Good for practice, good for science

A truly integrated discipline of psychology supports a flow of knowledge between science and practice. The basic science of psychology produces effective clinical interventions. The demand for effective psychological interventions inspires new goals for basic science. It is a never-ending flow, from science to practice to science to practice.

Integration of the science and practice of psychology is diminished by the absence of good translation. The fruit of new scientific knowledge is of little use if it cannot be put into the hands of clinical practitioners. Nor can the insight that comes with clinical expertise help focus our science if the researchers are not enlightened by it.

The science of psychology has produced an enormous wealth of knowledge to support clinical interventions. Effective, empirically supported treatments exist for depression, eating disorders, pain, anxiety, insomnia, substance use disorders and phobias. In most of these areas, multiple psychological interventions have been shown to be effective.

Frustration exists among some members of the clinical science research community of psychology. They know that substantial evidence is available to inform clinical treatment, and wonder why it is not put into practice more broadly and consistently. Fingers are pointed, with blame being placed on the practitioner community of psychology for its failure to use the best available scientific evidence.

It is tempting to compare psychology to medicine in this regard. Physicians seem to base their clinical practice on substantial research evidence. Why, the critics wonder, can't psychologists base more of their clinical practice on the research evidence?

The comparison is tempting indeed, but can yield false conclusions if not done carefully. It is wrong, for example, to conclude that medical students learn more about science and research as part of their medical school education than clinical psychologists do as part of their clinical training. All it takes is an examination of the respective curricula to know that the opposite is more likely to be true.

A better conclusion is that physicians benefit from a well-developed and heavily subsidized infrastructure that disseminates the current research evidence. Physicians and psychologists do not differ in their ability to understand, let alone generate basic research. They differ in their access to the relevant information. Physicians have at their fingertips simple, digested, practical guidance for effective treatment. Psychologists do not.

The key to achieving the goal of evidence-based practice in psychology is the development of treatment guidelines—documents that synthesize the research evidence in a way that informs clinical decision-making. Psychology has the evidence, and psychology trains the practitioners. Psychology is missing the translation.

Well-developed treatment guidelines for psychology will help practitioners and patients make better decisions. They will help fulfill the promise of a truly integrated discipline of psychology. As APA Executive Director for Professional Practice Katherine Nordal commented in last month's Monitor, treatment guidelines will help to make sure that our science contributes to the care of people with mental health and substance use disorders.

As the professional association for all of psychology, APA is in the best position to develop treatment guidelines. The results will be good for practice, science, and above all, the quality of health care.