Instead of bemoaning the differences between researchers and practitioners, both parties can take concrete steps to make their work more accessible to the other — and, in the process, improve client care, former APA President Alan Kazdin, PhD, says in the April 2008 American Psychologist (Vol. 63, No. 3).
More attention to three research areas can help make research more relevant to practice, he says.
Studying mechanisms of change. Many studies have shown the effectiveness of interventions for anxiety, depression and anger management, for example, and there are good theories on why they work. Lacking, however, are strong data showing why or how the positive change occurs, says Kazdin. Better understanding the mechanisms of change could help practitioners determine which therapeutic factors to pay more attention to, whether it is changes in a client’s thinking patterns or other factors that research show regularly improve client outcomes.
“Knowing how therapy works will allow us to optimize the processes critical to change,” he says.
Improving research on moderators, variables such as gender, culture and co-morbidity that can influence the relationship between an intervention and its outcome. For instance, the severity or timing of the onset of depression or the presence of multiple disorders can influence whether and how therapeutic change occurs.
But while psychologists have studied moderators for decades, they tend to study them in ways that cannot be translated easily to clinical practice, says Kazdin. Needed are analyses of the proportion of clients with moderating variables who do not respond well to a given treatment, as well as of those who improve anyway. Also needed is information on whether a given moderator influences outcomes across many different treatments.
“Researchers can design studies with these factors in mind,” he says.
Conducting qualitative research. Although it is not regularly taught in psychology graduate school, qualitative research — which allows scientists to look deeply at individual experiences and draw themes from them — can complement quantitative research, says Kazdin. As one example, it could be used to more fully understand the family, contextual and emotional factors that lead a depressed client to function or relate better with others, and to intervene accordingly.
Likewise, this method could address the most important topic of therapy: whether psychological treatments make a real difference in clients’ lives, Kazdin says.
“Most of the scales that measure outcome do not necessarily reflect how the person is doing in everyday life,” Kazdin says. “Qualitative research can address this aspect in depth, systematically and scientifically.”
Clinicians, too, can take steps to plug the research-practice gap, Kazdin believes. He recommends they:
Systematically measure patient progress. If clinicians routinely use valid and reliable measures of patient functioning, they could better assess whether a treatment is working and could make more informed decisions about treatment directions. Such measures would also lend objectivity to psychologists’ clinical judgment.
“We still have enormous confidence in our judgments, despite decades of research showing that our judgment can easily miss the mark,” he says. “Systematic observations can improve the information we have and the quality of our decisions about patient care.”
Codify their experiences. Clinicians possess knowledge on thousands of patients, and they have generated and tested hypotheses on each one. Yet “typically, this knowledge cannot be used in ways that will help future patients,” says Kazdin.
Regularly codifying or accumulating data could significantly advance both research and practice, he underscores: “Data obtained in clinical practice could directly contribute to knowledge, generate hypotheses to be studied in research, and in the process, make treatment research more aligned with and relevant to clinical practice.”
To this end, APA’s Board of Directors and Council of Representatives approved a Science/ Practice Directorate initiative in February that will systematically develop evidence-based clinical treatment guidelines for psychologists. The development of the guidelines is consistent with APA’s strategic plan for expanding psychology’s role in advancing health, says Daniel Galper, PhD, the Practice Directorate’s director of demonstration projects, practice research and policy. An advisory steering committee, to be appointed by the APA Board of Directors in June, will finalize a format and process for developing the guidelines.
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