When we're battling psychological problems and go see a therapist for treatment, we tend to trust that it's doing us good. But should we?

Not according to three clinical psychologists who have written a 145-page document for the November issue of the journal Psychological Science in the Public Interest. The three authors contend that far too many therapists are poorly trained and using outdated or unproven methods--while neglecting to use ones that actually work.

Timothy Baker, Richard McFall and Varda Shoham say that a lack of science-based training in many programs is the problem. They fault some PsyD programs and for-profit training centers especially. And they're calling for a reform of clinical psychology training programs and an overhauled accreditation system to deal with the issue. (Such a system is already under development.)

As an example of what they mean, Baker, McFall and Shoham note that only 30% of therapists are trained in cognitive behavioral therapy approaches for treating post traumatic stress disorder--even though this mode of treatment has been shown in studies to be the most useful treatment for such patients. And, further, only half of those who are trained in the method use it for these patients.

You can read the whole report here. And here's a Newsweek article you might want to check out, Ignoring the Evidence (by Sharon Begley).

The report--yes, it's long!--makes an interesting and not-very-flattering comparison between the state of general medicine in the early 1900s, before it began to move toward more science-based practice, and today's practice of psychology.

The authors say such reform is more important now than ever, given the increasing number of people diagnosed with mental disorders. And they say that increased health costs have both exacerbated the problem--by shunting more treatment away from trained psychologists toward general medical health settings--but also make it more important that effective treatments are chosen.

In an accompanying editorial, Columbia University psychologist Walter Mischel calls the report's analysis and call to action "long overdue" and one that "will be welcomed by those who grieve the widening gulf between clinical practice and scientific progress in psychology."

Mischel also quotes the late psychologist Paul Meehl as noting "that most clinical psychologists select their methods like kids make choices in a candy store: They look around, maybe sample a bit, and choose what they like, whatever feels good to them. For many of us who initially became clinical psychologists because we were inspired by the scientist-practitioner ideal, Meehl’s comment was as heartbreaking as it was accurate."

-- Rosie Mestel