by Jacqueline B. Persons, Ph.D., Oakland Cognitive Behavior Therapy Center and University of California at Berkeley
I’m writing this article to describe my career path as a clinician in private practice who conducts research, with a view to encouraging trainees and graduates of Psychological Clinical Science Accreditation System (PCSAS) programs to consider following it. My career has been extraordinarily rewarding, and I’m proud of the contributions to psychological science I’ve been able to make. PCSAS training will give you a solid foundation for the career path I describe here.
I received a Ph.D. in clinical psychology from the University of Pennsylvania, where I got strong research training and was expected to follow an academic path. However, when it was time to go on the job market, I simply did not feel prepared to do it. I also had the two-body problem. My husband, who was an academic (an economist), had just received a very nice offer from University of California at Berkeley. So, we came to Berkeley, and I started a private practice. I found that I loved clinical practice but did not want to give up research. Over time, I developed a way to integrate research into my daily work (Persons, 2018). At our group practice, the Oakland Cognitive Behavior Therapy Center, we have twin missions of providing top quality CBT and conducting research that will contribute to the science of our field. I also serve on the volunteer faculty in the Department of Psychology at the University of California, Berkeley.
The central thrust of my work has been to study the process and outcome of naturalistic CBT and to develop ways to individualize and personalize CBT while remaining evidence-based. My efforts to integrate science and practice led to my clinical writings on case formulation (e. g., Persons, 2008) and to more than 30 empirical papers in peer-reviewed journals. A recent paper showed that homework compliance is better when the content of the homework assignment is congruent with the patient’s reported take-home message from the session than when it is not (Jensen et al., 2021). And our latest paper, Gates et al. (in press) studied three decision support tools, the written case formulation, a list of treatment goals, and a plot of progress monitoring data. We found that all three tools were associated with reduced dropout, and that two tools, a list of treatment goals and a plot of progress monitoring data were associated with reduced post-treatment scores on the Beck Depression Inventory. Data for both these studies were collected in the course of routine practice.
For graduate students who might want to consider a career path as a researcher in private practice, I offer several suggestions. Learn a hypothesis-testing approach to your clinical work, not just how to deliver a treatment protocol (Shiloff, 2015). In a hypothesis-testing approach, you’ll develop a hypothesis (case formulation) about the psychological mechanisms that maintain your patient’s symptoms and problems, intervene to target those mechanisms, and collect data to assess whether the mechanisms change as predicted and whether your patient is making progress to accomplish their treatment goals. This hypothesis-testing approach allows you to provide top quality evidence-based care and can support a mode of clinical practice in which you collect data that can guide both the clinical work and research. Second, learn to carry out a single case experimental design. If your training program offers a course, take it, and if not, consider putting together a study group with a fellow student to work through a text on the topic (e.g., Kazdin, 2020). The rigorous study of a single case is an ideal research design for the practitioner. Third, initiate and carry out a piece of research during one of your clinical training experiences; this could be a single case experimental design, or even a study of the supervision process. Fourth, pay attention to your interests, and take leadership to get the training you need to treat the types of problems that interest you and to carry out research that interests you. Research in a clinical practice setting is only possible if it is intrinsically reinforcing and you can take leadership to move it forward. Finally, join the Association for Behavioral and Cognitive Therapies and the Special Interest Group on Research in Clinical Practice. If you want to join, let me know and I’ll add you to our group.
Please reach out to me if I can be of any help to you as you sort out your own career path, or in the event that you might have interest in coming to do a postdoctoral fellowship or work with me at the Oakland CBT Center. I’m at persons@oaklandcbt.com.
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References
Gates, V., Hsiao, M., Zieve, G. G., Courry, R., & Persons, J. B. (in press). Relationship to CBT outcome and dropout of decision support tools of the written case formulation, list of treatment goals and plot of symptom scores. Behaviour Research and Therapy.
Jensen, A., Fee, C., Miles, A. L., Beckner, V. L., Owen, D., & Persons, J. B. (2020). Congruence of patient takeaways and homework assignment content predicts homework compliance in psychotherapy. Behavior Therapy, 51(3), 424–433. https://doi.org/10.1016/j.beth.2019.07.005
Kazdin, A. E. (2020). Single-case research designs: Methods for clinical and applied settings (3rd edition). New York: Oxford University Press.
Persons, J. B. (2008). The case formulation approach to cognitive-behavior therapy. New York: Guilford.
Persons, J. B. (2018). Simultaneous practice and research: A model for conducting research in private practice. In R. T. Codd III (Ed.), Practice-based research: A guide for clinicians (pp. 153–169). New York: Taylor & Francis/Routledge.
Shiloff, N. (2015). The scientist-practitioner gap: A clinical supervisor self-discloses. Clinical Science, 18(3), 21–23.
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).