Task force on promotion and dissemination

TASK FORCE ON PROMOTION AND DISSEMINATION OF PSYCHOLOGICAL PROCEDURES
A Report Adopted by the Division 12 Board - October 1993
At the request of David Barlow, President of Division 12, and under the aegis of Section III, this task force was constituted to consider methods for educating clinical psychologists, third party payors, and the public about effective psychotherapies. Lacking theenormous promotional budgets and sales staff of pharmaceutical companies, clinical psychologists labor at a disadvantage to disseminate important findings about innovations in psychological procedures. Despite the great strides in the development and validation of effective treatments, it is not clear that the benefit of our approaches is widely appreciated, even by other clinical psychologists. Webelieve that if the public is to benefit from the availability of effective psychotherapies, and, if clinical psychology is to survive in this heyday of biological psychiatry, APA must act to emphasize the strength of what we have to offer -a variety of psychotherapies of proven efficacy. We suggest that psychologists hold an advantage in being the primary scientists in the psychotherapy field. Giventhe limited resources at APA's disposal, we should lead with our strength and spotlight our achievements in databased psychological interventions. Composed of clinical psychologists in psychology departments, medical schools, and private practice, along with experts in knowledge exchange, this task force considered the following issues: training for students at the predoctoral and internship leveland for practitioners, and promotion of psychological interventions to third party payors and the public. Task force members included representatives from a number of theoretical perspectives -- psychodynamic, interpersonal, and cognitive-behavioral -- to emphasize our commitment to promotion of all psychotherapies of proven worth, rather than those from any one school. A preliminary version ofthis report was presented at the APA meeting in Toronto to obtain member feedback. The revised report follows. The revised report and its recommendations were adopted by the Division 12 Board of Directors at its October 1993 meeting. Each section contains recommendations for APA action. I. Defining Empirically Validated Treatment Although there is a vast literature on the efficacy of differentpsychotherapy approaches, not all of the literature bears on current conclusions about treatment efficacy. The well-known meta-analysis of Smith, Glass, and Miller (1980), for example, convinced many that substantial evidence demonstrated the efficacy of psychosocial treatments. However, despite the 475 studies reviewed in the metaanalysis, several factors weighed against changing training based uponthe evidence. For one, the bulk of the studies reviewed by Smith et al. were conducted with subjects not seeking treatment for clinical problems (Andrews & Harvey, 1981). Although some of these studies did focus on clinical problems, the review predated the 1980 arrival of DSM-III, which represented a major advance in the reliable categorization of clinical disorders. Finally, and perhaps mostimportant, the studies in the Smith et al. review predated the standardization of treatments in research studies through the use of treatment manuals. With the exception of some highly specific behavioral treatments which were probably described in sufficient detail to permit replication of studies and to allow for adequate training of therapists, the Beck, Rush, Shaw, and Emery (1979) volume markedthe beginning of the availability of a treatment manual for a major treatment approach with a specific patient problem. Since that time, treatment manuals have become a required element of psychosocial treatment research (Luborsky & DeRubeis, 1984). Evidence that treatment manuals successfully standardize treatment has been accumulating (Crits-Christoph et al., 1991). Such standardization and...