Split Personality  

Cynthia McLoughlin

Division 32 (Humanistic Psychology) of the American Psychological Association, disturbed by the prospect that all clinical psychologists might be held to the view of psychology represented by the EST movement, responded by drafting its own version of practice guidelines, emphasizing the differences in philosophy that make their brand of psychotherapy incompatible with the model promulgated by EST advocates.

Background of the EST Movement

Advocates of Empirically Supported Treatment argue that (1) clinical psychologists are scientists, (2) psychotherapy is based on scientific theory, (3) science demands empirical validation of theory, and (4) therefore no form of psychotherapy that is not supported by empirical “proof” of its effectiveness should be countenanced.

We would be shocked to learn, they argue, that physicians were conducting experimental treatments without the consent of their patients, or that the Food and Drug Administration was approving medicines without proof of their effectiveness or knowledge of their possibly undesirable side effects. Just so, we should be shocked that the public has had no way of determining what is and is not effective psychotherapy and that the APA and other professional organizations do nothing to ensure that the public is protected from practitioners of what are, at best, experimental treatments of mental disorder.

The strongest advocates of EST within the American Psychological Association (APA) come from the Society for a Science of Clinical Psychology (or SSCP—Section III of Division 12—Clinical Psychology), which was formed in 1966 with the goal of promoting the tightest possible connection between science and practice in clinical psychology.

In the 35 years since its creation, this energetic and committed group has become an increasingly powerful voice within Division 12, whose website prominently features the findings of the Task Force on Empirically Supported Treatments and recommends that individuals inquire, when seeking psychotherapy, what diagnosis best fits them and what kinds of therapy have been scientifically proven to be effective in treating persons with that diagnosis; it has argued that government grants and third-party payer monies ought to go only to practitioners of “empirically supported treatments,” and it has undertaken the project of keeping track of research that, according to its standards, has proven one or another form of psychotherapy effective for a particular diagnosis.

With the rise of managed care, with escalating liability risks in our litigious society, and with the growing governmental regulation of psychology as a profession, the view of clinical psychology promulgated by the Society for a Science of Clinical Psychology has gained increasing support within the APA. Intense competition among the various mental health professions in the managed care marketplace has led to unprecedented efforts to demonstrate the efficacy of various types of psychotherapy. A science of clinical psychology that directly parallels the medical sciences is seen by many psychologists as the only way to keep psychology viable against the cheaper and quicker “fixes” of psycho-pharmacology.

The success of the EST movement has generated concern among clinicians whose relationship- and/or insight-oriented approaches to psychotherapy do not lend themselves to the methodology of randomized controlled clinical trials, psychotherapy manuals, and treatment guidelines for specific DSM disorders. Many family-systems, existentialist, humanist, feminist, psychodynamic, and psychoanalytic therapists find their own ways of thinking about human experience incompatible with the model of empirical support used by EST advocates. Increasingly they are wondering, not only how they are going to make a living, but whether the work they do is threatened in more direct ways by the movement toward “empirically supported treatments.”

(See the links above for a fuller account elaboration of the views of both critics and proponents of this controversial movement in psychology.)