Journal of Consulting and Clinical Psychology Copyright 1995 by the American Psychological Association, Inc.

1995, Vol. 63, No. 2, 179-181 0022-006X/95/S3.00

Introduction to the Special Section: The Case for Training in the

Provision of Psychological Therapy
Larry E. Beutler Philip C.Kendall
University of California, Santa Barbara Temple University

Recent trends, such as the national health care initiative, have brought into focus the importance of
identifying the qualifications of those who provide mental health services. This special section ex-
plores the research evidence for the value of professional training among those who provide psycho-
logical therapy. The set of articles describe what is known about the relationship to therapeutic
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

efficacy of professional training, training in ethnic diversity, and clinical supervision. These articles
This document is copyrighted by the American Psychological Association or one of its allied publishers.

suggest that professional training enhances clinical efficacy, especially if type of training, setting of
practice, and nature of patient problems are considered. They also suggest that supervision and
specific training in ethnic diversity enhance knowledge and sensitivity among psychotherapists. It is
anticipated that this special section will promote a dialogue about these conclusions.

Over the past 2 years, considerable attention has accrued
from the efforts of the U.S. Congress to enact a national health
care bill. At this writing, there is doubt whether any bill will be
enacted that will provide uniform mental health coverage. Even
if one is, it is uncertain whether coverage will be provided for
outpatient psychotherapy, and if so, it is unclear whether this
coverage will be extended to the practices of nonphysicians.
Congressional action recently has been postponed until a new
Congress is seated. Nonetheless, the debates of the past year
have unearthed issues that are unlikely to fade, and many of
these issues have a direct bearing on the future of psychological
intervention as a professional activity in the United States.
One simple fact has become clear in the debates over the na-
ture of acceptable service and who shall be covered—many of
the questions of inclusion would be more easily resolved by at-
tending to sound scientific research, if it is available. It was from
this concern that we elected to explore the scientific evidence
for a relationship between professional training and the clinical
improvement achieved by psychological therapies.
On its face, the answer to the question of whether a therapist's
level of experience and nature of training affect his or her clini-
cal efficacy appears obvious. Psychological therapy, after all, is
a complex activity that has generated extensive discussion and
intricate theory and has proliferated numerous rules to both
guide its application and to define who can practice it. However,
research evidence has been limited and that which is available
has not been consistently supportive of the value of professional
training. Reviewers of extant empirical evidence have some-
times concluded that there is little correlation between thera-
pists' levels of professional training, on one hand, and their clin-
Larry E. Beutler, Graduate School of Education, University of Cali-
fornia, Santa Barbara; Philip C. Kendall, Department of Psychology,
Temple University.
Correspondence concerning this article should be addressed to Larry
E. Beutler, Graduate School of Education, Counseling/Clinical/School
Psychology Program, University of California, Santa Barbara, Califor-
nia 93106.
179
ical efficacy, on the other (e.g., Beutler, Machado, & Neufeldt,
1994).
In considering the role of research in informing national
health care policy, we became concerned that inherent method-
ological difficulties in this area of research may result in mis-
leading interpretations of this literature when transported to the
political arena. For example, many studies of professional train-
ing and experience have oversimplified the issues, failing either
to attend to differences in levels of experience and training re-
quired to use various of the myriad of specific skills that consti-
tute each specific type of psychotherapy or to address the dis-
tinctive effects that might accrue for each intervention with
different types of problems, disorders, and patients.
It occurred to us that by virtue of these omissions, extant
reviews of the role of professional experience and training may
have reached factually inaccurate conclusions and may, thus,
lead to misinformed and misguided political policies. Two ex-
amples of how methodological conventions may result in mis-
leading conclusions came to mind. The first example arises
from the fact that almost all studies of professional training have
used a naturalistic design in which various undescribed "thera-
pies" are collapsed indiscriminantly within a single category. In
these studies, the nature of the therapies and characteristics of
the patients are given little attention. The primary analysis is a
comparison of clinical outcomes among therapists who vary in
levels of professional training. Studies that use heterogeneous
collections of psychological therapies, all of which apply both
their own unique methods and some that are common to all
therapies, can only reveal the manner in which professional
training affects the influence of the common factors on clinical
efficacy. The nonsignificant results that often emerge from such
research, therefore, only can be interpreted as indicating that
professional training does not alter substantially the influence
of common or nonspecific aspects of psychotherapy on clinical
outcomes, at least among mixed samples of psychiatric patients.
These results may tell little or nothing of any effect that profes-
sional training may have on the effectiveness of procedures that
are specific to one or another type of psychological therapy, nor
 180 LARRY E. BEUTLER AND PHILIP C. KENDALL
can these results logically inform policy makers about the im-
portance of professional training and experience for treating
specific types of patients or problems.
The second example arises from the use of a temporal defi-
nition of professional training or experience in contemporary
research studies; that is, in most research, time in training or
years of experience are used to define levels of professional
"training" and "experience," respectively. Certainly, time is not
isomorphic with quality of training and experience. These tem-
poral definitions ignore the importance of the experiences that
constitute training. Classroom theory courses do not provide
the same level of skill training as individual, clinical supervi-
sion; discourses on effective listening do not provide the same
type of level of training as criteria-based practice in the methods
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
of cognitive change therapies. Elsewhere, Beutler( 1994; Beutler
This document is copyrighted by the American Psychological Association or one of its allied publishers.
& Guest, 1988) has referred to the assumption that equivalent
time exposure during training produces equivalent skill levels
as "the germ theory of education" and has proposed the view
that a temporal definition of professional experience and train-
ing is subject to misinterpretation because it does not attend to
the critically important issue of "what is trained." Temporal
exposure is too broad a concept against which to assess specific
outcome effects. It may be that skill acquisition in the provision
of psychological therapies, like skill in performing any complex
behavior, derives more from the use of targeted goals, specific
feedback, and guided practice than from simple exposure and
unstructured supervision (Beutler et al., 1994; Luborsky,
1990). Evidence of a relationship between specificity of train-
ing and skill level achieved is, of course, of little consequence
without a demonstration that the attainment of specific skills
and knowledge does make a difference in patient outcomes.
This special section was conceived as a means of evaluating
the evidence for specialized training in specific skill and knowl-
edge areas for specific populations. We invited participants to
consider the evidence in favor of the proposition that profes-
sional experience and training are important to clinical efficacy.
This commission, we believe, parallels the type of question that
will be translatable to health care policy issues and especially to
the definition of the levels of professional experience and train-
ing that are desirable. We hope that it will spark and promote
both effective policy and research on issues that are important
to effective patient care.
Stein and Lambert (1995) lead off the section by considering
the evidence for graduate training in the provision of psycho-
logical therapy. By addressing contextual and patient variables,
their review reaches more complex but interesting conclusions
than previous ones. They report that there are modest effect
sizes favoring professionally trained therapists, especially when
the nature of outcomes, the settings in which therapy is con-
ducted, and patient variables are considered. Although their re-
view largely involves adult patients, it is notable that some stud-
ies (e.g., Kendall, Reber, McLeer, Epps, & Ronan, 1990) have
found similar effects favoring professional experience in the
use of manualized. interventions among conduct-disordered
children.
In the second article, Yutrzenka (1995) considers the value
of specific training in ethnic issues and cultural diversity. This
article was prompted by an awareness both that graduate train-
ing opportunities for working with clients of diversity are lim-
ited (e.g., Allison, Crawford, Echemendia, Robinson, & Knepp,
1994) and that training programs that are approved by the
American Psychological Association are increasing their offer-
ings in minority training (Bernal & Castro, 1994).
The literature relating diversity training and treatment effi-
cacy is limited; Yutrzenka (1995), nonetheless, provides a rea-
soned case for at least the indirect effects of such training. She
concludes that training in diversity issues is related to knowl-
edge, comfort with diversity, and awareness of cultural issues.
She observes suggestive patterns and areas of needed research
to further address the relationship of such training to clinical
efficacy.
Similar conclusions are reached in the concluding article by
Holloway and Neufeldt (1995). They suggest that, although
there is little evidence of a direct connection between traditional
supervision and therapist efficacy, there is evidence that super-
vision increases the proficiency with which one uses complex
therapy procedures, enhances knowledge and role definitions,
and increases one's ability to facilitate internal therapeutic pro-
cesses. They point to areas of needed research to link these areas
of enhanced performance to patient outcomes.
We must note here that we also invited contributors to review
the empirical literature on the role of specific training both on
gender issues and on residency and internship training in en-
hancing clinical efficacy. Unfortunately, the limited evidence
mustered by the invited contributors resulted in these topics not
being included in this section. The net result of our efforts thus
suggests that professional training may well enhance clinical
efficacy, but we have insufficient knowledge of what specific as-
pects of professional training and professional experience best
and most effectively contribute to such a relationship. There are
many areas of needed research, and we contend that there are
many opportunities to improve training in the provision of psy-
chological therapies. These opportunities will be realized
through research that (a) identifies specific knowledge areas
that are needed for effective clinical practice, (b) pinpoints the
specific skills that are associated with benefits among particular
groups of patients, and (c) validates methods for identifying lev-
els of therapist proficiency and skillfulness.
References
Allison, K. W., Crawford, I., Echemendia, R., Robinson, L., & Knepp,
D. (1994). Human diversity and professional competence: Training
in clinical and counseling psychology revisited. American Psycholo-
gist, 49, 792-796.
Bernal, M. E., & Castro, F. G. (1994). Are clinical psychologists pre-
pared for service and research with ethnic minorities: Report of a
decade of progress. American Psychologist, 49, 798-805.
Beutler, L. E. (1994, August). Applications of psychotherapy research to
the question of therapist training and experience. Paper presented at
the 102nd Annual Convention of the American Psychological Asso-
ciation, Los Angeles, CA.
Beutler, L. E., & Guest, P. D. (1988). Impact of psychotherapy supervi-
sion on therapist orientation and values. Journal of Consulting and
Clinical Psychology, 56, 653-658.
Beutler, L. E., Machado, P. P. P., & Neufeldt, S. (1994). Therapist vari-
ables. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psycho-
therapy and behavior change (4th ed., pp. 259-269). New York:
Wiley.
Holloway, E. L., & Neufeldt, S. A. (1995). Supervision: Its contribu-
 SPECIAL SECTION: TRAINING 181

tions to treatment efficacy. Journal of Consulting and Clinical Psy- therapy: Are therapy outcomes enhanced? Journal of Consulting and
chology. 6J, 207-213. Clinical Psychology, 63, 182-196.
Kendall, P. C, Reber, M., McLeer, S., Epps, J., & Ronan, K. R. (1990). Yutrzenka, B. A. (1995). Making a case for training in ethnic and cul-
Cognitive-behavioral treatment of conduct-disordered children. tural diversity in increasing treatment efficacy. Journal of Consulting
Cognitive Therapy and Research, 14, 279-297. and Clinical Psychology, 63, 197-206.
Luborsky, L. (1990). Theory and technique in dynamic psychother-
apy—Curative factors and training therapists to maximize them. Psy-
chotherapy and Psychosomatics, 53, 50-57. Received September 8, 1994
Stein, D. M., & Lambert, M. J. (1995). Graduate training in psycho- Accepted September 20, 1994 •
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Call for Papers

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Beginning in 1996, there will be a new peer-reviewed journal in the emerging interdisci-
plinary specialty area devoted to work and well-being. Its mission statement is as follows.

The Journal of Occupational Health Psychology publishes research, theory and public policy
articles in occupational health psychology (OHP), an interdisciplinary field representing a
broad range of backgrounds, interests, and specializations. OHP concerns the application of
psychology to improving the quality of worklife and to protecting and promoting the safety,
health, and well-being of workers. The Journal has a threefold focus on the work environ-
ment, the individual, and the work-family interface. The Journal seeks scholarly articles,
from both researchers and practitioners, concerning psychological factors in relationship to
all aspects of occupational health. Included in this broad domain of interest are articles in
which work-related psychological factors play a role in the etiology of health problems,
articles examining the psychological and associated health consequences of work, and
articles concerned with the use of psychological approaches to prevent or mitigate occupa-
tional health problems. Special attention is given to articles with a prevention emphasis.
Manuscripts dealing with issues of contemporary relevance to the workplace, especially with
regard to minority, cultural, or occupationally underrepresented groups, or topics at the
interface of the family and the workplace are encouraged. Each article should represent an
addition to knowledge and understanding of OHP.

Manuscripts should be prepared according to the Publication Manual of the American

Psychological Association and should be submitted in quadruplicate to:

James Campbell Quick, Editor

Journal of Occupational Health Psychology
University of Texas at Arlington
P.O.Box 19313
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Phone number: (817)273-3514
FAX number: (817)273-3515
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The Journal of Occupational Health Psychology (JO HP) will be published quarterly by
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