For nearly every professional continuing education workshop and graduate class in psychology, someone will be overheard evaluating the quality of the educational experience by whether the information contained is practical or theoretical. Practical is good, clear, and useful. Theoretical is esoteric and not useful. This strikes me as exactly the wrong framing. Certainly, there is the Lewin quote that “there is nothing so practical as a good theory.” Beyond that, eschewing theory in professional development or even pre-practice professional preparation leads to an approach to clinical practice that is bad for service delivery, bad for clients and patients, and bad for professional credibility. Theory is not something to be suffered through in graduate school. Theory is the critical ingredient in quality clinical practice and requires renewed emphasis at all levels of training.
Why Tips and Tricks Are Not Enough for Quality Clinical Practice
Being a professional psychologist is far more than implementing a collection of tips and tricks. Tips and tricks are those little procedures, processes, or ideas that can be immediately applied to specific settings and specific situations. As we become more experienced, we collect new therapy techniques, new assessment techniques, time savers, and shortcuts like a carpenter who collects a variety of hammers. But sometimes the problem is not a nail.
My first big case working in a hospital was a favor for a friend of one of our surgeons. They needed a good assessment of cognitive functioning to see the best way to teach this child, or if this child could learn at all before the family moved. I was new and did not have a caseload yet. So I scrambled a WISC (i.e., Wechsler Intelligence Scale for Children) kit and prepared for a standardized assessment of intelligence. The intake information came to me 30 minutes before the appointment (typically, I receive this information many days in advance). The child was blind, hydrocephalic, non-ambulatory, and nonverbal. All previous attempts by psychologists received a “not testable” conclusion. Knowing the tips and tricks of how to administer, score, and interpret a standardized test of intelligence is often useful, but not in this case. Yet understanding theory allowed me to quickly develop a measure of classical conditioning (pairing a bell and a palm touch), second-order conditioning, operant conditioning, adaptive behavior interviewing of caregivers, and rudimentary Piagetian tasks. This was not a test yielding numbers for a bureaucratic purpose (e.g., eligibility for an educational program) but an assessment that answered the presenting question. Without theory, this child would continue to carry the useless “not testable” designation.
Tips and tricks tend to be a one-size-fits-most approach to clinical work. Often, these are evidence-based approaches such as manualized interventions, novel therapy techniques, or application of new and well-developed tests. Sometimes a continuing education approach to tips and tricks involves someone armed with a great website, charisma, a large speaking fee, snake oil, and non-disclosure agreements for workshop participants. Evidence is non-existent or limited to testimonials (which does not constitute evidence of effectiveness), but the information seems practical, seems to be an answer to a difficult problem, and seems to be “simply common sense.” Tips and tricks may be evidence-based, but sometimes not.
How Theory Enhances Professionalism and Individualized Client Care
Quality theory guides hypotheses and predictions, novel approaches to applications, consideration of cultural and contextual variations, and professionalism. Focusing on theory allows for individualized clinical work to best meet the needs of clientele. Client needs are frequently defined by psychologists as what tips and tricks that the psychologist has mastered, not the true needs of the client. For example, after an assessment, the psychologist declared that the client needs exactly the form of cognitive behavioral therapy that the psychologist is an expert in. Knowing if this is the true client need is impossible, but it is often defined as such. Professionals solve complex problems with skills, knowledge, and professional and ethical judgment, and technicians only possess an array of skills that they try to apply to all clients in a Procrustean manner. The focus entirely on tips and tricks defines psychologists engaging in clinical practice as technicians and not professionals.
Relevant research requires the testing and building of theory. Much research is empirical and without a strong theoretical foundation. Clinicians require a coherent approach to compiling research for it to be useful. Research without a theoretical foundation often evaluates tips and tricks. But this is like trying to build a house that is useful and structured, but simply making bricks without architecture, design, or construction skills to erect the house. We often have a pile of well-made bricks with restricted usefulness, and are not much closer to having a useful house.
Credible and professional psychology is responsive to the needs of all patients and clients. Evidence-based practices are necessary, but not sufficient. For example, most published research excludes outliers in their program evaluations. Yet, what researchers call outliers, clinicians call clients. Strong theory provides guidelines for flexible and responsive practices that are required by professional psychologists.
We all need specific skills, tips, and tricks. We cannot function without a large and growing quiver of up-to-date skills. Yet, an emphasis on theory provides an approach to organizing these skills into a coherent and useful body of knowledge. The best introduction to new tips and tricks involves couching these new skills in the context of theory. Then theory provides guidelines for modifying and individualizing evidence-based approaches and techniques to meet the individual needs of diverse clientele and their families in the context of their culture and other aspects of the systems in which they function. The difference between what professionals do that technicians cannot is theory.
