Hi Cole,

  You offer a good snap shot of some of the conceptual and structural problems that result in psychotherapy being so fragmented and there being such a large gap between research and practice.

Along with my colleague Dr. Anne Stewart, I taught Integrative Psychotherapy Across the Lifespan this past semester. Attached is the syllabus and the take home thoughts. As you will see, we took a broader and more integrative/unified view of theory, practice and research in the field/

From where I sit, you are absolutely correct that we need to build a more effective bridge between research and practice. The question is how. My answer is that the way forward is with effective theory. Actually, we need effective “metatheory”. This includes attention to philosophical issues (like epistemology and descriptive metaphysics) and metatheoretical insights afforded by perspectives like systems theory and the Unified Framework. Work in this area will allow us to effectively interrelate the paradigms and generate a shared consensual “common factor” language that allows us to have a general understanding of people, psychopathology and change processes, both in general and in therapeutic settings in particular.

I fully acknowledge that although I see much light in moving in this direction, it is difficult because not too many people do this kind of work very well and it can be hard for folks to follow and make sense of, so the default is just to drop back to the comfort of the specific paradigms.

For a somewhat similar view, but one from a behaviorist who is focused more on consensus, see the attached Eubanks Goldfried article.

Best,
Gregg

From: tree of knowledge system discussion <[log in to unmask]> On Behalf Of Chance McDermott
Sent: Monday, May 4, 2020 10:52 PM
To: [log in to unmask]
Subject: Re: An interesting perspective on the state of child & adolescent clinical psychology

Thank you, Cole,

I liked that the article suggested that there is something valuable in studying what happens in everyday clinical practice,

-Chance

On Mon, May 4, 2020 at 9:02 PM Cole Butler <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Hi all,

I have been sitting in on my boss's graduate course, "Behavioral and Cognitive Behavioral Intervention for Children and Adolescents," and have been completing some of the associated readings. Our last week of reading is this week, and I came across this excerpt in the book that we use<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.amazon.com_Evidence-2DBased-2DPsychotherapies-2DChildren-2DAdolescents-2DThird_dp_1462522696_ref-3Ddp-5Fob-5Ftitle-5Fbk&d=DwMFaQ&c=eLbWYnpnzycBCgmb7vCI4uqNEB9RSjOdn_5nBEmmeq0&r=HPo1IXYDhKClogP-UOpybo6Cfxxz-jIYBgjO2gOz4-A&m=LRs-Uams-vXUPwgdZlTCg6QYRHduyoIVa5ns-hSkxWM&s=ITTUXQMgC6Iaa03wkBKwoCgId1kzYK7hwErHuixK_p8&e=>:

Coverage of Theoretical Perspectives on Youth Treatment

"The evidence-based psychotherapies encompass several of the influential theoretical perspectives that have guided youth treatment historically, but certainly not all the relevant theories. Behavioral (operant, classical, and modeling) approaches are common among the tested treatments, as are cognitive-behavioral applications; and family systems perspectives are evident in some treatments (e.g., Le Grange & Robin, Chapter 18, this volume). But numerous other schools of therapy (e.g., psychodynamic, client-centered, humanistic) are largely missing from the roster. A similar pattern is evident in meta-analyses of published treatment outcome research (e.g., Kazdin et al., 1990; Weisz, Weiss, Han, Granger, & Morton, 1995; Weisz et al., in press), with the great majority of the studies in those meta-analyses testing behavioral and cognitive-behavioral treatments.
A problem with this state of affairs is that many of the nonbehavioral treatment models that are common in everyday clinical practice are rarely found in the child and adolescent research literature (see, e.g., Kazdin et al., 1990; Weisz et al., in press). We have a strong and rapidly expanding evidence base on treatments that are not so widely used in practice, and we have a weak and barely growing evidence base on the approaches that are especially common in practice, some of which might prove to be effective if properly tested (Kazdin, 2015; Weisz, Kuppens, et al., 2013). Indeed, in a meta-analysis of randomized trials comparing certified evidence-based youth psychotherapies to usual clinical care (Weisz et al., 2013), 29% of the studies showed either negligible differences (effect sizes < 0.10) or superior effects for usual care, suggesting that we may have something to learn from everyday clinical practice. The treatment approaches that service providers use and trust clearly warrant more attention in clinical trials than they have received to date. The disparity between the scope of evidence and the scope of practice is illustrated by Kazdin’s (2000) count identifying more than 550 named therapies that are used with children and adolescents, only a tiny percentage of which have been subjected to any empirical test. The field could profit from research that broadens the array of empirically tested treatment models. Researchers willing to take on this challenge will find no shortage of candidate models."

I found this very interesting, as I find myself likened more to the "other schools of therapy" referenced herein, more so than to cognitive-behavioral therapies. I have noticed this inclination toward using behavioral-based therapies in child treatment research, and found it quite interesting that, as they point out, therapies in the community setting are usually not those.

It seems that the child-treatment folks are becoming more focused on integrated and/or alternative approaches in the child literature as well. At least, it seems so. I think a lot about going the clinical child track, and I would find it very compelling to examine how well other therapeutic systems outside of the domain of the hot-topic EBTs work.

Anyway, just some thoughts - figured some of you would find this interesting. I've attached a PDF of the book chapter if you'd like to read the rest of it (please do not distribute it).

Best,

Cole Butler
TPAC Project Coordinator
University of Maryland
UMD ADHD Lab<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.umdadhd.org_cole&d=DwMFaQ&c=eLbWYnpnzycBCgmb7vCI4uqNEB9RSjOdn_5nBEmmeq0&r=HPo1IXYDhKClogP-UOpybo6Cfxxz-jIYBgjO2gOz4-A&m=LRs-Uams-vXUPwgdZlTCg6QYRHduyoIVa5ns-hSkxWM&s=EBS8fUbhtMFDk4R1XDSu_q_ADjXw9XiZBdqX41JOCQk&e=>
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