discussed. Friends can easily be threatened because the
content of such discussions has the potential to disturb
the basis of the relationship. Can a husband discuss his
abandonment fears with his wife, whose perception of
her role may be disturbed by such revelations? Can a
son reveal his fear of failure to a father who has been
boastful of the son’s achievements? Can a daughter tell
her mother that she wants to give up her role as house-
wife in favor of a career without seeming to question
her mother’svalues?
In psychotherapy, all of this is possible. The
effective therapist is someone who can becoming to a close. The health care system cannot afford
to pay for ineffective treatment or treatment of
unknown efficacy. A number of forces are urging psy-
chologists to learn and use demonstrably effective time-
limited treatments with their clients. Even if they do,
this will not be enough to meet the mental health
needs of the population, and other effective ways of
treating clients than face-to-face psychotherapy are
being developed and tested, such as computer-assisted
treatment and bibliotherapy. For many clients such
interventions will be effective and sufficient. We need
to be able to identify who will benefit from such
approaches and who requires treatment with an indi-
vidual therapist and to develop programs of stepped
care. Training in clinical psychology is prolonged and
expensive—too prolonged and expensive for doctoral-
level clinicians to provide the bulk of the front-line care.
I think in the future clinical psychologists will be
involved less in direct care and more in developing new
interventions and testing them and training and super-
vising master’s-level providers. This new paradigm will
require a different orientation to doctoral training than
we presently have. This is one of the reasons I am
involved with other clinical psychologists in developing
a new accreditation system for scientifically oriented
clinical psychology doctoral programs—the Psychologi-
cal Clinical Science Accreditation System.What are the most important next steps for
evidence-based practice?
Our research indicates that psychologists already in
practice are unlikely to make the investment of time
and money required to learn ESTs if required to do so
on their own dime and their own time. Training in ESTs
needs to be infused into the graduate curriculum and
supported in agencies, hospitals, and other settings
where psychologists are employed, with time provided
both for the initial training and follow-up supervision.
There is research underway to determine howpsychologists can be most efficiently trained to compe-
tency in ESTs, and it is clear that our current approaches
to continuing education (e.g., attend a 3-hour or 1-day
workshop at a conference) are woefully inadequate.
Part of graduate training needs to be not only learning
ESTs presently available but developing the habit of
searching the literature to guide treatment and rou-
tinely assessing the outcomes for one’s clients. Feedback
about the successes and failures in their own practices
should motivate psychologists to persist in the life-long
learning required for ethical practice.Dianne L. ChamblessDianne L. Chambless, Ph.D.PSYCHOLOGICAL INTERVENTIONS 319