The science and practice of empirically supported treatments.

Abstract

As we described previously (Hunsley, Dobson, Johnston, & Mikail, this issue), the matter of empirically supported treatments (ESTs) has evoked many strong, sometimes negative, reactions from psychologists. We were, therefore, pleased to see that the commentators viewed the debate around ESTs as important and were supportive of professional psychology moving ahead with basing training and services on the appropriate and informed use of ESTs. We also appreciate the clear commitment expressed by all commentators to furthering the development of a scientific clinical psychology.Chambless (this issue) and Pilkonis (this issue) provided useful information on recent EST-related developments in the United States. The ongoing developments within the APA Division 12 Committee on Science and Practice and the expansion of funding for effectiveness and health service research by the National Institute of Mental Health (NIMH, 1998) augur well for the advancement of evidence-based psychological practice. As noted by Evans (this issue), there is much to be done to firmly establish the scientific basis of psychological practice. Moves by the Committee on Science and Practice to attend more to diversity and life-span considerations, as well as to aptitude-treatment interactions (i.e., what treatments for which clients?), should do much to ensure that EST listings are both comprehensive and valuable to practitioners.Before further exploring some elements of the EST debate in Canada, we would first like to underscore a perspective that is interwoven with efforts to develop evidence-based practices in psychology. Consistent with Morin's (this issue) comments, we view the current emphases in the Canadian health care system on accountability and evidence-based practice as providing an unparalleled opportunity for professional psychology to deliver on its birthright. Canadian professional psychology, both at the level of university training and provincial/territorial credentialing, has consistently required that psychologists (i) be trained in the science of psychology, (ii) maintain their knowledge of the scientific basis of the profession, and (iii) base their clinical activities on this scientific knowledge. It is an ethical requirement that Canadian psychologists keep informed of relevant knowledge and progress in their areas of psychological activity in order to provide services that are most likely to benefit clients (CPA, 1991). The requirement that health services be based on sound scientific evidence should, therefore, not only pose no threat to the practices of psychologists, it should be warmly embraced by psychologists. For many years, psychologists have been recognized as valuable health care professionals by virtue of their scientific training; now is the time for professional psychology to make good on the claim that we provide health services that are based on scientific evidence and principles.Generalizability of American experience to CanadaIs the Division 12 initiative relevant to the Canadian health care system? After all, the EST initiative was largely conceived as a way to ensure that organized psychology had a strong voice in determining what psychological services should be eligible for reimbursement under a system of managed health care (Beutler, 1998). Although a focus on this issue begs the question of why evidence-based practice shouldn't be expected of Canadian psychologists when it is expected of other Canadian health care providers, the issue of the relevance of ESTs to Canadian professional psychology is still pertinent.To address the comparability of psychology in the two health care systems, one must first recognize that, both historically and currently, psychological services in Canada are provided through a mix of public and private funding (King, this issue; Ritchie & Edwards, 1998). The concept of a single-tier health system has never applied to psychological services and, although allowed under the Canada Health Act, no province or territory has included psychological services within the coverage of medicare plans. …