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Clinical Science Model 2015 PDF
Clinical Science Model 2015 PDF
The Encyclopedia of Clinical Psychology, First Edition. Edited by Robin L. Cautin and Scott O. Lilienfeld.
© 2015 John Wiley & Sons, Inc. Published 2015 by John Wiley & Sons, Inc.
DOI: 10.1002/9781118625392.wbecp458
2 CLINICAL SCIENCE MODEL
advance knowledge about the origins, nature, Finally, if the model’s advocates are correct
assessment, amelioration, and prevention of in their belief that the scientific epistemology
mental and behavioral health problems. This offers the surest path to advancing knowledge
epistemology also offers the best framework and to improving clinical services, then it
for developing, evaluating, delivering, and dis- follows logically that this epistemology should
seminating the safest and most cost-effective be the centerpiece of all education and training
clinical services. Moreover, it provides the for future generations of clinical psychologists.
essential foundation for rigorous, high-quality, The goal should be to produce a cadre of
education and training in clinical psychology. integrative clinical scientists, all of whom have
The CS model’s advocates believe that a the knowledge and skills to function both as
scientific epistemology offers a systematic, basic and applied researchers, on the one hand,
disciplined, rational, quantitative, and self- and as independent providers and overseers
correcting method of seeking valid answers of clinical services, on the other hand. This
to some of life’s most difficult questions. This ability to bridge and integrate across domains
discovery process is central to the CS model. and roles allows them to contribute to the
Science is not a set of facts or answers. It is advancement of knowledge regarding mental
a framework by which to expand knowledge and behavioral health even as they are able to
incrementally, an unfolding pathway that yields deliver, disseminate, supervise, and administer
successive approximations to “truth.” Thus, the most cost-effective, empirically supported
a science-centered search for knowledge is a mental and behavioral health-care services.
means to an end, and should not be confused The CS model’s advocates justify their com-
with the end itself. It is a mistake, therefore, mitment to the scientific epistemology by
to equate the scientific epistemology with pointing to the promise they see in the his-
specific answers to specific questions, or to torical record of scientific achievements. They
criticize it for having failed thus far to solve believe science has proven itself—across a wide
specific problems or for reporting findings that range of problem areas and disciplines—to
subsequently are overturned by later findings. be the most productive and reliable of all
The model’s advocates also believe that a sci- approaches to seeking “truth.” It repeatedly
entific epistemology offers the best framework has yielded fruitful, often unexpected, and
for comparing, evaluating, and improving the amazingly effective and enduring solutions to
validity and utility of clinical assessments, as previously intractable theoretical and practical
well as the efficacy and effectiveness of clin- problems. The CS model’s advocates believe
ical interventions. Science has no monopoly that an uncompromising commitment to a
on good ideas, so the creative ideas behind scientific epistemology will be as fruitful and
beneficial for the field of clinical psychology as
clinical procedures can come from anywhere,
it has been for so many other fields of inquiry.
including research evidence, clinical expe-
Of course, the full payoff remains to be seen,
rience, intuition, and inspiration. However,
but proponents believe that no alternative
proponents of the CS model believe that the
epistemology can match science’s record; that
scientific method, with its strong inference
there is no better epistemic choice; and that
approach to choosing among plausible rival
science’s contributions to clinical psychology
ideas and claims, offers the most rigorously
have been very encouraging thus far.
systematic, valid, and productive way to sep-
arate the wheat from the chaff. Through its
Evolution of the CS Model
well-established quantitative and qualitative
methods of hypothesis testing and refinement, For the first 30 years following clinical psy-
it represents a programmatic, incremental way chology’s official birth, in the late 1940s, the
to pursue “truth.” field’s only recognized conceptual model was
CLINICAL SCIENCE MODEL 3
the number of students enrolled in such pro- evidence-based practitioners had formed a
grams, had grown to the point that over half society devoted to promoting clinical psy-
of all doctoral students in clinical psychology chology as a scientific discipline. Initially this
were being trained in scholar–practitioner society was called “Section III of Division
programs. Moreover, some of these programs 12 of the American Psychological Associa-
had started offering a PhD, even though tion: Section for the Development of Clinical
their research training differed substantially Psychology as an Experimental/Behavioral
from that offered by scientist–practitioner Science.” The society reorganized in 1990 with
programs. Clearly, the field had undergone a new name, “Society for a Science of Clinical
a significant change: research training, with Psychology” (Oltmanns & Krasner, 1993).
its scientific epistemology, no longer was the By 1994, many researchers, practitioners, and
common core of all clinical psychology. Many academics felt the need for a more substan-
in the scientist–practitioner camp viewed this tial reform effort on behalf of psychological
change as an alarming sign of the erosion of clinical science. They were distressed, in par-
clinical psychology’s scientific foundations. ticular, by what they perceived to be growing
Largely in response to this change, a third tensions between good scientific training,
model emerged in the 1990s—the clinical on one hand, and the requirements doctoral
science model. In many respects, the CS model programs must satisfy to receive professional
is not really new; it essentially represents accreditation. With support from NIMH and
a reaffirmation of the idealized, integra- the Association for Psychological Science, a
tive, science-centered version of the original representative group of 24 educators from
scientist–practitioner model. Proponents leading science-centered doctoral programs
of the CS model are not opposed to the met to discuss the future of clinical psychology
scientist–practitioner model, but encourage in the twenty-first century. This conference
like-minded clinical scientists to join them, led to the founding in 1995 of the Academy
under the CS banner, in calling for a renewed of Psychological Clinical Science (APCS),
commitment to a scientific epistemology, which now has over 60 members, comprising
along with the requirements that all clinical doctoral programs as well as clinical internship
psychologists must be trained both as scientists programs. All APCS members had subscribed
and as practitioners; that this training must to the scientist–practitioner model, but were
be integrated and reciprocally reinforcing, attracted to the emerging CS model, seeing
with clinical problems shaping the research it as a contemporary interpretation of the
questions, and with research evidence being scientist–practitioner model initially envi-
translated into improved clinical procedures; sioned by the scientist faction at the birth
and that clinical practitioners bear an ethical of clinical psychology in the 1940s. Within
responsibility to be held accountable for the APCS, the CS model is viewed as a way
validity of their claims and promises, and for of identifying and promoting the strongest
ensuring the cost-effectiveness of their services. possible science-centered approach to clin-
Essentially, the proponents of the emergent ical psychology—in research, service, and
CS model insist that science be restored to education.
what they believe is its rightful place as the The CS model’s advocates believe that the
centerpiece for all of clinical psychology—in 1940s vision of building a science-centered dis-
research, service, and education. cipline is a realistic possibility today, thanks to
From the field’s beginning, scientific clin- decades of basic and applied research into the
ical psychologists had argued for a stronger causes, assessment, treatment, and prevention
science-centered and unified interpretation of mental and behavioral problems. They argue
of the scientist–practitioner model. In the that psychological science has built a solid
1960s, for example, academic researchers and foundation that can unite science and practice,
CLINICAL SCIENCE MODEL 5
students acquire the core knowledge and skills an expert at everything; to be ethical, clini-
that define the domain of clinical psychol- cians must practice within the bounds of their
ogy (i.e., psychopathology and adaptation; expertise. And because the CS model obligates
assessment, measurement, and evaluation; clinicians to choose the most cost-effective
intervention and prevention; research meth- services, this also means that if research shows
ods, design, and quantitative methods). But that masters- or bachelor-level providers are
the model does not specify how these must be as effective as doctoral-level psychologists at
taught. Nor does it require that all graduates delivering a particular service, and can do
fit the same mold, or that they must be experts this at a lower cost, and then doctoral-level
at everything. The CS model simply promotes psychologists should defer to these more
a set of abstract principles, values, goals, and cost-effective providers. The CS model is not
standards for CS training. Within these broad intended to protect guild interests or to pro-
constraints, it offers flexibility, encouraging mote clinical psychologists into privileged
individual programs to experiment, to develop positions within the health-care system. The
the best educational program possible, taking CS model’s mission is to promote psycho-
into account the local circumstances, available logical science in the interest of advancing
resources, scientific expertise of the faculty, knowledge, improving health care, and serving
and research interests and aptitudes of the the public.
individual students.
The CS model takes a similar approach Criticisms of the CS Model
toward clinical practice, promoting abstract
principles, values, goals, and standards for The CS model’s lofty aspirations impose high
optimal clinical practice, but within these standards on clinical psychologists in all they
constraints, not requiring adherence to any do—in research, in application, and in edu-
list of specific assessment methods, diagnostic cation. These requirements, with their call for
systems, or intervention techniques. Again, accountability and their challenging implica-
as with course content or training techniques, tions, are a distinguishing feature of the CS
these are expected to change over time as our model, and are part of the model’s appeal to
scientific knowledge advances. Rather than many psychologists. Not surprisingly, however,
prescribing specific procedures, the CS model the model also has stirred criticisms among
simply requires that practitioners choose their some clinical psychologists (e.g., Wampold,
procedures based on the best available research 2001; Westen, Novotny, & Thompson-Brenner,
evidence. This evidence should lead practi- 2004). Space does not permit the coverage of all
tioners to reach a general consensus regarding such criticisms, but some prominent examples
the most promising procedures, at any given will give a flavor of the objections to the CS
point in time, and this naturally would lead model:
them to converge on a limited set of proce- Most clinical psychologists agree that the
dures. But the model would not be dictating scientific method—with its skeptical hypoth-
the use of these specific procedures per se; esis testing, reliance on controlled research,
rather, it would be dictating the process and and insistence on a critical and dispassionate
standards by which the procedures are chosen. quantitative analysis of evidence—is the best
This is consistent with the model’s scientific way to advance basic knowledge. At the same
epistemology. time, however, a number of clinical psycholo-
The model also requires practitioners to offer gists are skeptical about the contributions that
and deliver empirically supported procedures the scientific method and the results from con-
themselves only if they personally are qualified trolled scientific research can make to applied
and competent to use them. No one can be questions and to clinical practice. They worry
8 CLINICAL SCIENCE MODEL
that the model’s extensive research focus must The CS model has also been criticized for
be to the detriment of more applied activities. requiring that pedagogic content and methods
Some critics have claimed that the model’s be based on scientific evidence, rather than on
uncompromising commitment to the sci- personal preferences or commonly accepted
entific epistemology imposes unreasonable, traditions; that educators stay abreast of the
unrealistic, and counterproductive constraints literature and modify their practices as the
on clinical psychologists. For example, CS evidence changes; that faculty mentors model
advocates have been criticized for granting the integration of research and clinical practice
unwarranted preferential status to certain for their students; and that programs accept
“empirically supported” treatments, although a major share of the responsibility for the
numerous studies using randomized control achievements, competencies, and career out-
designs, with large and carefully selected sam- comes of their students and graduates. These
ples and with meticulous measurement of critics argue that such requirements impinge
outcomes, have shown clear treatment dif- on academic freedom. Proponents of the CS
ferences for a wide variety of specific clinical model not only believe that such account-
problems. These critics also have argued that ability to empirical methods and evidence is
limiting clinicians’ choices of intervention pro- reasonable; they also believe it is essential to
cedures to those with solid empirical support the integrity and future of the field.
from scientific research precludes consider- Perhaps the most common criticism to con-
ation of other factors believed to be critical front advocates of the CS model involves its
to clinical success, such as personal clinical approach to doctoral training. Specifically,
experience and judgment, commonly accepted critics argue that doctoral training in CS
standards of practice, client culture, training focuses too narrowly on preparing students
history, and nonspecific factors. This view has for careers as research scientists, and thus
received support from the American Psycho- does not prepare them adequately to accept
logical Association Presidential Task Force on independent responsibility for the delivery
Evidence-Based Practice (APA Presidential of clinical services. Clinical scientists see
Task Force on Evidence-Based Practice, 2006), this criticism as a misguided reflection of
which recommended that clinical psycholo- the outdated notion that clinical psycholo-
gists base their practice equally on research gists must make a dichotomous career choice
evidence, clinical experience, and considera- between research science and clinical prac-
tion of client culture. Clinical scientists have tice. Clinical scientists believe that first-rate
responded by noting that the CS model does science training and first-rate application
not rule out consideration of any factors a training are essential to the kinds of roles
priori; it simply asserts that empirical evidence that clinical psychologists will be expected
from controlled research must be the gold to fill in the future. In fact, the goal of doc-
standard for evaluating all claims about the toral training in CS programs is to integrate
value and relevance of any particular factor, the research and applied training so thor-
such as clinical experience or client culture. oughly that all graduates are highly competent
If the research evidence supports the claimed and qualified not only to engage in scien-
value of a given factor, then this factor should tific research but also to deliver the most
be considered when making clinical decisions; cost-effective psychological services. These
otherwise, it should not. In the absence of training goals are articulated explicitly in
such an empirically based criterion for judg- the accreditation criteria of the Psycholog-
ing the legitimacy of claims, all claims would ical Clinical Science Accreditation System
have an equal standing, no claims could be (www.pcsas.org).
discounted, and there could be no progress In sum, proponents of the CS model encour-
toward “truth.” age all clinical psychologists to adopt the CS
CLINICAL SCIENCE MODEL 9