This article discusses the lack of empirical evidence supporting current psychology training standards. It reviews research on the effects of clinical experience, supervision, coursework and research completion requirements. The research provides little evidence that these standards improve psychotherapy outcomes for future clients of psychology students. The article calls for psychology accreditation agencies to apply scientific principles and require empirical evidence that training standards benefit clients before mandating costly requirements. It proposes randomized studies comparing outcomes for students receiving different aspects of training could provide needed evidence about the efficacy of current standards.
The need for empirically supported psychology training standards (psychotherapy in australia malouff 2012)
1. PEER REVIEWED
The need for empirically supported
psychology training standards
J O H N M A L O U F F
The scientific method makes many important contributions to society. It is on this basis that
psychology training standards require universities to teach empirically supported psychotherapy
methods to students. A logical extension of this premise is to apply the scientific method to
the standards themselves. This article describes the need for empirically supported psychology
training standards supported by well-designed studies which can demonstrate that individuals
who receive training based on specific standards are more effective in their subsequent work
than individuals who do not receive the training. Relevant studies published so far do not support
the efficacy of current psychology standards. Future studies could use a variety of research
designs to evaluate specific training standards. The conclusions of this study extend to training
standards in the fields of psychotherapy and counselling.
I n general, national psychology-
training accreditation agencies
require universities to provide
is more effective than a placebo, that
multiple sources of data show the
effects, that the advantage is a lasting
& McLeod, 2008), based on concerns
about the large financial and other
costs imposed on universities and
psychology students with training in one, and that this advantage has been psychology students by current training
empirically supported psychotherapy found by multiple research groups standards (Michael, Huelsman, &
methods. This is true in Australia (Chambless & Hollon, 1998). Crowley, 2005). Hans Eysenck (1952)
(Australian Psychology Accreditation Psychology accrediting agencies threw down a similar challenge when
Council, 2010) and in the United States typically do not justify in their training he famously challenged researchers to
(American Psychological Association standards the reason for requiring test whether psychotherapy had any
Commission on Accreditation, 2009). training in empirically supported value. Thousands of researchers took
Although this article focuses on treatment, but a basis can be found in up the call and collected a wealth of
the training of psychologists, the many important successes of the supporting data (Lambert & Ogles,
accreditation agencies for the training scientific method in psychology and in 2004). To apply these standards to
of psychotherapists and counsellors many other fields of science. It would the training requirements imposed
likewise require training programs be logical to suggest that psychology by accreditation agencies, one would
to provide training in empirically training standards also should be based say that empirically supported
supported psychotherapy methods (e.g., on published data. They are not. requirements ought to have evidence,
British Association for Counselling At some point, psychology from multiple research groups, that the
and Psychotherapy (BACP), 2009; accrediting agencies must start to requirements lead to better outcomes
Psychotherapy and Counselling apply the scientific method to their in the clients of students who were
Federation of Australia, 2012). own professional decision making, trained in programs that meet the
The minimal empirical support for just as they encourage psychology requirements.
psychotherapy methods typically students to base decisions on evidence. Is there published evidence of
includes evidence that the treatment Psychologists have issued calls for the efficacy of psychology training
is more effective than no treatment. the collection of evidence about the standards? The search for empirical
At higher levels, empirical support effects of psychology training (Carey, support of specific training standards
includes evidence that the treatment Rickwood, & Baker, 2009; Gonsalvez begins with identification of the goals
28 PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012
3. Lutz, Leon, Martinovich, Lyons, & no research findings to show that of quality psychotherapy. However,
Stiles, 2007). Those findings suggest student supervision leads to better there is no evidence that any of this
that factors that affect therapists, client outcomes. Milne and James coursework leads to better outcomes for
possibly including training standards, (2000) concluded that their review of future clients of the students.
could have at best a modest effect on studies showed that clients benefitted
Research completion
client outcomes. from 'cognitive-behavioral' therapist
The next matter to address is to supervision, but the studies they cited Research completion has not been
what extent specific training standards did not support that conclusion. For examined with regard to whether
have evidence of efficacy for client instance, Parsons and Reid (1995), it contributes to more effective
psychotherapy outcomes. Is it necessary cited as showing that supervision treatment by students, perhaps because
to show that fifty hours of supervision benefitted clients, did not evaluate no one thinks that it would. This
is better than thirty hours? Probably clients. One recent study (Bambling, requirement may be an anachronism
not. It would be beneficial, however, King, Raue, Schweitzer, & Lambert, left from bygone days when earning
to show that costly, time-consuming 2006) found that supervision directed a degree beyond undergraduate
aspects of the training standards lead at developing a working alliance was supposed to make a person a
to better client outcomes. These aspects
include clinical experience, supervision,
coursework, and research completion.
There appears to be no evidence to suggest
Experience that coursework and research completion,
If one views psychotherapy as a
skill, psychotherapy experience seems
which make up a great deal of required
likely to be beneficial for improving
client outcomes. However, amount
psychology training, have any value to future
of professional experience usually
does not correlate significantly with
psychotherapy clients of the students.
client therapy outcomes, according
to a careful review (Christensen & with the client led to better outcomes scholar, or it may be an application
Jacobson, 1994) and subsequent studies with depression clients during of the scientist-practitioner model of
(Franklin, Abramowitz, Furr, Kalsy, the supervision, but there was no training psychologists. One might
& Riggs, 2003; Kolko, Brent, Baugher, examination of whether the effects argue that there is nothing wrong
Bridge, & Birmaher, 2000; Michael, lasted beyond the time of supervision. with training standards that serve
Huelsman, & Crowley, 2005; Vocisano, This promising finding has not been purposes other than the well-being
Klein, Arnow, Rivera, Blalock, & followed by anything similar. To of future psychotherapy clients of the
Rothbaum, 2004), although it is warrant the requirement of supervised students. This is true as long as the
possible to find studies that show an experience, one would want evidence overall training serves the well-being
association (Beutler et al., 2004), and from multiple research groups that of those clients. Because there is so
one older meta-analysis found a small compare students in training receiving little evidence of that, it would be
but significant correlation between the typical levels of supervision versus less prudent for accrediting agencies to
level of therapist experience and client supervision, with regard to their client focus on standards that have empirical
outcomes (r = .11; Stein & Lambert, outcomes after completion of training. support for their benefit to consumers
1984). The meta-analyses which of psychological services.
show that paraprofessionals, who had Coursework
Relevant research methods
virtually no psychotherapy experience, The requirement of specific training
and possible studies
had outcomes at least as good as those coursework seemingly would contribute
of professional psychologists (Berman to psychotherapy client outcomes. The best evaluation of the value
& Norton, 1985; Durlak, 1979; Hattie However, much of the required of training standards would involve
et al., 1984; Weisz et al., 1987, 1995) coursework in psychology programs has assigning psychotherapists randomly
suggest the possibility that professional nothing directly to do with treatment. to receive some required aspect of
experience has no effect. Instead, it tends to focus on statistics, accredited training, or not, and
psychopharmacology, and other topics then assessing their success with
Supervision randomly assigned clients. These
with, at most, slight connections to
Psychologists tend to view helping others overcome psychological studies would be especially valuable
supervision aspects of their training problems. Parts of training typically if they use validated measures to
as helpful (Orlinsky, Botermans, relate to psychological testing. collect outcome information from
& Ronnestad, 2001). However, the Whether that has value to clients is multiple sources, such as clients
outcome evidence regarding the value beyond the scope of this paper. Parts and observers (Chambless, 2001).
of clinical supervision is limited. of coursework, such as those focusing Intention-to-treat analyses can help
Holloway and Neufeldt (1995) on psychotherapy methods, seem to balance any differences between
concluded that there are virtually have direct relevance to the provision therapists in client drop-out rates
30 PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012
4. (see Atkins & Christensen, 2001). Conclusion available. This review presents several
These studies could assign students This review has focused on methods of data collection for the
randomly to some aspect of required whether there is empirical support evaluation of training standards.
training or not, keep everything else for psychology training standards One might make the argument that
the same for both groups, and then in helping psychologists produce present training standards are based
compare therapy client outcomes. positive treatment outcomes for their on the best available evidence, but
For instance, researchers could assign psychotherapy clients. There appears the standards appear to be based on
students randomly to 10 training cases to be no evidence to suggest that supposition rather than on evidence.
with supervision or 0 training cases coursework and research completion, Acting on the basis of evidence, rather
with supervision and then compare which make up a great deal of required than educated guesses helps a society
outcomes in subsequent clients treated psychology training, have any value make progress.
by the students. The study would to future psychotherapy clients of References
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AUTHOR NOTES
JOHN MALOUFF, Ph.D., is Associate Professor of Psychology in the School of Behavioural, Cognitive
and Social Sciences at the University of New England. His research interests include evaluating
the efficacy of: methods of coping with stressors; types of psychotherapy; self-help materials for
psychological problems; and, methods used to increase adherence to recommendations of health
professionals. He also has an interest in researching methods for running organisational meetings and
how to improve romantic relationships.
Comments: jmalouff@une.edu.au
32 PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012