Empirically Based Professional Practice

History of Concern for Evidence of Efficacy in Professional Psychology

The issue of the evidence base of clinical practice in psychology has a lengthy and important history that dates back more than 60 years to the period of explosive growth of professional psychology during and after World War II that transformed it from a small, primarily academic discipline to one of the core mental health professions. As long ago as 1942, social psychologist Theodore Sarbin predicted, on the basis of some of his own data, that actuarial prediction methods (“science”) would ultimately be able to outperform humans (“art”) along a variety of judgment dimensions. In 1954, Paul Meehl, who was to become one of the towering figures in clinical psychology over the next several decades, published a book that summarized his data confirming the consistent superiority of statistical prediction (“science”) over clinical prediction (“art”). Although advocates for art rather than science in clinical and counseling psychology since then have been heard from, support from behavioral scientists for the positions Sarbin and Meehl took so long ago on this issue has been strong and consistent.

Notwithstanding opposition to evidence-based practice by some mental health professionals, increasing efforts are being expended to require mental health practitioners to follow practice guidelines, and practice guidelines are becoming more prescriptive. Managed care organizations, third-party reimbursers, and state and federal agencies have come increasingly to expect psychologists, psychiatrists, and social workers whenever possible to employ practices with empirical support. As a consequence, many psychology and social work students and psychiatric residents receive training that emphasizes these practices as mandated by their professions. Practice guidelines incorporating evidence-based treatments have been put forth by the American Psychological Association and the American Psychiatric Association as well as by the U.S. Department of Veterans Affairs and the U.S. Agency for Health Care Policy and Research. And more and more patients have come to expect their therapists to know and use empirically supported treatments whenever possible.

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