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Is the scientist-practiitioner model the best way to guide the practice of clinical psychology?
What is the Scientist-Practitioner Model?
The scientist-practitioner model is defined as a training model which integrates science and practice in psychology, where each must constantly inform the other (O'Gorman, 2001). The model was established in Boulder, Colorado, in 1949, at the conference on Graduate Education in Psychology under the auspices of the United States Public Health Services and the American Psychological Association Committee for the Training of Clinical and counselling Psychologists (Jones & Mehr, 2007). This was driven by the rising demand for mental health professionals after the Second World War (O'Gorman, 2001).
The scientist-practitioner model was originally intended for training clinical psychologists only; it was then expanded for employ in training of all professional psychologists which comprised of both school psychologists and counselling psychologists (Mellot and Mehr, 2007). The model initially aims for training psychologists to be expert in both science and practice, which are capable of incorporating science into practice. However, the attention afterward placed on the successful integration of the science and practice instead of simply being expert in both domains (Jones & Mehr, 2007). Nowadays, this model is the typical program used for training of psychologists in the United States of American, the United Kingdom, Canada, Australia, and New Zealand (O'Gorman, 2001).
The essence of the scientist-practitioner model is to train the students who study psychology in acquiring both the research skills and the clinical skills. It is in compliance with scientifically-based protocols to convey psychological assessment and psychological intervention measure. This model is built upon the three elementary roles of psychologists (Stoltenberg & Pace, 2007). Firstly, a consumer of science; where this requires psychologists to employ prevalent research as the foundation of their practice. The idea is that scientist-practitioners should be capable to read, comprehend and administer relevant research findings, in addition to practice using the scientific approach. If there is no validated methods of assessment available, scientist-partitioners should be able to apply scientific principles of observation, hypothesis generation and hypothesis testing to each individual patient. This ensures that psychologists use empirically supported treatments to increase effectiveness and efficiency of their practice.
Secondly, an evaluator of science; where this requires psychologists to continuously appraisal and modify interventions employed in practice by estimating its efficacy, client progress, and overall success of the intervention (Stoltenberg & Pace, 2007). It also requires psychologist to enhance the understanding of the dysfunctions causing patients into the treatment. Scientist-practitioners should be able to perform appropriate evaluation, and therefore specify the particular choice of their treatments.
Thirdly, a producer of science; where this requires psychologists to contribute new findings and suggestion derived from their own science to the general and professional communities (Stoltenberg & Pace, 2007). Through re-examining the nature of psychological dysfunctions and improving/reforming the effectiveness and efficiency of treatments, this guarantees the pool of psychological knowledge is constantly growing.
Merits of the Scientist-Practitioner Model
Training psychologists to be scientist-practitioners enable them to gain important scientific skills such as critical thinking, ability to understand published research, and evaluation of published research as well as outcomes of individual interventions (Stoltenberg, Pace, Kashubeck-West, Biever, Patterson, & Welch, 2000). These skills are required to permit practice based on empirical science, and evaluation of treatment outcomes to ensure that clients are receiving optimal benefit from the treatment as well as the highest possible quality of care. By practicing using the scientific approach, clinical psychologists can account for interventions they chose to employ and be confident that they are effective and efficient. Without empirical science in support, psychologists would not be able to defend against accusations that it is only as effective as using snake oil, in which clients get better as time passes or simply because they have someone to talk to (Stritzke & Page, 2006). If the field of psychology does not defend itself against these accusations using empirical science, the public will gradually lose faith and trust in the value of psychological interventions.
Failure to incorporate the clinical care systems with the findings of clinical science leads to enlarge the gap between knowledge and practice. Moreover, failure to use available science has been found to be costly and harmful; it results in an excessive use of unnecessary care and underuse of effective care causing mistake in execution (Berwick, 2003). Therefore, it is important for science to not only be produced, but also to be consumed, to be useful to humanity. Training psychologists as scientist-practitioners help to ensure a continuous production and consumption of science through their roles as producers and consumers of science.
In society which stresses upon greater treatment benefits with minimal fees, it is important to continually research the efficiency of treatments. This is played through psychologists' roles as producers of science. It is vital that the pool of psychological knowledge continue growing at a pace quicker than it can be disseminated. This ensures that knowledge can be disseminated freely, but at the same time retain the need for professional clinical psychologists. It also ensures that the most efficient interventions are able to use with limited resources.
Criticisms of the Scientist-Practitioner Model
Since the beginning of the scientist-practitioner model, there has been much debate over whether the scientist-practitioner model is truly capable of producing psychologists who are proficient in both science and practice, and whether implementation of the model is necessary.
A review by Barlow, Hayes & Nelson (1984) argued that it was inadequate just being able to read scientific research and utilize the acquired information or knowledge to one's practice. For those psychologists who are short of the ability of interpreting of scientific methods and assessment are likely to constrain their capacity, such as analysing the research process and generalising the result to a meaningful extent, that is understandable by their own or others. This possibly leads them to only being able to adopt or reject evidence from empirical researches. Thus, if professional psychologists, or student, who lack of the ability to directly apply scientific method/assessment to their own clinical practice, they tend to have deficiency in learning knowledge and skills through journal articles, and hence, fail to generalise information to their own context.
As a result, this increases the likelihood of relying on the rule of authority instead of the rule of critical examination in clinical practice. Where psychology student tends to effect by what other clinical supervision has spoken and less so by the interpretation of the interventions as well as the effectiveness in the prevalent context. The problem in terms of generalising skills within one domain to other is equally true for those who employ in practice field or conduct research field that attempt to precisely address clinical problems.
Cognitive abilities were found to differ between research psychologists, who were found to have strong abstract abilities and tend to think in logical and structured format, and practicing psychologists, who were found to be imaginative, and prefer the intuitive approach (Frank, 1984). A recent survey continue to demonstrate the differences in interests, revealing that students studying clinical psychology have little interest in research, while students in the experimental psychology program have little interest in practice (Martin, Gavin, Baker, & Bridgmon, 2007). It was concluded that the role of researcher is incompatible with the role of practitioner due to differing talents and interests, and the two opposing roles cannot coexist in individuals.
Another criticism of the scientist-practitioner model is that clinical psychologists are not active in research. Studies found that very few clinical psychologists were involved in research and publications after graduating (Steinhelber, 1981: Kelly, Goldberg, Fiske, & Kilkowski, 1978: Milne & Paxton, 1998). Many reasons have been proposed to explain the lack of scientific activity among clinical psychologists. One reason could be due to the lack of support for conducting research in private practices (Frank, 1984). Deliberate practice is critical in the development of expertise; however, not every practice results in the enhancement of expertise. Without significant and applicable feedback together with supervising and estimation of one's performance, it is unlikely for development or improvement to occur.
In addition, it was reported by Wampold, 2006, in an effective treatment, therapist variables may not be adequately examined as mediating influences even though it is shown to be important in therapy outcomes. It is because; the feedback and suggestions based upon the private session between the practicing therapist and clients may not deliver well to trainee whose characteristics (e.g. cultural background) are notably different from the therapist. Of additional concern, suggested by Stoltenberg et al. 1998, is that the developmental differences in trainees are of diverse levels of knowledge and experience such that the therapist may present too much or too little assistance or transmit it in a way which is difficult to understand.
The Alternative Practitioner-Scholar Model
In 1973, the Vail conference held in Vail, Colorado, set a turning point for training of clinical psychologists. The Practitioner-scholar model was officially accepted as the alternative training model to the older scientist-practitioner model (Vespia & Sauer, 2006). This model placed more emphasis on the delivery of services in practice and less emphasis on research productivity, unlike the scientist-practitioner model which demanded a 50:50 balanced integration of science and practice. In the scope of the practitioner-scholar model, students are not anticipated to become research scientists, and thus, acknowledgement principle is relatively focused on appropriateness for practice rather than ability for research, mathematical, or statistical skills.
The aim of this model is to maintain, improve, and generate new knowledge appropriate to the transfer between and integration among research, practice, and education (McFall, 2006). The doctor of psychology (Psy.D.) which is based on the practice oriented practitioner-scholar model was also endorsed by the Vail conference. Psy.D. students are taught to be consumers of science and producers of small-scaled clinical science rather than traditional research science (McFall, 2006)
Immediately after the official acceptance of the practitioner-scholar model, it is quickly adopted by the clinical psychologists; however, counselling psychologists choose to remain with the original scientist-partitioner model (McFall, 2006). In the 1980s, the number of Psy.D. rapidly increase due to the increasing numbers of independent programs which is not associated with universities. Nevertheless, the number of Psy.D. programs began to increase rapidly in the 1980s, beginning with increasing numbers of independent programs not associated with universities. As a result, numerous university graduate programs also began to offer the Psy.D. in addition to the research oriented Ph.D., allowing students to choose the emphasis they prefer when undertaking graduate training (Plante, 2005).
Overall, the practitioner-scholar model is a less research-oriented version of the scientist-partitioner model; it is a training model for graduate programs that is focused on clinical practice. It promotes integration of science and practice but does not demand large-scale production of research. Furthermore, it supports a broader definition of research to include usage of diverse methodologies and research based on N=1 (Vespia &b Sauer, 2006). However, it is still based on the ideation of the scientist-practitioner model i.e., integration of science and practice. Thus, it encompasses many of the merits of the scientist-partitioner model like accountability and science-based practice.
Importance of Integrating Science and Practice
The scientist-practitioner model differs from the practitioner-scholar model in two major points which are in terms of the relative emphasis address to practice and science and in terms of the extent to which the research is anchored in practice. Though both models tend to place all training in scientific thinking, they are likely to differ in the terms of process, themes and desired outcomes of concrete research practice. Whereas scientist-practitioner research focuses more on large N designs and quantitative methods, the practitioner-scholar research is more likely to emphasize small N designs, qualitative methods, or program evaluation.
Without employing the scientist-partitioner model, it is uncetrain that psychologists can become capable in their role. It is because the model offers individuals to acquire the skill of thinking scientifically about problems in practice by learning how to conduct relevant research as well as exposure to research in the literature. Training students to conduct research develop the skill in understanding and evaluating the information from published literature. The scientist-partitioner model provides additional training and experience for student to conduct their own research and this avoid the problem to dismiss the research literature as irrelevant to their own practice.
In development of effective practitioners, it is not only important to integrate critical thinking with scientific training but also crucial in encouraging the growth of humility and carefulness of thought. The scientist-practitioner model not only provide a pathway to train student to identify problems, collect significant data, create hypotheses, and examine these hypotheses in a methodical manner but also trains student to become a scientist who recognise the admiration and respect for human limits. On the other hand, the practitioner-scholar model tends to increase the risk to build up beliefs and perform actions based on some logical misconceptions, such as self-serving biases and cognitive short-cuts (Nezu & Nezu, 1995).
In addition, Stoltenberg et al., (2000) argued that the scientist role is equally critical in the procedure of clinical activity as well as in conducting controlled empirical studies. As developing self-correcting influence, it decreases the likelihood of accepting the characteristic experience of others as generalisable fact.
Based on all these considerations, we argue that the scientist role is as important in the moment-by-moment process of clinical activity as it is in conducting controlled empirical studies. Without this self-correcting influence, we run the risk of accepting the idiosyncratic experience of others (or our own) as generalizable fact.
In conclusion, the scientist-practitioner model demonstrates the importance of integrating scientific thinking to practice. It provides opportunity for student to acquire skill such as examination, inference, formulating and evaluating hypotheses as well as deciding and estimating interventions. These are all procedures characteristic of scientific thinking and effective practice. The scientist-practitioner model, therefore, is the essence of training practitioners to the optimal level of clinical practice through provides a guideline in understanding scientific epistemology and method as well as evaluating empirical research.