My graduate training occurred at a university that heavily favors the use of evidence-based behavioral practice (EBBP). Taking this a step further, I am currently completing my internship at a site that trains its residents exclusively in treatments supported by extensive scientific evidence. Before all of this began, I already favored the use of science to guide mental health care, but through this education process I have come to fully appreciate the ability of science to help us weed through our biases and some of our well-intentioned, seemingly logical, but ultimately misguided ideas. As I have spoken to others within the field who have taken a different educational pathway, however, it has become abundantly clear to me that my perspective is far from universally accepted. In fact, the gap between what science shows us to be effective treatments and what is actually practiced is shockingly large (e.g., Lilienfeld, 2010).
There are many reasons why EBBP is not utilized nearly as often as I believe it should be, but one issue that I have spent a substantial amount of time thinking about and attempting to address over recent years is a simple failure in communication. Put simply, scientifically-minded psychologists do not do a particularly good job of informing the public of the nature and importance of their findings whereas non-scientifically minded psychologists have demonstrated a true knack for marketing their services. Due to our time demands and the importance of publishing peer reviewed articles and presenting at conferences to attain tenure, those of us who emphasize empirical research often fail to actually market the remarkable products developed through scientific studies. We write extensively about them in (necessarily) complex language published in esoteric journals and then talk to one another about these issues at conferences attended almost exclusively by like-minded individuals but we rarely explain these ideas in plainer terms to individuals who might actually need to utilize them. As a result, those in need of help often have no idea that EBBP even exists and are left to navigate a market full of a range of pseudoscientific and, at times, iatrogenic treatments.
One of the most basic tenets of salesmanship is that, without demand for a product, it will not sell. Sometimes a lack of demand is due to the fact that the product does not represent a pressing need or because something better is already available. Other times, however, that lack of demand simply represents a lack of awareness on the part of a consumer base that something they desire is actually available. This appears to be the reality of EBBP. There are many clinicians trained in non-evidence-based treatments and few consumers demanding anything different. As a result, EBBP has struggled to obtain anything resembling a market share proportionate with its value.
As a trainee a few months shy of completing my degree, I am hoping to be a part of a new generation of scholars who extend the conversation about science and EBBP to a broader audience, educating those outside of the field as well as those within it in an effort to increase knowledge and, perhaps more importantly, shift the degree to which the consumer base for mental health services demands evidence-based care. Whether this is done through websites, innovative teaching in classrooms, appearances on national media outlets, or other means, the end result could prove invaluable. Without a shift in the nature and the reach of the conversation, however, I fear that the gap between what we know and what we do will remain sharp and individuals in need will continue to often receive sub-optimal care.
Lilienfeld, S.O. (2010). Can psychology become a science? Personality and Individual Differences, 49, 281-288.
Michael Anestis, M.S. is a psychology resident at the University of Mississippi Medical Center, a doctoral candidate in the clinical psychology program at Florida State University and the co-founder of Psychotherapy Brown Bag (http://www.psychotherapybrownbag.com).