Thread by @mcmullarkey

If we prioritized improving patients' and trainees' lives clinical psych's structures would look entirely different

A part touched on but (understandably!) not emphasized in this piece: There's vanishingly little evidence our training improves clinical outcomes for patients
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https://twitter.com/ajshackman/status/1442884353135157261

Multiple studies with thousands of patients (though only 23-39 supervisors each!) show that supervisors share less than 1% of the variance in patient outcome

And that's just correlation, the causal estimate could be much smaller

tandfonline.com/doi/full/10.10…

journals.sagepub.com/doi/full/10.11…

There's evidence supervisors and trainees care more about a supervisors' "relational characteristics" than their "transmission of clinical know how"

It's ok to want to spend time with people we like, and there's no guarantee that will help patients

ncbi.nlm.nih.gov/pmc/articles/P…

But even if supervisors don't account for much variance in patient outcomes directly, maybe the experience gained in working with patients over time matters?

Unfortunately, the evidence we have for that is thin to nonexistent as well

A recent meta-analysis failed to find evidence that more experienced therapists improve symptoms or functioning more than less experienced therapists across 29 studies (though patients with more experienced therapists reported more treatment satisfaction)

ncbi.nlm.nih.gov/pmc/articles/P…

These findings align with decades of converging evidence that folks with less experience can deliver mental health interventions as well as experienced professionals (ie help patients get at least as much better)

psycnet.apa.org/record/1979-31…

ncbi.nlm.nih.gov/books/NBK80017/

They also align with analyses that therapists get at worst slightly less helpful to patients over time during training or at best minimally (d = 0.04) more helpful over time during training (Small therapist Ns though)

psycnet.apa.org/doiLanding?doi…

researchgate.net/profile/Tony-R…

Before you @ me, I know absence of evidence ≠ evidence of absence, and I wish the quality of these studies were MUCH higher

However, an institution that prioritized improving patients' and trainees' lives would have invested in rigorously testing our training model already

If less training is required to help people than our current model of "accumulate a ludicrous number of clinical hours while also doing 16 other jobs" we could improve trainees' lives by reducing hour requirements

researchgate.net/profile/Robert…

There's solid evidence we could prepare trainees in a much shorter amount of time

Trainings that take *much* less time than PhD programs (80 hours or less vs. 500 or more) can lead to medium effect sizes on patient outcomes vs control conditions in RCTs

annualreviews.org/doi/10.1146/an…

Even if our training improves patient outcomes more than the current evidence suggests, we could still do better

How long are we going to keep enshrining powerful people's personal preferences instead of investing in rigorously evaluating how we could do better as a field?

I'm not optimistic, and I hope I'm wrong

A clinical psychology that prioritizes improving patients' and trainees' lives would invest in evaluating whether its current training models accomplish those goals

And if those goals are not being met, we would prioritize solutions that center patients' and trainees' well-being

Or, if you would prefer the thrust of this thread in a succinct tweet

https://twitter.com/FromPhDtoLife/status/1443242699025420297?s=20