Chpt 9 Review

Journal of Marital and Family Therapy January 2005,Vol. 31, No. 1, 75–88

January 2005 JOURNAL OF MARITAL AND FAMILY THERAPY 75

INTEGRATING RESEARCH AND CLINICAL TRAINING IN MARRIAGE AND FAMILY THERAPY TRAINING PROGRAMS

Jennifer L. Hodgson East Carolina University

Lee N. Johnson University of Georgia

Scott A. Ketring Auburn University

Richard S. Wampler Texas Tech University

Angela L. Lamson East Carolina University

The future of the profession and practice of marriage and family therapy (MFT) rests with those who promote the integration of research and clinical practice. The Boulder scientist–practitioner model is useful in conceptualizing MFT training, but it is not the perfect solution. Four MFT programs (two master’s and two doctoral) are featured in this article for their work in integrating research and practice. Helpful strategies presented include: Encouraging students to question the therapy process; integrating research in the curriculum and supervision; discussing the positives and negatives of empirically supported treatments; focusing on change; and developing creative classroom experiences to use within the scientist–practitioner model.

The scientist–practitioner model of graduate education in psychology (a.k.a., the Boulder Model; Raimy, 1950) was the result of 73 educators and practitioners participating in a 2-week conference to discuss training standards for doctoral psychology programs. The Boulder Conference was organized because of the explosive growth of clinical psychology during WWII. Professionals within the field feared that traditional psychology graduate training was inadequate in training clinicians and clinical faculty. Although varying forms of the Boulder Model were implemented in psychology programs, critics such as Benjamin and Baker (2000) have asserted, “It is a model that has been much praised, much maligned, and, according to some, rarely if ever tried” (p. 233).

The goal of the Boulder Model is to teach clinical and research skills. However, it is a myth that scientist–practitioner education is a “midpoint on a continuum . . . that emphasize[s] either research or practice” (Belar, 2000, p. 249). The key to the model is integration. To understand the scientist–practitioner model as originally described, reference can be made to the resolutions from the Boulder Conference (Raimy, 1950) and a 1947 article on training in clinical psychology (American Psychological Association,

Jennifer L. Hodgson, PhD, and Angela L. Lamson, PhD, Department of Child Development and Family Relations, East Carolina University; Lee N. Johnson, PhD, Department of Child and Family Development, University of Georgia; Scott A. Ketring, PhD, Department of Human Development and Family Studies, Auburn University; Richard S. Wampler, PhD, MFT Program, Texas Tech University.

This article is based on a presentation at the 2002 AAMFT annual conference in Cincinnati, OH. Correspondence may be addressed to Jennifer Hodgson at East Carolina University, Department of Child and Family

Relations, 150 Rivers Bldg., Greenville, North Carolina, 27858-4353. E-mail: [email protected]

76 JOURNAL OF MARITAL AND FAMILY THERAPY January 2005

Committee on Training in Clinical Psychology, 1947) that provided the starting point for the Boulder Model. The 1947 report states that the integration of theory, practice, and research is needed throughout training. In 1950, the importance of students “[receiving] training in both research and practice in order to develop interest and background in both areas” (Raimy, 1950, p. 80) was reiterated. Because of this ambitious goal, Raimy acknowledged that, “Whether the four-year doctoral training program, which emphasizes both research and service, will achieve the desired result is a question to be settled by the future” (1950, p. 81). In spite of these concerns, “The Conference was clearly unwilling to see clinical psychology defined exclusively in terms of either research or service alone” (1950, p. 81).

The Scientist–Practitioner Model in MFT The issues for training in marriage and family therapy (MFT) programs are almost the reverse of those

faced by the Boulder Conference. In Boulder, the graduate programs in psychology were attempting to introduce clinical courses and experiences into doctoral programs that historically focused on research endeavors. In contrast, accredited master’s-level mental health programs, like programs in MFT and social work, have historically focused on training clinicians. The master’s degree has been considered the required level of training for clinical practice, and this has been written into state laws, whereas clinical psychology licensure and practice have been restricted to those with doctorates. The Commission on Accreditation of Marriage and Family Therapy Education (COAMFTE, 2003) and the American Association for Marriage and Family Therapy (AAMFT, 2002) have emphasized the need for research and practice training at both the master’s and doctoral levels.

The argument can be made however, that MFT has focused on practice at the expense of research in training (Crane, Wampler, Sprenkle, Sandberg, & Hovestadt, 2002). Recent revisions of the COAMFTE doctoral internship requirements to include advanced research training as well as clinical training is a positive step toward the scientist–practitioner model. Through the years, practical experience has remained one of the strengths of MFT master’s- and doctoral-level training programs. The fact that students in COAMFTE-accredited master’s and doctoral programs are required to gain 500 client contact hours at each level of training ensures that graduates have clinical experience. This high level of experience coupled with the requirement that MFT students receive 100 hours of supervision at each level of graduate training further increases the likelihood that students will graduate with the necessary clinical skills. However, there is much less emphasis in the COAMFTE standards on research, and students may not get the necessary skills to be successful scientist–practitioners. If more is not done within training programs to develop competent scientist–practitioners, we will continue to see MFT research being done by others who have limited loyalty to the field of MFT (Crane et al., 2002).

Positive Developments in MFT Despite the lack of research emphasis, positive strides have been made within the field of MFT in the

last 5 years. The COAMFTE and AAMFT have made progress in integrating research into the training curriculum and profession. The AAMFT sponsored a recent series of five research conferences that brought together MFT graduate students, clinicians, faculty, and researchers from related disciplines. Speakers at the last research conference presented evidence for the efficacy of MFT interventions (Sprenkle, 2003), as did those at the 2001 annual AAMFT conference, which focused on evidence-based research. Additional opportunities for reporting on MFT research efforts are extended at each annual AAMFT conference. The AAMFT has sponsored efforts of the MFT Research Consortium and practitioner surveys, in addition to supporting the efforts of the editors of the Journal of Marital and Family Therapy to expand the journal’s coverage of research.

In light of these trends, there have been calls to incorporate the Boulder Model into MFT education more fully (Crane et al., 2002). By implementing the scientist–practitioner model, MFT training programs will more adequately equip trainees to promote MFT as a profession, advance the research within our field, integrate research and practice in maintaining a state-of-the-art practice, provide a research background for practicing clinicians for effective practice evaluation, and decrease the cultural gap that exists between clinicians and researchers.

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Research on MFT is needed to promote the field, and, although research shows the effectiveness of MFT, more evidence is needed to further understand how change occurs within relationships, as well as translational research that applies existing research in community settings. High quality, relationally focused research is also needed in the hands of mental health policy makers who shape the practice of MFT. A scientist–practitioner model of training increases the interconnectedness between researcher and practitioner and creates a professional setting where the necessary research can be generated. Although this research is beneficial to the field, clinicians also benefit by gaining skills from learning about the evaluation and production of research.

Many of the skills necessary for good clinical work are also necessary to be a good researcher. Both must conceptualize ideas within relational problems, decide what questions to ask and how to ask them, and then evaluate the quality of the responses to formulate findings and make determinations for future impact. The processes used are similar and require the professional to apply theory logically, develop hypotheses, determine validity, draw conclusions, and make future plans. As students simultaneously learn the art of practice and research they will gain skills that will be beneficial throughout their careers.

Long-Term Gains from Implementation The field of mental health, which includes MFT, is constantly changing. It has been said that the “half-

life of psychological knowledge” is 10 years (Stricker, 1992, p. 545). Thus, if MFTs want to maintain an ethical practice based on current knowledge, they must continue learning throughout their careers. A scientist–practitioner education equips MFTs with the skills necessary to read research, review scholarly literature, compete for grants, attend presentations, and determine the value of the research and how it may be incorporated into practice. This awareness of the connectedness between research and practice also aids clinicians as they market their abilities and interact with funding sources.

The ability to integrate clinical skills with research skills will be increasingly important as therapists are asked to demonstrate effective practice to insurance providers. Many clinicians are dependent on insurance reimbursement within their practice setting. With increasing competition for insurance dollars, more requirements are being placed on practitioner access. One requirement has been for clinicians to demonstrate effectiveness of their treatments. A scientist–practitioner education may help to prepare trainees for the current climate of third-party reimbursement. Therapists with a scientist–practitioner education, who are applying to be on insurance panels, should be able to talk about their clinical skills and demonstrate, with data, the effectiveness of those skills. Scientist–practitioner trained therapists should also be better prepared to help and advocate for their clients by being able demonstrate, with data, treatment plans, client progress, and when necessary, the need for additional therapy sessions. This premise is partially supported by the Johnson, Sandberg, and Miller (1999) finding that research experience in graduate school increases the likelihood of MFTs evaluating their own practices.

Finally, scientist–practitioner training could diminish the cultural gap that exists between researchers and clinicians. Many reasons exist for the size of the gap, which are beyond the scope of this article. Researchers have shown that one way to increase research collaboration between researchers and clinicians is for researchers to gain the trust of clinicians (Sandberg, Johnson, Robila, & Miller, 2002). The scientist–practitioner model provides a similar education to both researchers and practitioners, resulting in a clearer consensus on the problems facing MFT thus, easing the establishment of a researcher–clinician alliance through common awareness. This reciprocal understanding could facilitate mutual trust and respect and lead to more collaborative efforts.

As MFT training programs initiate or increase implementation of the scientist–practitioner model, they may have more strength in marketing and advocating for the profession. From a clinical standpoint MFT has been marginalized as a practice modality and not viewed as a separate profession. Thus, MFTs must work to create a structure that further strengthens their professional identity. In fact, Crane et al. (2002) sum it up when they state, “We have faced the professional versus-practice issue on the clinical side, and it is time we face it on the research side as well” (p. 77). The implementation of the scientist–practitioner model could allow MFTs to accomplish this.

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Challenges to Implementation Because of the strong clinical focus of many MFT training programs, the implementation of the

scientist–practitioner model requires increased efforts to integrate research in training programs. Requests for more emphasis in research within the field have often been met with criticisms and concerns. First, many fear that adherence to the scientist–practitioner model of training has the potential of overemphasizing empirically supported treatments (EST) at the expense of dynamic approaches (Garfield, 1996, 1998; Henry, 1998). It is erroneous to believe that the scientist–practitioner model means only teaching evidence-based models. The essential key to the scientist–practitioner model is training students to integrate theory and research while teaching skills necessary for the critical evaluation of research and therapy models.

Further complicating the adoption of a scientist–practitioner model of training is the fact that programs have limited space to teach required courses. With an increase in ESTs, new knowledge concerning common factors, and an increasing emphasis on clinical research, there is pressure to eliminate or severely diminish the teaching of specific therapy models. No two programs will respond in the same manner. However, by teaching an integrative, critical format of the therapy models and research students will gain a working understanding of the wide array of treatment approaches along with the strengths and weaknesses of those approaches.

As training programs interweave different approaches to clinical care throughout the curriculum, the strengths and weaknesses of each approach can be highlighted. Stereotypical assumptions that evidence- based models are mechanistic and primarily technique based can be presented and discussed. Claims that non–evidence based therapy models have nothing to offer can also be discussed. Through discussion, trainees and future therapists can hopefully come to an improved understanding of the relationship between evidence and non–evidence based models as well as the role of contextual factors in therapy. In addition, as training programs teach their students to understand, evaluate, and implement science and practice, MFTs can hopefully avoid strict adherence to cookbook approaches of treatment and move past the days when many followed the charismatic leaders of new therapy models.

Finally, an often-cited limitation for a scientist–practitioner education is that therapy is an “art” not a “science” (Chambless, 1996). We do not wish to engage in a debate about whether therapy is an “art” or “science,” but advocate a stance that good therapy is both. At times therapists are required to apply and adapt ideas to individual settings artistically. Therapists must also have up-to-date scientific knowledge of people, relationships, how they adapt and change as individuals within relationships, therapy interventions and treatments, major mental health disorders, social problems, and contextual issues. We do not disagree that good therapy is indeed “artistic” in some of its individual applications; however, we cannot forget that science is also part of the equation, and quality training focuses on both parts.

With these arguments in mind, we want to further encourage the implementation of the scientist–practi- tioner model in MFT education. We want to reiterate that this implementation does not require the teaching of research at the expense of clinical skills or require everyone to become a grant-funded researcher. Rather, we advocate training standards for MFTs that infuse and integrate research, theory, and clinical skills throughout the curriculum, similar to the integration of diversity that has been beneficial to MFT training. To help guide others who wish to implement this model in their programs or courses, this article provides examples of how four COAMFTE-accredited programs (two master’s and two doctoral) have brought the scientist–practitioner model into their training programs and courses.

INFUSING AND INTEGRATING THEORY, PRACTICE, AND RESEARCH

East Carolina University Because East Carolina University (ECU) already had a strong clinical master’s program, the faculty

believed that infusing more research into it would be akin to building on a solid foundation. In the fall of 2000, we committed ourselves to the following goals: (a) To increase the presence of ESTs throughout the curriculum; (b) to augment faculty and student dialogue about the integration of research into clinical practice; and (c) to increase the amount and quality of research being done through our on-campus clinic. As a result, all students are now exposed to the rigors and merits of research throughout the program by

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teaching students how to read, interpret, and critique research for assimilation into practice. Beginning in the systems theory course, students critique research and theoretical articles around a

variety of systemic issues. They learn the necessary criteria for conducting a literature search and writing a professional paper (i.e., developing a research question, establishing a clear purpose and audience, using refereed journal articles and reputable books and websites, etc.). In this course, students also prepare a professional presentation based on current systemic research.

The family therapy theories course builds on this work. Students not only read and critique evidence- based research articles in the field of MFT (e.g., structural family therapy, multidimensional family therapy, multisystemic therapy, functional family therapy, narrative family therapy) but also critically evaluate both empirically supported and theory-driven treatments. They begin the course reading from two sources about the general implications of MFT research (Family Journal, v. 5(4); Nichols and Schwartz, chapter 16). Their main text is supplemented with a course pack containing articles on EST and related research. The articles are taken from various sources (e.g., American Journal of Family Therapy; Family Process; Journal of Clinical Child Psychology; Journal of Consulting and Clinical Psychology; Journal of Family Psychology; Journal of Marital and Family Therapy). Using these and other library sources, students are required to locate two research articles and write two (2–3 page) research abstracts (see the reference list for a complete list). This assignment teaches them how to locate, read, interpret, and critique research. It also helps them to gain skills in focusing on the main points of an article, including information on the purpose, subjects, instruments, procedures, and results of the research. Students are also instructed to critique the article for its readability, applicability, and potential for stimulating future research. When they turn in their abstracts, they are required to lead a class discussion on their articles. There they present the research and compare it to evidence collected on other models already discussed. Discussions get livelier and their writing gets stronger as the semester progresses and students grow in their understanding of research and the various theoretical models.

Lastly, to ensure that the students are making the connection between research and practice, students are required to complete approximately six case vignettes over the course of the semester. Along with each vignette, students are given four questions to answer related to applied and empirically supported aspects of each model. For example, “If the family asked you how you know your model may be helpful with their presenting concern, what would you say?” Although not all of our clients are looking for research to support their therapist’s effectiveness, it is important that therapists have a response or at least know where to look for one.

Research in our clinic has increased in the past 4 years. We revamped our clinic assessment protocol, placed its importance at a higher level, and educated our faculty and students about administering research in the clinic via a 3-hour training seminar and a detailed training manual. For the last several years, we have been actively collaborating with other MFT programs to compile couple therapy outcome data. Through this, our students have learned that collecting clinical data requires diligence and that getting posttreatment data is difficult but crucial. They have also realized the merits of evaluating their practice strategies and the process of therapy.

Finally, encouraging student participation in faculty research helps to dispel myths that research is all about sterile statistics, is not useful, and is boring. Opportunities are provided for students to work with faculty to collect data, enter it into a database, help with analysis, and write publications. Many students and faculty have co-conducted research and presented it together at local, state, and national conferences. Through these opportunities, students have been able to experience research from the ground up and have learned how exciting it is to share the results with others.

East Carolina University’s MFT faculty work hard to engage students in studies that will advance the field and enhance their understanding of the clinical value of research. Although our integration of the scientist–practitioner model is still in its infancy stage, we believe we have a strong start. We understand that for our students to be sufficiently prepared upon graduation, we must stay on top of trends and developments in the field and constantly revise our program to integrate research and clinical practice more fully.

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Auburn University Graduates from Auburn University’s (AU) master’s program have become successful clinicians, PhD

students, and faculty. Thus, when AU decided to restructure its program to integrate research and practice the MFT faculty wanted to make sure they did not lose what was already accomplished. Goals that we set at the beginning of the restructuring process included: (a) Reaching the EST models in more depth; (b) elaborating on the common factors vs. therapy models debate within our field; and (c) pushing for more clinical research by students and faculty. Each of these goals presented unique challenges that required faculty to work creatively together. The need to work collaboratively was most apparent during discussion on curriculum changes.

As the faculty discussed curriculum changes it became obvious that each member wanted to teach specific topics and specific therapy models and that these topics overlapped throughout the courses. After several conversations on the subject, it was decided to team teach within a modular format with one faculty member in charge of the course, but one or both of the other faculty teaching content within the course. Hence, each faculty would teach different parts of various courses to cover the EST models of therapy and theories in which they had particular expertise. To work out the logistics and keep course loads fair, we took the number of graduate clock hours each faculty taught during a given year and then divided those hours among the courses taught in modular format.

One example of how AU implemented changes is reflected in their course on couple therapy. Content of this course now focuses on Gottman’s (1999) research, emotionally focused therapy (EFT; Johnson, 1996), and integrative couples therapy (ICT; Jacobson & Christensen, 1996), with two of the three faculty members teaching content within this course. The students appreciate the research by Gottman, but faculty and students agreed that EFT and ICT better integrated research into practice. The students suggested teaching Gottman only as a research foundation, then EFT and ICT as therapy models informed by Gottman’s research. The logic was that EFT and ICT approaches were more useful, whereas the Gottman information could be easily integrated. The faculty made the changes and the flow of the course improved.

Similar changes were also implemented in the child/adolescent course. Important research topics (ADHD, ODD, and CD) and treatment approaches (e.g., multidimensional family therapy, Liddle, 2002; multisystemic therapy, Henggeler, 1998;, functional family therapy, Alexander, Pugh, & Parsons, 1998; and Treating the Tough Adolescent, Sells, 1998) are emphasized. Again multiple faculty members teach content within this course.

In an attempt to train clinical scientists, the faculty wanted to do more than emphasize EST models, they wanted to create interest in the debates and challenges facing the field. To accomplish this students get an overview of the history of AAMFT, the state of research within the field, and an introduction to the EST/common factors debate. This is done by teaching the EST and common factors debate through readings from The Heart and Soul of Change (Hubble Duncan, & Miller, 1999), teaching EST models, and using articles elaborating both sides of the debate.

To facilitate the goal of increasing faculty and student research, AU coordinated clinical data collection with the University of Georgia. These data are used to track client, therapist, and service variables throughout therapy and beyond to examine clinical effectiveness. The primary goal of collecting data was to benefit clinical practice; however, these data also provide a base for faculty and student research. Finally, the MFT faculty started a research project on the relationship between supervision and therapy effectiveness. The intent was to have a research project that is collaborative among the faculty and to demonstrate the priority faculty placed on clinical research.

Evidence of success of these changes has come each year following attendance at the AAMFT Annual Conference. Students return after comparing notes with other trainees, pleased at the level of their training and the level of integration between courses, practicum, theory, and research. In addition, as students gain an appreciation for research and the benefits of integrating research findings into practice, they become more concerned about thesis topics. A master’s student came to a faculty member’s office this semester after a discussion about research within the field and said that he wanted to alter his topic to a clinical focus. The faculty even discussed with a student the possibility of coordinating a clinical externship with thesis research. Students have also begun to collaborate with faculty on the supervision research and have presented posters their work from the project. Finally, lively debates are encouraged by faculty in the couple

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therapy class. These debates concern the different EST models along with dynamic models of therapy that are covered early in the curriculum (e.g., structural, strategic, solution focused, and Milan [see selected readings]).

Increasing the emphasis on research in a training program has been a major undertaking that has resulted in positive developments. Changes have been observed in student exit interviews, during supervision, and as students provide therapy. Examples of student comments include reporting that they enjoy the balance of research and clinical skills, reporting satisfaction with learning multiple theories and accompanying research, and reporting increased learning from courses and practicum applying theory and research. Faculty have also observed students applying research in therapy, making comments in supervision that are guided by research, and appropriately citing research during sessions. These comments and observations show that the changes have impacted the training process have been received well by students.

University of Georgia The University of Georgia’s (UGA) MFT doctoral program has long endorsed the scientist–practitioner

model and been known for its research tradition. Recently, to further implement the scientist–practitioner model, faculty set two goals: (a) Increase the amount of clinical research being done by students and (b) better integrate coursework, practicum, clinical practice, and research. As a first step, the clinical data collection process was redesigned to create a research database (in a collaborative effort with Auburn University). Next, UGA faculty focused on how each course in the curriculum builds on previous courses and worked to integrate research, theory, and practice. A clinical research methods course was added to emphasize this integration. Other areas have also been added, such as research presentations by students and faculty at monthly clinic meetings. Although there are many aspects of the scientist–practitioner model being used within the program, the rest of this section will focus on how the scientist–practitioner model can be applied to an individual course.

In redesigning the first MFT course taken by PhD students, it was decided that rather than talking about research, theory, or practice separately, emphasis would be placed on the process of change, involving research, theory, and practice. With the process of change as an overarching focus, treatment manuals from ESTs were chosen as the main readings for the course (e.g., emotionally focused therapy, Johnson, 1996; integrative behavioral couple therapy, Jacobson & Christensen, 1996; multidimensional family therapy, Liddle, 2002; functional family therapy, Alexander et al., 1998; and multisystemic therapy, Henggeler, 1998). However, prior to assigning students therapy models to read, students read articles to understand the current context of mental health in regards to the EST debate, and the therapy models versus common factors debate. These two debates provide insight into views of how change occurs and what causes change. Students read articles from three sources addressing the benefits and pitfalls of the EST and common factors debate (Journal of Consulting and Clinical Psychology; Psychotherapy Research; and Clinical Psychology: Science and Practice) and chapters from the Heart and Soul of Change (Hubble et al., 1999), as well as readings on the therapeutic alliance. An understanding of these issues provides students with a reference point for discussing therapy models, how change occurs, and what influences change.

For the next part of the class, students read five treatment manuals. Each model was the focus of class for 2 weeks. In the first week, students read the treatment manual and two or three recent outcome research articles on the model. Each model was discussed in terms of how it describes change as occurring, the role of the therapist, specific interventions, when to use/not use the model, the process of therapy, how dysfunc- tional and healthy functioning are defined, and limitations of the model. In the second week, students went to the library and reviewed the process research related to the model. Discussion in the second week focused on developing a table summarizing the process research within each model, leading to a class project to summarize the process research within each model discussed and submit the completed project for publication. This course plan brought knowledge about theories, practice, and research to the forefront, all integrated throughout the discussion.

Student response to the course has been very positive. Requiring students to submit their project for publication changed the intensity with which they were engaged in the project. Further, it underlined the

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message that they could contribute to the profession. Students appreciated the focus on “change” and that the models were discussed and not presented in a traditional lecture format. Over the semester, students began to make what could be called “scientist–practitioner” comments. For example, during a discussion of functional family therapy, a student asked if there were research that looked at adolescent gender differences in terms of change processes. The student hypothesized that, because males tend to externalize problems and females tend to internalize problems, they might change differently in the course of functional family therapy. An exciting discussion followed on functional family therapy process research, how the students, as clinicians, could adapt some of the interventions based on individual client needs, and ideas for future research. As a result of this class students were thinking about theory, practice, and research in an integrated manner and could take this strategy into other classes, clinical work, or research endeavors.

Texas Tech University Historically, about one-third of Texas Tech University’s (TTU) graduates enter academic settings, one-

third enters agency/institutional settings, and one-third enter private practice. Over the years, the faculty at TTU have worked to define the purpose of a doctoral education. In general, the faculty agreed that we must focus our training on preparing the next generation of MFT researchers and faculty members. For us, that means graduates who can advance the field through clinical research, teaching, and dissemination of knowledge through their own teaching, publications, and presentations. To train this next generation, TTU has taken steps to place research experience on an equal footing with clinical experience, to integrate research and therapy throughout the curriculum, and to equip students to conduct research. A training model has been developed that emphasizes research activities along with clinical training. This model is made clear to prospective students.

Some years ago, TTU faculty realized that many of their students were trying to complete a dissertation the year following qualifying examinations while also completing a clinical internship and, in many cases, holding outside clinical positions and teaching undergraduate courses. Further, students who had completed their coursework and clinical hours were tempted away into full-time positions that tended to make disser- tation research and writing a last priority. Although students were completing the doctoral program with up to 2000 post-master’s clinical hours, many had little or no research experience. Completing a dissertation “on roller skates” in their final year on campus or while holding down a full-time job took away much of the interest in and excitement about research and tended to segregate clinical practice (something you love to do) from clinical research (something you have to do).

To correct this imbalance, the TTU faculty decided that student involvement in research from the beginning of their careers needed to be the established norm. That is, research needed to be emphasized as coequal with practice. Faculty make it explicit that students under their supervision are expected to engage in continuous research activities, including publishing and presenting papers at conferences.

The faculty have tried to encourage beginning student researchers to develop questions that can be answered by existing databases. Beginning in 1989, we have maintained a clinic database that now contains demographic information, initial assessments (Brief Symptom Inventory, Derogatis & Melisaratos, 1983; Dyadic Adjustment Scale, Spanier, 1976; FACES-III, Olson, 1986;, General Family Functioning Scale, Epstein, Baldwin, & Bishop, 1983; Outcome Questionnaire-45.2, Lambert et al., 1996), case records, and videotapes of sessions for couples, families, groups, and individuals. In addition, several members of our faculty maintain other databases offered to students.

Because each faculty member has relatively large numbers of active graduate research advisees, and because each appreciates the value of group input and support, faculty members meet weekly with their students in “small group.” Although each has his or her own style, small group usually involves each student talking about his or her research ideas, problems, and successes with input from the other students and the faculty member(s). The small group process gives the faculty member an opportunity to teach about a new topic that is relevant to a student’s research (e.g., preparing the documents for the Institutional Review Board, logistic vs. multiple regression, participant recruitment strategies). In effect, the small groups have increased in importance and have come to play the role of research practicum in parallel with clinical practicum. With the small group model, beginning students have opportunities to join an on-going research

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effort, make use of an existing database, and/or develop their own first research project. All possible areas of student interest, either as individuals or as a group cannot be covered. Over the

years, TTU has gravitated toward expecting that students whom we supervise will be conducting research that, broadly speaking, fits in the context of our research interests—clinical judgment, intervention strategies, process research, outcome evaluation, high-risk families, attachment and therapy, and so forth.

The emphasis on publishing research starts at the beginning of both the master’s and the doctoral programs. The master’s degree was developed to allow us to better recruit (a) minority students who might see the doctoral program as an impossible time commitment and (b) undergraduates who might go to other programs or other fields instead of MFT. The master’s degree is intended to become a gateway to the PhD; however, the course work meets Texas requirements for associate licensure. Although TTU’s master’s program originally required a thesis, it became more of an impediment to research involvement, presen- tations at conferences, and publishing. Now, master’s-level students are required to earn authorship on a research-based manuscript submitted to a refereed journal. The expectation is that a student at the master’s level will be involved in learning all phases of research, including taking a strong role in writing the manuscript. The effect of this change has been that, instead of delaying research until they find a thesis topic, master’s-level students begin developing and carrying out their research ideas in the first year of the program.

At the doctoral level, students are required to be first or sole author on a research-based manuscript submitted to a refereed journal before they can sit for qualifying examinations. As is true at the master’s level, this requirement encourages students to begin research activities early in their program. One-half of the written qualifying examination is to critique a published article and propose a research study to improve or correct the published study. Because they are continuously involved in research, or writing and thinking about research, students reach the qualifying examinations and the dissertation with greater sophistication and comfort. The dissertation is often an outgrowth of these prior research experiences.

This research does not occur in a vacuum. Research ideas, concepts, and strategies are integrated into many of the classes—reviews of EST research in clinical practica, designing feasible clinically oriented studies as part of the two research methods courses (early master’s, late doctoral), requirements to use the clinic database to answer questions that arise in discussions of Diagnostic and Statistical Manual-IV (DSM- IV) or couple therapy models, and so on. Of particular importance is the integrative doctoral-level research course that students take before qualifying examinations. Students are presented with various research designs, qualitative and quantitative, and models of how to critique articles, and are expected to critique their own and their colleagues’ proposals for research studies. The final product of this course is the basic design for a dissertation.

There are other ways we try to encourage student involvement in research. Periodic “large group” meetings are opportunities for faculty members to present their current research to the entire group of students, to talk about research strategies, to brainstorm research ideas, or to have student research presen- tations. Many course projects become conference or journal submissions with the assistance of the course instructor (who may or may not be an author on the work). Students who participate on contracts and grants are offered access to the data collected and allowed to include their own instruments or analytic methods in the research effort. Clinic income, along with departmental and college funds, is used to defray travel costs to conferences if the student is presenting a paper or poster. Students are encouraged (and partially funded) to attend research-oriented meetings, workshops, and conferences (e.g., Family Research Conference) and to explore postdoctoral opportunities.

Finally, the faculty at TTU understands that our responsibility to support students does not end at commencement. Continuing research and writing involvement with our graduates is also important in launching them into successful careers.

DISCUSSION

We have described how four COAMFTE-accredited MFT programs (two master’s and two doctoral) have made progress to further implement the scientist–practitioner model. Some of the programs have made

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strides to increase research participation, whereas others have implemented changes focused on integration of research and practice. Despite differences in the nature of the changes, the goal for all of them has been the integration of theory, practice, and research. Several themes emerge across the programs:

1. Faculty members, as a group, must be committed to the scientist–practitioner model for it to be implemented successfully in a program. This means that program resources, including funds, must be allocated to both research activities and clinical work, that research and clinical issues must be integrated across the curriculum, and that faculty members must support each other in this integration. Regular reviews of the curriculum, including student input, are needed to keep a program focused on the scientist–practitioner model.

2. Cooperative clinical research endeavors within and among master’s and doctoral programs are an important way to use limited data and resources for research purposes. Such efforts also provide a model for students as they leave their graduate programs and begin careers, whether in academics, agencies/institutions, or practice.

3. Faculty members need to think outside the box when looking at each course they teach. The traditional, and often convenient, separation of theory, clinical methods, and research could be replaced with an integrated model. In fact, such an integrated model is practiced by faculty when they publish. It needs to be recognized and explicitly incorporated into courses.

4. Students enter MFT programs from a variety of disciplines and with varying levels of research and clinical experiences. Faculty should accept these differences and develop multiple pathways to research competence as they now do for clinical competence.

5. In a supportive environment, MFT students, master’s- or doctoral-level, quickly learn to see and value connections among theory, clinical work, and research when presented in an integrated fashion. Regardless of degree level, research training will be seen as necessary and helpful if these connections are consistently emphasized.

6. Faculty members should find ways to reward student research performance. Although funding trips to deliver papers at conferences may be beyond the program’s resources, annual awards for student paper submissions, published papers, and so on, and public recognition cost little.

Strategies for Future Progress First, we must go beyond the either research or clinical practice mentality. Debates do not benefit the

field if they focus on the exclusive promotion of either research or practice or dispute the merits of quanti- tative versus qualitative research. In reality, the skills important in research and clinical work can complement each other as noted here by all four programs in their descriptions. For example, ECU infuses research throughout their curriculum. This culminates in the students being able to articulate the value and relevance of research in class discussion, assignments, and clinical practice. The AU program shares how they encourage lively debates among the students where empirically supported and theory-driven models are brought to the table and reviewed. The UGA program uses creative class projects to challenge students to think critically about the relationship between research and practice; their efforts put toward publishable manuscripts. The TTU program recognizes the challenges inherent in keeping doctoral students focused on participating in and completing research. They implemented the use of small groups of students and faculty who mentor each other toward balancing and completing their required research and clinical work.

Second, MFT educators need to find better ways to share information and develop strategies to implement the scientist–practitioner model. Perhaps reestablishing a coordinating council of programs would meet this need. Such a council could make recommendations to professional organizations that set policies and agendas of MFT (e.g., COAMFTE, AAMFT, Association of Marital and Family Therapy Regulatory Boards) to ensure more input from MFT faculty in setting standards and reviewing national trends associated with MFT. Programs such as AU and UGA are already making this transition. They are working together on research through their clinics that actively involves students and will result in a stronger data set. Opportunities for programs to share strategies are also available at the annual AAMFT national conference. In fact, this article is the result of five faculty members from four different programs coming

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together to share information and advance their practice of the scientist–practitioner model. Faculty members are recognizing the need to break down walls and reach across to others who are also invested in effectively integrating research and practice.

Third, programs may want to recruit faculty who understand and support the scientist–practitioner model. Prospective faculty who are committed to the integration of research and clinical practice are identified by: (a) Their willingness to talk about and integrate both interests; (b) their ability to articulate the value they place on the relationship between the two; (c) their interest in learning more about research and clinical practice; and (d) their evidence of flexibility in thinking.

Programs should recognize that the process is not finished when the faculty member is hired. Junior faculty can benefit from mentoring. Faculty, within and across programs, need to collaborate on research studies and the integration of clinical applications. Mentoring received by faculty members and the relationships and partnerships built by the process would directly benefit students, which TTU probably exemplifies this best. Through their mentoring group where they work on supporting each other with research and writing deadlines, they also mentor one another in living up to the ideals of the scientist–practi- tioner model. Faculty at AU also found an innovative way to manage this issue. They divided up the main courses into modules and each taught what they knew best relative to research and practice. Although one faculty member remains “in charge” of the course, each faculty member covers the EST models of therapy and their preferred theories in which they have expertise. This is one way to retain faculty comfort in an ever-changing educational landscape.

Fourth, programs may want to select students who can learn within this model. Few prospective MFT students come with strong research interests and expertise. Programs can use the application/interview process to assess potential students’ curiosity about research and clinical practice, flexibility in thinking, capacity to get excited about ideas, and willingness to learn. In master’s programs, such as ECU and AU, although they do recruit students who are interested in research, they are also aware that most master’s students look forward to the clinical training. Their willingness to learn is critical and the philosophies of the programs are shared openly so that students understand that research will be a part of their educational experience. At the doctoral level, UGA and TTU have worked to recruit students who understand and embrace this model. As long as a student is open to new ways of thinking, and has respect for the contri- butions of research to clinical practice, the programs can help them to mature within the model.

With regard to the research side of the graduate experience, there are many venues for increasing student involvement in clinical research. Revising curricula to emphasize research is only one. Another option that all the represented programs support is to reward students’ work by helping them receive credit (e.g., authorship, stipends, class credit) for their contributions. Students need to own the research process, and a final product that includes their name is a big self-esteem builder and motivator. This involvement should not end once students have graduated—it is important that faculty continue to mentor their students as they graduate. Graduates are not always ready to carry out a research program on their own. Continued mentoring means staying in touch, making sure the dissertation/thesis gets written up for publication, encouraging new graduates to find ways to conduct research and publish, and including new graduates as coauthors whenever appropriate.

Fifth, as individuals and as programs, MFT faculty members need to identify financial resources to help promote the integration of research and practice. They also need to learn how to negotiate for start-up funds and work at locating small grants that can be used to conduct pilot research or seek additional clinical and research training. Faculty and students can tap into on-going projects, such as program evaluations for community agencies. There is potential mutual benefit in developing such partnerships. Faculty and students have the time and talent for research, as well as a clinical background. Agency personnel have the access to large numbers of potential participants/clients and clinicians and, at times, available funds to support the research. If not, local foundations and businesses are additional sources for financial support. Many provide limited funds for research and training endeavors. Finally, income generated by the program’s clinic can be used to cover the costs of implementing clinical research, as well serving as a source of funds for student research. Of course, these efforts do not preclude seeking more research-oriented federal funds; however, they represent ways to get started in research, provide pilot data, and be able to demonstrate the need for

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and capacity to conduct federally funded research. Sixth, programs that support a scientist–practitioner model need to install reliable systems to collect

data from couples and families as services begin and end and at various follow up times, as well as during interventions. Program faculty may also want to consider ways to change requirements in order to accept dissertations or theses in the form of publishable articles. Instead of the traditional dissertation, students can have the option of producing one (master’s thesis) or two (doctoral dissertation) manuscripts to be sent out for publication after passing the thesis or dissertation committee. These publications not only enhance the student’s employment prospects, but also promote and update developments in our field.

Conclusion The representation of two master’s- and two doctoral-level programs in this article was purposeful.

There is a distinct difference in the degree to which each embraces the scientist–practitioner model. The master’s programs appeared to work harder on infusing more research into their highly clinically focused programs. Although most students who enter these programs are seeking a terminal master’s degree, the faculty members recognize a responsibility to teach students how to be educated consumers of research and how to integrate research into practice. Through classroom assignments, participation in research, and active debates, both master’s programs shared how they decreased the disparity between research and clinical practice and increased the integration of them into their clinical training. Perhaps the first step for master’s programs that are interested in the scientist–practitioner model is to evaluate the amount of research that the students are exposed to in the curriculum. The second would be to encourage students to locate empirical support for interventions used in their clinical practice. If there is not sufficient research available, have them brainstorm a research design that would answer their question. Help them understand that research can advance clinical care, rather than being a distraction or irrelevant. Encourage them to question “why” we do things in therapy, the merits of EST, and how research may strengthen clinical practice and vice versa. Lastly, help them understand that integrating research and clinical practice is not just an assignment; it is a clinical philosophy.

Unlike the master’s programs, the doctoral programs presented in this article already had a strong research base in their training. Rather than the need for more emphasis on research, they focus more on the development of advanced research and clinical skills, increased dialogue and application of the scientist–practitioner model, and pursuit of quality contributions to the literature. They both work toward not only challenging existing practice strategies but also how they are measured through research. Doctoral programs beginning the process of rebalancing the relationship between research and clinical practice may want to draw on the individual strengths of their faculty. This may mean encouraging faculty to teach what they know best and finding effective ways of making certain students are digesting the material using both a scientist and a practitioner lens. Implementing course assignments that result in publishable manuscripts may be one way of motivating students to examine empirically supported and theory-driven treatments. These efforts may then culminate in literature that helps bridge the gap for clinicians who are curious about research but struggle with how to integrate it into their clinical practice.

Master’s programs, traditionally thought of as “providing quality clinical training” and doctoral programs traditionally focused on “building teaching and research skills,” may now have a new educational mission. Their mission would be to create a seamless path from which one logically flows into the other. Master’s students would not view research as beyond their scope of practice, but rather learn how to draw from it. Doctoral students would not leave behind their thirst for learning new methods of clinical practice, but would challenge existing research to ensure it is of the quality and rigor needed to advance the field.

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