Let’s focus on the evidence in our training programmes

Students who undergo professional training in psychology at many South African universities are usually selected because they are academically talented and show promise to excel in potentially rewarding and challenging careers as professional psychologists. However, trainers seldom examine the validity of the assumptions on which training models are based. Most psychology departments offer training in person centred, psychoanalytically oriented, narrative, and sometimes behavioural or cognitive behavioural therapies. Yet, the effectiveness of these forms of treatment may not always be referred to. Instead, theoretical formulations and treatments are taught depending on the theoretical orientation of the lecturers involved in postgraduate training. Lecturers often derive their theoretical orientation from the training programmes they themselves attended as students and from their lecturers who impressed them the most. In some sense our students are being taught what their teachers have been taught. This is not a problem in and of itself, except that the emphasis is then on theoretical tradition and blind allegiance rather than evidence to support claims that treatments for which students are being trained actually work. We owe it to patients to teach our students how to implement treatment modalities for which empirical support exists. Certainly, it is easy to claim that certain treatments are effective by citing anecdotal evidence in their favour. However, such arguments are flawed for at least three reasons. First, stories about therapeutic success from individual patients are in no way representative of the population of patients who present with that specific disorder. Thus for each story of success there may exist many stories of therapeutic failure, except that such instances seldom reach the attention of therapists, as patients who do not benefit from therapy simply do not return for further treatment. Second, one does not know whether the patient would have improved in the absence of treatment, as anecdotal data seldom have a hypothetical counterfactual, i.e. a control group, who does not receive treatment. Third, therapists who declare allegiance to a specific therapeutic modality often focus on experiences that support their beliefs and disregard those instances that call into question the effectiveness of their chosen modality. What we really need in our training programmes is a focus on psychological treatments that are supported by empirical evidence. One of the most respected methods of determining empirical support for any treatment is the randomised-controlled trial or RCT. RCT’s and other forms of treatment outcome studies provide acceptable evidence to determine whether a treatment works or not. Thus, if South African psychology departments are to train professionals who are adept at dispensing treatments from which patients can actually derive measurable gains, they need to abandon therapeutic modalities that hide from empirical testing, and embrace those that are supported by studies demonstrating efficacy and effectiveness studies. The argument in favour of empirically supported treatments is especially relevant if we have the expectation that third party payers such as medical aid companies foot the bill for psychological treatment. There should be no need for medical aids to pay for treatments that do not work or have not been demonstrated to work in alleviating psychological distress. The question is: are we ready to change the curricula in our professional training programmes?