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2009 Presidential Summit on the Future of Psychology Practice: Collaborating for Change

The summit's goal was to engage the broader practice community in an agenda-and priority-setting meeting to inform the work of the APA Practice Directorate and the APA Practice Organization.

By James H. Bray, PhD, Carol D. Goodheart, EdD, and Margaret Heldring, PhD

Reprinted from June 2009 APA Division Listserv

What happens when you bring 150 thought leaders from psychology, business, consumer groups, economics, insurance, medicine, and politics together to transform the practice of psychology? The Presidential Summit on the Future of Psychology Practice, held May 14-17, in San Antonio, Texas, did just that and was a transforming event to move the practice of psychology forward in the 21st century. Jeffrey Magnavita, PhD, a Div. 29 delegate to the Summit, summed up his experience at the summit this way: "It was awesome, inspiring, frustrating, challenging, generative and hopeful." The summit is part of the 2009 Presidential Initiative on the Future of Psychology Practice.

The summit's goal was to engage the broader practice community in an agenda-and priority-setting meeting to inform the work of the APA Practice Directorate and the APA Practice Organization. We assembled leaders in the practice of psychology and related professionals from other practice associations, government entities, training organizations, consumers, insurers, and businesses to identify:

  1. Opportunities for future practice to meet the needs of a diverse public.

  2. Priorities for psychologist practitioners in private and public settings.

  3. Resources needed to address the priorities effectively.

  4. Partnerships and roles to implement the priorities.

The summit was a vehicle for consideration of new forms, settings and partnerships for psychological practice; expanded thinking about practice trends; and conceptualizations of practice that cross traditional lines. The Task Force will use the findings from the summit to develop clear recommendations for our diverse practice community.

There were a number of outstanding keynote addresses. Day 1 included a thought provoking talk by Dr. Ian Morrison, a futurist, who discussed how businesses change. Morrison stated that in every business there are two curves: The first curve is the one you already do well and you're comfortable in. The second curve is a new way of doing things that is dramatically different from the first. To succeed, you have to manage both curves -- keep doing what works while developing new opportunities. Dr. Norman Anderson addressed health disparities and the importance of overcoming them in our future work. We had a wonderful talk after dinner by Ann McDaniel, vice-president of the Washington Post Companies. She gave us an update on the Obama administration and plans for health care reform.

Day 2 included talks by a health economist, Richard Frank, PhD, on the changes in funding for health and mental health care. He pointed out that while health care costs as a percentage of the GNP have increased over the past 20 years, mental health care costs have stayed stable as a percentage of the GNP. In addition, there has been an increase in the use of psychotropic medications, by both psychiatrists and other physicians, while payments for psychotherapy have declined. This is a strong reason for psychology to continue to fight for prescriptive authority.

Tillman Farley, MD spoke about his model of integrated community health care that places behavioral health squarely in the primary care model. Janet Reingold, media and marketing expert, discussed how to brand the profession and distinguish psychology from other disciplines. On Day 3 Elizabeth Gibson, PhD, a consulting psychologist, described how she helped transform Best Buy from a bankrupt company to a leading retailer in America. The principles she described are applicable to transforming the profession of psychology.

The real work of the Summit occurred in small work groups. The work groups were urged to think big and outside the box. Work groups addressed questions such as:

  • What are priorities for our constituents?

  • What are the pathways to get there?

  • What partners should we develop?

  • What are the economic challenges that present future opportunities?

  • What will be the impact of cross-cutting changes in the future of psychology practice in regards to diversity, science & technology developments, and partnerships?

Here are some of the issues that emerged at the summit, especially in light of national health care reform.

Practitioners are still being trained for the "first curve"—traditional practice. To thrive in the future, psychologists will need to redefine training and take advantages of new practice opportunities outside of traditional psychotherapy practice. That doesn't mean foregoing all the wonderful ways psychologists are currently trained, but it does mean adding new elements, skills, embracing best practices and getting interdisciplinary training.

The need to collaborate in primary care. As summit speaker Frank DeGruy, MD, said, "Mental health care cannot be divorced from primary medical care, and all attempts to do so are doomed to failure." It is becoming increasingly clear that health-care reform will include a greater emphasis on primary care and prevention of chronic disease. These are both areas that psychologists can make major contributions. This will require that we partner and practice with primarycare physicians and nurse practitioners. Most practicing psychologists have not been trained to work in these settings and in the busy style of primary-care medicine. It is one of our future practice opportunities.

The need to be accountable. Whether we like it or not, there are changes in health care payments and reimbursements that require practitioners to demonstrate accountability for their work. This was a clear message from the insurance, business and legislative delegates at the summit. We have the opportunity to define how we should be evaluated by developing our own psychology treatment guidelines and methods to assess our work. Psychiatry has done this. Their guidelines are used by the insurance industry to determine treatment and reimbursements. According to the summit's insurance and legislative delegates, there are not any for psychotherapy and psychological services. We have long resisted developing these guidelines, but the time has come to define psychological treatment practices, or others will do it for us.

Health promotion and prevention. The focus on primary care also opens opportunities for prevention of health problems and enhancing the health of our population. Many chronic health problems, such as diabetes, hypertension, obesity, are caused by psychosocial and life-style problems. Psychologists have much to offer to prevent these problems and help people better manage their chronic health problems.

Creating and nurturing partners for change. One of the innovations of the summit was to have a significant number of invited guests who represented other organizations, businesses and consumers of psychological services. They are open and interested in partnering with the APA in our advocacy efforts. These relationships need to be nurtured and strengthened in our future.

Future Plans

The Task Force on the Future of Psychology Practice will synthesize the ideas and recommendations from the summit. The Task Force will recommend them to the Committee for the Advancement of Professional Practice and into the APA strategic planning process and policy changes for the association. You can watch portions of the summit on the APA webpage. You can also learn more about the summit during a lunch at the COR meeting on Wednesday August 5 or a 2-hour session at the APA Convention, Friday, August 7 from 10 AM-12 noon.

The impact of this summit has the potential of bringing a sea change to the practice of psychology. The ideas and recommendations from the summit need to be implemented at all levels of our profession to make a real difference. As stated at the summit, "¡Lo que ocurrió en San Antonio, no puede permanecer en San Antonio! What happened in San Antonio cannot stay in San Antonio!" Ψ