An exploration of students' perceptions of empirically supported treatments: the significance of gender and ethnicity.

Abstract

A secondary analysis of a quasi-experimental study was conducted to evaluate differences in students 'perceptions of empirically supported treatments (ESTS) randomized to experimental (n= 10) and attention-control (n= 10) manual-based therapy interventions. The results indicated that attitudinal changes took place for both groups. The results further indicated that males have more favorable views of ESTs and of the research training environment, while African-Americans have less favorable attitudes about manual usefulness. Implications are suggested for training students to use ESTs.

Over the past decade, there has been a paradigm shift in the pedagogy of community counselors (i.e., mental health, drug and alcohol). Training has begun to emphasize the use of empirically supported treatments (Gotham, 2004; Fals-Stewart, Logsdon, & Birchler, 2004; Payne, Schreiber, & Riley, 2004) to foster counselor accountability and to meet managed care mandates (Anderson, Holberg, & Carson, 2000; Levant, 2004; Oliver, 2002). Empirically supported treatments (ESTs) or treatment manuals are standard clinical interventions designed for specific populations with systematic guidelines (Chamberless et al., 1998; Scaturo, 2001). ESTs have increasingly become an integral part of graduate and undergraduate education. However, there is lack of research on trainees' perceptions of ESTs. Addis and Krasow (2000) suggest that research in this area is necessary to understand the diffusion of ESTs in graduate and undergraduate counseling programs. The present study sought to measure changes in graduate and undergraduate students' perceptions of ESTs from the beginning to the end of the semester. In particular, we sought to measure differences in attitudes toward ESTs between both male and female students and students of color and Eurocentric students randomized to experimental and attention-control manual-based therapy interventions.

LITERATURE REVIEW

The integration of science and practice in counseling programs has attained a growing level of consensus among researchers in the field (Cukrowicz et al., 2005). In fact, researchers have increasingly advocated for the dissemination of ESTs in undergraduate and graduate counseling programs because of investigations substantiating the benefits (Read, Kahler, & Stevenson, 2003). For instance, ESTs are associated with improvements in treatment outcomes (Crits-Christoph et al., 1995; Miller, Yahne, & Tonigan, 2003). Investigations also have documented the impacts of ESTs on counselors' skills, such as developing therapeutic alliances with clients (Godley et al., 2001; Luborsky & DeRubeis, 1984; Wilson, 1996) and promoting treatment fidelity and competence (Dobson & Shaw, 1988; Freitas, 2002; Miller & Binder, 2002). However, many counselors oppose the use of ESTs because they view them as a cookbook approach that oversimplifies the therapeutic process (Addis & Krasnow, 2000). Counselors' negative views of ESTs may explain the discrepancy between the promising interventions that are disseminated in class and the techniques that are commonly practiced in the community (Read et al., 2003).

The few studies that have empirically assessed counselors' satisfaction with ESTs have revealed both positive and negative attitudes toward manual-based treatments (Addis, 2002; Addis & Krasnow, 2000). Hays, Rardin, Jarvis, Taylor, Moorman, and Armstead (2002) reported that the majority of APA-internship directors resist using ESTs because of their lack of confidence with the scientist-practitioner model and the limited effectiveness of the prescribed treatment. Hagedorn, Willenbring, Kivlahan, Kenny, and Postier (2004) similarly identified that the majority of 174 VA substance use disorder leaders disbelieved in the usefulness of ESTs. In addition, two studies have examined trainees' views of addition treatment manuals. Simons, Jacobucci, and Houston (2005) surveyed 36 undergraduate and graduate students' attitudes and found that students with extensive work experience and twelve-step orientations were more resistant to using ESTs. Simons Jacobucci, and Houston (in press) further examined novice, seasoned and professional counselors' views toward addiction treatment manuals. Of the 72 counselors in this sample, 52% viewed the treatment manual as a weakening agent in the client-counselor relationship. These negative findings may not be an exact demonstration of counselors' views on treatment manuals, but may be due to sample selection biases. More research should be conducted to distinguish clear and reliable patterns of counselors' views on treatment manuals.

Despite the reluctance on the part of some counselors to embrace the movement toward manual-based treatments, others suggest that ESTs are a small revolution in the field of counseling and psychotherapy (Dobson & Shaw, 1988; Luborsky & DeRubeis, 1984). Najavits, Weiss, Shaw, and Dierberger (2000) conducted a survey on 44 counselors and estimate that 80% were satisfied with the treatment manual and 81% were comfortable implementing it. In another study, Najavits, Van Horn, Siqueland, Thase, Ghinassi, Weiss, Frank, and Luborsky (2004) propose that counselors were likely to use treatment manuals, but only when they were allowed to incorporate their own modifications of the specific EST. Moreover, Godley and colleagues (2001) identified that counselors' responses to implementing ESTs range from "manuals provide structure and consistency" to the "manuals restrict autonomy and creativity." Addis and Krasnow (2000) also detected a weak relationship between fewer years of experience and more favorable attitudes toward ESTs, therefore counselors with less work experience were more open to using an EST in treatment. It is possible that ESTs serve as a therapeutic tool for inexperienced counselors and this area of research helps to disconfirm the notion that novice counselors view manuals as overly prescriptive and rigid.

There is a chronic gap between counselors and researchers on the topic of evidence-supported treatments (ESTs). Counselors assess ESTs as narrow and of limited use with varied problems of clients in community settings, while researchers complain that they are slow to adopt the high-quality treatments (Goodheart cited in Goodheart, Kazdin & Sternberg, 2006). The commitment of counseling programs to the scientist-practitioner model of training has led to the transportability of ESTs in graduate and undergraduate curriculums (Cukrowicz et al., 2005; Phillips, Szymanski, Ozegovic, & Briggs-Phillips, 2004). While some have advocated for manuals to help train clinical psychology doctoral students, others believe that master's degree counselors commonly found in practice settings would benefit from the use of manual-guided interventions (Godley et al., 2001). The Research Training Environment (RTE) has been linked to students' interest in research (Bishop & Bieschke, 1998; Mallinckrodt, Gelso, & Royalty, 1990), research self-efficacy (Bishop & Bieschke, 1998; Kahn, 2001), and scholarly productivity (Hollingsworth & Fassinger, 2002). Gelso (1993) proposes that inadequate RTEs contribute to the lack of research interest and scholarship productivity. There is a little research on RTE theory as it relates to students' views of ESTs (Simons et al., 2005). ESTs blend theory with research and application; therefore students' views of ESTs may be related to the inadequacies of the RTE. Thus, applying RTE theory to an EST training program for graduate and undergraduate students is warranted.

The purposes of this study were threefold. The first objective was to add to the paucity of research on undergraduate and graduate students enrolled in community counseling (i.e., behavioral health and addiction) programs and their views of ESTs. Although the literature has revealed both positive and negative attitudes toward ESTS, the majority of previous investigations have sampled psychologists (Addis & Krasnow, 2000; Najavits et al., 2000; Najavits et al., 2004) and most of the participants surveyed were male (Addis & Krasonow, 2000; Hagedorn et al., 2004; Najavits et al., 2004) and Caucasian (Addis & Krasnow, 2000; Najavits et al, 2004). The second objective was to expand this area of research by examining differences in views of ESTs between both male and female students and students of color and Eurocentric students randomized to experimental and attention-control interventions. To date, no study has examined differences in views of ESTs with multiple assessments and experimental control, nor have investigations measured differences between male and female students and students of color and Eurocentric students. The final objective of this study was to apply RTE theory to an EST training program. The current study examined four research hypotheses:

1. Do students in the experimental group have higher ratings of treatment manuals and manual usefulness after the manual-based therapy intervention compared to those in the attention-control group?

2. Do male students differ from female students in their attitudes toward treatment manuals, views of manual components and perceptions of manual usefulness?

3. Do students of color differ from Eurocentric students in their attitudes toward treatment manuals, views of manual components and perceptions of manual usefulness?

4. Do students in the experimental group have higher ratings of research-self-efficacy and the RTE after the manual-based therapy intervention compared to those in the control group? Do male and female students of color differ from male and female Eurocentric students in their research self-efficacy skills and appraisals of the RTE?

METHOD

Participants

Graduate and undergraduate college students from a Catholic teaching university in a northern metropolitan area completed a survey about their research course. Data was gathered from 20 students at the beginning of the semester. Students were randomly assigned to either an experimental (n = 10) or an attention-control group (n = 10). All of them also completed the survey at the end of the semester during the 2004-2005 academic years, so that retention from pre- to post-test was 100%. As indicated in Table 1, more than half of the students identified themselves as African-American and female. Graduate and undergraduate students as well as experimental and control groups did not significantly differ in gender, ethnicity, and years of work experience. An independent t-test and a chi-square test were used to compare demographic characteristics of graduate and undergraduate students assigned to experimental and attention-control groups.

Measures

Demographic Questionnaire, developed by the researchers, was used to gather information on age, race, theoretical orientation, certification status, employment, and recovery history.

Attitudes toward Manuals, developed by Addis and Krasnow (2000), is al 7-item questionnaire that was used to measure negative attitudes about treatment manuals. Participants rate their level of agreement with each statement on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Internal consistency for the seventeen items is high ([alpha] = .88).

Characteristics of treatment manuals, developed by Addis and Krasnow (2000), is a 9-item questionnaire that was used to assess how practioners conceptualize the content of treatment manuals. Participants rate each item according to how well the statements characterize treatment manuals on a 4-point Likert scale ranging from 1 (not at all a characteristics) to 4 (very characteristic). Internal consistency for the nine items is high ([alpha] = .80).

Research Self-efficacy, developed by Kahn and Scott (1997), is a twelve-item scale that was used to measure four domains of research self-efficacy including: research design skills, quantitative skills practical research skills, and writing skills. Participants endorse their levels of agreement with each statement by circling a score on a nine-point rating scale ranging from "0" no confidence to "9" total confidence. Internal consistency for the twelve items is high ([alpha] = .90).

Research Training Environment Scale (RTES), developed by Gelso, Mallinckrodt, & Royalty (1991), is a 45-item inventory designed to assess effective research training environments. The instrument includes 9 subscales, each examining a different component of the training environment such as involving students in research early and faculty modeling of appropriate scientific behavior. Items were presented as statements and participants indicate their levels of agreement with each statement on a five-point Likert scale ranging from "1" disagree to "5" agree. Test-retest reliability coefficient is high ([alpha] =.92).

The Protocol Implementation Questionnaire (PIQ) developed by Najavits and colleagues (1996), is a 36-item scale that elicits counselors' views on implementing protocol treatments in a research study. This scale has three sections that measure satisfaction, desired modifications (i.e., ideal manual), and influences on implementation of the protocol treatment. Participants indicate their levels of agreement with each statement on a five-point Likert scale ranging from "1" strongly disagree to "5" strongly agree. Internal consistency for the 36 items is high ([alpha] = .89).

What do you think of Treatment Manuals (Views of Treatment Manuals), developed by Najavits and colleagues (2000b), is a 15-item questionnaire that identifies counselors' views of treatment manuals. This scale measures attitudes, beliefs and opinions of treatment manuals. Participants indicate their levels of agreement with each statement on a five-point Likert scale ranging from "1" strongly disagree to "5" strongly agree. Internal consistency for the 15 items is modest ([alpha] = .57).

Interventions

Researchers tested two types of intervention. The approaches varied by intended target population (PTSD and substance abuse vs. substance abuse), theoretical orientation (cognitive-behavioral vs. cognitive-motivational), and content exposure (maximum vs. minimum exposure). The two interventions are described in detail elsewhere, but brief descriptions of the interventions and the manuals are summarized below.

Experimental Condition (Seeking Safety Treatment Manual/ Cognitive Behavior Therapy). The Seeking Safety manual (Najavits, 2002) is an integrated treatment approach for PTSD/ substance abuse that can be used early in recovery from both disorders. This manual provides a therapeutic guide and extensive client handouts to be used in a variety of treatment settings (Najavits, 2004). Seeking Safety offers 25 treatment topics that teach clients interpersonal, behavioral, and cognitive coping skills to gain control over symptoms of both disorders. Ten students assigned to this condition were required to read the Seeking Safety Manual, sample articles on the Seeking Safety website (www.seekingsafety.org), and watch the video, Trauma and Substance Abuse I: Therapeutic Approaches (Abueg et al., 1998).

Attention-control condition (Motivational Enhancement Therapy with Drug Abusers Manual). MET (Miller et al., 1995; Miller & Rollnick, 1991) is a systematic intervention approach for evoking change with problem drinkers. It is based on the principles of motivational psychology and is designed to produce rapid, internally motivated change. This manual was prepared for an outpatient treatment setting and may be particularly useful in situations where contact with clients is limited to one or few sessions. Ten students assigned to the attention-control condition were required to read only the preface of the MET with drug abusers manual (Miller et al., 1995) and to watch a video that provides an overview of motivational enhancement therapy (Miller, 1989). The preface defines MET and the video is an introduction to MET that is usually previewed before the eight demonstration videos, thus limiting the procedural information and EST content.

Design and Procedure

A secondary analysis of a quasi-experimental research study was conducted to evaluate differences in reactions to ESTs between male and female students and students of color and Eurocentric students. Twenty graduate and undergraduate students enrolled in community (i.e., behavioral health and substance abuse) counseling programs participated in this study as part of a research design course. In-class time for the undergraduate and graduate research course was almost identical and taught by the same instructor. In-class time (90 minutes per week) began with an introduction into the nature of social research and ethics in the helping profession, and then proceeded to an arrangement of lessons on research design and data collection techniques. Each course had the same number of examinations (2), paper assignments (2), research activities (4), and student presentations (1).

All of the students completed an informed consent form and a survey measuring attitudes toward research and treatments manuals at the beginning of the semester. Then, students were randomly assigned using an odd-even table of numbers. Ten students assigned to the experimental group were given the Seeking Safety manual and articles about seeking safety treatment, while 10 students assigned to the attention-control group were given the MET preface. Each group of students watched a video during a class period in the middle of the semester. Students were administered a post-survey at the course end and they completed this survey at their own pace, placed it in a coded envelop and returned it to their researcher. Each survey took approximately 30 minutes to complete. Debriefing took place during the last class in the form of an explanation of the results and implications.

RESULTS

Pre-Post Survey Differences in ESTs for Experimental and Control Groups

Using a pre-post survey, students' attitudes were observed at two points in time. A Repeated-Measure Multiple Analysis of Variance was used to assess differences in Attitudes toward Manuals, PIQ, and Views of Treatment Manuals for students randomized to experimental (n=l0) and control (n=l0) conditions. For beliefs about treatment manuals F (19) = 19.41, p<.01, students made significant increases in their beliefs about ESTs from pre-intervention (x = 53.12) to post-intervention (x = 59.00). There were no other significant differences in attitudes toward ESTs and manual usefulness for experimental and control groups.

Gender and Ethnic Differences

Using an independent t-test, differences were detected for attitudes toward ESTs, manual usefulness, and components of treatment manuals between males and females as shown in Table 2. Another notable finding is that students of color had higher ratings for manual components compared to Eurocentric students as shown in Table 3. These findings suggest that gender and ethnicity influence the way students perceive ESTs and their usefulness.

Perceptions of Research

Using a Repeated-Measure Multiple Analysis of Variance, differences were observed in research self-efficacy and research training environment scores at two points in time between male and female students and students of color and Eurocentric students randomized to experimental and attention-control groups. One of the most striking findings is that the experimental group had higher research self-efficacy and RTE scores after exposure to the manual-based therapy intervention compared to those in the attention-control group, although pairwise comparisons were not significant. However, univariate analyses showed that the experimental group (x = 159.90) had higher research self-efficacy scores F (1, 9) = 7.72, p<.05) than the control group (x = 120.40), suggesting that students exposed to the maximum content of the manual-based therapy intervention develop more confidence in their research skills. In contrast, the experimental group (x = 123.19) had less favorable ratings for the RTE F (1, 8) = 6.24, p<05) compared to the control group (x = 144.23). Univariate analyses of post-surveys also demonstrated differences in RTE scores for gender and ethnicity. Males (x = 144.24) had more favorable ratings of the RTE F (1, 8) = 5.36, p<.05 than females (x = 123.18). Students of color (x= 141.82) also had higher ratings of the RTE compared to Eurocentric students (124.99), F (1, 8) = 6.20, p<.05. These positive and negative changes are indicative that attitudinal changes took places after the intervention for both male and female students and students of color and Eurocentric students.

DISCUSSION

The diffusion of ESTs in undergraduate and graduate community counseling programs can assist in bridging the gap between research and practice (Gotham, 2004; Fals-Stewart et al., 2004; Payne at al., 2004). This secondary analysis provides an opportunity to study the transportability of ESTs in undergraduate and graduate community counseling programs. The first objective of this study was to measure differences in students' views of ESTs. Students in experimental and control groups changed their beliefs about ESTs after exposure to the maximum and minimum content of the training intervention. The lack of interaction effects for participants may be attributed to diffusion of treatment biases (Rosenthal & Rosnow, 1991). For instance, the minimum content may have led to changes in beliefs about ESTs as those hypothesized with the maximum content of the treatment protocol. Future research is necessary to determine if differences in beliefs about ESTs occur after a training intervention between experimental and control conditions with larger samples so that results are reliable and valid.

A second objective of this study was to identify differences in views of ESTs between male and female students. Males consistently had higher ratings of ESTs compared to females. In fact, males were more likely to report that a therapist is obligated to use a treatment if that protocol is found to be scientifically effective then if it had not been studied. Males also reported that ESTs are helpful tools for conducting research and research information is a necessary component that should be included in a treatment manual. These findings are congruent with investigations on mentoring women in higher education (Casto, Caldwell, & Salazar, 2005). Many authors suggest that female students should be exposed to female faculty who have positive views of research and who blend practice with research to improve scholarship productivity (Bishop & Bieschke, 1998; Gelso, 1993; Trierweiler cited in Goodheart et al., 2006) and perhaps to enhance their views of ESTs.

A third objective of this study was to assess differences in attitudes about ESTs and manual usefulness between students of color and Eurocentric students. Consistent with previous research on counselors' attitudes about ESTs (Najavits et al., 2000), students of color had more negative attitudes toward manual usefulness. Students of color had higher ratings for ESTs as a treatment protocol imposed by a third-party payer and they reported being more competent to implement a manual after reading about the intervention compared to Eurocentric students. However, Eurocentric students were less likely to rate ESTs as methods that weaken the therapeutic relationship is consistent with multicultural counseling research. Researchers propose that Eurocentric trainees have different levels of racial and cultural awareness and benefit from different kinds of interventions for improving clinical judgments compared to trainees of color (Burkard & Knox, 2004; Gushue, 2004). It is possible that students of color and Eurocentric students have different cognitive processes, which in turn, influence their subjective appraisals of ESTs. Qualitative methods should be used in future research to detect differences in attitude formation of ESTs between students of color and Eurocentric students in order to understand how ethnicity influences their acceptance and rejection of treatment manuals.

A fourth objective of this study was to measure differences in perceptions of research between male and female students and students of color and Eurocentric students randomized to experiment and attention-control conditions. The experimental group had higher confidence ratings for performing research compared to those in the control group. Results also showed that the experimental group was less satisfied with the research training environment than the control group. There are two possible interpretations for these findings: Experimental students exposed to the maximum content of the EST protocol are more likely to understand the importance of the science-practitioner model and to acquire confidence in their research skills. Increases in research self-efficacy indicate an awareness of the lack of research incorporated into the undergraduate and graduate counseling curriculums. Most of the students are trained in mental health and substance abuse counseling without the rigor of methodology courses that are commonly incorporated in traditional psychology programs. Exposure to an EST gave students an opportunity to understand the importance of research underlying counseling theory and a desire to learn more about research methodology, thus decreasing their satisfaction with the research training in undergraduate and graduate community counseling programs.

A unique contribution from this study was discovering differences in views of the RTE between male and female students and students of color and Eurocentric students. Both males and students of color have higher ratings of the RTE which is incongruent with research on RTE and gender. Hollingsworth and Fassinger (2002) suggest that participants' gender is not related to the RTE. There are two possible explanations for the inconsistent results. First, previous research surveyed doctoral counseling psychology students and most these participants were Caucasian and female. It is possible that the doctoral counseling curriculum contributes to a deeper understanding of the RTE; therefore, Caucasian and female students in the doctoral counseling program may have different values of the RTE compared to the current sample of participants. Second, the majority of males and students of color were exposed to the maximum content of the manual-based therapy intervention. Exposure to the maximum-content of the intervention may have led to their positive views of the RTE which is consistent with social-cognitive theory. Social-cognitive theory proposes that students exposed to scientific activity both formally and informally positively reinforces their favorable attitudes toward research (i.e., expected value of research) (Gelso, 1993). RTE theory emphasizes the importance of teaching how research is accomplished in practice settings (Phillips et al., 2004) and more research in this area is required to comprehend the link between ESTs and the RTE in graduate and undergraduate community counseling programs.

Implications

There are several implications that may be potentially useful for faculty members. First, methodology courses should be incorporated into undergraduate and graduate community counseling curriculums so that students can be exposed to the scientist-practitioner model at the beginning of their formal education. Statistics, research and independent study courses are necessary to train counselors in the scientific-model and to enhance their comprehension of counseling techniques derived from empirical investigations. Second, mentoring is required to pique students' interest in research. Faculty modeling of appropriate scientific behaviors and attitudes may have a positive impact on students' research attitudes. For instance, faculty may provide opportunities for students to work with them on research projects. Programs may recognize student research activities by providing travel monies to present at research conferences and highlighting their accomplishments in newsletters and awards (Gelso, 1993). Third, empirically supported treatments (ESTs) must be disseminated in undergraduate and graduate counseling courses to prepare counselors for the shifting standards and practices in the community. If one of the goals of scientific training in community counseling programs is to enhance students' attitudes toward ESTs--to help overcome their resistance to using manuals in practice settings then the training environment needs to encourage and reinforce the use of ESTs. ESTs should not only be disseminated in counseling theory, internship and practicum courses, but faculty must encourage and reinforce students' use of treatment protocols. For example, faculty members' responses to students' utilization of ESTs may serve as potent reinforcers. Positive reinforcement for students' use of ESTs ought to be deliberate and systematic (Gelso, 1994). Fourth, gender-specific strategies may be helpful when incorporating ESTs into counseling courses. Studying gender and ethnicity in undergraduates and graduates allowed us to discover females and students of color are more resistant to using a treatment protocol, and they may gain a better understanding of ESTs' usefulness if they could relate to the video and reading material. It may be advantageous to develop ESTs within a multicultural framework because of the increasing number of women and minorities enrolling in undergraduate and graduate programs (Maton et al., 2006). Finally, this preliminary study identified both gender and ethnic differences in the way students perceive ESTs; therefore, ESTs need to be developed that show both cross-cultural interactions between both female counselors with male clients and counselors of color with Eurocentric clients. If these suggestions were to be utilized then students may be more accepting of ESTs.

Limitations

This secondary analysis is a preliminary evaluation that adds to the research on students' perceptions of ESTs; however, several methodological limitations should be noted when interpreting the results. First, this study is an exploration of the diffusion of ESTs in an undergraduate and graduate counseling psychology programs. Second, participants were predominantly African-American, nontraditional students and usually first-generation to attend a four-year college. Third, surveys were collected at two different time points and there are likely testing-effects, social-desirability effects and self-report biases associated with the results. Fourth, the EST intervention that was used for the attention-control group may have been too similar to the treatment protocol that was used for the experimental condition and there is probably diffusion of treatment effects associated with the results. Finally, the small sample of participants prevents one from making conclusions that are more definitive. Future research should replicate this study and assess students' views of ESTs using quantitative and qualitative methods with larger samples to identify a clear and consistent pattern of results. This would make an interesting future study.

REFERENCES

Addis, M.E., & Krasnow, A.D. (2000). A national survey of practicing psychologists' attitudes toward psychotherapy treatment manuals. Journal of Consulting and Clinical Psychology, 68 (2), 331-339.

Addis, M.E. (2002). Methods for disseminating research products and increasing evidence-based practice: Promises, obstacles, and future directions. Clinical Psychology: Science and Practice, 9 (4), 367-378.

Abueg, F., Brown, P., Dansky, B., Keane, T., Lovern, J., & Najavits, L. (1998). Trauma and substance abuse: Therapeutic Approaches. Cavalcade Productions.

Anderson, T., Holberg, J. L., & Carson, K.L. (2000). The contextual therapeutic relationship: Ecological considerations in psychotherapy research and practice. Psychotherapy: Theory, Research and Practice, 37 (2), 107-116.

Bishop, R. M., & Bieschke, K.J., (1998). Applying social cognitive theory to interest in research among counseling psychology doctoral students. Journal of Counseling Psychology, 45 (2), 182-188.

Burkard, A.W., & Knox, S. (2004). Effect of therapist colorblindness on empathy and attributions in cross-cultural counseling. Journal of Counseling Psychology, 51 (4), 387-397.

Casto, C., Caldwell, C. & Salazar, C.F. (2005). Creating mentoring relationships between female faculty and students in counselor education: Guidelines for potential mentees and mentors. Journal of Counseling and Development, 83 (3), 331-342.

Chambless, D.L., Baker, MJ., Baucom, D.H., Beutler, L.E., Calhoun, K.S., Crits-Christoph, P., Daiuto, A., DeRubeis, R., Detweiler, J., Haaga, D.A., Johnson Bennett, S., McCurry, S., Mueser, K.T., Pope, K.S., Sanderson, W.C., Shoham, V., Stickle, T., Williams, D.A., & Woody, S.R. (1998). Update on empirically validated therapies, II. The Clinical Psychologist, 51 (1), 3-16.

Crits-Christoph, P., Frank, E., Chambless, D.L., Brody, C., & Karp, J.F. (1995). Training in empirically validated treatments: What are clinical psychology students learning? Professional Psychology: Research and practice, 26 (5), 514-522.

Cukrowicz, K.C., White, B.A., Reitzel, L.R., Burns, A.B., Driscoll, K.A., Kemper, T.S., & Joiner, T.E. (2005). Improved treatment outcome associated with the shift to empirically supported treatments in a graduate training clinic. Professional Psychology: Research and Practice, 36 (3), 330-337.

Dobson, K.S., & Shaw, B.F. (1988). The use of treatment manuals in cognitive therapy experience and issues. Journal of Consulting and Clinical Psychology, 56 (5), 673-680.

Fals-Stewart, W., Logsdon, T., & Birchler, G.R. (2004). Diffusion of an empirically supported treatment for substance abuse: An organizational autopsy of technology transfer success and failure. Clinical Psychology: Science and Practice, 11(2), 177-189.

Freitas, G.J. (2002). The impact of psychotherapy supervision on client outcome: A critical examination of 2 decades of research. Psychotherapy: Theory/Research/Practice/ Training, 39 (4), 354-367.

Gelso, C.J. (1993). On the making of a scientist-practioner: A theory of research training in professional psychology. Professional Psychology: Research and Practice, 24 (4), 468-476.

Gelso, C.J., Mallinckrodt, B., & Royalty, G.M. (1991). The Research Training Environment Scale. Princeton, NJ: Educational Testing Service.

Godley, S.H., White, W.L., Diamond, G. Passetti, L., & Titus, J.C. (2001). Therapists reactions to manual-guided therapies for the treatment of adolescent marijuana users. Clinical Psychology: Science and Practice, 8 (4), 405-417.

Goodheart, C.D., Kazdin, A.E., & Sternberg, R.J. (2006). Evidence-Based Psychotherapy: Where Practice and Research Meet. Washington, DC: American Psychological Association.

Gotham, H.J. (2004). Diffusion of mental health and substance abuse treatments: Development, dissemination and implementation. Clinical Psychology: Science and Practice, 11 (2), 160-176.

Gushue, G.V. (2004). Race, color-blind racial attitudes, and judgments about mental health: A shifting standards perspective. Journal of Counseling Psychology, 51 (4), 398-407.

Hays, K.A., Rardin, D.K., Jarvis, P.A., Taylor, N.M., Moorman, A.S., & Armstead, C.D. (2002). An exploratory survey on empirically supported treatments: Implications for internship training. Professional Psychology: Research and Practice, 33 (2), 207-211.

Hagedorn, H., Willenbring, M., Kivlahan, D., Kenny, M., & Postier, A. (2004, June). Beliefs about evidence-based practice in addiction treatment: A survey of Veterans Administration substance use disorders providers. Paper presented at the meeting of the College on Problems of Drug Dependence Conference, San Juan, Puerto Rico.

Hollingsworth, M.A., & Fassinger, R.E. (2002). The role of faculty mentors in the research training of counseling psychology doctoral students. Journal of Counseling Psychology, 49 (3), 324-330.

Kahn, J.H. (2001). Predicting the scholarly activity of counseling psychology students: A refinement and extension. Journal of Counseling Psychology, 48 (3), 344-354.

Kahn, J.H., & Scott, N.A. (1997). Predictors of research productivity and science-related career goals among counseling psychology graduate students. The Counseling Psychologist, 25, 38-67.

Levant, R.F. (2004). The empirically validated treatments movement: A practitioner/educator perspective. Clinical Psychology: Science and Practice, 11(2), 219-224.

Luborsky, L., & DeRubeis, R.J. (1984). The use of psychotherapy treatment manuals: A small revolution in psychotherapy research style. Clinical Psychology Review, 4, 5-14.

Mallinckrodt, B., Gelso, C.J., & Royalty, G.M. (1990). Impact of the research training environment and counseling psychology students': Holland personality type on interest in research. Professional Psychology: Research and Practice, 21 (1), 26-32.

Maton, K.I., Kohout, J.L., Wicherski, M., Leary, G.E., & Vinokurov, A. (2006). Minority students of color and the psychology graduate pipeline: Disquieting and encouraging trends, 1989-2003. American Psychologist, 6 (2), 117-131.

Miller, W.R. (1989). Motivational interviewing: A clinical demonstration videotape. Albuquerque, NM: University of New Mexico. Available from William R. Miller, Ph.D., Department of Psychology, University of New Mexico, Albuquerque, NM, USA 87131-1161.

Miller, W. R., Zweben, A., DiClemente, C.C., & Rychtarik, R.G. (1995). Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. Project MATCH Monograph Series, Vol. 2. NIH Pub. No. 94-3732. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.

Miller, W. R. & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behaviors. New York: Guilford Press.

Miller, W.R., Yahne, C.E., & Tonigan, J.S. (2003). Motivational interviewing in drug abuse services: A randomized trial. Journal of Consulting and Clinical Psychology, 71 (4), 754-763.

Miller, S.J., & Binder, J.L. (2002). The effects of manual-based training on treatment fidelity and outcome: A review of the literature on adult individual psychotherapy. Psychotherapy: Theory, Research, Practice and Training, 39 (2), 184-198.

Najavits, L.M. (1996). Protocol Implementation Scale. Unpublished measure, Harvard Medical School and McLean Hospital, Belmont, MA.

Najavits, L.M., Weiss, R.D., Shaw, S.R., & Dierberger, A.E. (2000). Psychotherapists' views of treatment manuals. Professional Psychology. Research and Practice, 31 (4), 404-408.

Najavits, L.M., Weiss, R.D., Shaw, S.R., & Dierberger, A.E. (2000b). What Do You Think About Treatment Manuals Questionnaire. Unpublished measure, Harvard Medical School and McLean Hospital, Belmont, MA.

Najavits, L.M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. New York: Guilford Press.

Najavits, L. (2004). Treatment of posttraumatic stress disorder and substance abuse: Clinical guidelines for implementing seeking safety therapy. Alcoholism Treatment Quarterly, 22 (1), 43-63.

Najavits, L.M., Van Horn, A., Siqueland, L., Thase, M.E., Ghinassi, F., Weiss, R.D., Frank, A., & Luborsky, L. (2004). Therapists' satisfaction with four manual-based treatments on a national multisite trial: An exploratory study. Psychotherapy: Theory, Research, Practice, & Training, 41 (1), 26-37.

Oliver, N. I. (2002). Privatizing Medicaid-funded mental health services: Trading old political challenges for new ones. Journal of Orthopsychiatry, 72 (3), 324-330.

Payne, W.J., Schreiber, D., & Riley, G. (2004). Transitions in counselor preparation: From occupational training programs to professional education. Journal of Teaching Addictions, 3 (4), 19-28.

Phillips, J.C., Szymanski, D.M., Ozegovic, J.J., & Briggs-Phillips, M. (2004). Preliminary examination and measurement of the internship research training environment. Journal of Counseling Psychology, 51 (2), 240-248.

Read, J.P., Kahler, C.W., & Stevenson, J.F. (2001). Bridging the gap between alcoholism treatment research and practice: Identifying what works and why. Professional Psychology: Research and Practice, 32 (3), 227-238.

Rosenthal, R. & Rosnow, R.L. (1991). Essentials of Behavioral Research, 2nd edition. New York: McGraw-Hill, Inc.

Scaturo, D.J. (2001). The evolution of psychotherapy and the concept of manualization: An integrative perspective. Professional Psychology: Research and Practice, 32 (5), 522-530.

Simons, L., Jacobucci, R., & Houston, Hank (2005). Undergraduate and graduate students' attitudes toward addiction treatment manuals. Journal of Teaching Addictions, 4 (2), 23-43.

Simons, L., Jacobucci, R., & Houston, Hank (in press). Novice, seasoned and veteran counselors' views of addiction treatment manuals: The influence of counselor characteristics on manual usefulness. Journal of Psychoactive Drugs.

Wilson, G.T. (1996). Manual-based treatments: The clinical application of research findings. Behavioral Research Therapy, 34 (4), 295-314.

Correspondence concerning this article should be addressed to Lori Simons, Ph.D., Associate Professor of Psychology, Social Science Division, Widener University, One University Place, Chester, PA 19013-5792, [phone] or [phone], email: [e-mail] or [e-mail]

Lori Simons and Tina Giorgio

Widener University

Hank Houston and Ray Jacobucci

Alvernia College 

TABLE 1
Descriptive Data for Undergraduate and Graduate
Students in Experimental and Control Groups

Students                            Control      Experimental
Variables                           (n=10)          (n=10)

Age: Mean Years, (SD)            42.50 (10.57)   38.40 (7.39)

Gender
Male                             30              60
Female                           70              40

Ethnicity
African-American                 70              70
Caucasian                        30              30

Student Status
Undergraduate                    40              30
Graduate                         60              70

Work Hours                       40.00 (0.00)    40.00 (0.00)

Years of Counseling Experience
Less than one-year               20               0
1-4 years                        10              20
5-10 years                       30              60
More than 10 years               40              20

Type of Position
Counselor                        40              30
Supervisor                       20              30
Social Worker/Case Manager       20              20
Education/Residential Aide       20              20

Type of Program
Drug and Alcohol                 40              30
Mental Health                    20              20
Human Service                    20              30
Education                        20              20

Certification Status
Yes                              20              20
No                               80              80

TABLE 2.
Gender Differences for Attitudes toward ESTs

                                Males      Females

EST Variables                M     SD     M      SD    t (18)

A therapist is obligated
to use a scientifically
effective technique         3.77   .97   2.54   1.21   2.46 *

ESTs is a helpful
tool for research           4.22   .44   3.27   1.19   2.25

Research information
should be incorporated
into a treatment protocol   3.66   .50   2.40   1.07   3.22 **

** p < .01, * p < .05.

TABLE 3
Ethnic Differences for Attitudes toward ESTs

                             African-
                            Americans     Caucasians

EST Variables               M      SD     M      SD     t(19)

ESTs are treatment
protocols imposed by
a third-party payer        3.23    .72   1.83   1.16   3.22 **

Competent to implement
a manual after reading
about it                   2.71   1.06   1.66    .81   2.13 *

ESTs weakens the
therapeutic relationship
between the counselor
and client                 2.64    .49   1.66    .81   3.31 **

** p < .01, * p < .05.