Empirically supported treatments in psychology: Implications for Canadian professional psychology.

Abstract

AbstractIn this article we examine several interconnected efforts to develop evidence-based practice in professional psychology. We first review the American Psychological Association's Division 12 Task Forces' development of criteria and listings for empirically supported psychological treatments. Next, we present related efforts to develop procedures to identify treatments that have established efficacy and to develop practice guidelines. The possible impact of these initiatives on Canadian professional psychology in the domains of training, credentialing, practice, and research are then examined. Finally, we present recommendations for steps that should be taken by Canadian psychology organizations to respond to these initiatives in order to ensure that psychological practice in Canada is optimally supported by scientific evidence.In 1993, growing concerns with the future of psychological services in the context of managed health care, an increasing emphasis on accountability and cost containment, and a desire to emphasize the scientific basis of psychological treatments led Division 12 (Clinical Psychology) of the American Psychological Association (APA) to strike a Task Force on the Promotion and Dissemination of Psychological Procedures. The Task Force developed criteria for empirically evaluating psychological treatments and made recommendations as to the methods for educating psychologists, the public, and mental health service payers about these treatments.The work by Division 12 of APA is only one of a number of recent efforts to promote the use of scientific data in determining optimal services for patients or clients. The generic term for this increasing trend among health care professions is evidence-based practice. As we describe in this article, although the formats used to promote increased accountability through the use of scientific findings may vary, all have in common the goal of ensuring that people seeking treatment receive services that are informed by research findings.In this article, we (i) review the role this and subsequent Division 12 task forces have had on defining what constitutes an empirically supported psychological treatment and (ii) present information on several related initiatives which attempt to further evidence-based practice by formulating best practices or practice guidelines. Based upon our review, we then discuss the implications such initiatives will have for Canadian professional psychology. We conclude the article with a number of recommendations for professional psychology training, credentialing, practice, and research in Canada.The APA Division 12 Task ForcesTo serve the widest possible interests, membership on the initial APA Division 12 Task Force was selected to represent a breadth of theoretical orientations (e.g., cognitive-behavioural, psychodynamic, interpersonal) and a range of occupational settings (e.g., academic psychology departments, medical schools, private practice). Rather than evaluating treatments without reference to particular disorders, or evaluating treatments as they applied across various disorders, the Task Force opted for a strategy of evaluating treatments according to their application to specific mental health disorders (e.g., exposure/guided mastery for specific phobia, brief psychodynamic therapy for depression). The Task Force also chose to set the boundaries of what would define a treatment according to the availability of a treatment manual. Recognizing the arbitrary and subjective nature of any set of criteria for evaluating treatments, the Task Force opted for two categories of support: treatments classed as well established and those that are probably efficacious. These criteria have changed only slightly since the initial report, and the current version (Chambless et al., 1998) is presented in Table 1.(f.1)TABLE 1 Criteria for Empirically Supported Treatments Well-established Treatments I. …