Theoretical Evaluation Self-Test (Test): A Preliminary Validation Study.

"Nothing is as practical as a good theory." Kurt Lewin (cited in Gabbard, 1994, p. 29) Over nearly 40 years, several scales have been developed to measure therapist theoretical orientation (Poznanski & McLennan, 1995). This study, unlike previous efforts, focuses on "community clinicians"--social workers and other mental health professionals (such as psychologists, counselors, psychiatrists, and psychiatric nurses) who work in community treatment settings. Community clinicians must add several components to the traditional repertoire of psychotherapy theories and clinical approaches: an ability to work with a broad range of cultures and socioeconomic backgrounds, theoretical constructs to articulate the environmental influence on clients, and integration of psychosocial interventions with biological treatments. Theoretical orientation guides how the clinician understands psychopathology and the process of helping, and each theory and approach has associated techniques and a style of relating to the client. Norcross (1985) stated that theoretical orientation serves "descriptive, explanatory, developmental and generative functions in clinical practice" (p. 14). Theoretical orientation influences what clinicians think and what they say. Survey and measurement research on psychotherapy theories find that differences in theoretical orientation persist over time, even as eclecticism becomes more common (Larson, 1980; Norcross, Hedges, & Castle, 2002; Poznanski & McLennan, 1995). Quantitative process studies show that clinicians of different theoretical orientations say different things to clients, ask questions about different features of a problem, and even have a different emotional tone (Ablon & Jones, 1998; Jones & Pulos, 1993). The words "theoretical" and "theory" in common usage mean any beliefs or concepts, not necessarily a formal theory. Some concepts that influence clinical practice are explicitly nontheoretical, such as the pragmatic case management approach. In keeping with convention, the term theoretical orientation is used to designate even these less theoretical influences on a clinician's approach to treatment. Survey research of mental health professionals suggests that eclecticism and integrationism are increasing. Jensen and colleagues (1990) reported on a national survey of 423 mental health professionals, drawing a random sample from mailing lists of professional associations of psychiatrists, psychologists, social workers, and marriage and family therapists. The authors found that 68 percent of mental health professionals said that they use multiple theories, and in reviewing 25 other studies showed that this proportion is increasing. Hollanders and McLeod (1999) found in a study of 309 British therapists that 87 percent reported the use of multiple theories in practice. Both studies found that only a small proportion of clinicians identified as one-theory only practitioners. Given this reality of multitheoretical practice, the definition of theoretical orientation must be broadened to include combinations of two or more theories. Wachtel (1997) and Millon and Davis (1997) provided cogent discussions of how some of the major psychotherapy theories can be combined coherently. The most prevalent broad theoretical orientations identified by surveys are psychodynamic, cognitive-behavioral, family therapy, and humanistic-experiential (Jensen et al., 1990; Norcross et al., 2002; Norcross, Prochaska, & Farber, 1993). An eclectic or integrative orientation was the most frequently endorsed; the most common component theory was psychodynamic, followed in order of frequency by cognitive-behavioral, family therapy, and humanistic-experiential. Norcross and his colleagues have conducted three surveys of the membership of the psychotherapy division of the American Psychological Association, one each in the 1980s, the 1990s, and in 2000. These relatively large surveys, with random samples ranging from 214 to 481, demonstrate the continued salience of theoretical orientation, the rise of eclecticism--integrationism, and the relative stability of the four major theory groups. …