The escalating costs of health care and other recent trends have made health care decisions of great societal import, with decision-making responsibility often being transferred from practitioners to health economists, health plans, and insurers. Health care decision making increasingly is guided by evidence that a treatment is efficacious, effective-disseminable, cost-effective, and scientifically plausible. Under these conditions of heightened cost concerns and institutional-economic decision making, psychologists are losing the opportunity to play a leadership role in mental and behavioral health care: Other types of practitioners are providing an increasing proportion of delivered treatment, and the use of psychiatric medication has increased dramatically relative to the provision of psychological interventions. Research has shown that numerous psychological interventions are efficacious, effective, and cost-effective. However, these interventions are used infrequently with patients who would benefit from them, in part because clinical psychologists have not made a convincing case for the use of these interventions (e.g., by supplying the data that decision makers need to support implementation of such interventions) and because clinical psychologists do not themselves use these interventions even when given the opportunity to do so. Clinical psychologists' failure to achieve a more significant impact on clinical and public health may be traced to their deep ambivalence about the role of science and their lack of adequate science training, which leads them to value personal clinical experience over research evidence, use assessment practices that have dubious psychometric support, and not use the interventions for which there is the strongest evidence of efficacy. Clinical psychology resembles medicine at a point in its history when practitioners were operating in a largely prescientific manner. Prior to the scientific reform of medicine in the early 1900s, physicians typically shared the attitudes of many of today's clinical psychologists, such as valuing personal experience over scientific research. Medicine was reformed, in large part, by a principled effort by the American Medical Association to increase the science base of medical school education. Substantial evidence shows that many clinical psychology doctoral training programs, especially PsyD and for-profit programs, do not uphold high standards for graduate admission, have high student-faculty ratios, deemphasize science in their training, and produce students who fail to apply or generate scientific knowledge. A promising strategy for improving the quality and clinical and public health impact of clinical psychology is through a new accreditation system that demands high-quality science training as a central feature of doctoral training in clinical psychology. Just as strengthening training standards in medicine markedly enhanced the quality of health care, improved training standards in clinical psychology will enhance health and mental health care. Such a system will (a) allow the public and employers to identify scientifically trained psychologists; (b) stigmatize ascientific training programs and practitioners; (c) produce aspirational effects, thereby enhancing training quality generally; and (d) help accredited programs improve their training in the application and generation of science. These effects should enhance the generation, application, and dissemination of experimentally supported interventions, thereby improving clinical and public health. Experimentally based treatments not only are highly effective but also are cost-effective relative to other interventions; therefore, they could help control spiraling health care costs. The new Psychological Clinical Science Accreditation System (PCSAS) is intended to accredit clinical psychology training programs that offer high-quality science-centered education and training, producing graduates who are successful in generating and applying scientific knowledge. Psychologists, universities, and other stakeholders should vigorously support this new accreditation system as the surest route to a scientifically principled clinical psychology that can powerfully benefit clinical and public health.

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临床心理学的现状和未来前景：迈向心理和行为保健的科学原则方法。

医疗保健成本的不断上升和其他近期趋势使得医疗保健决策具有重大社会意义，决策责任往往从从业者转移到健康经济学家、健康计划和保险公司。医疗保健决策越来越多地以治疗有效、可有效传播、具有成本效益且科学合理的证据为指导。在成本问题和机构经济决策日益严重的情况下，心理学家正在失去在精神和行为健康护理中发挥领导作用的机会：其他类型的从业者提供的治疗比例越来越大，精神科药物的使用也越来越多相对于心理干预的提供而言，这种情况急剧增加。研究表明，许多心理干预措施是有效、有效且具有成本效益的。然而，这些干预措施很少用于本来可以从中受益的患者，部分原因是临床心理学家尚未为使用这些干预措施提供令人信服的案例（例如，通过提供决策者支持实施此类干预措施所需的数据）而且因为即使有机会，临床心理学家本身也不会使用这些干预措施。临床心理学家未能对临床和公共卫生产生更重大的影响，可能是因为他们对科学的作用抱有深深的矛盾心理，并且缺乏足够的科学培训，这导致他们重视个人临床经验而不是研究证据，使用评估实践心理测量支持可疑，并且不使用有最有力证据证明有效的干预措施。临床心理学在其历史上的某个时刻类似于医学，当时从业者主要以前科学的方式进行操作。在 1900 年代初医学科学改革之前，医生通常持有当今许多临床心理学家的态度，例如重视个人经验而不是科学研究。医学的改革在很大程度上是美国医学会为增加医学院教育的科学基础而做出的原则性努力。大量证据表明，许多临床心理学博士培养项目，尤其是心理学博士和营利性项目，研究生入学标准不高，师生比例较高，在培训中不强调科学，培养出的学生无法申请或产生结果。科学知识。提高临床心理学的质量以及临床和公共卫生影响的一个有前途的策略是通过新的认证体系，该体系要求高质量的科学培训作为临床心理学博士培训的核心特征。正如加强医学培训标准可以显着提高医疗保健质量一样，提高临床心理学培训标准将加强健康和心理保健。这样的系统将 (a) 允许公众和雇主识别经过科学训练的心理学家；(b) 污蔑科学培训方案和从业人员；(c) 产生理想的效果，从而普遍提高培训质量；(d) 帮助经认可的项目改善其在科学应用和生成方面的培训。这些效应应促进实验支持的干预措施的产生、应用和传播，从而改善临床和公共卫生。基于实验的治疗方法不仅非常有效，而且相对于其他干预措施也具有成本效益；因此，它们可以帮助控制不断上升的医疗费用。新的心理临床科学认证系统（PCSAS）旨在认证提供高质量以科学为中心的教育和培训的临床心理学培训项目，培养能够成功生成和应用科学知识的毕业生。心理学家、大学和其他利益相关者应大力支持这一新的认证体系，将其视为实现具有科学原则的临床心理学的最可靠途径，从而极大地造福于临床和公共卫生。