It's not a message all practitioners want to hear, but it has to be said: The traditional model of psychology practice, focused on a 50-minute intervention, has to embrace new opportunities to stay relevant in the long term. In today's changing marketplace, with another round of health-care reform in the works and demands for accountability rising, psychology practitioners need to take a hard look at their skills and devise new ways of thriving.
That was the message that emerged from the 2009 Presidential Summit on the Future of Psychology Practice, a landmark event held May 14–17 in San Antonio, Texas, that gathered 100 psychologists and 50 leaders from other professions to begin shaping a new vision of the profession.
"Psychology is at an important transition point and is in the process of evolution and change," said summit chair and APA President James H. Bray, PhD. "With advances in neuroscience, genetics, collaborative health care and international business opportunities, we're more relevant than ever and we need to take advantage of these possibilities."
The summit was sponsored by a variety of groups. See the Web site for a full list.
Identifying the "second curve"
Psychology practice is going through a process that all professions and businesses eventually confront, said summit keynote speaker Ian Morrison, an internationally known author, consultant and futurist.
In every business, he said, there are two curves: The first is the one you already do well and you're comfortable in; the second 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 the opportunity. And that's a tough balancing act, said Morrison.
"If you jump too soon from that first curve, you walk away from all that profit, all the revenue, from the old business," he said. "But if you don't start building the second curve, you're not going to be a performer in the 21st century."
IBM is an example of a business that has mastered second-curve transitions brilliantly, he said. Their first curve was adding machines. Then they went to mainframes, then to PCs, then client servers, then software. Now they're on to consulting.
To help determine what psychology's next curve should be, APA President-elect and summit co-chair Carol D. Goodheart, EdD, outlined the four dominant forces that will drive the future of psychology practice:
• Changing economics.
• Advances in technology and science.
• The increasing diversity of the nation and its work force.
• Collaborations with other professionals.
"Some people freeze in the face of these kinds of challenges, but these forces also present opportunities," said Goodheart. "It is not enough to illuminate the future and say that these forces will change things. We need a roadmap to get there."
Providing an economic map was keynote speaker Richard Frank, PhD, the Margaret T. Morris professor of health economics at Harvard Medical School. First, Frank offered the good news: Access to mental health care in the United States has improved over the past 40 years, driven in part by institutional and policy changes, including Medicare and Medicaid. Overall treatment rates, for example, have increased from 12 percent in 1990–92 to 20 percent in 2001–03. "We still have a ways to go, but we have made some strides forward," Frank said.
But what hasn't changed is the amount spent on mental health care. While the United States spent 7 percent of its gross domestic product on health care in 1970, and spends more than 17 percent today, the country spent 0.84 percent on mental health care in 1970, and today, it's not much higher at 0.91 percent. Overall, the United States spends more money on mental health care because the nation's GDP has grown, but most of that new money has been spent on psychotropic medications, not psychological services.
Can that imbalance be corrected? Possibly, said Frank, but it won't be easy. Expanding psychosocial services in a cost-effective way, he said, will depend on two factors: The degree to which treatments are evidence-based and the skills and training of those who deliver that care "so that it realizes the potential that was seen in the laboratory."
Keynote speaker Tillman Farley, MD, has set up clinics that provide such cost-effective psychologist services. He directs medical services at Salud Family Health Centers in northern Colorado, which offers what he calls a "primary-care model of mental health." Patients see physicians and mental health care providers all in the same time and space—no waiting for an appointment if a provider spots a mental health concern. Overall, he reported, 70 percent of his mental health providers' time is spent on such activities as screening, interventions and follow-up phone calls, and only about 30 percent on traditional, hourlong therapy. In fact, many of the centers' psycho-educational interventions last only 5 to 15 minutes.
"It doesn't make sense that all psychological issues need 50 minutes," he said.
Other keynote speakers who offered insights on the issues confronting practitioners included:
• APA CEO Norman B. Anderson, PhD, who discussed racial and ethnic health disparities. "Minority patients get lower-quality assessments and treatments," he said—and that is an opportunity for psychologists to make a difference in the future.
• Communications strategist Janet Reingold, who urged psychology to brand itself to raise awareness and understanding of psychologists' many roles, from health promotion to crime prevention to transportation safety. "If a car company can sell fun and a soda company can bottle optimism, then psychology can generate joy," said Reingold.
• APA Executive Director for Professional Practice Katherine Nordal, PhD, who gave an overview of the advocacy issues her directorate is pursuing on behalf of psychologists, particularly health-care reform. Nordal emphasized that psychologists need to be accountable for the services they provide. "It's all going to be about outcomes, evidenced-based practice and pay-for-performance," she said.
• Organizational consultant Elizabeth Gibson, PhD, who said it won't be easy for practitioners to adjust to these new realities. They will face a sense of loss, confusion, a mistrust of others and a fear of letting go of their old ways of practice. "But you don't need to let go of everything," she said. "We need to ask what are we like when we're at our best and how can we preserve that?"
(All of the summit's keynote addresses can be viewed on APA's Web site . In fact, the summit chairs had hoped to web cast the entire event live, but budget challenges prevented that.)
Throughout the summit, participants broke into groups to discuss the factors that are changing psychology practice. Summit co-chair Margaret Heldring, PhD, summarized the summit's major ideas, culling from 70 hours of lectures and breakout groups what she called a "treasure trove of creativity and imagination."
Among the major themes she reported were:
• The sun is about to shine on primary care, but it will change us. As psychologists prepare to grow into the future, they must be open to the change process, even as they leave behind something familiar and beloved.
• Practitioners are still being trained for the "first curve"—traditional practice. So to thrive in the future, psychologists will need to redefine training. That doesn't mean foregoing all the wonderful ways psychologists are currently trained, Heldring said. But it does mean adding new elements, embracing best practices and getting interdisciplinary training.
• At issue is whether we will be able to live up to our promise to help society. "That is, after all, our mission," Heldring said.
All of these ideas and many more will be part of the summit's task force report due out this fall.
In fact, said Bray, the summit is just the beginning of a process that will be built on in a variety of ways, including a two-hour session at APA's Annual Convention in Toronto, Aug. 7, at 10 a.m.–noon; an ongoing survey of psychologist's thoughts on the future of the profession at http://forms.apa.org/president; and through summit co-chair Carol D. Goodheart's work as APA president next year.
"This is not going to end with this meeting," said Bray. "We are very well-positioned for the future."
WHAT PARTICIPANTS SAID
On the final day of the summit, the conference chairs asked participants to sum up their "Aha!" moments, Twitter-style: in 140 characters or less.
Here's a sampling:
"Make the profession increasingly valuable to society, and the rewards will follow."
"We need to expand beyond clinical practice."
"Talk more with others, especially those we serve."
"We push our creativity by working with other professionals."
"We need to hang together, or we'll hang separately."
"We have an obligation to change."