Issues in Psychotherapy as the Practice of Psychology

Journal of Psychotherapy Integration, Vol. 4, No. 1, 1994
40
Davison
tic interventions should be based on empirical research-and the important
1966 book by Goldstein, Heller, and Sechrest was prophetic in the direc-
Commentary
tions these efforts should and would take-it cannot be denied that psy-
chotherapy as a whole is not yet the practice of psychology. Their paper,
then, is a timely reexamination of how far we have come and especially of
how far we have to go.
Since its very beginning as a subspecialty of psychology following
Issues in Psychotherapy as the Practice of
World War II, clinical psychology has espoused the point of view that what
Psychology
we believe to be true about psychopathology, how we assess it, and how
we design interventions is supposed to be based on psychological science.
,2
If our field means nothing else, it certainly means that. Sechrest and Smith
Gerald C. Davisonl
are to be commended for reminding us of these scientific roots and taking
us to task for not being as true to them as our rhetoric implies.
Sechrest and Smith are quite right to lament the failed promise of
psychotherapy to have become by now a true application of basic psycho-
Sechrest and Smith provide a well-reasoned argument that psychotherapy is
not, as it should be, an integral part of the science of psychology; and that,
logical principles. However, in spite of a favorable nod in the direction of
conversely, the science of psychology is not an integral part of psychotherapy.
cognitive behavior therapy, they neglect to mention several trends in theory
Many of their philosophical and empirical points are well taken, but my own
and research that would seem to meet the very criteria they stipulate. Some
view is that they have overlooked or downplayed the work of investigators,
of these relate more to psychopathology than to intervention, but the two
going back at least thirty years, which exemplies the kind of research and
domains are hardly separate (though much psychotherapy is unfortunately
applied psychology they properly advocate. Domains include depression,
formulated without due regard for the causes, past and present, of the prob-
anxiety, sexuality, schizophrenia, and in particular the cognitive and behavioral
lems to be dealt with therapeutically). While one is always on safe ground
therapies. However, the heuristic role of clinical hypothesis formation and
to assert that "more research needs to be done," it is important to acknow-
awareness of complex clinical realities must also be appreciated if contributions
ledge scholarly efforts that already demonstrate that the theories, method-
from primarily laboratory-based psychology are to be realistic and relevant.
ologies, and findings of psychological science have already been brought
Their exhortations to make psychotherapy and clinical psychology a truly
to bear in trying to understand psychological disorder and its prevention
applied psychology may be very timely, given increasing pressures from third
party payers that the services provided to patients enjoy empirical support.
or amelioration. A few noteworthy examples follow.
Overall, their paper can serve as a reminder that the scientist-professional
model is alive and well, or at least should be resuscitated and invigorated.
EXPERIMENTAL-COGNITIVE RESEARCH IN
KEY WORDS: psychotherapy; practice; integration; education and training.
HUMAN SEXUALITY
As argued many years ago by Gagnon and Simon (1973), human sexu-
INTRODUCTION
ality must be understood within a cognitive framework. We do not respond
solely in a reflexive fashion to tactile stimulation; rather, we endow certain
Sechrest and Smith (1994) have provided a lively argument that (a)
patterns of sensory input with sexual meaning. It is obvious that we are
basic, core psychology is not relied upon enough in the design of psycho-
able to feel sexual without any tactile or other exteroceptive stimulation at
therapeutic interventions, and that (b) it should be. Although many years
all, as when the thought of a loved (or lusted after) individual arouses us
have passed since contemporary behavior therapy stipulated that therapeu-
sexually.
'Department of Psychology, University of Southern California, Los Angeles, California, USA.
In the early 1970s, Geer (Geer & Fuhr, 1976) initiated a program of
2Correspondence should be directed to Gerald C. Davison, Department of Psychology,
l aboratory research into cognitive factors in human sexuality, employing
University of Southern California, Los Angeles, California, 90089-1061, USA.
genital plethysmographic measures as dependent variables and a variety of
39
1053-0479/94/0300-0039507.00/0 0 1994 Plenum Publishing Corporation

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Psychotherapy as Psychology
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Davison
visual and auditory input as independent variables. Over the past 20 years,
dren manifest impairment on cognitive tasks that make extensive demands
Geer and his colleagues have demonstrated both the empirical and heu-
on information-processing capacity.
ristic utility of employing information-processing concepts (e.g., attention-
distraction) and techniques (e.g., dichotic listening tasks) to further our
understanding of human sexuality, with implications for how to intervene
BEHAVIOR AND COGNITIVE THERAPY
with sexual dysfunctions (Geer, Lapour, & Jackson, 1993). Related theory
and research have been reported by Barlow and associates (Barlow, 1986),
Originally proposed as the application of basic psychology to thera-
and the information-processing approach has been employed more gener-
peutic intervention, cognitive and behavior therapy would seem to exem-
ally by Lang (1979) and Bandura (1986) in their theoretical and empirical
plify the kind of "psychotherapy is the practice of psychology" that Sechrest
work on emotion and behavior.
and Smith argue for. Yet their paper makes only passing mention of the
tremendous volume of research and theorizing in the behavior therapy field
over the past 40 or so years. If they find fault with, for example, the social
EXPERIMENTAL-COGNITIVE RESEARCH IN DEPRESSION,
skills training work of Liberman and his colleagues (e.g., Liberman, DeRisi,
& Mueser, 1989) and of Paul and Lentz (1977) with chronic schizophrenics,
ANXIETY, AND SCHIZOPHRENIA
it would have been informative for them to discuss it. Does not a recog-
nition of serious skills deficits in schizophrenics, like filling out a job ap-
Also notably missing in the Sechrest-Smith paper is any mention of
plication or making eye contact during conversation, and attempts to
the experimentally based work of Beck and associates on the cognitive as-
remediate such deficits by modeling and operant shaping, represent an ap-
pects of depression (e.g., Beck, 1967, 1976; Haaga, Dyck, & Ernst, 1991),
plication of laboratory research? Other examples abound in the literature,
of Barlow and associates on anxiety (e.g., Barlow, 1988; Craske, Brown, &
and while there is sometimes a conceptual "stretch" between an experi-
Barlow, 1991), and of Foa and co-workers on posttraumatic stress disorder
mental principle and a clinical application, we must remind ourselves that
(e.g., Foa, Feske, Murdock, Kozak, & McCarthy, 1991; Foa & Kozak,
one always has to fill in gaps ("place meat on the theoretical skeleton";
1986). All this empirical work demonstrates how an understanding of cog-
Lazarus & Davison, 1971) when extrapolating from highly controlled ex-
nition facilitates the design of effective psychotherapeutic interventions.
perimental situations to the more complex and less controllable clinical do-
Noteworthy in the Beckian literature is research by Hammen and oth-
main. The design of laboratory analogue research is no less "artistic."
ers (e.g., Hammen, Marks, Mayol, & deMayo, 1985) on relationships be-
While Sechrest and Smith probably find such efforts as these wanting
tween particular schemata and the nature of life stressors, research that
(page 2-3), they neglect to be specific as to why. It would be useful if they
draws on theorizing and procedures in experimental cognitive psychology.
would provide some detailed examples from their own or others' research
To be recognized here also is the work inspired by Seligman's learned help-
on what they consider to be proper integration of psychotherapy into psy-
lessness perspectives on depression. Recall that Seligman's original reports
chology (or vice versa).
(e.g., 1975) came from research on dogs who were deprived of effective
instrumental responses to escape from shock. Several modifications based
on his seminal work continue to enhance our understanding of depression
BASIC RESEARCH AND CLINICAL REALITIES-A
and to provide directions for improved therapeutic interventions (e.g.,
TWO-WAY STREET
Abramson, Metalsky, & Alloy, 1989).
Finally, over the past 30 years, psychopathology researchers have em-
As we and others have argued for many years (e.g., Davison & Laz-
ployed experimental-cognitive theory and methodologies in studying cog-
arus, 1993; Lazarus & Davison, 1971), the traffic can and should flow in
nitive aberrations in schizophrenics, shedding light on the nature of
both directions. If analogue research is seen by clinicians as irrelevant to
schizophrenia (e.g., Broen & Storms, 1966; Dokeki, Polidoro, & Cromwell,
the challenges in the applied arena, this may be due to the lack of appre-
1965). In a recent summary of cognitive and neuropsychological studies of
ciation among nonapplied researchers of the heuristic value of clinical data
schizophrenic children, for example, Asarnow, Asanen, Granholm, Sher-
as well as to their insufficient knowledge of clinical realities. There is a
man-Vasse, Watkins, & Williams (in press) show that schizophrenic chil-
ti me-honored and central role for clinical innovation in providing ideas for

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Psychotherapy as Psychology
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44
Davison
researchers who are able to exert more experimental control in their labo-
past 50 years clinical psychology has been wrestling with the challenge of
ratory research settings than is typically possible either practically or ethi-
applying basic research to the complex clinical problems that are our sci-
cally in the applied context. In other words, and to extend the many good
entific and applied domain. As we all know, this is a daunting task. It is
points made by Sechrest and Smith about the need to make psychotherapy
obvious to anyone in touch with clinical reality that clinicians and clinical
more of a truly applied psychology, controlled research is likely to be of
instructors often act and teach in ways that are unsupported by empirical
limited conceptual as well as practical utility and relevance if it is not in-
research. Sometimes this is necessary, given the limits of what psychological
formed by knowledge of clinical phenomena. Most of the research that
science has to offer. Indeed, given the complex social, political, and ethical
Sechrest and Smith urge us to be more cognizant of is analogue in nature
context in which psychotherapy exists, it is doubtful-and probably unre-
relative to the clinical situation. The methods and findings of such research
alistic and inadvisable-to assert that psychotherapy can or should be noth-
may have limited generalizability to the complex, "noisy" clinical domain.
ing but the practice of psychology. However, if for no other reason than
At worst, such experimentation may be naive, irrelevant, and misleading.
the growing insistence of health insurers for empirically supported treat-
ments, it is appropriate for us to emphasize and promote the empirical
foundations of clinical psychology in general. Influenced myself by some
A NOTE ON EDUCATION AND TRAINING
of Sechrest's seminal writings in the 1960s, my colleagues and I have striven
to make our clinical and instructional activities as consistent as possible
Sechrest and Smith argue well for interdisciplinary collaboration.
with controlled data (cf. Davison & Neale, 1994; Goldfried & Davison,
Pointing out that psychotherapy research pays scant attention to the cir-
1976). Articles such as the one by Sechrest and Smith are useful reminders
cumstances of people's lives once they leave treatment-issues such as pov-
of how far we have yet to go if we would fully realize the potential of the
erty, discrimination, and other factors typically relegated to other fields
scientist-professional model.
such as sociology or social work-they urge psychotherapy "to get a life."
Good point, both scientifically and morally. Their observations could and
should have been extended to how we select, educate, and train our gradu-
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