Weissman Myrna M, Verdeli Helen, Gameroff Marc J, Bledsoe Sarah E, Betts Kathryn, Mufson Laura, Fitterling Heidi, Wickramaratne Priya
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York State Psychiatric Institute, New York, New York 10032, USA.
Arch Gen Psychiatry. 2006 Aug;63(8):925-34. doi: 10.1001/archpsyc.63.8.925.
Approximately 3% of the US population receives psychotherapy each year from psychiatrists, psychologists, or social workers. A modest number of psychotherapies are evidence-based therapy (EBT) in that they have been defined in manuals and found efficacious in at least 2 controlled clinical trials with random assignment that include a control condition of psychotherapy, placebo, pill, or other treatment and samples of sufficient power with well-characterized patients. Few practitioners use EBT.
To determine the amount of EBT taught in accredited training programs in psychiatry, psychology (PhD and PsyD), and social work and to note whether the training was elective or required and presented as a didactic (coursework) or clinical supervision.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey of a probability sample of all accredited training programs in psychiatry, psychology, and social work in the United States. Responders included training directors (or their designates) from 221 programs (73 in psychiatry, 63 in PhD clinical psychology, 21 in PsyD psychology, and 64 in master's-level social work). The overall response rate was 73.7%. Main Outcome Measure Requiring both a didactic and clinical supervision in an EBT.
Although programs offered electives in EBT and non-EBT, few required both a didactic and clinical supervision in EBT, and most required training was non-EBT. Psychiatry required coursework and clinical supervision in the largest percentage of EBT (28.1%). Cognitive behavioral therapy was the EBT most frequently offered and required as a didactic in all 3 disciplines. More than 90% of the psychiatry training programs were complying with the new cognitive behavior therapy requirement. The 2 disciplines with the largest number of students and emphasis on clinical training-professional clinical psychology (PsyD) and social work-had the largest percentage of programs (67.3% and 61.7%, respectively) not requiring a didactic and clinical supervision in any EBT.
There is a considerable gap between research evidence for psychotherapy and clinical training. Until the training programs in the major disciplines providing psychotherapy increase training in EBT, the gap between research evidence and clinical practice will remain.
每年约3%的美国人口接受精神科医生、心理学家或社会工作者提供的心理治疗。有少量心理治疗属于循证治疗（EBT），因为它们已在手册中明确界定，并且在至少两项有随机分组的对照临床试验中被证明有效，这些试验包括心理治疗、安慰剂、药丸或其他治疗的对照条件，以及具备充分样本量和特征明确的患者样本。很少有从业者使用循证治疗。
确定在精神病学、心理学（哲学博士和心理学博士）及社会工作领域经认可的培训项目中循证治疗的教学量，并留意培训是选修还是必修，以及是以讲授式（课程作业）还是临床督导的形式呈现。
设计、地点和参与者：对美国所有经认可的精神病学、心理学及社会工作培训项目的概率样本进行横断面调查。回复者包括来自221个项目的培训主任（或其指定人员）（73个精神病学项目、63个哲学博士临床心理学项目、21个心理学博士项目以及64个硕士水平社会工作项目）。总体回复率为73.7%。主要结局指标为在循证治疗中同时需要讲授式教学和临床督导。
尽管各项目提供了循证治疗和非循证治疗的选修课，但很少有项目要求在循证治疗中同时进行讲授式教学和临床督导，且大多数必修培训是非循证治疗。精神病学领域要求进行循证治疗课程作业和临床督导的比例最高（28.1%）。认知行为疗法是所有三个学科中最常提供且作为讲授式教学要求的循证治疗。超过90%的精神病学培训项目符合新的认知行为疗法要求。学生人数最多且侧重于临床培训的两个学科——专业临床心理学（心理学博士）和社会工作——中，分别有最大比例（分别为67.3%和61.7%）的项目不要求在任何循证治疗中进行讲授式教学和临床督导。
心理治疗的研究证据与临床培训之间存在相当大的差距。在提供心理治疗的主要学科的培训项目增加循证治疗培训之前，研究证据与临床实践之间的差距仍将存在。
