REPORTS OF THE ASSOCIATION
American Psychological Association
Policy in Context
The Development and Evaluation of Guidelines for Professional Practice
Geoffrey M. Reed, Christopher J. McLaughlin, and Russ Newman
American Psychological Association
Over the past two decades, a major trend in health care has
been the development and promulgation of guidelines for
the provision of a wide range of health care services by
health care professionals. Although professional organiza-
tions and other health care entities have long been devel-
oping and disseminating guidelines, the recent proliferation
is related to the emphasis on evidence-based medicine or,
more broadly, evidence-based practice. The underlying as-
sumptions of evidence-based practice in general and of
many guidelines in particular are that probabilistic studies
provide the best evidence of what works and that better
health outcomes will accrue from the direct application of
research findings by individual health care professionals
working with individual patients (Tannenbaum, 1994).
Some of the roots of the evidence-based practice discourse
can be traced to a report by Wennberg (1984), who found
substantial unexplained variation in the rates that similar
populations received specific medical procedures for given
health conditions. This and subsequent small area variation
studies were “widely interpreted to mean that physicians
were uncertain about the value of alternative treatments and
that their actions were consequently influenced by clini-
cally extraneous factors such as tradition and convenience”
(Tannenbaum, 1999, p. 758).
The growing managed care movement took up this
perspective with enthusiasm during the 1990s. Health care
professionals were portrayed as major causes of waste,
inefficiency, and escalating cost in the health care system,
which justified the transfer of control from physicians to
the health plan via a variety of supply-side initiatives.
Health care systems and health care plans pursued goals of
reducing practice variation and standardizing care, devel-
oping increasingly specific rules (standards, guidelines,
practice parameters, critical pathways, best practices, etc.)
for the provision of care, with professionals often cast as
interchangeable providers offering encounter-based as op-
posed to relationship-based services (Gutek, 1995) based
on an industrialized model of health care (Reed, McLaugh-
lin, & Milholland, 2000).
The emphasis on guidelines development also re-
ceived substantial federal support. Congress, concerned
December 2002 ● American Psychologist
Copyright 2002 by the American Psychological Association, Inc. 0003-066X/02/$5.00
Vol. 57, No. 12, 1041–1047 DOI: 10.1037//0003-066X.57.12.1041
with the continuing health care cost crisis, created the
Agency for Health Care Policy and Research (AHCPR) in
1989. A central aspect of AHCPR’s charge was the devel-
opment of practice guidelines, with the explicit goal of
changing the practice patterns of physicians and other
health care providers (AHCPR, 1993a). Throughout the
1990s, National Institutes of Health agencies, under con-
gressional pressure to demonstrate their practical contribu-
tion to U.S. health care, launched a series of “technology
transfer” initiatives to disseminate research-based treat-
ments to the field. These efforts were generally based on
the assumption that the major challenges in improving
health care and reducing health care costs included teach-
ing health care professionals to use research-based treat-
ments properly and developing appropriate clinical change
and outcomes assessment strategies to ensure that they
were doing so.
As viewed within American Psychological Associa-
tion (APA) policy, guidelines are “pronouncements, state-
ments, or declarations that suggest or recommend specific
professional behavior, endeavor, or conduct” (APA, 2002a,
p. 1052, this issue). A key feature of guidelines as they are
defined by APA is that they are aspirational in intent.
Guidelines differ from standards in that standards are man-
Geoffrey M. Reed, Christopher J. McLaughlin, and Russ Newman, Prac-
tice Directorate, American Psychological Association.
We are grateful to William C. Howell, former executive director of
the APA Science Directorate, for his collaboration in getting these efforts
started. We recognize the important contributions to APA’s developing
guidelines policy of the Board of Professional Affairs (BPA) and its
Committee for the Advancement of Professional Practice (COPPS). We
wish particularly to acknowledge the chairs of BPA over the past several
years—Deborah J. Tharinger, 1995; Melba J. T. Vasquez, 1996; Daniel J.
Abrahamson, 1997; Robert A. Brown, 1998; Ronald H. Rozensky, 1999;
Suzanne Bennett Johnson, 2000; Janet R. Matthews, 2001; and Sandra L.
Shullman, 2002—as well as the chairs of COPPS—Philip H. Witt, 1995;
Richard H. Reichbart, 1996; Catherine Acuff, 1997; Lisa R. Grossman,
1998; Steven B. Bisbing, 1999; Jean Lau Chin, 2000; Erica H. Wise,
2001; and Kristin A. Hancock, 2002—all of whom have been closely
involved in this work.
Correspondence concerning this article should be sent to Geoffrey M.
Reed, Practice Directorate, American Psychological Association, 750
First Street, NE, Washington, DC 20002-4242.
1041
datory and may be accompanied by an enforcement mech-
anism (APA, 1993). For example, the “Ethical Principles of
Psychologists and Code of Conduct” (APA, 2002c, this
issue) includes enforceable standards. In contrast, current
APA policy for practice guidelines (APA, 2002b, this is-
sue) requires that the guidelines note explicitly that they are
not intended to be mandatory, exhaustive, or definitive;
may not be applicable to every clinical situation; and are
not intended to take precedence over the judgment of
psychologists. APA’s official approach to guidelines
strongly emphasizes professional judgment in individual
patient encounters and is therefore at variance with that of
more ardent adherents to evidence-based practice.
Guidelines have also become among the most active
and controversial topics in APA policy development over
the past several years. APA policy requires that all APA
guidelines— even those to be promulgated solely in the
name of a division of APA— be approved by the APA
Council of Representatives. Guidelines documents have
been increasingly scrutinized in the APA policy process
because of increased practitioner sensitivity to mandates
and limitations as a result of their experience with managed
care and increased anxiety about the potential legal risk to
practitioners created by guidelines. This reaction has often
surprised those involved in the development of the guide-
lines that have been reviewed as potential APA policy, as
these individuals have generally been well-intentioned in
their efforts to support, educate, or protect practitioners
rather than controlling them or putting them at risk.
Several governance groups within APA have some
degree of oversight responsibility in the development and
monitoring of guidelines. The APA Board of Professional
Affairs (BPA) has primary responsibility for guidelines
intended to inform the provision of services by psycholo-
gists. BPA’s mission, as stated in the APA Bylaws, in-
cludes “developing recommendations for and monitoring
the implementation of APA policy, standards, and guide-
lines for the profession of psychology” (APA, 1999, p. 23).
The Board of Educational Affairs attends to the develop-
ment of education and training guidelines, including guide-
lines for accreditation, as an aspect of its responsibilities.
And the Board of Scientific Affairs regularly addresses the
need for and development of guidelines for various re-
search activities.
This article and the two accompanying policy docu-
ments focus on guidelines for professional practice and
related policy development in this area by BPA over the
past decade. BPA’s work in this area has been based on its
belief that the intention of guidelines should be to facilitate
the continued systematic development of the profession
and to support a high level of professional practice by
psychologists.
Treatment Guidelines
Within the domain of guidelines for professional practice,
APA policy distinguishes two types: treatment guidelines
and practice guidelines. Treatment guidelines are defined
as those that provide specific recommendations about treat-
ments to be offered to clients. Treatment guidelines are
1042
client directed or client focused, as opposed to practitioner
focused, and tend to be condition or treatment specific.
Outside APA, guidelines of this type are often referred to
as clinical practice guidelines, defined as systematically
developed statements to assist practitioner and patient de-
cisions about appropriate health care for specific clinical
circumstances (Field & Lohr, 1990). Treatment guidelines
typically have one of three targets: (a) primary prevention
of disease through population-based preventive interven-
tions (e.g., pediatric immunizations), (b) early detection of
a specific condition through population-based screening
(e.g., mammography), or (c) treatment of a specific disor-
der or condition after it has manifested (e.g., treatment of
depression in primary care settings).
Outside APA, a vast array of health care guidelines
have been promulgated by government agencies, profes-
sional societies, health systems, health plans, and managed
care companies. The National Guidelines Clearinghouse,
sponsored by the federal Agency for Healthcare Quality
and Research (AHQR; formerly AHCPR) in partnership
with the American Medical Association and the American
Association of Health Plans, listed in September 2002
approximately 900 treatment guidelines documents spon-
sored by over 200 organizations, including nearly 100
guidelines in behavioral health areas. This represents only
a portion of the guidelines that have been developed, be-
cause an approval process for inclusion in the clearing-
house involves assessment of the guidelines in relation to
specific criteria. Guidelines are also being removed from
the system when they are over five years old. We recom-
mend that anyone interested or concerned about develop-
ments in the area of guidelines take some time to examine
the contents of the clearinghouse on the World Wide Web
at http://www.guideline.gov.
There have long been advocates for the development
of treatment guidelines by APA. A part of the motivation
for this appears to be the desire to advance the cause of
psychological and behavioral interventions that appear to
be threatened by biomedically based guidelines being pro-
duced elsewhere. A decade ago, however, BPA—in col-
laboration with the Board of Scientific Affairs (BSA) and
the Committee for the Advancement of Professional Prac-
tice (CAPP)— decided that rather than providing yet an-
other competing set of guidelines, a better course of action
was to develop a policy basis for the systematic evaluation
of treatment guidelines. The goals of this policy were not
only to assist the practitioner in differentiating good from
bad guidelines but, perhaps more important, to provide a
systematic and APA-approved policy basis for protesting
against poor, unreasonable, unjustified, or biased treatment
guidelines being promulgated in the marketplace.
This joint effort of BPA, BSA, and CAPP resulted in
the Template for Developing Guidelines: Interventions for
Mental Disorders and Psychosocial Aspects of Physical
Disorders (APA, 1995b), approved by the APA Council of
Representatives in February 1995. This document stirred
considerable controversy, in part because it seemed to
privilege specific research methodologies for establishing
the effectiveness of treatments and in part because of the
December 2002 ● American Psychologist
general sensitivity among psychologists to the restrictions
being imposed on them by managed care. Some psychol-
ogists feared that the template appeared to encourage the
development of treatment guidelines that might be used to
disenfranchise certain forms of treatment and certain sec-
tors of the profession. In our view, many of these fears
were exaggerated on the basis of misperceptions and a
confusion of the template with other efforts related to
evidence-based practice. However, on the basis of these
concerns and experience with implementing the template,
BPA led a joint BPA/BSA/CAPP review and revision of
this document beginning in 1997.
As a part of this review and revision, Stricker, Abra-
hamson, Bologna, Hollon, Robinson, and Reed (1999) ex-
amined a selection of available treatment guidelines and
found wide variation in the quality of their coverage of the
relevant literature as well as the scientific and clinical basis,
specificity, and generalizability of their treatment recom-
mendations. This variability was partly explained by
whether the guidelines had been developed by government
agencies, professional societies, or health care entities such
as managed care organizations. Several of the guidelines
reviewed were developed by the AHCPR, described above
as one of the most active government agencies in this area.
Stricker and colleagues noted that AHCPR’s guidelines
were clearly designed to educate rather than to legislate,
were interdisciplinary in nature, and provided extensive
empirical and clinical information. At the same time, these
guidelines did not always accurately translate the evi-
dence they reviewed into the critical pathways or algo-
rithms recommended to guide patient flow and deter-
mine the protocol for treatment under particular sets of
circumstances.
For example, AHCPR’s guidelines on the detection
and treatment of depression in primary care were based on
an extensive and thorough review of relevant literature by
an interdisciplinary panel and provided a detailed descrip-
tion of the disorder and the available treatment options
(AHCPR, 1993b, 1993c, 1993d, 1993e). Despite the rec-
ognition in the literature review that psychotherapy is at
least as effective as pharmacotherapy in the treatment of
many (if not most) depressions and may be of longer
lasting and broader benefit, the treatment algorithms the
guidelines offered exhibited a serious biomedical bias that
was inconsistent with the available evidence. These algo-
rithms would lead most patients to be treated pharmaco-
logically, with referral for psychotherapy only after re-
peated failures with various medications (Munoz, Hollon,
McGrath, Rehm, & VandenBos, 1994).1
Stricker and colleagues (1999) noted that some of the
least specific guidelines they reviewed were those devel-
oped by commercial organizations seeking to control costs.
The National Committee for Quality Assurance (NCQA) is
a managed-care–funded accrediting body that has devel-
oped standards for the managed care industry. Among
these standards is the requirement that each managed care
organization adopt and disseminate guidelines “for the
provision of acute and chronic care services that are rele-
vant to its enrolled membership” (NCQA, 2000, p. 42),
December 2002 ● American Psychologist
which has obviously contributed to their proliferation.
However, Stricker et al. found that managed care guide-
lines were particularly likely to conflate evidence-based
treatment recommendations with issues related to cost and
utilization management. Further, the basis for determining
what type and duration of treatment is reimbursable was
often not specified in the guidelines. Stricker and col-
leagues acknowledged cost as a legitimate consideration in
selecting among effective alternative treatments but noted
that some guidelines appeared to bear little relationship to
the literature and seemed to be “attempts to implement
economic control by restricting clinical services in an ar-
bitrary fashion, under the cover of presumed scientific
justification” (Stricker et al., 1999, p. 71).
Another important source of treatment guidelines has
been professional organizations, these guidelines perhaps
representing an attempt to retain authority for health care
decision making. The most prominent of these efforts have
been those of medical societies. For example, the American
Psychiatric Association has developed and published 12
treatment guidelines and the American Academy of Pedi-
atrics has issued the same number. Stricker and colleagues
(1999) noted that guidelines promulgated by professional
associations were similar to those developed by govern-
ment associations in that they adopted an educative stance
rather than mandated professional behavior. However,
these guidelines were substantially less likely to be devel-
oped in an interdisciplinary fashion and could be exces-
sively influenced by professional turf issues and were
therefore particularly vulnerable to biomedical bias. Al-
though such guidelines generally make explicit the fact that
they are intended to apply only to members of the profes-
sion that developed them, they may have broader implica-
tions to the extent that they are used legally to establish a
standard of care and are adopted by health care systems
and health plans to apply to all health care professionals.
For example, as a means of meeting the aforementioned
NCQA requirement, the largest mental health managed
care organization has adopted the guidelines of the Amer-
ican Psychiatric Association, which strongly emphasize
1
It is relevant to the current discussion that in 1996, after producing
19 guidelines, AHCPR discontinued the development and revision of
guidelines. Instead, AHRQ now funds “evidence-based practice centers”
to develop “evidence reports”— comprehensive reviews of relevant liter-
ature in specific areas—with the idea that these reports may be used as a
basis for guidelines development efforts by other organizations. Over 60
of these reports have been generated on topics nominated through a public
process. Although guideline developers are free to come to their own
conclusions on the basis of the evidence provided in the report, significant
biomedical bias may be introduced into the report depending on the
criteria for inclusion of studies in a particular area. For example, many
psychosocial and behavioral interventions for attention-deficit/hyperactiv-
ity disorder (ADHD) are difficult or impossible to test using a double-
blind randomized controlled trials methodology (e.g., Pelham et al.,
1993). These studies were omitted from the initial draft of the AHCPR
evidence report on the treatment of ADHD prepared by the McMaster
University Evidence-Based Research Center (Jadad, Boyle, Cunningham,
Kim, & Schachar, 1999) because of the selection criteria used for inclu-
sion of studies in this report. This was eventually partly corrected in
response to comments received by AHRQ from Russ Newman.
1043
pharmacologic treatments (provided by psychiatrists) over
psychological and behavioral interventions.
The joint governance review and revision of the 1995
template resulted in the “Criteria for Evaluating Treatment
Guidelines” (APA, 2002a, this issue), which replaced the
template as APA policy on its approval by the Council of
Representatives in August 2000. The “Criteria for Evalu-
ating Treatment Guidelines” focuses on the evaluation
rather than the development of treatment guidelines and
provides a framework that health professionals can use to
determine the strength and clinical applicability of any
treatment-specific guideline. With this policy now in place,
APA has a consistent, authoritative basis for reviewing
treatment guidelines in an efficient and objective manner
and providing feedback to their developers. Recently, BPA
charged its Committee on Professional Practice and Stan-
dards to develop a checklist for use in applying the “Cri-
teria for Evaluating Treatment Guidelines” to a particular
guidelines document. This checklist is available online at
http://www.apa.org/practice/guidelines/treatcrit.html.
Practice Guidelines
A second type of guideline consists of recommendations to
professionals concerning their conduct and the issues to be
considered in particular areas of clinical practice. These
guidelines may focus either on general practitioner behav-
ior or on special considerations relevant to specific clinical
situations or specific populations. These guidelines do not
focus on recommendations for treatment of specific clinical
conditions. Current APA policy refers to these types of
recommendations as practice guidelines.
Various professional societies in health care areas use
different labels to refer to policies that offer guidance of
this sort to their members. However, most recognize that
offering such guidance is a legitimate function of profes-
sional associations, and most associations of health care
professionals have developed and approved policies offer-
ing recommendations for practice in their profession. In-
deed, professional associations are often seen as having a
unique standing and role in offering such professional
advice and consultation to their members (see Reed et al.,
2000).
Practice guidelines are generally based on expert and
professional consensus in the field about recommended
professional procedures in the targeted clinical area or with
a particular client population. They also are informed by
relevant scientific literature and may rely on empirical
evidence when it is available. They often are developed for
areas of practice in which there is some controversy or
question or in areas where health care practice comes into
contact with the judicial system, and in these cases they are
often informed by legal opinion.
Table 1 lists a number of practice guidelines ap-
proved by the APA Council of Representatives over the
past 30 years. Many of these were developed by BPA
through its Committee on Professional Practice and
Standards (COPPS).
An examination of Table 1 suggests that over the past
decade, in addition to the efforts of BPA and COPPS, there
1044
has been increasing interest on the part of divisions and
governance groups concerned with specific populations
(e.g., older adults; ethnic and linguistic minorities; lesbians,
gay men, and bisexuals) in developing guidelines to inform
and improve the treatment of these populations. At the
same time, divisions and groups identified with specialties
within psychology have exhibited a trend in interest in
developing guidelines for provision of services or for ed-
ucation and training in those areas. (Few guidelines in this
second category have yet been approved by the Council of
Representatives, and those that have been approved are not
considered practice guidelines and therefore do not appear
in Table 1.)
These developments began to raise concern among
some practitioner constituencies of APA. As the health care
system was in the midst of its embrace of treatment guide-
lines as described above and managed care was imposing
severe restrictions on treatment, some came to see APA-
developed practice guidelines as yet another form of ex-
ternal control over practitioners. Concerns were also raised
about the potential for practice guidelines to be used to
limit generalist practice, as well as their potential use in
litigation to impeach psychologist witnesses or to challenge
the behavior of practitioners.
BPA believed that practice guideline development
based on sound principles and APA policy would inform,
assist, and protect practitioners and their patients, but at the
same time recognized the importance of the concerns that
were being raised. BPA attempted to bring some concep-
tual order to the process of guideline development by
directing COPPS to develop the Criteria for Guideline
Development and Review (APA, 1995a), which was ap-
proved by the Council of Representatives in February
1995. This document established the APA policy that prac-
tice guidelines should not be created “as a means of estab-
lishing the identity of a particular group or specialty area
. . . nor should they be created with the purpose of exclud-
ing certain persons from practicing in a particular area”
(APA, 1995a, p. 2).
Several internal groups, including COPPS, relied on
the 1995 document to guide their development of practice
guidelines. BPA monitored these developments closely. A
particularly useful experience occurred in 1999, when BPA
had the chance to work extensively with one of these
groups, the drafting team for the “Guidelines for Psycho-
therapy with Lesbian, Gay, and Bisexual Clients,” which
was subsequently approved by the Council of Representa-
tives in February 2000 (APA Division 44/Committee on
Lesbian, Gay, and Bisexual Concerns Task Force on
Guidelines for Psychotherapy With Lesbian, Gay, and Bi-
sexual Clients, 2000). BPA learned from this experience
and its own ongoing evaluation that the 1995 document did
not provide sufficiently clear guidance to developers and
evaluators of practice guidelines and did not distinguish
sufficiently among guidelines of varying quality.
BPA asked COPPS to develop a revised policy that
would be conceptualized as a companion to the “Criteria
for Evaluating Treatment Guidelines” (APA, 2002a) and
would address specifically those policy issues relevant to
December 2002 ● American Psychologist
Table 1
Selected Practice Guidelines Approved by the American Psychological Association (APA) Council of
Representatives (Council)
Date of approval
Policy approved by Council by Council Primary group for development of policy Publication citation

“Guidelines for Psychologists
Conducting Growth
Groups”
“Guidelines for Therapy With
Women”
“General Guidelines for
Providers of Psychological
Services”
“Guidelines for Providers of
Psychological Services to
Ethnic, Linguistic, and
Culturally Diverse
Populations”
“Record Keeping Guidelines”
“Guidelines for Child Custody
Evaluations in Divorce
Proceedings”
“Guidelines for Psychological
Evaluations in Child
Protection Matters”
“Guidelines for the Evaluation
of Dementia and Age-
Related Cognitive Decline”
“Guidelines for Psychotherapy
With Lesbian, Gay, and
Bisexual Clients”
Guidelines for Test User
Qualifications
Guidelines on Multicultural
Education, Training,
Research, Practice, and
Organizational Change for
Psychologists
1973 Board of Professional Affairs (BPA)
1978 Task Force on Sex Bias and Sex
Role Stereotyping in
Psychotherapeutic Practice, BPA
1987 Committee on Professional
Standards, BPA
1990 Task Force on the Delivery of
Services to Ethnic Minority
Populations, Board of Ethnic
Minority Affairs
1993 Committee on Professional Practice
and Standards (COPPS), BPA
1994 COPPS, BPA
1998 COPPS, BPA
1998 APA Presidential Task Force on the
Assessment of Age-Consistent
Memory Decline and Dementia
2000 Joint task force of Division 44
(Society for the Psychological
Study of Lesbian, Gay, and
Bisexual Issues) and APA
Committee on Lesbian, Gay,
and Bisexual Concerns
2000 Board of Scientific Affairs, BPA,
Committee for the Advancement
of Professional Practice
2002 Joint task force of Division 17
(Counseling Psychology) and
Division 45 (Society for the
Psychological Study of Ethnic
Minority Issues)
APA, 1973
APA Task Force on Sex Bias and
Sex Role Stereotyping in
Psychotherapeutic Practice,
1978
APA Committee on Professional
Standards, 1987
APA Office of Ethnic Minority
Affairs, 1993
APA Committee on Professional
Practice and Standards, 1993
APA Committee on Professional
Practice and Standards, 1994
APA Committee on Professional
Practice and Standards, 1999
APA Presidential Task Force on
the Assessment of Age-
Consistent Memory Decline,
1998
APA Division 44/Committee on
Lesbian, Gay, & Bisexual
Concerns Task Force, 2000
Turner, DeMers, Fox, & Reed,
2001 (Executive summary)
Not yet published

the development and evaluation of practice guidelines.
After a two-year development and review process, the
Council of Representatives approved the new policy doc-
ument, “Criteria for Practice Guideline Development and
Evaluation” (APA, 2002b), in August 2001.
The “Criteria for Practice Guideline Development and
Evaluation” (APA, 2002b) addresses and more clearly em-
phasizes several of the concerns expressed by the practi-
tioner community. The document sets as APA policy that
guideline development should be undertaken on the basis
of a clear documentation of practitioner need or request for
guidance in a particular area of practice. The document
explicitly recognizes that practice guidelines have potential
legal uses. It is important to note that BPA does not view
this potential as an indication that practice guidelines
should not be developed. Rather, this potential highlights
the importance for guideline development to be based on
demonstrable practitioner and consumer need and for pol-
icy on practice guideline development to require guideline
language providing both sufficient flexibility for responsi-
ble clinical judgment as well as an emphasis on the aspi-
rational nature of the guidelines. It is equally important that

December 2002 ● American Psychologist 1045

practitioners understand how to respond when their behav-
ior is challenged on the basis of guidelines. As noted, the
“Criteria for Practice Guideline Development and Evalua-
tion” specifically recommends that every practice guideline
document state explicitly that the guidelines are not in-
tended to be mandatory, exhaustive, or definitive; may not
be applicable to every clinical situation; and are not in-
tended to take precedence over the judgment of psycholo-
gists. The policy also requires regular review of existing
and future practice guidelines so that the need for revision
of APA-approved guidelines can be assessed on an on-
going basis. A checklist for use by guideline developers
and evaluators in applying the “Criteria for Practice Guide-
line Development and Evaluation” was also developed,
which is available online at http://www.apa.org/practice/
guidelines/praccrit.html.
An examination of the guidelines listed in Table 1
makes very apparent that they were developed in an evolv-
ing policy context. Some guidelines, such as the 1973
“Guidelines for Psychologists Conducting Growth Groups”
(APA, 1973), may no longer be relevant, but no mechanism
has existed for the scheduled review, revision, or sunsetting
of outdated guidelines. Other guidelines are written in a
way that would no longer be recognized as consistent with
the requirements of current policies. The most recent
guidelines clearly correspond most closely to the charac-
teristics of practice guidelines described in this article and
in the “Criteria for Practice Guideline Development and
Evaluation” (APA, 2002b), as they were created in the
context of current policy development. APA policy is
likely to continue to evolve as the association gains more
experience with the usefulness and limitations of guidelines
documents.
Conclusion
APA policy development in the area of guidelines for
professional practice has been based on the evolving per-
spective of BPA over the past decade. Although APA has
chosen not to develop treatment guidelines, APA’s policy
as reflected in the “Criteria for Evaluating Treatment
Guidelines” (APA, 2002a) is based on the stance that
treatment guidelines can be relevant and useful in clinical
practice but should not be determinative. In particular,
guidelines based exclusively on the theoretical and meth-
odological perspectives of narrow efficacy studies are un-
likely to be relevant to practitioners in real-world practice
and are unlikely to be used. The “Criteria for Evaluating
Treatment Guidelines” conveys substantial respect for clin-
ical judgment and expertise and for the number and com-
plexity of factors that may affect the applicability of a
particular intervention in any specific clinical circum-
stance. APA policy related to practice guidelines, as artic-
ulated in the “Criteria for Practice Guideline Development
and Evaluation” (APA, 2002b), is based on the perspective
that practice guidelines have a useful purpose for practi-
tioners when they are developed in response to a recog-
nized need in the field and that APA is the most appropriate
and reputable organization to develop such recommenda-
tions for psychologists.
1046
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