I am a clinical psychologist. I am not a member of the American Psychological Association (APA). I earned my PhD in 1980 and ended my APA membership more than 20 years later after time in both clinical practice and in executive roles within the managed behavioral healthcare industry. It seemed to me that the association had rejected the business side of healthcare, as if we had all embraced a calling, a noble profession, and not a business.
I raise this now because the APA has a new, existential set of challenges in front of it, and I will be evaluating membership in a professional organization along with hundreds of thousands of other behavioral healthcare professionals. A break from the customary is needed. Yet I am afraid that most psychologists and most association leaders are not ready for change. While I don’t pretend to understand the concerns of social workers, marriage and family therapists, licensed professional counselors and the like, I don’t think the issues they face are markedly different from those of psychologists.
We are fighting for professional advancement and hoping that the world sees our work as psychotherapists as valuable. Yet I have some bad news. Hope is not a strategy.
I would like to take credit for the phrase, “Hope is not a strategy,” but I must admit that I stole it from the title of a popular book on sales strategy. I would offer that psychotherapists should be reading more sales strategy books because whatever clinical job you currently enjoy, sales and marketing are in your future. Healthcare sales are in flux and the silent healthcare providers will be marginalized. We need organizations like the APA to offer realistic guidance in this environment. My experience with the APA is that they promote the professional value of psychologists in a tepid way—largely avoiding the question of biological solutions versus psychosocial solutions—and they ignore the marketplace realities faced by real psychologists. Maybe that has changed—as I stated earlier, I have not been a member for a very long time.
I should clarify a couple of basic points. I love the profession of psychology, and I want people who have devoted themselves to this field to succeed and prosper. At the same time, I also hate the arrogance of mental health clinicians who have long told people to trust them, based on nothing. While I did read much of Sigmund Freud’s work in my earlier years, my fundamental understanding is that he wanted his creative musings about individual patients to be taken as proof of something more universal. Not many serious researchers believe that today. Yet we still have people promoting solutions with marginal proof. I have long been an advocate for better data on clinical outcomes, but things are much more serious today. We will soon be solidifying how to regard and reimburse the behavioral healthcare field for the next decade.
This is a time for better political action rather than better research activity. We are faced with the realities of the post-ACA healthcare landscape, and we need leadership to guide us through the uncertainties of the future. There are few organizations to reach out to at such a time, and this article is a call to all professional organizations to address current realities in a way that they never have historically. It is a call for all behavioral healthcare professionals to realize that they can either become healthcare activists or accept whatever the richer healthcare professions decide is the best future course.
Most healthcare organizations with deep pockets care little about psychotherapy. They are too busy managing surgeries, medications and medical devices to worry about the trivial dollars expended upon psychotherapy. The headlines today criticize the exorbitant increases in pharmaceutical costs and rarely stop to consider the dramatic results achieved by psychosocial interventions.
For example, we have endless stories about opiate overdoses, and yet we rarely hear reports on how people with chronic pain can be significantly helped with interventions such as mindfulness and cognitive behavioral therapy. We are a society that is addicted to easy medical solutions, and one consequence is that we are suffering from those easy medical solutions. If you are advising a loved one, would you encourage opiates or psychological techniques? You will surely be challenged mightily if you advise against medication.
Should we wait for the preponderance of scientific evidence to demand that psychosocial interventions be adopted, and then wait for a few more generations of clinical specialists to insist that we actually implement those recommendations? That is the norm, but it is not acceptable in a time of crisis, if ever. Are we in a time of crisis? I would just offer that behavioral health disorders are the most expensive, most disabling, and most poorly diagnosed and treated among healthcare conditions today. However, since we have no silver bullets that are commanding large investments (as Prozac did decades ago, to no large effect), we are just watching a tsunami develop with no real answers about what to do after it hits.
We need to reimagine the role of professional organizations in healthcare. They must be more activist with a clear agenda for change, rather than simply collecting dues for a nominal role in the healthcare establishment. While I must state that my politics are progressive, liberal and certainly not in step with the current national leadership, my call to action is not along political party lines. I am not interested in partisan discussions. I am only interested in discussions that further the field of behavioral healthcare.