APA Candidate: Steve Hollon
- Please describe your contributions to the independent practice of psychology, including any positions held and committee work past and/or currently you have made to Division 42.
My primary contribution to independent practice has been to chair the steering committee advising the APA in the generation of clinical practice guidelines. The empirical science is clear; there is no non-psychotic disorder (the vast majority of the people who seek mental health services) for which psychosocial interventions are not at least as efficacious as medications and often longer-lasting. Nonetheless psychotherapy has been losing market share to medications. A quarter century ago two-thirds of the people treated for depression were treated with psychosocial interventions alone; with the advent of the SSRIs that ratio has been reversed. The United Kingdom, which relies on NICE guidelines to determine what works best, has invested £700 million pounds to train more psychotherapists so as to not have to rely so much on medications. Reimbursement is about to undergo a fundamental change in this country and we need clinical practice guidelines to make our case.
- The recent reorganization of the Association into APA (c3) and APASI (c6) is a critical issue affecting the ability to advance, defend, and protect the practice of psychology. What concrete measure(s) would you implement to address this issue on behalf of practice constituents?
The best defense is a strong offense. Psychotherapy is simply more cost-effective than medication treatment for the vast majority of patients (it has enduring effects that medications lack) and we need to make that clear to third party payers. I am not a fan of prescription authority; psychiatry has virtually abandoned the provision of psychotherapy and it is not clear why we press to do somethingpoorly that psychiatry does well when we are so much better at doing that which is more cost-efficient. If we can get psychiatry to join us in generating clinical practice guidelines (they currently do their own and will not work with us so long as we pursue prescription authority) we can force them to stick to the empirical data and join in recommending psychotherapy over medications for the vast majority of patients. If we do third party payers will notice and adjust reimbursement accordingly.
- Please provide your position and how you intend to address each of the following APA governance concerns: a) improved transparency of the APA Board of Directors (BoD) with APA Council; b) the continued effects of the Good Governance Project, particularly the delegation of fiscal and operational responsibilities exclusively to the APA BoD; and c) the effects from the Independent Review and the related, ongoing litigation.
a)Council sets the policies that the Board of Directors then implements. The actions of the Board should be open and transparent to the Council. At the same time the Board often has to act in response to issues that Council has yet to deliberate so must have some flexibility.b)I am strongly supportive of the goals the Good Governance Project, particularly the delegation of fiscal and operational responsibilities exclusively to the APA BOD. Unlike Council, APA members directly elect BOD members. It is small in number, forward thinking with respect to major issues, and nimble in its approach. c) I am a strong proponent of full disclosure. While I have not followed the issues involved in the Independent Review or the ongoing litigation I am strongly opposed to any violation of ethical principles and would deal with any litigation that arose as a consequence on a principled basis.
- What do you see as additional vital area(s) facing the independent practice of psychology? How do you plan to confront these areas during your presidency?
We need to make the case that psychotherapy is at least as efficacious as medications for the non-psychotic disorders (the vast majority of people seeking treatment) and often longer lasting. As good as medications are they are purely palliative (they only work for so long as you take them) whereas psychosocial interventions are often curative. The empirical data are clear and in the other western democracies they guide the reimbursement process (see the marvelous treatise Thrive by Richard Layard and David Clark that changed funding patterns in the United Kingdom). We are one of only two countries that allow direct-to-consumer advertising for medications (something that the AMA opposes) and no other country in the world depends so much on medications. We need to press for multidisciplinary guidelines based on the best scientific evidence (as the IOM recommends) and if we do the psychosocial interventions will thrive as in the UK.