An overview of some current challenges within the field of clinical behavior analysis.

Abstract

Clinical Behavior Analysis (CBA) is facing a number of difficult challenges and in many ways is at an important crossroads. This paper outlines several key issues and discusses possible directions CBA might pursue within the context of the current marketplace. Among the challenges faced today are a lack of common ground between academic psychologists and community-based psychologists and limited dialogue between CBA and mainstream clinical psychology. These are further complicated by economic strains that have led to increasing pressure to change the nature of clinical practice including the use of practice guidelines and empirical based treatment algorithms. Although promising, the basic assumptions of these types of treatment models may be premature. This paper explores some of the possible associated limitations and questions the use of empirical approaches to the exclusion of other treatment modalities at this time. Despite these challenges, CBA may be in a unique position to advance clinical psychology and is seen as having much to offer. The potential strengths of CBA are discussed and recent examples of the use of CBA within traditional clinical settings are highlighted. ********** One has only to pick up a recent copy of the American Psychological Association's Monitor or a similar publication to realize that clinical psychology is facing a number of changes and challenges that will greatly impact the field as we now know it. Clinical Behavioral Analysis (CBA) may have much to offer the field at this time, but there are obstacles, some from within our own history, which may prevent us from effectively participating in the upcoming evolution of clinical psychology. My various roles as a medical school faculty member are such that I have a foot firmly planted in both the fee-for-service clinical camp as well as the ivory towers of academia. Based on my experiences in trying to balance these two different sets of contingencies, I would like to identify some of the key issues impacting CBA and clinical psychology in general. One observation is that we as academic clinicians need to start spending more time talking to community-based clinicians. There has been prominent coverage in trade publications such as the Monitor and discussions in recent editions in The Behavior Therapist (e.g. Raw, 1999a; 1999b; 1999c). However, many academic clinicians seem to continue to be unaware of or unconcerned about the growing pressures that community-based clinicians are under and the level this pressure is reaching. Part of this lack of awareness appears to be due to a widening schism between what academic clinicians are doing and what community-based clinicians are doing. Despite the ongoing research efforts of academic psychologists, community-based clinical psychologists are paying less and less attention to that body of work. There is already a general attitude expressed by many of the community-based clinical psychologists I encounter that much of what we do as researchers is not relevant to what they do. The separation between research and clinic practice is going to get wider if we do not address this issue. In particular, there is a need for clinical behavior analysts, who to date have largely worked in academic settings, to communicate more with other kinds of clinical psychologists. Traditionally CBA researchers have had even less dialogue with community-based clinicians than other academic psychologists. This has continued in large part due to the marked discrepancies in philosophical orientation between CBA and the cognitive-behavioral orientation of most community-based practitioners. Behavior analysis has a long history of not attending to, if not openly vilifying, the research and clinical activities of other psychological orientations, especially cognitive psychology. There are important historical reasons for this conflict which are beyond the scope of this paper. However, if CBA clinicians continue to ignore mainstream clinical psychology, faced with the changes that are coming in our field, we are going find ourselves cut out and left behind. …