I would like to share some of my thoughts regarding the evolution of professional psychology.

     First of all, the profession needs to continue and strengthen our efforts to shape the changing marketplace for professional practice. The changing marketplace for psychologists and psychological services is without doubt the single most important issue for professional psychology today. The industrialization of health care has turned psychotherapy into a commodity, which seriously shortchanges the consumers of mental health services and drastically reduces the numbers of psychologists-psychotherapists who can earn a living in practice. In response, organized psychology and individual psychologists have developed a broad range of initiatives to maintain and enhance the importance of mental health services in the nation's health care system. These initiatives at times seem to be "turning the tide on managed care". They include legislative and litigative actions undertaken to contain the abuses of managed care, such as the Patient's Bill of Rights legislation and the New Jersey Psychological Association's no-cause termination lawsuit against MCC Behavioral Care, Inc. and the California Psychological Association's lawsuit against Aetna U.S. Healthcare. The recent action of tobacco litigation attorneys filing class action suits against managed care companies is a very encouraging sign. In addition, some psychologists have moved to create leverage for psychological services in the marketplace. Capitalizing on our inherent strategic advantages in being the best trained and most research-oriented mental health profession, some psychologists are creating data-driven integrated health care delivery systems that could compete very effectively with managed care companies.

     Second, there is a growing recognition of the importance of psychologists being involved in matters of public policy. Psychologists' role in public policy is expanding. We now have psychologists who serve as state and federal legislators, as public administrators, and on public commissions at the local, state and national level. We need to keep public policy issues at the forefront of professional psychology, because I believe that professional psychology's future hinges to a large extent on our ability to respond to important public health and societal needs.

     Third, and no less important, is the evolving nature of professional practice. The scope of psychological practice is expanding and diversifying into new areas -- areas where the distinction between applied scientist and professional practitioner begins to blur -- such as health psychology (and its related aspects such as psychology in primary care, psychoneuroimmunolgy, and applied psychophysiology), neuropsychology, rehabilitation psychology, forensic psychology, feminist psychology, child and family psychology, multicultural psychology, geropsychology, business and industry consultation, and psychopharmacology. In addition, public sector care is very recently being seen anew, as an area rife with possibilities for an expanded scope of practice, such as in the correctional systems, and in the federal (VA) facilities, state hospitals, and community mental health centers, which serve those with long-term mental illness.

     Two of the most important issues for the future of professional psychology arise from the evolving nature of professional practice: the redefinition of psychology from specialty mental health care to primary health care and the expansion of the scope of practice of psychology to include psychopharmacology. As a specialty profession of mental health care, we deal primarily with the people who self-identify as having psychological problems and who have access to a mental health specialist, which is just a fraction of those who need psychological services. As a primary health care profession we would be able to serve the much larger group of people who do not have access to mental health care or who do not identify their problem as psychological. To grasp this potential, please consider a few facts about health care: (1) Seven out of the nine leading causes of death have significant behavioral components; (2) At least 50% (and maybe as much as 75%) of all visits to primary care medical personnel are for problems with a psychological origin (including those who present with frank mental health problems and those who somaticize) or psychological component (including those with unhealthy lifestyle habits such as smoking, those with chronic illnesses, and those with medical compliance issues); (3) The vast majority of people receiving mental health treatment are cared for by medical professionals with minimal specific training in mental health. The Cartesian world view, which separates mental health from physical health, is breaking down, and as a result psychology has a tremendous opportunity to evolve into a premier primary health care profession. At the very least this would put psychologists on the front lines of health care, working collaboratively with physicians and nurses. The more visionary -- if less probable -- perspective is that health care should be reorganized so that psychologists serve as primary caregivers at the gateway to the health care system, functioning to diagnose and treat the more prevalent psychological problems, and referring to medical physicians when indicated.

     With regard to expanding the scope of practice to include psychopharmacology, the prescription privilege agenda has the capacity to dramatically accelerate the evolution of professional psychology, and to move us closer to fulfilling our potential of being a premier primary health care profession. The Department of Defense Psychopharmacology Demonstration Project graduates who are now prescribing have recently demonstrated through the USGAO report of 1999 that not only will properly trained prescribing psychologists NOT be a public health hazard as psychiatry has so ignominiously claimed, but also that such psychologists will do an outstanding job at psychodiagnosis and at expertly combining psychological and pharmacological treatment.

     Fourth, We need to continue to identify new opportunities for practice and provide guidance on how psychologists can access these opportunities. It cannot be emphasized enough that the future evolution of professional psychology will entail the development of roles that do not now exist – in health care, schools, the courts, the correctional system, businesses, etc. – in the numbers that psychologists entered the role of outpatient therapists in the 1970s and 80s.

     Fifth, In regard to training, I think we -- the education and training community -- need to respond not only to present-day marketplace concerns resulting from the industrialization of health care), but even more importantly to future concerns such as the evolution from specialist to primary care and psychopharmacology. We have not even begun to grapple with the training issues involved in the evolution to primary care, which, if taken seriously, might involve the revamping of the curriculum such that the generalist predoctoral training would be in health psychology, and mental health (perhaps in some specialized form such as the psychology of long-term mental illness) would be one of the postdoctoral specialties available.

     Last but certainly not least, we need to enhance science-practice collaboration. For one thing, the APA Science-Practice Task Force wrote of the need for practitioners to identify clinically-immediate problems for scientists to investigate. Secondly, with the increased emphasis in NIMH on "effectiveness" research, which studies psychological interventions as they are actually implemented, opportunities for practitioners and scientists to create practice-research networks are greater than they have been in a long time.

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Ronald F. Levant, Ed.D., A.B.P.P., is Recording Secretary of the American Psychological Association. He was the Chair of the APA Committee for the Advancement of Professional Practice (CAPP) from 1993-95, a member of the Board of Directors of Division 42 (1991-94), and a member of the APA Board of Directors (1995-97). He is Dean, Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, FL.

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