Internet Editor’s Note: Dr. Travis Osborne recently published an article in the Psychotherapy Journal titled “Overcoming a barrier to practice-based research: Access to an Institutional Review Board (IRB) for independent ethics review.”
If you’re a member of the Society for the Advancement of Psychotherapy you can access the Psychotherapy article via your APA member page.
Not a member? You can access a free copy of their journal article here.
Practice-based research, or research that is conducted in naturalistic care settings, often by clinicians, has the potential to advance the science and practice of psychotherapy. Unfortunately, relatively few clinicians are actively involved in conducting research and as a result, much of their clinical wisdom and treatment data are not represented in the scientific literature. There are many barriers for clinicians who want to engage in both clinical work and research and a number of authors have described these challenges, as well as potential solutions (see Koerner & Castonguay, 2015; LeJeune & Luoma, 2015; Osborne 2018b). However, none of these proposed solutions are likely to be very effective until more clinicians develop professional identities as researchers. The lack of a researcher identity on the part of most clinicians likely precludes many from ever considering whether they have the interest or skills to integrate research into their work. This article explores several factors that may contribute to the lack of a researcher identity among clinicians and offers some suggestions for how to address this issue.
Setting the Stage During Graduate Training
Arguably, the best time for clinicians to start developing a researcher identity is during graduate training. Doctoral level psychology training programs have widely implemented the scientist-practitioner model (Chang, Lee, & Hargreaves, 2008), which is intended to train psychologists who can both apply the products of science and also produce scientific research (Lampropoulos et al., 2002). Yet, few psychologists pursue careers that involve both clinical work and research (Goldfried & Wolfe, 1996). For instance, the majority of clinical psychologists identify as practitioners and predominantly work in private practice settings and most scientific research and publishing are done by a relatively small number of people in the field (Norcross et al., 2005).
Some barriers emerge from how graduate training programs, especially doctoral programs in clinical psychology, tend to socialize students to think about and plan for their careers. Although many, if not most, of these programs require that students meet competencies in both clinical and research domains, students often receive messages that they need to choose a career path as either a clinician or a scientist. Some of these messages are likely well intended and are efforts to help flesh out students’ interests to order to provide appropriate mentoring and also prepare them for the job market, as many jobs in the field tend to emphasize either clinical or research skills.
However, at least some of the time these messages are likely driven more by the expectations and preferences of the training programs or faculty. I have supervised and interacted with numerous graduate students over the years who were very clear about which choice was expected of them, even if that did not match their own interests or goals. Interestingly, not one of them wanted to be a researcher but felt pressure to become a clinician. Instead, all have wanted to do clinical work, but have felt pressure to go into academia and build research careers. This has meant that the decision to follow their own interests and become clinicians has typically necessitated breaking academic ties (at least on some level) and also likely rejecting part of their own identities as researchers. This is unfortunate, as many of these students had excellent clinical and research skills and would have enjoyed opportunities to continue to use both skillsets.
I also left graduate school with the impression that I needed to choose between clinical work and research. Although I did not feel a pressure for either direction from my own mentors, I did enter the field with the strong impression that I had to choose and was repeatedly asked by other students/trainees, faculty and supervisors during internship interviews, and other professionals at conferences, whether I wanted to be a clinician or researcher. Nobody ever asked me if I wanted to be both! Because I did not want a career in academia and I liked clinical work, I made the decision to become a clinician and decided upon finishing my degree that I would likely never be involved in research again. It was many years before I was able to re-integrate that aspect of my professional identity and see myself as a clinician-researcher.
Regardless of the reasons, it can be argued that clinical psychology graduate programs are not succeeding in encouraging most psychologists to concurrently function as both clinicians and researchers (Chang et al., 2008). And when they do, is much more likely to be in the direction of researchers doing clinical work (i.e., researchers who study treatment development, psychotherapy process variables, etc.), as opposed to clinicians doing research. Thus, very few psychologists likely leave graduate school even knowing what practice-based research is, much less how to build a career that includes or is centered around such activities.
Several changes to graduate training programs could help to increase the number of practice-based researchers in our field, including: (1) offering courses on practice-based research and related methodologies, or at minimum, incorporating this information into existing courses on research design and methodology; (2) integrating information into intervention courses about how relatively easy to implement clinician behaviors, such as using standardized measures to monitor treatment progress, can make it much easier to conduct research in clinical settings; (3) providing examples of studies and articles from practice-based researchers along-side those from academia-based researchers throughout program curricula; and (4) giving trainees, particularly those who are more interested in clinical work, explicit messages about considering career paths that would combine their clinical and research skills, instead of messages (inadvertent or purposeful) that suggest they should choose one or the other. Graduate programs and faculty are powerful shapers of students’ professional identity development and could make a notable impact on students’ awareness of, interest in, and excitement about becoming practice-based researchers.
Increasing the Visibility of Role Models and Mentors
Another impediment for clinicians developing a researcher identity is the lack of visible models of clinicians who conduct research. Role models and mentors are an important component of professional identity formation (Cruess et al., 2015). Individuals in our field who want to primarily be researchers, but also do at least some clinical work, have numerous potential role models and mentors to look to in this pursuit. Examples would include virtually all of the notable treatment developers from the last 30-40 years, particularly those who have developed evidence-based psychotherapies, as these interventions, by definition, involve rigorous research evaluation (e.g., Aaron Beck, Marsha Linehan, David Barlow, Michelle Craske, Edna Foa, Patricia Resick, and Bruce Chorpita, to name a few). Aside from exposing students to their work during the course of graduate training, many graduate programs also have such individuals in their departments serving as faculty and research advisors and mentors.
However, for individuals who want to primarily be clinicians, but also want to conduct research, such role models and mentors take considerably more work to find. To start, there are fewer of these individuals in the field. Additionally, their work is likely taught less in graduate programs (for reasons already discussed) and they are not likely to be serving as faculty advisors/mentors in graduate programs because, by definition, they typically work outside of academia. Thus, those interested in pursuing practice-based research careers have to seek out such models on their own and potentially after completing their graduate training.
I was fortunate enough to be introduced to the pioneering practice-based research work of Jacqueline Persons during a graduate school course on cognitive-behavioral therapy. Several of her outcome studies on CBT interventions for depression and anxiety that were conducted in her clinical practice were included in the course, in addition to data from randomized controlled trials for similar CBT interventions. Her studies stuck with me and many years later when I was working as a clinician at a specialty center, I drew from her work when helping to design an outcomes monitoring program that would dovetail with a practice-based research program. In addition to reviewing her published articles, I also attended presentations she gave at professional conferences on practice-based research topics. This exposure to her work provided an invaluable model for how I might be able to do such work and helped me to think about how research could play a role in my work as a clinician. A recently published book on practice-based research could serve as a similar kind of starting point and guide for those who are interested (Codd, 2018).
There are several ways that our field could shine a brighter spotlight on the work of practice-based researchers to make it more visible. First, journals could publish more special sections devoted to practice-based research to highlight research conducted in clinical settings. Similarly, professional conferences could solicit submissions for presentations and symposia from practice-based researchers to help ensure that this perspective is represented. Second, professional associations could form practice-based research special interest groups or committees to provide a means for those who are interested in going into this kind of work to more easily access likeminded professionals who might be able to serve as mentors. Third, practice-based researchers could reach out to graduate programs and offer to teach specific classes or whole courses on practice-based research, as well as to serve a clinical supervisors or sit on research project committees to provide more direct access to mentoring for those in training. Finally, practice-based researchers could make special efforts to reach out to organizations and publications that are directed toward graduate students (the American Psychological Association of Graduate Students (APAGS), for example), to help communicate information to those early in their training and about how research can be integrated into clinical careers.
Building Practice-Based Research Communities
Just as the lack of easy to identify role models can get in the way of clinicians developing a researcher identity, so too can the lack of practice-based research communities. Professional roles, activities, and identities are maintained and strengthened over time by associations and involvement with other professionals who share those roles, activities, and identities. Due to the relatively limited number of practice-based researchers in our field, these communities can be challenging to find and/or create.
Many professional organizations, groups, and learning communities in our field tend to either focus on clinicians (consultation groups, continuing education workshops) or researchers (academic conferences). Even conferences that include both researchers and clinicians tend to have presentations that are data driven and those that are clinically-oriented and do not provide much about integration of clinical work and science from the perspectives of clinicians. Additionally, given that most clinicians work in private practice, those who are interested in practice-based research may find it challenging to find others who share this interest.
There are several ways to create and strengthen communities to support practice-based researchers. As previously mentioned, the development of special interest groups and committees on practice-based research within professional associations at the state and national level would provide easy to access mechanisms for professionals to network, consult, and collaborate. Clinicians wanting to engage in research could also team up with colleagues with similar interests and create mechanisms for ethical review of their work, given that access to an institutional review board (IRB) is often limited for those in private practice and other clinical settings.
A number of colleagues from across the country and I, all of whom conduct practice-based research, formed an IRB with the specific purpose of supporting research conducted in clinical settings. Several recent publications about how this IRB was formed and operates can serve as a template for others who are interested in creating similar mechanisms for ethical oversight of this kind of research (Osborne, 2018a; Osborne & Luoma, 2018). Additionally, over the last 10-20 years there has been an increased focus on the development of practice research networks within psychology and behavioral health (Jeong, Castonguay, & Xiao, 2018). These networks seek to pull together groups of clinicians and researchers to collaborate on research projects. There are many ways such networks can be structured and function and they offer a unique way for clinicians to participate at various levels of the research process. Engagement in any of these types of communities could go a long way toward helping clinicians build and strengthen their identities and skills as researchers.
Practice-based research is one potential way that our field can work to close the gap between science and practice, while at the same time integrating the considerable wisdom and skill from those who deliver the bulk of psychological treatments. However, much work is needed at a broad-based level to facilitate the kind of researcher identity development among those clinicians who are interested to make this effort successful. It is critical that this identity development be encouraged and nurtured starting in graduate training and that there be visible and professional models and communities to help strengthen and support this identity development over the long-term.
Cite This Article
Osborne, T. (2018, October). Helping clinicians build identities as practice-based researchers: The importance of training, role models, and communities. [Web article]. Retrieved from http://www.societyforpsychotherapy.org/helping-clinicians-build-identities-as-practice-based-researchers
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