Feature

APA President Nadine J. Kaslow, PhD, has diagnosed psychology with a serious problem: fragmentation.

Researchers don't talk enough with practitioners, says Kaslow, vice chair of the Emory University School of Medicine's department of psychiatry and behavioral sciences and chief psychologist of Atlanta's Grady Health System. Practitioners don't collaborate enough with educators. Psychologists as a whole don't always prioritize advocacy. Even at the individual level, psychologists don't consult or collaborate enough. All this, she says, weakens the discipline and keeps psychology from achieving its full potential to enhance public well-being.

That will all change if Kaslow gets her way. Her presidency's overarching theme will be uniting psychology, and she plans to spend her yearlong term finding ways to encourage psychologists to come together, at both the individual and broader levels.

"I first became interested in the issue of uniting multiple identities within individual psychologists," says Kaslow, who describes herself as a scientist/practitioner/educator committed to serving the public interest. "Over time, I became interested in how to think about this within our profession as a whole."

Examples of what she has in mind already exist, Kaslow says. Her presidential initiative will build on those efforts, which include connecting researchers, practitioners and others through APA's new clinical practice guidelines initiative; bringing psychologists together across borders through APA's memoranda of understanding with psychological associations around the globe; and bringing educational materials on behavioral health to the wider health-care community through a new MedEdPORTAL initiative.

Among individuals

At the most basic level, says Kaslow, psychologists can benefit themselves and the profession by joining together to enhance their mutual competence. She'd like to see the traditional individualistic notion of ethics and competence within psychology replaced by a more communitarian approach.

"Communitarianism means that we're in this together, that we're responsible not just for ourselves but for other psychologists," says Kaslow. "It's another way of talking about connecting people with each other in really meaningful ways."

What's needed, she says, is for psychologists to learn from each other as equal partners — something that will enhance the competence of the entire discipline.

"The whole is greater than the sum of its parts," says Kaslow. "If each of us does a good job but we don't bring it together, we don't move the field forward as much and don't have as much quality in everything we do."

Kaslow and several colleagues laid out this vision of what they call "the competent community" in a 2012 paper in the American Psychologist. In the paper, they call for a shift in how psychologists think of their ethical obligation to be professionally competent, supplementing the traditional individualistic notion of accountability with communities of psychologists responsible for supporting their colleagues' competence. In this way, the authors argue, problems will be less frequent and the discipline strengthened.

"We think we're good at self-assessment, but in reality we're not as good as we think we are," says Linda Forrest, PhD, a co-author of the paper and professor emerita of counseling psychology and human services at the University of Oregon.

And that's why relationships with others become so important, she says. "If we have strong relations with others, it's more likely that we will learn from them when we're inaccurate in our conceptions of our own competence," she says.

Having a diverse network to learn from is key, Forrest adds, citing an article she, Kaslow and others published in Professional Psychology: Research and Practice in 2013.

"The greater the diversity of people in your competence constellation, the stronger your constellation is in terms of keeping track of your competency," says Forrest. "The whole idea is different psychologists listening carefully to how each views the world and the kinds of problems each of us works with and the way that if we work in teams we can often have a bigger, more accurate picture."

Within psychology

Now Kaslow wants to spread this notion across all of psychology and beyond, with psychologists coming together with colleagues in other areas of psychology, psychologists in other countries and even professionals in other disciplines altogether.

One of the best examples of uniting psychology's many facets is APA's clinical practice guidelines initiative, which brings science, practice and education together for the public interest, says Kaslow.

"The guidelines are a fantastic example, because they're really about pulling together the research evidence with the practice part," she says. "Then if you take it one step further, you would use the guidelines to educate students and even the public."

Using a rigorous methodology, APA is bridging the gap between research and practice by synthesizing the evidence base on specific conditions. Work is already underway on guidelines for depressive disorders, obesity and post-traumatic stress disorder.

The guidelines won't just help practitioners and their patients, says Steven D. Hollon, PhD, a psychology professor at Vanderbilt University who chairs the initiative's advisory steering committee. They can also help policymakers, payers and consumers themselves see what the most effective treatments are for various conditions.

The expert panels reviewing the literature on both psychosocial and pharmacological treatments and summarizing the data include researchers, clinicians, people involved in the health-care delivery system, even consumers themselves, says Hollon, noting that bringing together such diversity strengthens the resulting products.

"You want a real balance of perspectives," he says. "The evidence doesn't interpret itself, so you want people with a whole range of experiences, preferences and orientations to take a look at the evidence and come up with reasoned, even-handed guidelines."

The dialogue should go the other way, too, says Marvin R. Goldfried, a psychology professor at Stony Brook University and past president of APA's Div. 12 (Society of Clinical Psychology)and Div. 29 (Psychotherapy).

In a series of papers published in Behavior Therapy in 2013, Goldfried and colleagues describe how they are building a two-way bridge between science and practice. A collaboration between Div. 29 and Div. 12 has created a way for practitioners to share with researchers their clinical experiences using empirically supported treatments.

"The clinical trials that have been conducted for certain therapies don't tell the whole story," says Goldfried. "We thought it would be a good idea to have a vehicle whereby practicing clinicians using treatments based on clinical trials could report back some of the difficulties they're having and to cast them as hypotheses that researchers could engage in."

That already happens with medications, Goldfried points out, explaining that the Food and Drug Administration gives practitioners a way to report problems even after drugs have been approved and marketed.

Now Goldfried and his colleagues have created a similar mechanism for psychologists: They have developed online surveys that allow practitioners to identify the real-life variables — such as a difficult family situation or a weak therapeutic relationship — that interfere with their ability to reduce their patients' symptoms.

The first three surveys focused on panic disorder, social anxiety and general anxiety disorder; the next two will cover post-traumatic stress disorder and obsessive-compulsive disorder. The results will be available at www.stonybrook.edu/commcms/two-way-bridge/index.html.

This mechanism will not only enhance research, says Goldfried. It will also help ensure that practitioners pay attention to the latest research.

"The hope is that if the practicing clinician sees him or herself as having a voice in what gets done, he or she will be more likely to look at the research findings that are associated with that," says Goldfried.

Around the world

It's not just important to unite psychologists within the United States, says Kaslow. It's just as important to unite with — and learn from — psychologists in other countries.

That's already happening, thanks to APA's memorandum of understanding initiative, says Merry Bullock, PhD, who directs APA's Office of International Affairs. Through the program, APA and other national psychology associations agree to engage in mutual learning and collaboration.

"The goal is for APA as an organization to find ways to talk with and interact with its fellow national psychology organizations," says Bullock. "We think of the memorandum of understanding program as providing opportunities for that to happen."

APA signed its first memorandum of understanding with the Psychological Society of South Africa in 1998. Since then, APA has signed agreements with associations in a dozen other countries: Australia, China, Colombia, Cuba, Japan, Jordan, Mexico, Norway, Portugal, Spain, Sweden and the United Kingdom.

The partners have visited each other's offices and participated in joint symposia at international psychology conferences. Plans are underway for developing collaborative continuing-education programs and a leadership network that might facilitate getting psychological research to policymakers or address leadership pipeline issues in psychology.

A "learning partner" model undergirds the program, says Bullock.

"This is not about APA or psychologists from the United States going out into the world to give something," she explains. "It's about psychologists from the United States learning with and from other psychologists in countries around the world."

Taking that kind of perspective will enrich and strengthen psychology as a field, says Bullock, explaining that psychology in the United States is based on a small percentage of the world's population — primarily North American and European.

"But there are more psychologists in Latin America than in the United States, more psychologists in Europe than in the United States and the number of psychologists is growing rapidly in Asia and Africa," she says. "It's really important that we understand that there are multiple different perspectives and that we cannot assume that models developed in the United States provide universal explanations for behavior everywhere."

Across disciplines

The Affordable Care Act is facilitating another type of uniting that Kaslow wants to see more of — the coming together of psychologists and other health-care professionals.

"The whole notion of patient-centered medical homes, for example, is very much about having integrated, collaborative teams working together and bringing different perspectives as equal partners, including being equal partners with patients and families," she says.

The patient-centered medical home exemplifies what Donna Rasin-Waters, PhD, calls the "big win" of health-care reform: the integration of physical and mental health.

"We're no longer separating out mental health and substance abuse and physical health but really uniting and integrating treatment for the patient as a whole person with multiple aspects to their health care," says Rasin-Waters, a clinical psychologist and neuropsychologist at the Veterans Affairs Harbor Health Center in Brooklyn, N.Y.

That merging will improve patient care, says Rasin-Waters. It will also advance scientific progress.

"We have a lot to offer medical professionals and vice versa," she says. "It's really a rich environment to do a lot of translational research, cross-checking of data, understanding the patient from their perspective and culture and really sharing that."

APA is already working to ensure that future generations of health-care professionals benefit from psychological science.

In collaboration with the Association of American Medical Colleges (AAMC), APA is creating the first-ever psychological science collection within AAMC's MedEdPORTAL, an online repository of health education teaching and assessment resources.

The new collection will include peer-reviewed health education models, non-peer-reviewed innovations being developed and tested at health institutions and online continuing-education activities.

MedEdPORTAL is a major teaching resource for medical schools, dentistry schools and other health-care training programs, says Cynthia D. Belar, PhD, executive director of APA's Education Directorate.

"Creating this portfolio is an important way to promote the use of psychological science by other health professionals," says Belar. "It's also important because it supports the scholarship of teaching through a peer review process."

For Kaslow, the MedEdPORTAL initiative is just another example of the kind of uniting she'd like to encourage during her presidency.

"To effectively integrate science, practice, education and the public interest, we must have respect for what we have to offer and what others have to offer, be willing to learn from them while also offering our strengths and working jointly with them," she says. "In sports, there's a saying, ‘It takes teamwork to make the dream work.'"

Rebecca A. Clay is a writer in Washington, D.C.