Ferkauf’s Sarah Kate Bearman Bridges the Chasm Between Psychological Research and Practice
As a camp counselor, Sarah Kate Bearman was always intrigued by the “problem” kids—the high-energy, high-maintenance kids who had trouble following the rules and tried everyone else’s patience. Unlike many of her peers, Bearman saw children who didn’t really differ from better-adjusted, happier campers beneath the moodiness and attitude.
“I saw so much typical child behavior in these kids,” she said. “When children first start to develop problems with anxiety or depression, they don’t look that different than other kids—because they’re not. The older they get, though, the wider that gap grows.”
Bearman, now an assistant professor at Yeshiva University’s Ferkauf Graduate School of Psychology, kept thinking about that gap. It provided so much time for intervention: in theory, the earlier she could catch a child starting to slip, the more successful she could be in steering his or her developmental path back to a normal trajectory. After college, Bearman decided to become a child psychologist, completing a two-year research assistantship in pediatric pharmacology at Massachusetts General Hospital and pursuing a graduate degree at the University of Texas at Austin and a postdoctoral fellowship at Judge Baker Children’s Center of Harvard Medical School.
Bearman initially planned to research how disorders such as depression developed. But when she began her externship in clinical settings, she noticed a troubling phenomenon.
“I spent all this time learning one set of treatments that were scientifically tested and shown to be helpful, but in the child guidance center where people were actually practicing, I didn’t see anyone using those treatments,” Bearman said. “That really perplexed me. Why weren’t people using the methods we had developed?”
It was a question she learned more and more psychologists and researchers were asking, reaching divided—and often embittered—conclusions. Practicing clinicians are rarely trained to use scientifically-supported methods and feel allegiances to the treatments they’ve used throughout their career, believing they’re effective based on personal experience. And many are skeptical of treatments developed in academia, arguing that university settings don’t resemble real practice conditions and researchers with no experience in community mental health can’t relate to the problems practicing clinicians face in the field.
Researchers, in turn, are concerned that potentially life-improving treatments are being overlooked in favor of treatments that have never been tested in rigorous research trials and feel practitioners don’t do enough to seek proper training or keep up with developments in the field. But many community mental health providers aren’t psychologists—much of the workforce that treats children are social workers or licensed mental health counselors—and of those that are, few attended doctoral programs emphasizing empirically-supported methods.
“Even if you wanted to go out and learn these treatments as a member of the mental health community, there are barriers in your way,” Bearman said. “You could go to a two-day training, but those are days you can’t see clients, so you lose the billing time. You might get a manual to use, but without any supervision or consultation, you’d run into difficulties using it in the real world.”
In the meantime, some therapies that have been proven to be ineffective or even harmful, such as group sessions for teenagers who break the law, are still being offered in mental health settings, and work being done by researchers often lacks grounding in real community practice that could make it more effective or adaptable. And the majority of children treated for mental health disorder are never offered a method that has been tested or proven to be effective.
That’s where Bearman comes in.
This year, Bearman launched a program supported by the National Institute of Mental Health to tailor existing scientifically supported treatments for depression and related problems for use in several New York City middle schools.
“School guidance counselors are trained to be supportive and develop kids’ emotional health, not intervene in a depressive disorder,” said Bearman. “But the truth is if they don’t intervene, kids don’t get treated. Eighty percent of kids who receive treatment for mental health problems are treated in schools—even if counselors make referrals to psychologists, kids won’t actually go, either because they don’t have the means, their parents don’t know enough about the clinic or their disorder, or they’re afraid of the associated stigma.”
Working with an advisory committee of school guidance counselors, Bearman seeks to adapt empirically supported treatments for a better fit in school settings, where longer one-on-one sessions often called for in researched therapies may not be a viable option. She’s also hoping to imbue those therapies with the guidance counselors’ knowledge of their students and community. “I work in that gap,” explained Bearman, “trying to see how we can foster knowledge transfer from both sides to form a partnership.”
What do scientifically supported treatments look like?
“One of the biggest misconceptions kids or families have is that therapy is going to involve things they’ve seen on TV, lying on a couch with someone listening to them and nodding and saying cryptic things,” said Bearman. “In reality, the treatments we offer are more similar to things they’ve already experienced in school. We may be teaching them to manage their mood in the same way they learn to play soccer or write an essay.” In some supported therapies, psychologists give children assignments similar to homework to help them slowly build a basic skill set to replace mechanisms that aren’t working as well.
In addition to the middle school program, Bearman is a co-investigator in a Cleveland study, funded by the Annie E. Casey Foundation, focusing on team decision-making by child welfare agencies and a Boston study of evidence-based practices to treat anxiety, depression and disruptive conduct in community health clinics. And she’s teaching her passion at Ferkauf, in first-year courses including Fundamentals and Applications of Empirically Supported Practices as well as advanced courses like Dissemination and Implementation of Evidence Based Practices in Youth Mental Health Settings, to help defuse the tension between researchers and practitioners right when it starts.
“We have to figure out a way that everyone can speak the same language and work together towards the same goal,” said Bearman. For her, that goal is to get children effective mental health treatment early—before their disorder becomes their identity.
Learn more about Bearman’s research here.