1) 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 in training 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.
2) The financial crisis facing the APAPO is a critical issue affecting the viability of the Practice Organization that will seriously affect the future ability to advance, defend and protect the practice of psychology. What concrete measure(s) would you implement to address this financial and viability issue on behalf of the APAPO and practice constituents?
I do not yet understand the reasons behind the financial crisis facing APAPO but I am a quick study and I have run other major organizations like ABCT and have kept them solvent through tough times in the past. I suspect a major reason for the crisis is that practitioners have dropped away because they get little return on their investment in the form of dues and the practice assessment. I plan to use the APA presidency as a “bully pulpit” to educate the public and third party payers as to the cost-effectiveness of the psychosocial interventions (see the treatise Thrive by Richard Layard and David Clark). I want to pull the other major professions into the process (something that the IOM recommends and the AHRQ prefers) and when we do the relative benefits of psychotherapy will be clear. When practicing clinicians get something tangible the economic woes will resolve.
3) Please provide your position and how you intend to address each of these important APA governance concerns: a) improved transparency of the APA BOD with APA Council; b) the Good Governance Project, particularly the delegation of fiscal and operational responsibilities exclusively to the APA BOD; c) the Independent Review and re-engaging of Hoffman.
Not having been all that involved in APA governance, I know little about the specifics of these issues but I do follow certain principles: a) I am a strong advocate for transparency in governance and I believe that Council should have a full accounting of how the organization’s money is spent; b) While I am sympathetic with the goals the Good Governance Project but I want to be sure that delegation of fiscal and operational responsibilities to the BOD does not undermine effective oversight by Council which is charged with setting APA policy; and c) While I am opposed to torture I think the Hoffman report may have gone too far (the actions of a few do not necessarily imply culpability by the organization) and if there are questions as to how things were handled I would not have re-engaged the author of the original report to clear them up.
4) What do you see as additional vital area 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 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, a guide is used to guide reimbursement (see the marvelous treatise Thrive by Richard Layard and David Clark that changed funding patterns in the United Kingdom). We are only one of 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.