Empirically Supported Treatments in Psychology: Recommendations for Canadian Professional Psychology
Force on Empirically Supported Treatments (Section on Clinical Psychology of the Canadian
Early in 1996, the Executive of the Section on Clinical Psychology of the Canadian Psychological Association (CPA) decided to constitute a task force charged with developing a position paper on possible responses for Canadian psychology to the American Psychological Associations (APA) initiative on empirically validated treatments (now referred to as empirically supported treatments). During the year, Dr. John Hunsley agreed to chair the task force, and Drs. Keith Dobson, Charlotte Johnston, and Sam Mikail subsequently agreed to serve as task force members. In December, 1996 the CPA Board of Directors agreed to sponsor the position paper with the Section on Clinical Psychology.
After consultations with the Executive of the Section on Clinical Psychology and the CPA Board of Directors, the task force developed the framework for the proposed paper. Although a significant focus would be the efforts of APAs Task Force on Promotion and Dissemination of Psychological Procedures, members agreed that the scope of the position paper would include related initiatives that focused on enhancing accountability through the use of scientific evidence (e.g., the development of clinical practice guidelines). During the latter half of 1997, task force members discussed the project and began the writing of the position paper. Draft documents were circulated among the task force members and a final document, agreed upon by all members, was submitted to the Executive of the Section on Clinical Psychology for their mid-winter meeting in January, 1998. Based on comments from the Executive, the task force revised the report and submitted the final report to the Executive in May, 1998.
For members of the task force, the main objectives for this position paper were to outline the nature of the issues addressed by the American initiative to designate treatments as empirically supported and to indicate ways in which Canadian psychology might respond to these issues. The process for granting the status of "empirically supported" to certain types of psychological interventions is now established in the United States. Criteria have been developed, listings of such interventions have been disseminated, the process itself has been accepted by the APA, and the requirement that accredited programs and internships educate students about these treatments has been incorporated into the most recent revision of the APA accreditation criteria. In our view, history is likely to label this initiative as a major milestone in the development of a scientific clinical psychology: for the first time, organized psychology in the United States announced to the public and to third party payers that there are effective psychological treatments for certain mental disorders and psychological problems. Given the influence of American clinical psychology on research and on our standards for training and service provision, we believe the impact of this initiative will undoubtedly be felt in Canada.
Many different reactions have been, and continue to be, evoked by this process of classifying some interventions as empirically supported and explicitly encouraging training in these interventions. For some psychologists, this is a welcome step that heralds a new and bright future for professional psychology. For others, the entire concept of deeming certain treatments (and, therefore, not others) as effective is reviled and rejected. The "gold at the end of the rainbow" for some is, for others, a dangerous and misleading event that bears much resemblance to the opening of Pandora's box. Whatever the reactions of individual psychologists, the plan for endorsing treatments based on accumulated scientific evidence is unlikely to disappear. Already, steps are being taken to expand the list by (i) adding empirically proven interventions for children, adolescents, and the elderly and (ii) incorporating prevention programs that have been demonstrated to have clinically important effects. Undoubtedly the nature of the criteria for demonstrating empirical support will evolve, possibly requiring more (or less) evidence than is currently required, possibly including criteria for utilizing qualitative research, and possibly expanding the definition of what constitutes a successful outcome (e.g., symptom reduction, increased work functioning, reduced use of health care resources).
It is in this context that we offer both our perspectives on the initiative and our recommendations for Canadian psychologys response. We hope that this position paper will serve to focus the dialogue that has begun in Canadian professional psychology on this initiative and to augment the ongoing challenge of advancing the quality of services we can provide to the Canadian public.