more likely to address precipitants, predisposing factors, and an inferred mechanism to explain symptoms and problems. Effect sizes indicated that the average clinician in the training group produced a better formulation than 86% of those in the control group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial

CONTEXT: Episodic tension-type headache is common and is often treated using manual therapies. Few data exist for the efficacy of these interventions. OBJECTIVE: To determine the effects of spinal manipulation therapy on adults with episodic tension-type headache. DESIGN: Randomized controlled trial lasting 19 weeks. SETTING: Outpatient facility of a National Health Service-funded chiropractic research institution in Denmark. PARTICIPANTS: Volunteer sample of 26 men and 49 women aged 20 to 59 years who met the diagnostic criteria for episodic tension-type headache as defined by the International Headache Society. INTERVENTION: Participants were randomized into 2 groups, 1 receiving soft tissue therapy and spinal manipulation (the manipulation group), and the other receiving soft tissue therapy and a placebo laser treatment (the control group). All participants received 8 treatments over 4 weeks; all treatments were performed by the same chiropractor. MAIN OUTCOME MEASURES: Daily hours of headache, pain intensity per episode, and daily analgesic use, as recorded in diaries. RESULTS: Based on intent-to-treat analysis, no significant differences between the manipulation and control groups were observed in any of the 3 outcome measures. However, by week 7, each group experienced significant reductions in mean daily headache hours (manipulation group, reduction from 2.8 to 1.5 hours; control group, reduction from 3.4 to 1.9 hours) and mean number of analgesics per day (manipulation group, reduction from 0.66 to 0.38; control group, reduction from 0.82 to 0.59). These changes were maintained through the observation period. Headache pain intensity was unchanged for the duration of the trial. CONCLUSION: As an isolated intervention, spinal manipulation does not seem to have a positive effect on episodic tension-type headache.     

Empirically supported treatments: Implications for training.

This article discusses the role of empirically supported treatments (ESTs) in the training of clinical psychologists. Training in ESTs can be integrated in ways that vary depending on the level of training and setting. Predoctoral programs, internships, postdoctoral programs, and continuing education are discussed in regard to special challenges and sequencing of training. A preliminary set of guidelines for training in ESTs is suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Step-down trend tests for identifying the minimum effective dose

This article discusses the role of empirically supported treatments (ESTs) in the training of clinical psychologists. Training in ESTs can be integrated in ways that vary depending on the level of training and setting. Predoctoral programs, internships, postdoctoral programs, and continuing education are discussed in regard to special challenges and sequencing of training. A preliminary set of guidelines for training in ESTs is suggested.     

Jousting With Straw Men: Comment on Westen, Novotny, and Thompson-Brenner (2004).

Empirically supported treatments (ESTs) do not cure every patient, and the randomized trial is not a flawless methodology. Upon these often-noted and widely accepted points, D. Westen, C. M. Novotny, and H. Thompson-Brenner (2004a; see record 2004-15935-005) built a critique of ESTs and EST research. However, important work developing effective, clinically relevant treatments for serious problems was omitted from the Westen et al. (2004a) review. Little documentation was offered for the purported "assumptions" of EST methodology that Westen et al. (2004a) criticized; and different review standards were applied to studies supporting versus those disagreeing with Westen et al.'s (2004a) views. Finally, the correlational research designs proposed as a remedy by Westen et al. (2004a) have far more serious weaknesses than randomized trials, thoughtfully applied to real-world clinical care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The utility of empirically supported treatments.

How does a psychotherapist decide what treatment approach is most appropriate for a client? This issue has been addressed by the Division 12 Task Force on Promotion and Dissemination of Psychological Procedures (1995) and has stimulated considerable debate among psychologists about the importance of identifying, teaching, and practicing empirically supported treatments (ESTs). This article examines recent literature supporting both sides of this issue in an attempt to identify and understand the arguments in favor of and against the movement to identify and implement ESTs and their treatment manuals. On the basis of current research related to ESTs, recommendations are offered pertaining to practice, research, and training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-Based Practice: Beyond Empirically Supported Treatments.

Must the clinician choose between a practice that is strictly objective and data based and one that is purely subjective and experience based? Optimally, practitioners need to follow a model of evidence-based psychotherapy practice, such as the disciplined inquiry or local clinical scientist model, that encompasses a theoretical formulation, empirically supported treatments (ESTs), empirically supported therapy relationships, clinicians' accumulated practical experience, and their clinical judgment about the case at hand. Some shortcomings of ESTs are reviewed, and a form of evidence for psychotherapy practice is presented that entails the accumulation of systematic case studies published online. Practitioners can contribute to such a database and be guided in their practice by those cases most relevant to their clients' problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Responses of practicing psychologists to a web site developed to promote empirically supported treatments.

Increased adoption of empirically supported treatments (ESTs) has been hindered in part by inadequate and inconvenient access to EST information and training. To improve diffusion of ESTs, the authors developed a Web application to provide practitioners with concise information by disorder on ESTs. The resulting site, therapyadvisor.com, was evaluated by 239 practicing psychologists to assess the usefulness of the site and explore possible interactions of EST attitudes on ratings of usefulness and impact. Two thirds of participants indicated using ESTs in practice, and limited time and resources were cited as primary barriers to EST adoption. The Web application was rated positively by most participants and was reported to increase awareness of and commitment to try ESTs among approximately 60% of participants. The results of this project support the feasibility of a Web application to increase diffusion and promote further adoption of ESTs. Technological and e-learning advances are promising directions for encouraging the adoption of ESTs specifically and evidence-based practice generally, particularly among busy practitioners who have inadequate time and resources for more traditional forms of dissemination and training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported psychological treatments: A natural extension of the scientist–practitioner paradigm.

The impact on Canadian professional psychological treatment practices of the American Psychological Association's Division 12 (Clinical Psychology) Task Force's development of criteria and listings for empirically supported psychological treatments, along with other industrial efforts to standardize the identification of treatments with established efficacy is described in the article by J. Hunsley et al (see record 1999-01869-001). C. M. Morin voices comments on some aspects of the article which may need further thought. The reasons for, and utility of such a movement toward empirically supported treatment (ESTs) is investigated. The defining characteristics of an EST (from the Task Force's perspective) are subject for debate. Why have only 2 categories of ESTs (well established empirical support vs probably efficacious)? The implications of the adoption of EST-based systems will reverberate throughout training, practice, and public health policies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)