EST's: Part Deux

Just when I thought the logic of EST's made total and complete sense...I guess being able to critically think about varying positions is what grad school is all about, but man, its making my head spin. I'm discovering that I can be swayed pretty easily by "the written word" which is probably a good and bad thing, depending on the situation! Anyway, I wanted to broadly touch on a few issues from the readings this week, mainly from the Weston et al.(2004) article, the first issue being about the "appropriate" sequence to test a treatment. From the Chambless and Holon (1998) article last week, we learned that the standard is to first prove that a treatment is efficacious in the lab and only after this has been accomplished can the treatment be brought out into the community (to be proven effective). However, as Weston et al. (2004) point out, starting with such "pure" samples in highly controlled environments may seriously limit the generalizability of a treatment. Along these lines, RCTs typically have pretty stringent inclusion criteria and may exclude people with more complex, co-occurring symtoms, particularly those that show some personality disturbances. I do not think it is reasonable for one to assume that because a treatment has been shown to be efficacious for highly specific sample with highly specific symptoms/conditions in a lab that it will necessarily fare just as well with all the variablity and comorbitity (which the article states is the norm rather than the exception) that appears in clinical settings and communities. Having said that, I think I need to re-evaluate what I said in my blog last week about the necessity of treatment specificity! I do think it is important to identify exactly how a particular treatment works for some specific disorders, but I'm starting to believe that there are conditions that will benefit more from integrative strategies that are able to address/treat several different aspects of a person's condition. I like the suggestion at the end of the Weston et al. (2004) article about "using practice as a natural laboratory" (pg. 657).

This idea takes me to my next thought about the integration of theory and practice, which is the basis of the Sehcrest & Smith (1994) article. My various mentors over the past few years have all reiterated to me the importance of guiding clinical practice on sound research. While I completely argree, the readings this week underscored the importance of a more "transactional philosophy of clinical science" (Weston et al., 2004) where both science and practice can inform eachother. Just as clinicians need to be aware of and up-to-date on current research, I think its fair set the same standards for researchers. In the words of Sechrest & Smith (1994), "...psychotherapy should become an integral part of all psychology" (pg. 4).