Scientist-Practitioner Model of Training

The integration of professional practice with scientific thinking and research has been a defining characteristic of professional psychology since its inception, although it was first formally articulated as part of the doctoral training model at the Boulder conference in 1949. The scientist-practitioner model has been central to counseling psychology identity and training since its endorsement at the Greyston conference in 1964 and reaffirmation at the Georgia conference in 1987. In 1990, The National Conference on Scientist-Practitioner Education and Training for the Professional Practice of Psychology reaffirmed the scientist-practitioner model as a true integration of science and practice in which each activity continually informs the other. In spite of the professional consensus that psychologists should approach their practice scientifically and base their practice activities on scientific evidence, there is an equally strong consensus that counseling psychology (and other areas of professional psychology) have fallen short of realizing the scientist-practitioner model.

Now, more than ever, a true integration of science and practice is needed. Changes in the healthcare system, increasingly demanding managed care entities, and competition with other mental health professions have created greater demand for proof that psychologists’ activities and interventions are effective. Traditional fee-for-service psychological activities are being replaced by activities such as program development and administration, training and supervision of other mental health professionals, evaluating the effectiveness of behavioral healthcare and educational programs, and influencing public policy.

History and Definitions

The scientist-practitioner model, also known as the Boulder model, was developed at the Conference on Graduate Education in Clinical Psychology held at the University of Colorado at Boulder in 1949. This 2-week-long conference was the first national meeting held to discuss standards for doctoral training in psychology in the United States. Conference attendees concluded that psychologists should provide both professional services and research contributions. Furthermore, the 1949 Boulder conference attendees endorsed a wide range of psychological practice, including work with more normal clientele and traditional counseling psychology realms such as vocational counseling. In 1954, Pepinsky and Pepinsky further articulated the activities of the counselor-as-scientist. As early as 1961, however, psychologists began to recognize and be concerned about the scientist-practitioner split.

Current Status

Hayes and colleagues, in perhaps the most comprehensive consideration to date of how psychologists enact the scientist-practitioner model, described an integrated model of science-based practice in managed behavioral health care, which includes psychologists’ contributions to community-level prevention and health development services, practice guidelines and triage to services provided by different levels of practitioners, evaluation and outcome assessment, and the development of new treatments from innovation through program evaluation and efficacy testing to dissemination. Models such as this show how psychologists can integrate science and practice in a wide variety of ways in the full range of settings in which they work. However, there are still barriers to over-come as counseling psychology moves forward toward science-practice integration.

Training Issues

Many members of the original Boulder delegation questioned whether all graduate students could be trained to do both science and practice. Not only has such integrated training in science and practice been impossible to date, but it has been shown to be unrealistic to expect all psychologists to be both skilled practitioners and productive researchers. The successful conduct of research and practice requires different styles and skills, and individuals seeking a career in professional psychology self-select into professional activities that reflect their unique personalities, aptitudes, and interests. Because of fundamental differences in the demands of science and practice, there are few truly integrated scientist-practitioners, in any setting, to serve as role models. The reality of graduate training in psychology is that science and practice activities are typically separated, with the majority of scientific training and mentoring occurring in classroom settings with faculty and the majority of practice training and mentoring occurring in external practicum settings with psychologists who identify as practitioners.

A number of counseling psychologists have attempted to build more systematic scientist-practitioner attitudes and behaviors into counseling psychology training. Efforts have been made to develop models to incorporate scientific thinking and methods (e.g., hypothesis testing) into practice activities such as assessment. Changes have been suggested to the practicum training sequence to include systematic data collection using single-case or time series research methods and empirically based rationales for specific treatment interventions. Other suggested additions to a counseling psychology program curriculum to increase scientific activity include an ongoing research practicum, a qualitative methods course, and an advanced research design course specific to counseling psychology. To date, efforts to increase scientist-practitioner integration have been typically focused on increasing the scientific thinking and activity of practice-oriented students, and little attention has been given to increasing the practice orientation of researchers.

Technological Issues

One of the greatest barriers to true integration of science and practice is the currently available research technology. Randomized clinical trials (RCTs), considered the gold standard in psychotherapy research, rarely yield information that practitioners can use. Current psychotherapy research methods, typically focused on treatment efficacy, have been used to identify treatments that work (i.e., yield outcomes better than no treatment). However, psychotherapy research methods have not consistently distinguished particular therapeutic approaches as more or less effective than others, making those methods of little utility to practitioners in terms of their professional decision making or accountability. Furthermore, RCT designs have relied upon strategies such as random assignment, uniform diagnostic groups, and treatment manualization, making them difficult to generalize to the real-world activities of practitioners who deal with complex cases and culturally diverse clients.

There have been recommendations for increased focus on effectiveness research, testing psychological treatments in real-world settings with real clients, but such effectiveness research initiatives are just beginning to yield methodological and outcome developments. Effectiveness research efforts are quite promising, and effective interventions and therapists are being identified. However, conducting psychotherapy research in real-world practice settings poses a number of unique logistical, ethical, and methodological challenges.

One of the greatest challenges inherent in psychotherapy science and in the scientist-practitioner model is the need to develop methods that adequately tap into the scientific and therapeutic activities of practitioners. At this point, little is understood about the counselor-as-scientist (i.e., the processes that drive the moment-by-moment decisions of practitioners). The success of the scientist-practitioner model depends on counseling psychology’s ability not only to address questions derived from practice but also to learn from the scientific process of practitioners.

Evidence-Based Practice

The newest development in science-practice integration is evidence-based practice. Evidence-based practice was originally defined as the systematic use of research evidence to make practice decisions. More recently, evidence-based practice has been more broadly conceptualized to include a general attitude toward gathering and using evidence, taking evidence from a variety of methods and sources, and using a wider range of information in making professional decisions. It has been argued that evidence-based practice can be a bridge over the scientist-practitioner split, as psychologists all begin to consider themselves to be evidence-based practitioners, rather than scientists or practitioners.

The American Psychological Association convened a panel of prominent practitioners and psychotherapy scientists to define evidence-based practice. The task force, in their 2005 policy statement, defined evidence-based practice in the most comprehensive manner to dateā€”from any profession. Evidence-based practice demands that treatment decisions are based on the best available research evidence, on clinical expertise, and on client characteristics, culture, and preferences. Furthermore, the task force called for a broader conception of evidence (e.g., clinical observation, case studies, ethnographic research, process-outcome studies), for efforts to understand and facilitate the clinical expertise processes (e.g., studying clinician practices, developing measures clinicians can use, providing real-time client progress feedback), and for greater attention to the influence of client characteristics (e.g., testing tailored treatments, applications to populations other than majority populations, improving psychologists’ competence with diverse clients, identifying models of client preference-based treatment decision making). Evidence-based practice, in this comprehensive formulation, may be the avenue by which psychologists come to embody the science-practice integration envisioned by the Boulder and Greyston delegates more than a half-century ago.

References:

  1. APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271-285.
  2. Belar, C. D., & Perry, N. W. (1992). National Conference on Scientist-Practitioner Education and Training for the Professional Practice of Psychology. American Psychologist, 47(1), 71-75.
  3. Heppner, P. P., Carter, J. A., Claiborn, C. D., Brooks, L., Gelso, C. J., Holloway, E. L., et al. (1992). A proposal to integrate science and practice in Counseling Psychology. The Counseling Psychologist, 20(1), 107-122.
  4. Meara, N. M., Schmidt, L. D., Carrington, C. H., Davis, K. L., Dixon, D. N., Fretz, B. R., et al. (1988). Training and accreditation in counseling psychology. The Counseling Psychologist, 16, 366-384.
  5. Stoltenberg, C. D., Pace, T. M., Kashubeck-West, S., Biever, J. L., Patterson, T., & Welch, I. D. (2000). Training models in counseling psychology: Scientist-practitioner versus practitioner-scholar. The Counseling Psychologist, 28(5), 622-640.
  6. Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum.

See also: