The curse of exciting times: Current challenges within the field of clinical behavior analysis.

Abstract

There is an old Chinese curse that says you live in exciting and we as clinical psychologists are certainly living in exciting times these days. Most of us are aware of the increasing pressure community-based clinical psychologists are experiencing, although we are not necessarily sensitive to the impact this pressure is having on those practitioners or on our field. In large part, many of the changes and challenges we are facing are byproducts of the increasing financial limitations and time restrictions being place on community-based clinical psychologists and it has become apparent that there are a number of changes ahead that will greatly impact the field as we know it. Clinical behavior analysis has much to contribute to the field. On a fundamental level, we have the strength of an empirically grounded theory and a lengthy history of research demonstrating effective clinical work. Additionally, our historical roots in pragmatism allow for the adaptation and integration of techniques from other branches of clinical psychology, not traditionally seen as behavioral. We will need to be aware of the current context, however, if we are to effectively participate in the transition clinical psychology is undergoing. In addition, there are number of obstacles which make it difficult for CBA to be a part of this process; some of the variables controlling these trends are in our hands. First there is our isolation from other branches of psychology. We need to spend more time talking to clinical psychologists from alternative theoretical orientations. This is true for both academic psychologists and clinical behavior analysts. I work in a department of anesthesiology, a somewhat unusual setting for a clinical psychologists, and my various roles in the medical school are such that I have a foot in the clinical camp and a foot in the ivory towers of academia. In trying to balance these contingencies, it has become apparent to me that there is a schism between what academic clinicians are doing and what community-based clinicians are doing. If that schism grows, we may find that community-based clinical psychologists will pay less and less attention to the research we produce. There is already a general attitude ex- pressed by many of the clinical psychologists I encounter that much of what we do as researchers is not relevant to what they do as clinicians. It is vital that we attend to this issue. On a more practical level, we as clinical behavior analysts need to participate in dialogues with other clinicians if we want to play a role in the changes psychology is already undergoing. As CBA is largely performed by academic psychologists at this point, we don't often consider our role in the economic marketplace. Since the marketplace is largely oriented toward cognitive-behavioral therapy, it is wise for us to plan specifically how CBA will fit into the future marketplace. This has implications for attracting future behavior analysts into the field. Although applied behavior analysis has been highly successful in our work with the developmentally disabled and in closed communities/hospital settings, many have been reluctant to move into settings in which our influence over the functional contingencies is more limited and relies heavily on verbal and rule-governed behavior. Despite pioneering early work in the outpatient arena by Kanfer and Saslow (1965, 1966), Ferster (1973), Krasner (1978, 1988), and Rachlin (1988), the role of functional analysis in the outpatient treatment session and a more molar view of a client's life were largely unexplored. The more traditional treatment areas for behavior analysts do not represent the typical setting in which most clinical psychologists practice and when these behavioral treatments appear, they are similar to cognitive treatments (e. …