Title: Editorial: Closing the Gap between Research and Practice — The Importance of Practitioner Training
Abstract: O V E R T H E PA S T 10–15 years there has been growing pressure for mental health practitioners to use empirically supported treatments. This pressure has come from various sources including professional associations as well as those funding clinical services; however, the dissemination of empirically supported psychosocial treatments into general clinical practice has progressed very slowly. For various reasons, practitioners have been reluctant to fully embrace the empirically supported psychosocial treatments movement (Addis,Wade, & Hatgis, 1999). It is not the case that practitioners reject scientific knowledge. Rather, a primary reason for this hesitance is that there are so many questions regarding the robustness of the existing evidence. Perhaps the primary issue of concern to many clinicians is the relative lack of evidence that empirically supported psychosocial treatments are effective under ‘real-world’ clinical conditions. At the heart of the issue is the fact that for most empirically supported psychosocial treatments, their efficacy has been demonstrated but not their effectiveness (Weisz & Kazdin, 2003). Efficacy is demonstrated when an intervention has been shown to work under the tightly controlled conditions of a research study (e.g., therapists highly trained by the researcher to deliver the intervention as perfectly as possible with a selected population that is often motivated). Randomized clinical trials which are often considered the hallmark of efficacy research have high internal validity, but they typically lack external or ecological validity. For example, a meta-analytical review of 35 studies examining empirically supported psychosocial treatments reported that, on average, approximately two-thirds of potential subjects were excluded from these studies due to issues such as comorbidities (Westen & Morrison, 2001). This is concerning given that Meichenbaum (2003) has noted that less than 20 per cent of mental health patients have only one clearly definable Axis I diagnosis. Effectiveness on the other hand is demonstrated when an intervention is shown to work under ‘typical’ clinical conditions (e.g., heavy caseloads, productivity pressures, reimbursement issues), provided by ‘typical’ clinicians (e.g., various levels of training and different theoretical orientations), with ‘typical’ clients (e.g., more diverse populations in terms of socio-economic level, motivation, culture, and comorbidities). Unfortunately, there has been relatively little emphasis on the need for effectiveness trials prior to disseminating ‘empirically supported’ psychosocial treatments into clinical settings. This trend has led to much suspicion from practitioners. As Schoenwald and Hoagwood (2001) have stated, ‘Premature dissemination of psychotherapies that ill fit clients, practitioners, provider agencies, or service systems can “poison the waters” among these