Empirically Supported Treatments in Psychology:
Implications for Canadian Professional PsychologyTask Force Report for the CPA Section on Clinical Psychology
Submitted by
John Hunsley, Keith S. Dobson, Charlotte Johnston,
& Samuel F. Mikail
Executive Summary
In 1993 the Division of Clinical Psychology of the American Psychological Association developed a task force on the promotion and dissemination of psychological procedures which (i) developed criteria for determining whether a treatment has empirical support and (ii) made recommendations about the dissemination of empirically supported treatments
Since that time, the task force has released several documents describing criteria for listing of empirically supported treatments and providing lists of such treatments (the task force is now a standing committee, the Committee on Science and Practice)
Throughout its existence, the task force has had both strong proponents and opponents: proponents have emphasized the importance of psychology taking a lead in determining the level of scientific evidence necessary for indicating that a psychotherapy has empirical support, whereas opponents have voiced concerns over the process and terminology used by the task force, the nature of psychotherapy research methodology, and the possible negative professional impact of the task force listing of treatments
From a broader perspective, the effort to determination empirically supported psychotherapies is but one example of the general trend in health care in most Western countries to promote evidence-based practice (i.e., the use of scientific data to determine optimal services for patients/clients); other examples relevant to psychology include scientific reviews in Germany and the United Kingdom to ensure that psychotherapeutic services are based on empirical evidence, the American Psychiatric Association practice guidelines, the Quality Assurance Project (Australia and New Zealand) practice guidelines, and the Agency for Health Care Policy (United States) and Research practice guidelines.
The use of clinical practice guidelines is the most common approach to encouraging evidence-based practice in health care, and has been used for a number of years by medical associations-recent efforts by American psychological organizations along these lines have included the establishment of a template for developing psychological practice guidelines (American Psychological Association) and the development of the Practice Guidelines Coalition (including the Association for Advancement of Behavior Therapy and the American Association of Applied and Preventive Psychology)
There are likely to be important implications for Canadian professional psychology of both American initiatives and other national initiatives to promote evidence-based practice in psychology, including: the requirement for internships and programs accredited by the American Psychological Association to provide training in empirically supported treatments; the possibility that moves in the United States toward the professional credentialing of speciality skills (related to empirically supported treatments) could limit the options available for the development of speciality designations in Canada, and; the possibility that practice guidelines could be required of Canadian psychologists by third party payers or other agencies
Recommendations of the CPA Clinical Section Task Force
1. The Section on Clinical Psychology of CPA should explicitly endorse the work of Division 12 of the APA on empirically supported treatments.
2. The Section on Clinical Psychology of CPA should encourage CPA to explicitly endorse the work of Division 12 of the APA on empirically supported treatments and to seek representation on future Task Force committees on empirically supported treatments. CPA should also examine the possibility of sponsoring with Division 12 of the APA future Task Force committees.
3. The Section on Clinical Psychology of CPA should encourage CPA to seek to participate in the summit meetings on practice guidelines already taking place in the United States. Alternatively, CPA could be encouraged to work with other groups (such as the Canadian Register of Health Service Providers in Psychology and the Canadian Council of Professional Psychology Programs) to actively develop such guidelines in Canada with other psychological and behavioral health professions.
4. The Section on Clinical Psychology of CPA should encourage the CPA Accreditation Panel to require training in empirically supported treatments as a mandatory criterion for the accreditation of doctoral programs and internships in clinical psychology. For internships, there should be explicit recognition that the extent of such training may be limited due to the limited availability of supported treatments for some practice domains and client populations served by the internship. Additionally, the Section should encourage the CPA Accreditation Panel to survey training programs and internships on the extent to which training in empirically supported treatments is currently available.
5. The Section on Clinical Psychology of CPA should encourage CPA to work with other national and provincial psychological organizations (such as the Canadian Register of Health Services Providers in Psychology and the Council of Provincial Associations of Psychology) to develop and promote continuing education and training in empirically supported treatment approaches.
6. The Section on Clinical Psychology of CPA should encourage CPA to work with provincial regulatory bodies and the Canadian Register of Health Service Providers in Psychology to require knowledge of and training in empirically supported treatments as part of the assessment of suitability to independently provide health services to the public.
7. With regard to public policy in Canada, the Section on Clinical Psychology of CPA should encourage CPA to (i) inform federal and provincial ministries of health about the use of empirically supported treatments (ii) lobby these ministries to direct funding toward those programs that promote empirically supported approaches to specific patient problems. Efforts to inform the ministries should emphasize the complexity of treatment planning and the limitations inherent in the classification of treatments as empirically supported, but should also indicate where there are clearly preferable treatment options based on scientific data.
8. Similarly, the Section on Clinical Psychology of CPA should encourage CPA, in conjunction with all interested organizations, to lobby health insurance companies regarding the use of empirically supported treatments. Efforts to inform these companies should emphasize the complexity of treatment planning and the limitations inherent in the classification of treatments as empirically supported, but should also indicate where there are clearly preferable treatment options based on scientific data.
9. In conjunction with all interested organizations, the Section on Clinical Psychology of CPA should develop a clear statement, for the public and other stakeholders in the health care system, on the scientific context of psychological services. This statement should discuss the importance of using an evidence-based approach to service provision and should explicitly discuss the fact that scientific validation inevitably lags behind routine practice. Accordingly, there should be a statement that a treatment may be beneficial for an individual even if it is not listed as being empirically supported (i.e., the difference between a treatment being untested and being ineffective).
10. To ensure that psychological practitioners are cognizant of methods for enhancing practice accountability, the Section on Clinical Psychology of CPA should encourage CPA to: (i) implement an accreditation criterion requiring training in outcome evaluation for clinical training programs and (ii) sponsor continuing education workshops on outcome evaluation and other approaches to enhancing accountability
11. The Section on Clinical Psychology of CPA should encourage CPA to coordinate a national data base (perhaps in association with the Canadian Institute for Health Information) on treatment outcome from large treatment sites (e.g., teaching hospitals and university based clinics) in order to obtain data on actual practice effectiveness. This would augment the information gathered in efficacy research and could be used in the development of practice guidelines.
12. The Section on Clinical Psychology of CPA should encourage CPA to lobby the major national granting agencies regarding the importance of including psychological treatment efficacy and effectiveness research in their purview of fundable health and social science research. For those granting agencies that currently fund health service research, CPA should encourage the agencies to include, as possible research domains, research on (i) the effectiveness of training and supervision for dissemination of empirically supported treatments, (ii) the utilization of treatment manuals in the delivery of services, and (iii) measures of competence/proficiency in the delivery of services.