This article discusses the lack of empirical evidence supporting current psychology training standards. It reviews research on the effects of clinical experience, supervision, coursework and research completion requirements. The research provides little evidence that these standards improve psychotherapy outcomes for future clients of psychology students. The article calls for psychology accreditation agencies to apply scientific principles and require empirical evidence that training standards benefit clients before mandating costly requirements. It proposes randomized studies comparing outcomes for students receiving different aspects of training could provide needed evidence about the efficacy of current standards.

1. PEER REVIEWED
The need for empirically supported
psychology training standards
J O H N M A L O U F F
The scientific method makes many important contributions to society. It is on this basis that
psychology training standards require universities to teach empirically supported psychotherapy
methods to students. A logical extension of this premise is to apply the scientific method to
the standards themselves. This article describes the need for empirically supported psychology
training standards supported by well-designed studies which can demonstrate that individuals
who receive training based on specific standards are more effective in their subsequent work
than individuals who do not receive the training. Relevant studies published so far do not support
the efficacy of current psychology standards. Future studies could use a variety of research
designs to evaluate specific training standards. The conclusions of this study extend to training
standards in the fields of psychotherapy and counselling.
I n general, national psychology-
training accreditation agencies
require universities to provide
is more effective than a placebo, that
multiple sources of data show the
effects, that the advantage is a lasting
& McLeod, 2008), based on concerns
about the large financial and other
costs imposed on universities and
psychology students with training in one, and that this advantage has been psychology students by current training
empirically supported psychotherapy found by multiple research groups standards (Michael, Huelsman, &
methods. This is true in Australia (Chambless & Hollon, 1998). Crowley, 2005). Hans Eysenck (1952)
(Australian Psychology Accreditation Psychology accrediting agencies threw down a similar challenge when
Council, 2010) and in the United States typically do not justify in their training he famously challenged researchers to
(American Psychological Association standards the reason for requiring test whether psychotherapy had any
Commission on Accreditation, 2009). training in empirically supported value. Thousands of researchers took
Although this article focuses on treatment, but a basis can be found in up the call and collected a wealth of
the training of psychologists, the many important successes of the supporting data (Lambert & Ogles,
accreditation agencies for the training scientific method in psychology and in 2004). To apply these standards to
of psychotherapists and counsellors many other fields of science. It would the training requirements imposed
likewise require training programs be logical to suggest that psychology by accreditation agencies, one would
to provide training in empirically training standards also should be based say that empirically supported
supported psychotherapy methods (e.g., on published data. They are not. requirements ought to have evidence,
British Association for Counselling At some point, psychology from multiple research groups, that the
and Psychotherapy (BACP), 2009; accrediting agencies must start to requirements lead to better outcomes
Psychotherapy and Counselling apply the scientific method to their in the clients of students who were
Federation of Australia, 2012). own professional decision making, trained in programs that meet the
The minimal empirical support for just as they encourage psychology requirements.
psychotherapy methods typically students to base decisions on evidence. Is there published evidence of
includes evidence that the treatment Psychologists have issued calls for the efficacy of psychology training
is more effective than no treatment. the collection of evidence about the standards? The search for empirical
At higher levels, empirical support effects of psychology training (Carey, support of specific training standards
includes evidence that the treatment Rickwood, & Baker, 2009; Gonsalvez begins with identification of the goals
28 PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012

2. of the standards. Is it enough for Fauth, Gates, Vinca, Boles, & Hayes effect explains the results, it could be
students to demonstrate competence in (2007) to conclude that changes in that the training led to more effective
specified skills or should the standards training are needed. treatment. It is unknown whether the
lead to better outcomes for future Finally, two recent studies improvement in outcomes continued
clients of the students? The ultimate produced varying results. A study after the end of training. Overall,
goal of standards is to benefit clients, of psychotherapy-session outcomes research findings provide little support
so it would be appropriate to measure of student therapists in a clinical for the idea that typical professional
client benefit (O’Donovan & Dawe, doctorate program showed no training of psychologists leads to better
2002). This review focuses on effects of association with number of years outcomes for their psychotherapy
training standards on psychotherapy
outcomes. Other possible benefits of
the standards relating to assessment Overall, research findings provide little
per se and ethics are beyond the scope
of this paper. support for the idea that typical professional
Research findings training of psychologists leads to better
Professional training in general
With regard to client psychotherapy
outcomes for their psychotherapy clients.
outcome, there is relevant evidence
about the value of formal training
of training completed (Boswell, clients.
standards. Meta-analyses of studies of
Casonguay, & Wasserman, 2010). A somewhat related body of research
treatments delivered to clients assigned
However, a study of CBT training of has examined whether differences
to either licensed psychologists or
community psychologists over a year among psychotherapists lead to
paraprofessionals show either that the
showed that their depressed clients differences in client improvement.
paraprofessionals had significantly
that year improved more during the The usual estimate from multilevel
better outcomes or that the two groups
training year than their clients the modeling is that therapist differences
were equal in outcomes (Berman &
year before (Simons et al., 2010). explain a modest amount of variance
Norton, 1985; Durlak, 1979; Hattie,
While it is possible that a Hawthorne (8% or so) in client outcomes (see e.g.,
Sharpley, & Rogers, 1984; Weisz,
Weiss, Han, Granger, & Morton,
1995).
A meta-analysis by Stein &
Lambert (1995) using a subsample of
the studies used in prior meta-analyses
found evidence of better outcomes
for professional psychotherapists. The
authors stated that only one included
study was designed adequately to
control for confounding influences.
However, that one study, by Strupp
and Hadley (1979), did not have
random assignment of clients to
therapists. The Strupp and Hadley
study found the same therapy
outcomes for paraprofessionals
(university professors) and professional
psychotherapists.
A more recent study also showed
equivalent therapy outcomes for
paraprofessionals (self-help group
members) and professionals (Bright,
Baker, & Neimeyer, 1999). Studies
such as the pre-post study of Bein et al.
(2000) of mental health professionals
receiving traditional psychotherapy
training, including teaching and
supervised experience, have shown
no lasting benefit with regard to
effectiveness with clients, leading
Illustration: © Savina Hopkins, 2012. www.savinahopkins.com
PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012 29

3. Lutz, Leon, Martinovich, Lyons, & no research findings to show that of quality psychotherapy. However,
Stiles, 2007). Those findings suggest student supervision leads to better there is no evidence that any of this
that factors that affect therapists, client outcomes. Milne and James coursework leads to better outcomes for
possibly including training standards, (2000) concluded that their review of future clients of the students.
could have at best a modest effect on studies showed that clients benefitted
Research completion
client outcomes. from 'cognitive-behavioral' therapist
The next matter to address is to supervision, but the studies they cited Research completion has not been
what extent specific training standards did not support that conclusion. For examined with regard to whether
have evidence of efficacy for client instance, Parsons and Reid (1995), it contributes to more effective
psychotherapy outcomes. Is it necessary cited as showing that supervision treatment by students, perhaps because
to show that fifty hours of supervision benefitted clients, did not evaluate no one thinks that it would. This
is better than thirty hours? Probably clients. One recent study (Bambling, requirement may be an anachronism
not. It would be beneficial, however, King, Raue, Schweitzer, & Lambert, left from bygone days when earning
to show that costly, time-consuming 2006) found that supervision directed a degree beyond undergraduate
aspects of the training standards lead at developing a working alliance was supposed to make a person a
to better client outcomes. These aspects
include clinical experience, supervision,
coursework, and research completion.
There appears to be no evidence to suggest
Experience that coursework and research completion,
If one views psychotherapy as a
skill, psychotherapy experience seems
which make up a great deal of required
likely to be beneficial for improving
client outcomes. However, amount
psychology training, have any value to future
of professional experience usually
does not correlate significantly with
psychotherapy clients of the students.
client therapy outcomes, according
to a careful review (Christensen & with the client led to better outcomes scholar, or it may be an application
Jacobson, 1994) and subsequent studies with depression clients during of the scientist-practitioner model of
(Franklin, Abramowitz, Furr, Kalsy, the supervision, but there was no training psychologists. One might
& Riggs, 2003; Kolko, Brent, Baugher, examination of whether the effects argue that there is nothing wrong
Bridge, & Birmaher, 2000; Michael, lasted beyond the time of supervision. with training standards that serve
Huelsman, & Crowley, 2005; Vocisano, This promising finding has not been purposes other than the well-being
Klein, Arnow, Rivera, Blalock, & followed by anything similar. To of future psychotherapy clients of the
Rothbaum, 2004), although it is warrant the requirement of supervised students. This is true as long as the
possible to find studies that show an experience, one would want evidence overall training serves the well-being
association (Beutler et al., 2004), and from multiple research groups that of those clients. Because there is so
one older meta-analysis found a small compare students in training receiving little evidence of that, it would be
but significant correlation between the typical levels of supervision versus less prudent for accrediting agencies to
level of therapist experience and client supervision, with regard to their client focus on standards that have empirical
outcomes (r = .11; Stein & Lambert, outcomes after completion of training. support for their benefit to consumers
1984). The meta-analyses which of psychological services.
show that paraprofessionals, who had Coursework
Relevant research methods
virtually no psychotherapy experience, The requirement of specific training
and possible studies
had outcomes at least as good as those coursework seemingly would contribute
of professional psychologists (Berman to psychotherapy client outcomes. The best evaluation of the value
& Norton, 1985; Durlak, 1979; Hattie However, much of the required of training standards would involve
et al., 1984; Weisz et al., 1987, 1995) coursework in psychology programs has assigning psychotherapists randomly
suggest the possibility that professional nothing directly to do with treatment. to receive some required aspect of
experience has no effect. Instead, it tends to focus on statistics, accredited training, or not, and
psychopharmacology, and other topics then assessing their success with
Supervision randomly assigned clients. These
with, at most, slight connections to
Psychologists tend to view helping others overcome psychological studies would be especially valuable
supervision aspects of their training problems. Parts of training typically if they use validated measures to
as helpful (Orlinsky, Botermans, relate to psychological testing. collect outcome information from
& Ronnestad, 2001). However, the Whether that has value to clients is multiple sources, such as clients
outcome evidence regarding the value beyond the scope of this paper. Parts and observers (Chambless, 2001).
of clinical supervision is limited. of coursework, such as those focusing Intention-to-treat analyses can help
Holloway and Neufeldt (1995) on psychotherapy methods, seem to balance any differences between
concluded that there are virtually have direct relevance to the provision therapists in client drop-out rates
30 PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012

4. (see Atkins & Christensen, 2001). Conclusion available. This review presents several
These studies could assign students This review has focused on methods of data collection for the
randomly to some aspect of required whether there is empirical support evaluation of training standards.
training or not, keep everything else for psychology training standards One might make the argument that
the same for both groups, and then in helping psychologists produce present training standards are based
compare therapy client outcomes. positive treatment outcomes for their on the best available evidence, but
For instance, researchers could assign psychotherapy clients. There appears the standards appear to be based on
students randomly to 10 training cases to be no evidence to suggest that supposition rather than on evidence.
with supervision or 0 training cases coursework and research completion, Acting on the basis of evidence, rather
with supervision and then compare which make up a great deal of required than educated guesses helps a society
outcomes in subsequent clients treated psychology training, have any value make progress.
by the students. The study would to future psychotherapy clients of References
not be easy to do. It might require the students. There is evidence with American Psychological Association
multiple research centres or multiple regard to the effects of experience and Commission on Accreditation (2009).
years to have enough power to detect supervision, but the weight of evidence Guidelines and principles for accreditation
differences in client outcome. It would at this point does not provide clear of programs in professional psychology.
require either a large number of clients support of current training standards Retrieved from http://www.apa.org/ed/
with similar problems, or a valid accreditation/about/policies/guiding-
that relate to either experience or principles.pdf
method to assess outcomes (e.g., client supervision. The relevant evidence
goal achievement) across different in total does not show empirical
Australian Psychology Accreditation
types of problems. Many outcome Council (2010). Rules of accreditation and
support for the contribution of current accreditation standards for psychology
studies of types of psychotherapy have psychology training standards to courses. Retrieved from http://www.
to overcome similar difficulties. positive outcomes for psychotherapy apac.psychology.org.au/Assets/Files/
Weaker, but less complicated, quasi- clients (see Bickman, 1999; Mahrer, APAC_Rules_for%20_Accreditation_
analytic and correlational methods 1999). Whether the training standards
and_Accreditation_Standards_for%20_
could provide valuable supplemental Psychology_Courses_Ver_10_June_2010.
contribute to some other important pdf.
evidence. In these studies, for instance: outcome for the public is beyond the
1) therapists who have received scope of this paper.
Atkins, D. C., & Christensen, A. (2001). Is
professional training worth the bother?
some aspect of standard-required For accrediting agencies to A review of the impact of psychotherapy
training, or not, could be assessed operate in the realm of the principles training on client outcome. Australian
for their client outcomes; of evidence-based practice, they Psychologist, 36, 122–130.
2) therapists in training could must produce evidence to support Baker, K. D., & Neimeyer, R. A.
be assessed for psychotherapy their standards. Psychotherapy (2003). Therapist training and client
outcome early in the training is an important part of work as a characteristics as predictors of treatment
and near the end; psychologist, and this evidence response to group therapy for depression.
3) therapists could be assessed Psychotherapy Research, 13, 135–151.
needs to show that existing training
for outcomes before and after standards contribute to psychotherapy Bambling, M., King, R., Raue, P.,
some specific training; outcomes. Although this article focuses Schweitzer, & Lambert, M. (2006). Clinical
4) the client success of therapists supervision: Its influence on client-rated
on training standards set by psychology working alliance and client symptoms
with different levels of some accredition agencies, the logic of the reduction in the brief treatment of major
type of required training, such as argument applies also to psychology depression. Psychotherapy Research, 16,
experience treating clients, could be training programs which operate under 317–331.
assessed for client outcomes; and, the standards, and to government Bein, E., Anderson, T., Strupp, H., Henry,
5) students who are at different agencies that register or license W., Schacht, T., Binder, J., & Butler, S.
levels of completion of a psychologists. Training programs that (2000). The effects of training in time-
training program, e.g., those aim to be scientific in their orientation limited dynamic psychotherapy: Changes
who have completed 1/4 of the in therapeutic outcome. Psychotherapy
carry a responsibility to show that Research, 10(2), 119–132.
program versus those who have the training they provide has positive
completed 3/4, could be assigned benefits for future clients of the Berman, J. S., & Norton, N. C. (1985). Does
psychotherapy clients randomly, professional training make a therapist
students. The government agencies more effective? Psychological Bulletin, 98,
with everything else the same have their own duty to act in the public 401–407.
for both groups of students, interest in light of available evidence.
followed by a comparison Beutler, L. E., Malik, M., Alimohamed, S.,
The present argument also applies Harwood, T. M., Talebi, H., Noble, S., &
of treatment outcomes. to psychotherapy and counselling Wong, E. (2004). Therapist variables. In M.
Similar findings from different accreditation and training programs. J. Lambert (Ed.), Bergin and Garfields’s
research groups would be especially It is time to start developing strategies handbook of psychotherapy and behavior
valuable (Chambless, 2001). that will lead to an evidence-based
change (5th ed., pp. 227-306). New York:
Wiley.
approach to training. This process may
be difficult, complex, and lengthy, Bickman, L. (1999). Practice makes
perfect and other myths about mental
but appropriate research methods are
PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012 31

5. health services. American Psychologist, Franklin, M. E., Abramowitz, J. S., Furr, Psychology, 39, 111–127.
54, 965–978. J. M., Kalsy, S., & Riggs, D. S. (2003).
O’Donovan, A., & Dawe, S. (2002).
A naturalistic examination of therapist
Boswell, J. F., Casonguay, L. G., & Evaluating training effectiveness in
experience and outcome of exposure and
Wasserman, R. H. (2010). Effects of psychotherapy: Lessons for the AOD field.
ritual prevention for OCD. Psychotherapy
psychotherapy training and intervention Drug and Alcohol Review, 21, 239–245.
Research, 13, 153–167.
use on session outcome. Journal of
Orlinsky, D. E., Botermans, J. F., &
Consulting and Clinical Psychology, 78, Gonsalvez, G. J., & McLeod, H. J. (2008).
Ronnestad, M. H. (2001). Towards
717–723. Toward the science-informed practice
an empirically grounded model of
of clinical supervision: The Australian
Bright, J. I., Baker, K. D., & Neimeyer, R. A. psychotherapy training: Four thousand
context. Australian Psychologist, 43,
(1999). Professional and paraprofessional psychologists rate influences on their
79–87.
group treatments for depression: A development. Australian Psychologist, 36,
comparison of cognitive-behavioral and Kolko, D. J., Brent, D. A., Baugher, M., 139–148.
mutual support interventions. Journal of Bridge, J., & Birmaher, B. (2000). Cognitive
Parsons, M. B., & Reid, D. H. (1995).
Consulting and Clinical Psychology, 67, and family therapies for adolescent
Training residential supervisors to provide
491–501. depression: Treatment specificity,
feedback for maintaining staff teaching
mediation, and moderation. Journal of
British Association for Counselling & skills with people who have severe
Consulting and Clinical Psychology, 68,
Psychotherapy (2009). Accreditation disabilities. Journal of Applied Behavior
603–614.
of training courses including the core Analysis, 28, 317–322.
curriculum. Retrieved from http:// Hattie, J. A., Sharpley, C. F., & Rogers, H.
Psychotherapy and Counselling Federation
www.bacp.co.uk/admin/structure/ F. (1984). Comparative effectiveness of
of Australia (2012). PACFA training
files/repos/416_course_accreditation_ professional and paraprofessional helpers.
standards 2012. Retrieved from http://
scheme_.pdf Psychological Bulletin, 95, 534–541.
www.pacfa.org.au
Carey, T. T., Rickwood, D. J., & Baker, K. Holloway, E. L., & Neufeldt, S. A. (1995).
Simons, A. D., Padesky, C. A.,
(2009). What does $AUD27,650,523.80 Supervision: Its contributions to treatment
Montemarano, J., Lewis, C. C., Murakami,
worth of evidence look like? Clinical efficacy. Journal of Consulting and Clinical
J, Lamb, K., … Beck, A. T. (2010).
Psychologist, 13, 10–16. Psychology, 63, 207–213.
Training and dissemination of cognitive
Chambless, D. L. (2001). Empirically Lambert, M. J., & Ogles, B. M. (2004). behavior therapy for depression in adults:
supported psychological interventions: The efficacy and effectiveness of A preliminary examination of therapist
Controversies and evidence. Annual psychotherapy. In M. J. Lambert (Ed.), competence and client outcomes. Journal
Review of Psychology, 52, 685–716. Bergin and Garfields’s handbook of of Consulting and Clinical Psychology, 78,
psychotherapy and behavior change (5th 751–756.
Chambless, D. L., & Hollon, S. D. (1998).
ed., pp. 139–193). New York: Wiley.
Defining empirically supported therapies. Stein, D. M., & Lambert, M. J. (1995).
Journal of Consulting and Clinical Lutz, W., Leon, S. C., Martinovich, Z., Graduate training in psychotherapy: Are
Psychology, 66, 7–18. Lyons, J. S., & Stiles, W. B. (2007). training outcomes enhanced? Journal of
Therapist effects in outpatient Consulting and Clinical Psychology, 63,
Christensen, A., & Jacobson, N. S. (1994).
psychotherapy: A three-level growth 182–196.
Who (or what) can do psychotherapy: The
curve approach. Journal of Counseling
status and challenges of nonprofessional Vocisano, C., Klein, D. N., Arnow, B.,
Psychology, 54, 32–39.
therapies. Psychological Science, 5, 8–14. Rivera, C., Blalock, J. A., Rothbaum,
Mahrer, A. R. (1999). Embarrassing B.,…Thase, M. E. (2004). Therapist
Durlak, J. A. (1979). Comparative
problems for the field of psychotherapy. variables that predict symptom change in
effectiveness of paraprofessional and
Journal of Clinical Psychology, 55, 1147– psychotherapy with chronically depressed
professional helpers. Psychological
1156. outpatients. Psychotherapy: Theory,
Bulletin, 86, 80–92.
Research, Practice, Training, 41, 255–265.
Michael, K. D., Huelsman, T. J., & Crowley,
Eysenck, H. J. (1952). The effects of
S. I. (2005). Interventions for child and Weisz, J. R., Weiss, B., Han, S. S.,
psychotherapy: An evaluation. Journal of
adolescent depression: Do professional Granger, D. A., & Morton, T. (1995). Effects
Consulting Psychology, 16, 319–324.
therapists produce better results? Journal of psychotherapy with children and
Fauth, J., Gates, S., Vinca, M. A., Boles, of Child and Family Studies, 14, 223–236. adolescents revisited: A meta-analysis of
S., & Hayes, J. A. (2007). Big ideas for treatment outcome studies. Psychological
Milne, D., & James, I. (2000). A systematic
psychotherapy training. Psychotherapy: Bulletin, 117, 450–468.
review of effective cognitive-behavioral
Theory, Research, Practice, Training, 44,
supervision. British Journal of Clinical
384–391.
AUTHOR NOTES
JOHN MALOUFF, Ph.D., is Associate Professor of Psychology in the School of Behavioural, Cognitive
and Social Sciences at the University of New England. His research interests include evaluating
the efficacy of: methods of coping with stressors; types of psychotherapy; self-help materials for
psychological problems; and, methods used to increase adherence to recommendations of health
professionals. He also has an interest in researching methods for running organisational meetings and
how to improve romantic relationships.
Comments: jmalouff@une.edu.au
32 PSYCHOTHERAPY IN AUSTRALIA • VOL 18 NO 3 • MAY 2012