The (Un)disputed Champion of Psychotherapy – Clinical psychologists and their theoretical orientations

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Clinical Psychologists Theoretical Orientations 1960–2010

A recent study by Norcross & Karpiak (2012) looked at survey data from members of APA Division 12 (Society of Clinical Psychology). In their study they included data that has been collected and published regularly since 1960, via self-administered questionnaires. In this new study the authors randomly sent a self-administered questionnaire to 1,285 members of APA Division 12 residing in the United States. 588 were returned giving a response rate of 45,8%, and, according to the authors, the sample was geographically and demographically representative of the population. However, they do add the reservation that the sample might not say anything about psychologists who are not affiliated with APA Division 12.

The (Un)disputed champion of Clinical Psychology

Looking at the data two clear trends emerge, first cognitive therapy is the most prevalent theoretical orientation in 2010s, and secondly psychodynamic and the other major theoretical orientations are on a steady decline.

Cognitive and Behavioral Therapies are the primary theoretical orientations reported by 46% of the respondents, 22% see them selves as eclectic/integrative and 18 % as psychodynamic-orientated. This means that every other psychologist in the US is identifying with a theoretical orientation, with at best modest research support and in many cases with none research support at al.

To be the best, you have to beat the best

I wanted to investigate the topographical research landscape of psychotherapy orientations. Using R statistical software I downloaded data about the number of publications each year for PDT and CBT. I extracted the number of relative publications each year by querying PubMed from R via PubMed’s E-utilities and extracted hits with R’s XML package. The plots were then made with ggplot2.

The queries used:
PDT = “psychodynamic therap*[tiab] OR psychodynamic psychotherap*[tiab]”
CBT= “cognitive behav* psychotherap*[tiab] OR cognitive behav* therap*[tiab]”

Update: Neuroskeptic pointed out, in a comment, that I could narrow down my search by using PubMed’s affiliation field. So I did that by adding (United States of America[ad] OR United States[ad] OR US[ad] OR USA[ad]) to the queries. Since, PubMed started adding affiliation fields 1988 the US-data is more zoomed in compared to the global chart.

Comparing clinical psychologists theoretical orientation to PubMed publications using R statistical software and ggplot
Figure 1. Comparing US clinical psychologists theoretical orientation to PubMed publications using R statistical software and ggplot

As you can see in Figure 1. psychodynamic proponents are absolutely not putting in the hours in the research labs, but nonetheless they still have a disproportionately large amount of practitioners. Moreover, practitioners who identify themselves as eclectic/integrative should really consider the data and heed the tremendous research effort put up by cognitive and behavioral therapists.

Flogging a dead dodo?

As I’m a psychologist myself, I’m well aware of the jargon concerning evidence based treatments from its dissidents. I don’t think these data will do anything to sway their minds. However, I strongly urge policy makers to look at the available research data before making decisions affecting the mental health services. One can’t simply disregard the sheer amount of evidence and research regarding cognitive behavioral therapies.

Notes about the R code

I will release the complete code to automatically download PubMed counts in a later post. I still have some bugs to sort out before it’s ready. Update: I’ve posted my script in another post: An R Script to Automatically look at PubMed Citation Counts By Year of Publication
Norcross, J., & Karpiak, C. (2012). Clinical Psychologists in the 2010s: 50 Years of the APA Division of Clinical Psychology Clinical Psychology: Science and Practice, 19 (1), 1-12 DOI: 10.1111/j.1468-2850.2012.01269.x

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