We'd Like to Thank the Academy
When he issued his "Manifesto" a decade ago, Indiana University's Richard McFall was unknowingly helping to set the stage for one of the more influential entities in psychological science - the Academy of Psychological Clinical Science, which has risen to become a force for revolutionizing training in psychology and by extension, psychological practice.
APCS describes itself as "an alliance of leading, scientifically-oriented, doctoral training programs in clinical and health psychology in the United States and Canada. Academy membership is open to doctoral programs with strong commitments to, and established records of, successful clinical science training."
This was his challenge to the psychological community:
"The time has come ... to declare unequivocally that there is only one legitimate form of clinical psychology: grounded in science, practiced by scientists, and held accountable to the rigorous standards of scientific evidence. Anything less is pseudoscience.
"It is time to declare publicly that much of what goes on under the banner of clinical psychology today simply is not scientifically valid, appropriate, or acceptable. When Section III members encounter invalid practices in clinical psychology, they should 'blow the whistle,' announce that 'the emperor is not wearing any clothes,' and insist on discriminating between scientific and pseudoscientific practices."
And, if clinicians must be scientists, he said, it follows that "the primary aim of doctoral training is to train competent clinical scientists who function under these principles."
This belief in a commitment to scientific training in clinical psychology was the bedrock upon which the Academy was built a few years later. Its seeds were planted 30 years earlier, however, when McFall was himself a student at Ohio State University and his mentor was Julian B. Rotter, now professor emeritus at the University of Connecticut.
"The philosophy of the program at OSU was that they were training people for careers in clinical research," McFall recalls. "I think the rest of the world is now catching up with that point of view."
THE TRUTH IS OUT THERE
In his concluding paragraph, Rotter had sounded this alarm: "If psychologists are not more active and more explicit in their evaluation of techniques of intervention, they will find themselves restrained from the outside ... as a result of their own failure to do what ethical and scientific considerations require."
McFall echoed the alarm: "I was saying, 'if we don't get our own house in order and regulate ourselves, somebody else will do it for us.'"
"I don't think the public has an idea what's going on out there," McFall says, remembering how, when he took his ideas to his own local community mental health board, the members "couldn't believe we weren't already delivering only scientifically proven treatments."
That local board adopted his proposal and established two specialty clinics, in anxiety disorders and depression, based on the best treatments available as supported by empirical evidence. So unusual was this at the time that the community center won a national award for excellence. Says McFall, "To me, what seemed self-evident was really exceptional."
A corollary to the scientific approach, he says, is truth-in-advertising. If one is going to offer services as a scientist, then follow four rules: "Describe the services clearly. State clearly how patients can expect to benefit from them, and be explicit; don't just say, 'You're going to feel better.' Tell them what the evidence is that the claimed benefits are actually going to be delivered. And explain any side effects they ought to worry about - the downside, the risks. This is what we expect of medicine. These are basically the U.S. Food and Drug Administration principles."
SUMMIT LIKE IT HOT
In 1992, after years of trying to change the existing accreditation system from within, a Summit meeting was held for the purpose of examining alternative accreditation strategies. The Summit was organized under the auspices of APS in conjunction with the Council of Graduate Departments of Psychology (COGDOP), and attended by 140 representatives of accredited academic departments.
Among the key players in the Summit were McFall, Richard Bootzin of the University of Arizona, and Don C. Fowles of the University of Iowa. Bootzin helped set up the Summit, along with Marilynn Brewer, Emanuel Donchin, Virginia O'Leary, and Richard Weinberg. Fowles and McFall sat on a steering committee charged with drafting an alternative accreditation system, along with Brewer, Donchin, O'Leary, Elizabeth Holloway, and Steve Elliott.
The alternative accreditation system reflected concerns about firmly establishing the primacy of a scientific base in clinical training. "Not all clinical training programs were enthusiastic about the alternative," McFall remembers. "Those of us who felt strongly about the direction clinical psychology should go realized we were not going to drag the whole enterprise along with us." Instead they discussed "forming our own little subgroup" and "even kicked around names of programs that would be exemplars of the kind of training" they believed in.
ANATOMY OF AN ACADEMY
"He was the moving force behind the creation of APCS," Fowles says of McFall. "He did a brilliant job of bringing people together."
Since those early days, the Academy has garnered considerable influence over the scientific landscape. Its members are now routinely included as site reviewers for the APA's Committee on Accreditation. The Academy is responsible for overseeing the clinical track of the program for the APS Annual Convention. It is routinely consulted and advised on policy matters affecting the issues it is most concerned about - by the National Science Foundation, by the National Institute of Mental Health, and others.
"We are more recognized," says Bootzin, the current APCS President, "and we are asked to the table more often on a variety of issues. Our advice is often sought on policy issues that either affect graduate training or help advance psychological clinical science. For example, when NIMH was going through reevaluation a year or so ago, they had a task force that included some of our members. NIMH came to an Academy meeting to give a presentation and solicit suggestions, and a year later gave another presentation about the task force conclusions.
"This happens fairly often, and certainly wouldn't have happened before because we didn't exist. There is now a place for federal organizations and others to ask advice and solicit feedback, a mechanism for information exchange that might affect our members' programs that wouldn't otherwise have been available."
The Academy's influence is underscored by Alan Kraut, APS executive director, who says that "whenever APS encounters an issue involving clinical training, the Academy is the first place we go to for guidance, because we know they represent the leading edge of science-based clinical training programs. In fact it was an idea generated at the organizational meeting of the Academy that gave me the idea to approach NSF to ask that NSF open its Fellowship programs more specifically to clinical psychology students. Based on input from the Academy, I argued that, whereas NSF should not support applied research or training, there is a basic science in clinical psychology, just as there is a basic science in any subdiscipline, that NSF should support. They agreed."
"We evaluate all membership applications," says Bootzin, an APS Fellow and Charter Member who has been researching sleep disorders for three decades. "No one was 'grandfathered' in." The peer-evaluations, he says, "focus on the missions of the programs, how the knowledge base is advanced, how students are trained for doing the science and how that knowledge is applied."
Not only are programs reviewed by a committee of peers when they first seek membership, the APCS president says, "We're about to start reevaluating programs that are already members, because things change in any program. It's a way of strengthening ourselves." That practice, he says, is to begin next year.
The Academy currently has 37 member doctoral training programs. "There are certainly additional programs we think would be appropriate," Bootzin says, "but we have the large majority of such programs. Those that have joined are prototypical of the type that we feel are appropriate. We're hopeful that other programs that identify with our goals would want to join."
The primary concern of the Academy has always been that in clinical psychology there's a balance to be struck between trying to advance the knowledge base of the field and applying that knowledge, says Bootzin.
"That balance shifts from time to time, as well as from program to program. It was the observation of a number of individuals during the last 10 years or so that 'guild' issues were getting a lot of attention, to the point we thought the science base was being neglected. We wanted accreditation and licensing done in a way that facilitates the goal of advancing knowledge. The Academy was formed as a way of providing a coalition and support for programs that focused more on the science, to make sure that the advancement of science wasn't neglected."
INTERNS OF ENDEARMENT
Incoming president Fowles agrees. "The internship is a critical part of clinical science training," the APS Fellow says. "It can all too often happen that students are exposed to clinical science in their graduate curriculum but then clinical science is not supported in their practicum training. We need an integration of the academic and clinical side, not a discontinuity or 'blown fuse.' Thus, internship faculty play a crucial role in instilling a clinical science approach to clinical psychology.
"The faculty in internship settings also represent an important and powerful group on the national scene. To have them advocating for clinical science is invaluable. In many ways, PhD program faculty and resources and internship faculty and resources complement each other nicely. Together we can be more effective."
Part of the problem, Fowles says, is visibility: "I would guess that there are more internships than PhD programs that do not know about the Academy, and we would like to publicize the Academy to those internships."
APCS Treasurer Marc Atkins knows firsthand the importance of recruiting internship programs to APCS. Atkins, an APS member, directs the clinical child psychology internship of the Institute for Juvenile Research at the University of Illinois at Chicago, an internship year that offers intensive clinical training to doctoral candidates in clinical psychology.
"Most internship programs foster clinical practice, as opposed to a clinical science," he says. "This often results in a large gap between what is taught in graduate school and what is learned during the internship year, often perceived as a year in which science is not relevant and students who have not amassed large numbers of clinical hours in graduate school will be less successful and, due to a shortage of internship slots, possibly not placed."
Atkins's program seeks to bridge that gap. "I see the Academy as an organization that is ideally suited to support this type of training. The goal of the internship is to promote a scientist-practitioner orientation, with an emphasis on the integration of applied research and clinical practice. In our program, students from Academy graduate programs are more competitive than from programs with less emphasis on scientific training.
"I believe that internship programs bring an important perspective to the Academy. We are active clinical settings and therefore ideal sites for both translation studies and effectiveness trials. Both of these are high priorities for mental health research. The Academy has been in the forefront of these issues, providing a forum for interaction among programs that is likely to promote high standards for the training of clinical scientists."
And, adds Bootzin, with a longer list of quality, science-focused internship program members in the Academy, "graduate students in Academy programs who are looking for internships would have more information on programs that are like-minded."
COMING SOON TO A DEPARTMENT NEAR YOU
"Psychologists are so broadly trained, to the extent Academy program graduates are distributed across many areas, they bring the kind of attitude about the development of knowledge and evaluation of knowledge that serves well, given the need to develop new programs and evaluate the programs that are in existence."
What's next on the Academy's agenda? "It's my impression," says incoming President Fowles, "that APCS is most visible or salient among the representatives of the member programs, and that many other faculty are not involved. It seems timely to try to make contact with those faculty and find out from them what they think we can do to advance the field in important ways. What things do they care about that could be facilitated by organizational support from APCS?
"Some ideas that have been discussed include holding national conferences on focused topics, exchanging ideas about different approaches to graduate education or to specific courses, and creating committees to write a series of white papers on topics of importance to clinical science that would represent APCS's position."