Let us move ahead together: Commentary on "Empirically supported treatments in psychology: Implications for Canadian professional psychology."

Abstract

Given the general endorsement that Hunsley, Dobson, Johnston, and Mikail (this issue) provide of the efforts of the Society of Clinical Psychology (Division 12 of the American Psychological Association) to identify and to disseminate supported treatments (ESTs), it will be no surprise that I find much to admire in their discussion of the movement toward evidence-based practice in clinical psychology. Thus, my comments are not a critique of their views but rather a response intended to provide additional information and to establish grounds for future progress and collaboration, especially in the research arena.The APA Division 12 Task ForcesHunsley et al. begin with a concise history of the Division 12 efforts that takes us to the final publication of the Task Force chaired by Dianne Chambless (Chambless et al., 1998). Later pieces of history include:The expansion and integration of the Task Force on Psychological Interventions with a similar Task Force on Lifespan Interventions, promoting greater attention to treatment outcome research done with children and adolescents and with geriatric patients;The development of a subcommittee structure that should allow greater range to the work and opportunities to respond to the criticisms of both the practice and the scientific communities. We now have three subcommittees -- one focused on issues relevant to updating the list of ESTs, e.g., clarifying rules of evidence, examining methodologies for aggregating data; a second focused on scientific concerns, e.g., mechanisms of change in psychotherapy, indices of statistical and clinical significance; and a third focused on issues of dissemination to the multiple audiences that we hope to reach, e.g., the lay public, practitioners, research and health care policy-makers, and academic colleagues;A meeting in Pittsburgh in June 1998 that allowed discussion of issues in all three (subcommittee) areas and development of strategies for moving forward with this broader agenda; and broader agenda; andThe evolution of the Task Force into a standing committee, the Committee on Science and Practice (CSP), that was approved by the members of Division 12 in 1998.(f.1)Concerns with Terminology And ProcessWe take seriously the conceptual and rhetorical implications of our work. Thus, we have officially changed the vocabulary, now preferring the phrase, empirically supported treatments, rather than empirically validated treatments.We also take seriously the challenge of operationalizing more clearly the review procedures to be used in future iterations of the work and the rules of evidence that will be invoked, including rules about what constitutes sufficient empirical support. Therefore, we are struggling with issues of defining more explicitly (a) what constitutes the same versus a different treatment; (b) the elements of good enough experimental designs in studies to be included for review, including guidelines regarding minimum sample size, statistical power, maximum levels of attrition, use of effect sizes and other measures of clinical significance, evidence of continuing impact at follow-up evaluations, and similar issues; and (c) alternative hierarchies of strength of empirical support, perhaps to replace the two-category system (well established and probably efficacious) that currently exists.This effort is being led by John Weisz and Kristin Hawley at UCLA, who are producing increasingly comprehensive drafts of a coding manual that documents CSP decisions in these areas and that will provide a more reliable way for us (and others) to undertake reviews of the treatment outcome literature. Our general strategy has been to move more toward a meta-analytic approach to the research literature and to use less of a threshold approach, i.e., to document (at a minimum) two positive studies that exist to support the efficacy of a treatment. On a broader level, this strategy points to the need for reviewing general principles of meta-analytic work and for incorporating best practices from this area in order to ensure that the work of the CSP is on sound scientific footing. …