My interest in psychology was triggered by my elder brother Aus, who was already practicing as a counseling psychologist when I was considering my own career. I became hooked on research during my training as a clinician, and after practicing for four years, I went to Stanford to do a Ph.D. David Rosenhan and Al Bandura were strong influences there, and my early post-doctoral research on self-efficacy and mood reflected their influence. It was a natural step to the prediction of relapse in depression, and then to an interest in prediction of relapse in other disorders. A chance remark by a colleague, Penny Davis, sparked my interest in expressed emotion (EE) as a predictor of relapse in schizophrenia. I later spent a sabbatical at the MRC Psychiatry Unit in London, where Christine Vaughn encouraged me to do a review on the topic. The evolution of research goes on—I retain a research interest in family support, but now I primarily work on comorbidity of substance abuse and mental disorders.

At about the same time as the review on EE, I was conducting a collaborative dissemination trial on family intervention in schizophrenia. It involved training over 200 practitioners in standard community health centres to do an individual and a family version of the intervention, and for their clients to then participate in the randomized trial. Maintaining the practitioners' involvement and ensuring treatment fidelity was extraordinarily difficult. The outcomes nonsignificantly favoured family intervention over the first 6 months, but over 12 months even the apparent superiority disappeared. The trial remains unpublished. This experience triggered an interest in the principles of training and dissemination of innovation, which I am still pursuing.

Theoretical development is very satisfying—apart from the EE paper mentioned above, one I did in 1990 on grief for the British Journal of Psychiatry ("Towards a cognitive-behavioral intervention for adult grief," British Journal of Psychiatry, 157:373-83, September 1990) was an exciting one to do—the existing work raised so many fascinating questions. Interestingly, that paper did not attract many citations, so perhaps my own evaluation of it is not shared by others. My current work on the nature of craving and urges has also been very satisfying. However, it is the impact (if any) that we have on individuals—our students, practitioners, clients—that I think really counts. The papers will probably be forgotten by most people in the field in a relatively short time, and all too soon the paper copies will disintegrate. If we've been able to benefit individuals through our work, even transiently, that is much more valuable. For that reason, I get a buzz out of the treatment trials—especially our research on the treatment of alcohol abuse by correspondence. Some people from very remote areas who would not otherwise have received help reported having a lasting benefit.

Not as much as I'd hope. But perhaps it is a bit grandiose to think that it will. I try to talk about relevant research to the media and to my colleagues, but I think the real impact is often much less than we believe. Clinical practice, for example, is so hard to change in any systematic and lasting way. Media interest or public awareness is a flash in the pan. I am part of an international group that is currently trying to make a lasting impact on community attitudes and practices concerning alcohol misuse. This kind of work through existing community groups and agencies has the potential for a much wider impact from our research than we would otherwise have.

I had of course hoped that others would like the EE review, but I was surprised by the degree of interest. I guess it was the right kind of review at the right time.

  What lessons would you draw from your work to pass on to the next generation of researchers?

I suppose, don't be discouraged if your work is not recognized at first. There is no substitute for hard work to learn our craft, and we continue to develop over time. Sometimes very creative ideas go unrecognized by others for a long time.

I think one of the key problems with current research—especially among Ph.D. students—is a narrow focus. This is both a short time span of interest in papers—we have a lot to learn from older research and theoretical writings—and a focus on too narrow an area. A creative approach often comes from researchers reading widely, and being exposed to a range of ideas and experimental paradigms. My own work has really benefited from a wide range of interests. Although I am perhaps not as well known in any one area than I would have been if I'd specialized more, I think what I do has more breadth than if I was more narrowly focused.

I think we need to communicate our work more effectively. Scientists are characterized as out of touch with everyday experience—Einstein caricatures in white coats who would not know real life if they tripped over it. Or worse, sinister figures creating or discovering monsters (Frankenstein, King Kong, or genetic). This even occurs with many clinical practitioners, who despite a scientific training, still rely on subjective clinical judgment in preference to sound evidence. Clearly, there are some good reasons why this has occurred. Not all scientific advances have been to society's ultimate benefit, and sometimes the research is less relevant than it might be (e. g. the debate over efficacy vs. effectiveness trials has been a useful one in clinical areas). But a lot of the suspicion is not well founded, and it comes back to a lack of sophistication in communicating our work. We need to value marketing of research and its applications, or else it will fail to have the impact it deserves. This is not to devalue pure research that does not have an immediate application—the current focus on targeted funding and immediate benefit is also problematic, as is a focus on financial aspects of benefits. We need to sell the excitement of discovery to the public for its own sake. I guess if there was one single change, it would be that science attracted as much media coverage, and attracted as much community interest as sport does now. I know that is probably not achievable, but at least we can try to whet the community's interest in what we are doing.

Most of my work has been collaborative, and other people have made a major impact on its outcomes. Most of all, the support of my wife, Lois, has been critical to any success my work may have achieved.

Dr. David J. Kavanagh
University of Queensland
Department of Psychiatry
Brisbane, Queensland, Australia