by Shannon M. Savell, M.A., University of Virginia
Many scholars have asserted that one vast improvement in the field of clinical psychology over the past few decades has been advances in examining both the efficacy and effectiveness of different therapeutic treatment modalities and a move towards evidence-based practice (Spring, 2007). Developing empirically supported treatments and utilizing evidence-based practice in clinical psychology will likely move the field forward in meeting mental health care needs (La Roche & Christopher, 2009). However, for critical consumers of the research literature, it is easy to spot one fundamental flaw in many randomized controlled trials (RCTs), currently our gold standard in clinical science. That flaw is in regards to sample characteristics. The lack of diversity across various social identities whether racial-ethnic identity, sexual identity, gender identity, age, or religious identity is striking (Henrich et al., 2010; La Roche & Christopher, 2009). Given that many RCTs are conducted with convenience samples, it is no surprise that the vast majority of participants identify as White and from middle to upper socioeconomic status (Henrich et al., 2010; La Roche & Christopher, 2009). This begs the question of generalizability and for whom these empirically supported treatments really work. One well-known reason we see large RCTs and meta-analyses of RCTs over-represented with White, highly educated participants are the downstream effects of structural racism and discrimination in clinical science (Roberts et al., 2020).
Throughout the history of psychological science, research practices have perpetuated racial discrimination and other forms of oppression in a number of ways (Roberts et al., 2020). Excluding Persons of Color and other socially marginalized groups from participating in research is just one example. Many research practices have exploited said groups and perpetuated stereotypes and discrimination such as the misinterpretation of intelligence testing data to fit a deficits based agenda which many have argued is steeped in racism (Turkheimer, 1997; 1998). Another lesser known reason for the lack of diversity in RCTs is related to the history of abuses and exploitation by researchers which has understandably resulted in mistrust of research and medical systems and apprehension about participating in research (Williams et al., 2013). The mistrust and apprehension has been highlighted especially during the pandemic with many scholars calling attention to the history of abuses in the past as a barrier to trust in systems presently (Quinn & Andrasik, 2021). Additionally, by neglecting to properly incentivize and fund scholarship aimed at promoting diversity, equity and inclusion, the lack of representativeness in clinical science and lack of cultural responsiveness in clinical practice have continued in present day (La Roche & Christopher, 2009; Roberts et al., 2020).
Over the past decade, we have seen more research funds devoted to aiding in recruitment of diverse populations and more scholarship and funding to not only diversify psychological science research participant samples but also to ensure researchers from marginalized social identities can pursue tenure track research positions so that there is more representation and diversity at every level from undergraduates to college professors and primary investigators (Roberts et al., 2020). However, many scholars have pointed out the vast room for additional improvement. Recently, scholars have argued that only when clinical science more accurately reflects society and when the researchers themselves also reflect society will we see the immense improvement in psychological science that we need so we can better understand what treatments work best and for whom (Galán et al., 2021).
Many of the challenges in this work are related to funding and training. There is a need to increase training and education in racially and socially just research practices, a need to incentivize and require students and faculty to demonstrate cultural humility in research, and a need to properly incentivize, fund and promote research that addresses the development of culturally responsive treatment practices (Galán et al., 2021).
Recommendations for improvements in clinical training and research in addition to suggestions for pursuing antiracist clinical science and practice more broadly have been summarized in Galán et al. 2021. One practical example of how to increase trust with community stakeholders for participating in research and pursuing a representative and inclusive sample is to utilize community focused participatory research, meet participants in preferred locations, and provide transportation to laboratories and access to childcare and food during or after participation (Stewart, 2018). Further, the Social Responsiveness Toolkit for Education and Training in Health Service Psychology (CCHPTP, 2021) developed by the Council of Chairs of Training Councils (CCTC) in 2021 stands out as an incredible resource for students, faculty, and, programs more broadly, who want practical tips on how to pursue more socially responsive research, teaching, and practice.
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References
CCHPTP. (September 2021). CCHPTP. Retrieved September 30, 2021, from http://www.cchptp.org/d8/content/cctc-social-responsiveness-toolkit.
Galán, C. A., Bekele, B. M., Boness, C.L., Bowdring, M. A., Call, C. C., Hails, K. A., McPhee, J., Mendes, S. H., Moses, J., Northrup, J. B., Rupert, P., Savell, S., Sequeira, S., Tervo-Clemmens, B., Tung, I., Vanwoerden, S., Womack, S. R., Yilmaz, B. (2021). A Call to Action for an Antiracist Clinical Science. Journal of Clinical Child & Adolescent Psychology.
Disclaimer: The views and opinions expressed in this newsletter are those of the authors alone and do not necessarily reflect the official policy or position of the Psychological Clinical Science Accreditation System (PCSAS).