Introduction to a special issue on clinician–researchers: a career engaged in both therapy research and practice¹

¹While there are clinician–researchers outside of psychology (e.g. social workers, counselors, physicians) the emphasis of this special issue is on applied psychologists because: (1) applied psychologists are professionals specifically trained in both the provision of clinical services and the production of research, (2) it is the model of training with which I am most familiar, and (3) it is the focus of this journal.

Abstract

This special issue is devoted to understanding the experiences of professionals who both conduct therapy research and provide psychotherapy. To introduce this special issue, I first provide a brief overview of the potential significance of this topic, including my personal interest in this type of career, and the genesis of this special issue. Next, I address the prevalence of this kind of career among psychologists. I then discuss each of the six papers presented in this special issue, including salient themes connecting these authors’ works. Finally, informed by this scholarship and the research of others, I present a model for helping to conceptualize the various ways of being a clinician–researcher and conclude with a list of key points of learning, including recommendations for future inquiry.

Keywords:

• Psychotherapy
• process and outcome
• career
• clinician
• research
• therapist

This special issue is devoted to understanding the experiences of professionals who are engaged in both research on therapy and the provision of psychotherapy – a subpopulation of scientist-practitioners who tread a unique career path.

Why this special issue?

Trained in the scientist-practitioner model, I strongly identify as a psychotherapy researcher and as a clinician, and have been actively involved in both for many years – dating back to my graduate training and continuing through my time as a full time assistant professor in an academic setting. By 2015, however, four years after completing my doctoral degree in counseling psychology at the University of Maryland, three years into a full-time academic position, one year after obtaining my psychology license, and a little bit pregnant with my first child, I found myself neither seeing clients, nor doing my own independent research on therapy. I had a desire, but no near-term plan, to reengage with both.

That I was not gathering my own data or seeing my own clients came as a surprise to me, and led me to question how that had happened. Did I not love either as much as I thought I did? Was I not managing my time well enough to continue my part-time therapy practice and start a psychotherapy research clinic, while attending to the demands of my faculty position and my personal life? Was I just lazy? Did I have other priorities? Or was I thinking about this all wrong? Other people seemed to be pulling off this kind of career and I wanted to learn more about how they were doing it. I decided to organize a round table of experts held at the annual convention of the American Psychological Association (APA) that year in Toronto and ask them: How have they negotiated a career that has involved clinical practice and psychotherapy research? The results of that discussion are presented in the first article in this issue, A modified consensual qualitative research analysis of “Sharing wisdom: Doing therapy while doing research on therapy,” a roundtable discussion among counselor-researchers (Berman, Chapman, Nash, Kivlighan, & Paquin, this issue). I then decided to expand the discussion through an open call for submissions to a special issue of Counselling Psychology Quarterly devoted to personal narrative, reviews of relevant literature, and original empirical work examining the unique career experiences of those engaged in both researching and conducting psychotherapy. Through this work, I learned a great deal – and my hope is that students and early career and other professionals struggling to negotiate being a therapist and a therapy researcher also will find something useful in this special issue.

Just how many professionals are pulling off this kind of career?

In the early days of counseling psychology, academic positions that were split between university counseling centers and academic counseling training programs (typically called “split” or “joint” appointments) were a common practice model in which professionals could engage in both therapy research and therapy practice. The rationale for this model was that it allowed counseling psychologists (particularly early career psychologists) access to therapy clients where they could put clinical theories “to the test,” conduct studies about how therapy worked, sharpen clinical skills, and work toward licensure. However, it appears that these split or joint appointment positions have all but disappeared, thus closing one viable employment option for psychologists wishing to be clinician–researchers (D. Kivlighan, personal communication, June 20, 2017).

At present, it is difficult to determine the prevalence of clinician–researchers, as it seems that those who do this work in recent years most often wear many different hats. In the U.S., 47% of all doctoral-degree holding psychologists identify their primary job as providing services (i.e. health care services), although recent data suggest this number is even higher, with roughly 2/3 of all psychologists identifying their primary job as being in health care (R. Fassinger, personal communication, May 16, 2017). Furthermore, between 2012 and 2015 there were approximately 106,000 licensed psychologists in the U.S., although not all licensed psychologists see clients for therapy (APA, 2015). In contrast, only 16% of psychologists in the US identify their primary job as being in research, and 18% in teaching, who may also be conducting research (National Science Foundation, National Center for Science and Engineering Statistics, Scientists and Engineers Statistical Data System (SESTAT), 2013).

These figures, although useful, do not answer the ultimate question of who is doing both therapy and therapy research, which would require data at a more fine-grained level. For example, we do not know how many of these research and teaching psychologists: (1) conduct research on therapy, specifically, and (2) see clients in therapy. It seems extraordinarily likely, however, that the answer is a much smaller number than estimated here. Similarly, of those who identify their primary job as service-related, we do not know how many of these psychologists: (1) provide direct clinical services to individual clients (as opposed to organizations, for example) and include psychotherapy services specifically (as opposed to psychological assessment, for example) and (2) are involved to some extent in research related to therapy. And of course, these data only represent psychologists in the US. An older study surveying the work experiences of counseling psychologists (Goodyear et al., 2008) is currently being updated (J. Lichtenberg, personal communication, June 2, 2017), and while those data are helpful in determining primary and secondary job settings, they still do not necessarily reveal who among us might be identified as clinician-researchers. In their study examining clinicians’ use of psychotherapy science to inform their own practice, Morrow-Bradley and Elliott (1986) used membership in APA’s Division 29 Society for Psychotherapy as a starting point for estimating the number of psychologists who might be engaged in some way with both therapy research (critically consuming it, for example, not necessarily producing it) and therapy practice. More recently, Safran, Abreu, Ogilvie, and DeMaria (2011) used membership in the international Society for Psychotherapy Research (SPR) as a closer estimation of who might be conducting therapy research and providing therapy.

In their study appearing in this issue, Reese and colleagues (this issue) used membership in each professional society as a starting point for tapping the number of professionals who could reasonably be identified as clinician-researchers—the target population upon whom this special issue is focused. Therefore, based on the work of these authors, we can estimate the number of clinician-researchers as being higher than 123 (Safran et al., 2011) and fewer than 3,158 (the total membership of Division 29 and SPR combined, although this number is likely inflated for several reasons, including overlapping membership between societies). Interestingly, at the time of writing this introduction, out of the 35 participating authors in this special issue, 8 (22%) reported they were currently members of both Division 29 and SPR, while 17 (48%) reported they were not currently a member of either. In other words, nearly half of the contributing authors of this special issue—professionals who are engaged to some extent in producing therapy research and seeing clients—would not be included in counts of clinician-researchers using membership in these professional societies as a proxy.

The papers in this special issue

The papers in this special issue are diverse in methodology, structure, and voice, and I am excited to be able to present them. Berman et al. (this issue) and Bartholomew, Perez-Rojas, Lockard, and Locke (this issue) use qualitative inquiry to examine the career experiences of professionals engaged in therapy practice and therapy research. Berman et al. is the centerpiece of this special issue and provides an analysis of a roundtable discussion among psychotherapy researchers at various stages of their careers. In this study, we found that there are benefits and challenges to continuing to do both, and systemic factors appear to play a role in one’s ability to continue to do both research and practice. In their study, Bartholomew and colleagues interviewed full time clinicians engaged in conducting therapy research in one university counseling center to learn more about what the experience of participating in both means to these clinician–researchers. Individuals and system administrators who want to foster work environments in which clinician-generated research, practice-based evidence, and meeting clinical demand all are integrated will be particularly interested in these researchers’ findings. Notably, clinicians at this site all reported having protected time for research built into their employment contracts, and a workplace culture supportive of clinicians’ research.

Friedlander (this issue) and Lee and Spengler (this issue) use personal narrative to invite us into their professional development as clinician–researchers. Friedlander provides a rich first person account of a professional career engaged in the science and practice of psychotherapy using the theme of reflexivity in language. Professionals and trainees – especially those interested in couples and family interventions – will be particularly interested in the interplay she describes between developing as a researcher and as a therapist. Likewise, Lee and Spengler describe their journeys of becoming experts in Emotionally Focused Couple Therapy, including how their therapist-selves and researcher-selves became integrated parts of a whole identity. Both authors also discuss clinical supervision as fertile ground for inspiring clinically-oriented research questions. Picking up on that thread, Reese et al. (this issue) surveyed clinician–researchers who are also engaged in providing clinical supervision and examined how all three roles might be integrated. For example, more than 92% of participants in their study reported that psychotherapy research played a role in how they supervised, with process and outcome research being most important. The manuscript by Reese et al. represents an important contribution to the literature about the synergy and benefits of a career engaged in both the science and practice of therapy, and how supervision fits into that synergy.

Castonguay et al. (this issue) provide yet another instructive practice research network (PRN) study. Their study developed as a result of clinicians’ curiosity about whether they could predict and recall the therapy interventions that they actually used with particular clients. This study highlights two things: (1) the finding that theoretical orientation of the therapists did not correlate with the type of interventions therapists actually ended up using, thus potentially adding more support to the finding that effective therapists are flexible in their approaches in order to meet the unique needs of their clients (Ackerman & Hilsenroth, 2003), and (2) that it is not always clear to researchers what full time clinicians (or at least this group of clinicians) are wondering about or wanting to know more about in their own daily practice! This is a reminder of the essential importance of PRN studies so that psychotherapy research remains relevant for all stakeholders.

A proposed model of the clinician–researcher

How much therapy research does a therapist have to do in order to be a clinician–researcher? How much clinical work does a therapy researcher have to do in order to be a clinician–researcher? And how integrated do these activities and roles need to be in the life of a clinician–researcher in order for one to identify as such? Based on the work of Safran et al. (2011), the body of work of Castonguay and colleagues on Practice-Research Networks (particularly Castonguay et al., 2010; Castonguay, Pincus, & McAleavey, 2015), and the papers included in this special issue (Bartholomew, Perez-Rojas, Lockard, & Locke, this issue; Berman et al., this issue; Castonguay et al., this issue; Friedlander, this issue; Lee & Spengler, this issue; Reese et al., this issue), I propose a heuristic for helping to solidify the existence of a professional identity called clinician-researcher, and to understand – if only in the most basic way – the career experiences of clinician–researchers (Figure 1). The proposed model depicts a matrix, delineating four quadrants of professional experience. Along the x-axis is level of therapy research activity, where no therapy research activity is at one end, and high levels of therapy research activity are at the other. Unlike Morrow-Bradley and Elliott (1986) and Safran et al. (2011), I define research activity as active participation in producing research (as opposed to consuming research to inform one’s practice). Serving as a volunteer therapist in a study, or meeting regularly with a research team to develop and implement a study (or both) are examples of being part of producing research. Along the y-axis is level of therapy activity, with no engagement in providing therapy at one end, and high levels of involvement in providing therapy at the other. I define therapy activity as interacting directly with clients, in the role of therapist, to provide psychotherapeutic intervention. Using this definition, reading case studies to stay informed about the process of psychotherapy, or providing supervision (while important) are not conceptualized as therapy activity.

Figure 1. The clinician-researcher.

Note: The X axis = Therapy research activity; Y axis = Therapy provision activity.

Additionally, the matrix is temporally bound, and is meant only to represent a snapshot in time. Psychologists and other mental health professionals – including the authors and research participants in this special issue – should be able to locate themselves in one of these quadrants. One’s location in the matrix may change depending on one’s professional and personal trajectories, and could be used as a way of contrasting actual and ideal placement. For example, it is likely that all of the research participants from the Bartholomew et al. (this issue), Lee and Spengler (this issue), as well as many of the co-authors of Castonguay et al. (this issue) would likely locate themselves in the upper quadrants, with some individual variability in terms of where they would plot themselves along the x-axis. Additionally, Friedlander (this issue), along with most of the other members of the roundtable discussion (Berman et al., this issue), would likely locate themselves somewhere in the upper right quadrant, while others would locate themselves in the lower right quadrant. At present, I would locate myself in the lower right quadrant because, while I am currently collaborating on research related to therapy (x-axis), I am also busy with research not about therapy (e.g. on the experiences of women in STEM, on the process and outcomes of intergroup dialogues), and I am not currently seeing clients (y-axis). As these activities shift, my exact location on the matrix will shift – and my ideal location is somewhere much closer to the nexus. But importantly: I can find myself on this map of being a clinician–researcher.

What is clear from all of the work presented in this special issue and the work of others in this area of study is that there are benefits to having some level of engagement in both therapy research and therapy practice for professionals (Castonguay et al., 2010; Safran et al., 2011) and for training new professionals (Castonguay et al., 2015; Gelso, Mallinckrodt, & Judge, 1996; Miles & Paquin, 2014; Stockton & Morran, 2010). While I would argue against wearing ourselves out trying to be or do all things, I propose that for those of us for whom the clinician–researcher identity has salience, being able to locate ourselves on the matrix allows us to learn something about our own point of reference, and where we might like to go. In other words, for those of us who find ourselves in one of the three quadrants in which either clinician or researcher activities are “low,” there may be usefulness in considering ways of “moving towards the center” in our own work integrating therapy science with therapy practice, and as a way of providing an optimal model for students.

Key points of learning: Top 15 things I have learned from editing this special issue about pursuing this kind of career

(1)	Systemic supports are vital, and include supervisor support, coworker support, workplace climate, and structural supports such as physical space, time, and compensation for research and clinical activities. A system that enables integration of research and practice is important to making this happen.
(2)	Gathering one’s own data is not necessary to engage in psychotherapy research; often, collaboration that capitalizes on existing resources and expertise is how this work gets done.
(3)	Gathering therapy data can be a completely integrated part of one’s clinical work, completely separate, or somewhere in between. Similarly, but stated from a different perspective, doing clinical work can be a completely integrated part of one’s research or completely separate, or somewhere in between.
(4)	Practice-Research Networks (PRNs) are an innovative, vital part of a solution for folks interested in staying involved in both research and practice.
(5)	PRNs can be structured in many different ways (e.g. in-house in a counseling center or research and training clinic; or external, linking many private practitioners across regions).
(6)	PRN studies are challenging and difficult to coordinate, but there are multiple, flexible ways of contributing skills, time and resources to this important work.
(7)	Similarly, different infrastructure/systemic supports create different ways of being involved in therapy research, ranging from spearheading/lead-authoring research projects, to serving as a clinician in someone else’s research while actively attending research team meetings, to providing data that will be combined with other clinician data for a national survey, to receiving a reduction in teaching load for academics interested in pursuing therapy research and clinical work, to being allowed to see clients in one’s faculty office or university’s counseling center or using one's lab space to see clients in the context of research.
(8)	Whatever demands/barriers operate in your workplace based on institutional oppression/privileging of your social identities (gender, race, immigration status, language, ability, etc.) will play a role in creating demands/barriers for you in your pursuit of this type of career.
(9)	Synergy does seem to happen when professionals are engaged in both, there is value in that synergy, it happens in different ways for different people, and sometimes it is not always expected or intuitive.
(10)	Roughly half of those who are doing the work of clinician–researchers reside outside of the U.S.
(11)	Doing some of both shapes the way one thinks of doing either.
(12)	Doing some of both informs one’s teaching and mentoring of students.
(13)	Some professionals experience a high level of integration with these roles/activities, some experience no sense of integration, and some will experience some level of integration – but the correlates or mechanisms associated with integration are unknown.
(14)	While there are some themes, there is no “one way” professionals have developed this kind of career for themselves.
(15)	The clinician–researcher professional identity likely has a developmental component; the more strongly one identifies with it, the more actively one seeks to develop/use both sets of skills and engage with both kinds of activities.

Areas for future inquiry

What is not depicted in the model proposed in Figure 1 is the level of integration one experiences regarding these roles and activities. It seems reasonable to posit that the participants in Bartholomew et al. (this issue), Friedlander (this issue), Lee and Spengler (this issue), and some of the participants in Berman et al. (this issue), if asked directly, would say that the roles and activities associated with conducting therapy research and therapy practice – while different – feel fairly integrated for them. For instance, Berman et al. stated that “integration almost seemed to be suggested as a natural part of the process of engaging in both roles.” After reviewing the articles presented here, and in preparation for writing this introduction, my hypothesis is that however integrated or compartmentalized/fragmented these activities and roles are experienced is related to how many (or how few) systemic supports are in place to support these activities. In other words, a professional who experiences a high level of integration is more likely to have a high level of systemic support, and a low level of integration (or high level of fragmentation) is associated with a low level of (or no) systemic support. Additionally, given that half of the clinician–researchers identified in Reese et al. (this issue) reside outside of the U.S., what are the various contextual or systemic realities for clinician–researchers outside of the U.S. that might foster this kind of career? Future research could investigate these and other research questions concerning role/activity integration in diverse workplaces of clinician–researchers around the world.

In conclusion, I am deeply appreciative for the excellent work of these 35 contributing authors and I am especially thrilled to be able to use this special issue as a teaching tool with the emerging counselors and psychologists I am lucky enough to train and teach. For most of them, “moving towards the center” is most saliently connected to the idea of practice-based evidence or “being local clinical scientists” as they learn to gather data during the therapy process to determine if and how their interventions are helping (Barlow et al., 2015; Chen, Kakkad, & Balzano, 2008). Castonguay and colleagues (2010) wrote,

We believe that clinicians truly integrate science and practice every time they perform a task in their clinical practices and are not able to provide an unambiguous answer to questions such as: “Right now, am I gathering clinical information or am I collecting data?” or “At this moment, am I trying to apply a helpful intervention with my client or am I implementing a research task?” Frequently, setting up rigorous empirical investigations that will lead them to answer these questions by saying, “Perhaps both,” may be the most fruitful and exciting pathway to bridge research and practice (pp. 352, 353).

Fostering the identity and development of clinician–researchers – during graduate training and in the workplace – is indeed exciting and important work.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

¹ While there are clinician–researchers outside of psychology (e.g. social workers, counselors, physicians) the emphasis of this special issue is on applied psychologists because: (1) applied psychologists are professionals specifically trained in both the provision of clinical services and the production of research, (2) it is the model of training with which I am most familiar, and (3) it is the focus of this journal.