Clinical Psychology

experimental laboratory. Sometimes even the lan-
guage of behavior therapy is straight out of the
experimental research journals. In behavior therapy,
there is an easy communication between the
researcher and the clinician, and very often, the
same person alternates comfortably between
the two roles. Such rapport increases the likelihood
that advances in the laboratory will be reflected in
new therapeutic techniques and, conversely, that
clinical experience will serve a vital role in deter-
mining the kind of research and evaluation that are
carried out.

Limitations

Linking Practice to Science. For some years, the

CBT movement rode the crest of a wave of scientific

respectability. Many behaviorists, especially the radi-

cal variety, seemed to be clamoring for preferred

status by claiming that behavior therapy rested on

the sturdy, established scientific principles of learning

theory. Psychodynamic approaches, by contrast,

were said to be crude extrapolations from a mental-

ism only slightly removed from witchcraft. But

research rarely has been conducted to“dismantle”

What are the biggest challenges you face as a

practitioner?

Delivery of quality treatments within limited financial

and staff resources is difficult in any setting. However,

there is often additional bias against the public fund-

ing of aggressive new treatments for what are seen as

chronically mentally ill individuals or for forensic, or

“offender,”populations. Empirical support of treat-

ments for these populations is limited, so it can be

difficult to defend implementing these treatments

during times of deep budget cuts.

Demonstrating the benefit of treatments for

these populations and helping legislators and other

influential bodies to understand, value, and provide

funding for effective treatments is critical. It can also

be difficult to maintain focus on clinical services in a

public mental health setting, as paperwork, team

meetings, behavioral crises, and administrative

responsibilities abound.

Does research inform what you do? If so, how have

you changed your practice to be more effective for

your clients?

I feel strongly that psychologists (like any other service

or product provider) must bear the burden of proof

that the treatment they provide is appropriate to the

presenting concern, has some objective record of ben-

efit for similar problems, and is being delivered

according to protocol. Given this point of view, I have

worked to educate the administration and staff in the

organizations where I have been employed about the

importance of implementingall elementsof a proto-

col, rather than adopting only the most cost-efficient

portions of a treatment. It has taken longer to imple-

ment“full protocol”in some settings due to resistance

to the initial cost involved, but has been worth the

effort when the clinical benefit is seen. Additionally, it

has been necessary on many occasions to pursue fund-

ing for patient treatment beyond the usual channels.

For example, it is important to ask insurance companies

to provide sessions beyond the typical frequency or

overall number limits for a year when the client is

diagnosed with a condition that requires more inten-

sive or longer-term treatment (refractory agoraphobia,

borderline personality disorder, etc.).

Rhonda Oswalt Reitz

Rhonda Reitz, Fulton State Hospital, Fulton, MD

PSYCHOTHERAPY: BEHAVIORAL AND COGNITIVE-BEHAVIORAL PERSPECTIVES 425