Two agencies of the National Institutes of Health are urging behavioral scientists and practitioners to work together in designing research methodologies that examine treatments as they're actually delivered in real-world settings, such as clinics and community centers.
Most psychologists agree that such cooperation is important. However, some are skeptical that meaningful, dynamic collaborations will result.
Too often, practitioners say, scientific research isn't relevant to their everyday practice in which diverse patient populations often have multiple problems that bring them to treatment. Behavioral scientists, on the other hand, tend to view the problem as some practitioners being reluctant to use research that has been conducted about psychological interventions.
"We certainly need to take this step forward. Maybe these projects will be different and will do things to bring practitioners and researchers together in ways that have never been done before," says Stephen Ragusea, PsyD, a member of APA's Council of Representatives and a private practitioner in Pennsylvania. But Ragusea is skeptical about whether this gap can be bridged.
The National Institute on Drug Abuse recently set aside $10 million for research that will test whether treatments for drug abuse and addiction that have been proven effective in academic settings will work in community treatment centers. The institute recently awarded funding to five universities: Yale University, University of Pennsylvania, Johns Hopkins University, University of California, Los Angeles, and Oregon Health Sciences University. Each will collaborate with community treatment programs in their region.
Meanwhile, the National Institute of Mental Health (NIMH) expects to spend more than $100 million on effectiveness research over five years. The agency is funding research on alleviating treatment-resistant depression by using psychotherapy, medication and a combination of both. Other NIMH research is exploring the effectiveness of emerging interventions and treatments in relieving schizophrenia and Alzheimer's disease.
Both scientists and practitioners agree that such collaborations are critical to the field.
"Practitioners are realizing that research can provide some of their best protection in a changing health-care environment and clinical researchers are increasingly focused on 'effectiveness' research, which can best be done in collaboration with practitioners," says Geoffrey Reed, PhD, APA's assistant executive director for professional development in the Practice Directorate.
"But," he says, "it's really the funding agencies that can nurture this type of collaboration over time."
To further these collaborations, APA division members representing interests in practice issues met in August with NIMH representatives during APA's Annual Convention in Boston to discuss the types of research practitioners would find most useful. That meeting, says Reed, is evidence that practitioners and behavioral scientists are beginning to talk and NIMH is listening to their ideas.
But while practitioners are encouraged by the programs, they fear that scientific research typically won't consider how treatment is delivered in clinical settings.
Behavioral scientists usually compare one type of therapy with another, says Marvin Goldfried, PhD, a professor of psychology at the State University of New York at Stony Brook.
For instance, he says, researchers might compare the effectiveness of cognitive-behavior therapy with interpersonal therapy by randomly assigning patients to one treatment or another without taking into account the patient's individual needs. This is different from clinical practice where psychologists use a blend of interventions to match a patients' treatment to the source of their problems, says Goldfried.
Clinical psychologists fear that policy-makers and managed-care organizations will use the research results to determine what treatments they will pay for, he says. If the research is constrained for methodological reasons, it might restrict psychology practice. That could have serious consequences for practitioners and patients.
Although such concerns may continue, other psychologists point out that it's essential that practitioners stay involved in the collaborations.
"If practitioners don't become actively involved in the process," says Michael Murphy, PhD, director of clinical training at Indiana State University, "it will be done without them."