Recently, the American Psychological Association (APA; 1993) Division of Clinical Psychologists (Division 12) established a task force to define empirically validated treatment and make recommendations in relation to methods for educating mental health professionals, third-party payors, and the public about effective psychotherapies. Predictably, the task force report has a somewhat controversial status but continues to be an influential blueprint for the improvement of clinical psychology in various countries including Australia. The role of the Australian Association for Cognitive and Behaviour Therapy (AACBT) is highlighted in relation to accreditation and mandatory professional development (Australian Psychological Society).

Whereas King's (1977) focus was clinical psychology, the present commentary considers empirical validation of psychological practice in health settings. Comparisons are made with the fact that most diagnostic and therapeutic medical practices in use have yet to be empirically validated. At the population level, modern medicine does not appear to have had a large impact on any of the major causes of premature death, past or present. Conversely, there is strong evidence that all current major causes of death are closely related to behaviour pattern. However, there are formidable obstacles to the uptake and future development of behavioural interventions in health settings. Issues subsumed under the rubric of quality of care are particularly important, including appropriateness (treatment should not be applied when it is not needed — avoidance of overservicing), and necessity (treatment should be available to persons in need — avoidance of underservicing). The general public, health practitioners, and health policy makers are relatively uninformed about relevant psychological practices and about the central role of psychological processes in all aspects of human health.

The concept of empirically validated treatments is an attempt to focus psychological training and practice on treatments that work. In this paper, I examine the complexities of defining the concept with reference to the treatment of relationship problems. The key criterion employed to define a treatment as empirically validated is established efficacy within controlled trials. I suggest that the criteria need to be expanded to include assessment of the variability, clinical significance, and durability of treatment effects, the relative efficacy of alternative approaches, and the ease of dissemination of treatments. Whilst few, if any, psychological treatments currently have data on whether they meet all these criteria, I suggest that setting these more ambitious criteria will direct us towards the ultimate goal of offering better psychological treatments.

This commentary argues that empirically validated treatments for child and youth behaviour and emotional difficulties are available, but they are relatively inaccessible to the vast majority of Australian children and their families. Although effective interventions have been developed, few children receive these services. There are many children who have identifiable problems or who are at increased risk for psychosocial problems whose needs have not been adequately addressed by either the research or the professional community. These include children in rural and remote areas, Aboriginal and Torres Strait Islander children, children of migrants, and children with chronic physical illnesses. A comprehensive, preventively focused clinical science of prevention is needed to improve the reach and impact of psychological services for children.

The movement towards evidence-based practice in psychology and medicine should offer few problems in cognitive-behaviour therapies because it is consistent with the principles by which they have been developed and disseminated. However, the criteria for assessing empirical status, including the heavy emphasis on manualised treatments, need close examination. A possible outcome of the evidence-based movement would be to focus on the application of manualised treatments in both training and clinical practice; problems with that approach are discussed. If we are committed to evidence-based treatment, comparisons between psychological and pharmacological interventions should also be included so that rational health care decisions can be made. We should not be afraid of following the evidence, even when it supports treatments that are not cognitive-behavioural in stated orientation. Such results should be taken as an opportunity for theoretical development and new empirical inquiry rather than be a cause for concern.

“Treatment” connotes “one off” and “short-term” and treatments are applied after problems have failed to respond to natural, culturally acceptable methods. In developmental disability, continuing interventions that begin early are our best hope; natural methods are part of the problem. Treatment methods are validated for particular problems and circumstances.need to be applied competently and monitored by therapists who have throrough grounding in scientific method and principles of behaviour. Nominating empirically validated treatments does not diminish the need for highly trained behaviour analysts.

A strong case can be made that, in all areas of intervention into the lives of others, the interventions used ought be empirically validated. In response to the paper by King (1997), this paper argues that there is a need to improve the empirical basis of interventions in education, particularly in the areas of curriculum design, classroom management, and academic remediation. Further, it is argued that an initial step in facilitating that improvement is by ensuring that trainee teachers receive an extensive exposure to the scientific literature on educational practices.

Driving while disqualified represents a serious and recurrent social problem, with approximately 40% of convicted individuals reoffending. The high relapse (or recidivism) rates in this group are thought to be associated with compulsivity or addictive processes. In this paper we describe a cognitive-behavioural treatment program (relapse prevention) for offenders convicted of driving while disqualified. This program represents a significant innovation in the rehabilitation of persistent driving offenders, as in the past most intervention programs have focused on driver education and/or alcohol treatment. A major assumption of the relapse-prevention approach is that for many men their driving offences represent a maladaptive response to stressful events such as interpersonal conflict. Therefore, the primary treatment approach revolves around teaching individuals more effective ways to solve their interpersonal problems and to regulate negative affective states.

The assessment of sexual aggression presents many difficulties for clinicians. The tendency of offenders to minimise or deny their offending, and their frequent distrust of mental health professionals, require high levels of skill to circumvent. In addition, the multifactorial nature of rape means that assessment needs to cover a broad range of content areas and utilise a number of different methods. In this paper we suggest that a comprehensive assessment should inquire into the developmental history of rapists, social competency, attitudes and beliefs about women and sexual crimes, sexual knowledge, sexual preferences and disorders, empathy, offence variables, psychiatric history, and substance abuse. The clinical interview remains the primary method of information acquisition, and needs to be tailored to match the particular interpersonal style of rapists. The use of psychometric and physiological measures are also valuable sources of clinical data.