EMPIRICAL VALIDATION AND PROFESSIONAL CODES OF ETHICS: DESCRIPTION OR PRESCRIPTION?

Abstract

Codes of ethics have begun to refer to preferences that interventions be “empirically supported.” The movement toward Empirically Supported Treatments (ESTs) is based on a medical model of intervention using randomized controlled trials as the prime method, one originally developed to test the efficacy of educational reforms and, later in the twentieth century, of medical interventions. It presumes standardized, “objective” procedures that demonstrate interventions in an unambiguous manner. As a methodology it limits the demonstrable efficacy of alternative forms of psychotherapy. Alternative practices, including constructivist approaches, are at risk of being considered unethical within this framework because their practitioners are unlikely to conduct the kind of outcome research that is considered necessary to demonstrate efficacy (e.g., APA Division 12 criteria). This article will consider the historical context of the professionalization of psychotherapy, the development of modes of outcome research, and the role of institutional texts such as ethics codes. The latter can act as regulatory tools guarding the autonomy of the psychology profession, and responding to the pressures of the market to maintain psychology's self-regulatory role. The move toward placing ESTs within codes of ethics is premised on limited conceptions of therapy that, we argue, fail to grasp the moral nature of the therapeutic relationship.

Notes

1. CORE is involved in the development and implementation of practice guidelines for Britain's National Health Services (NHS) through the National Collaborating Centre for Mental Health (NCCMH), which is a joint venture between CORE and the Royal College of Psychiatrists' College Research Unit.

2. It is not possible for us to locate our argument in the vast literature on the effects of managed care on psychological practice in the United States. For two widely differing positions see Chambliss (2000) and Miller (1998). For an interesting ethnographic study of the way in which clinicians resist or modify practices in response to managed care see Kirschner and Lachicotte (2001). We limit ourselves to the question of ESTs and codes of ethics.