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The Future of Psychology Practice and Science

James H. Bray Baylor College of Medicine

This article reviews the 2009 APA President’s initiativesand recommendations for the future of psychology practiceand science. The future of psychology practice requiresthat we expand the focus of traditional practice; becomehealth care providers, not just mental health providers; useevidence-based practice, assessment, and outcome mea-sures; incorporate technology into our practices, includingelectronic health records; and change training and focus tomeet the needs of our diverse society. The future of psy-chological science requires that we train and work inmultidisciplinary teams, employ different methods and approaches, and shift our focus to translational science. The

future of our profession requires substantial changes ingraduate education to prepare our students for science and practice in the 21st century. In light of advances in scienceand practice that reveal the critical importance of psycho-social and behavioral factors in health and disease, I call for the creation of a department of behavioral health withinthe federal government.

Keywords: health care, psychology practice, training, psy-chological science

“The best way to predict the future is to create it.”

The theme of my 2009 presidential year was theFuture of Psychology Practice and Science. Myoverarching goal was to create a new vision and

future for our profession and the people we serve. Psychol-ogy is in the process of evolution and change to meet theneeds for practice and science in the 21st century. Ourcurrent models and practices, while excellent, are often notacceptable in our current environments. This situation re-quires that we generate new and innovative ideas andmethods for our practice and science. With advances inneuroscience and genetics, the expansion of translationalresearch, sweeping demographic changes, and an increasein international business opportunities, psychology is be-coming more relevant than ever, and there are many new

opportunities for our profession. We need to take advan-tage of these opportunities by collaborating with otherdisciplines and integrating scientic and technological ad-vances into our work.

The Context of My Presidency While running for president of the American Psycho-

logical Association (APA) in 2006 –2007, I talked withhundreds of psychologists—practitioners, scientists, andeducators—who told stories of struggling to make a rea-

sonable living while being apprehensive about their ownfutures in psychology. These psychologists were concernedwith, among many other issues, decreasing reimbursementsfor psychological services, the lack of resources for scienceinitiatives, the high costs of doctoral training, problemswith the annual convention, difculties in attracting youngpsychologists to the eld, and the cost of APA membershipin relation to the cost of membership in specialty societies.Although National Institutes of Health (NIH) budgets are atrecord high levels, many psychologists cannot get theirresearch funded, and some psychology laboratories arechallenged to stay in operation. Psychological sciencemakes life-changing contributions to our society, but psy-chologists often are not recognized for these contributions.

Between the time I was elected in 2007 and the timeI became president in 2009, APA underwent signicantchange, change that was both planned and a response to theeconomic climate of the times. One of the worst recessionsin U.S. economic history occurred during the fall of 2008,and the downturn in the stock market and economy hadsignicant negative effects on the nances of APA. Theattendant escalation in the numbers of homeless peoplehappened to coincide with one of my presidential initia-tives: Psychology’s Contribution to End Homelessness

(Bray, Milburn, et al., 2009). However, the economic crisisresulted in opportunities for much-needed change in the Association and our profession.

Inside APA, the nancial crisis caused us to reexam-ine the entire budget and all of our programs and to makesignicant cuts in many of them, even some that wereconsidered “sacred cows.” It also opened the door to con-sideration of new ways of doing business and facilitated thecreation of APA’s rst-ever Strategic Plan. New opportu-nities for the profession were created by the change in U.S.presidential administrations, the focus on health care re-

Editor’s note. James H. Bray was president of the American Psycho-logical Association (APA) in 2009. This article is based on his presidentialaddress, delivered in Toronto, Ontario, Canada, at APA’s 117th AnnualConvention on August 7, 2009.

Author’s note. I want to thank my colleagues who participated in the2009 presidential task forces (see Bray, 2010, for a list of names of task force members and descriptions of the task forces). Our accomplishmentsin 2009 could not have happened without their many contributions.

Correspondence concerning this article should be addressed to JamesH. Bray, Department of Family and Community Medicine, Baylor Collegeof Medicine, 3701 Kirby Drive, 6th Floor, Houston, TX 77098. E-mail: [email protected]

355July–August 2010 ● American Psychologist© 2010 American Psychological Association 0003-066X/10/$12.00Vol. 65, No. 5, 355–369 DOI: 10.1037/a0020273

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form, and an increased emphasis on science. I discuss theseissues and opportunities in the remainder of this article.

Transforming Our Profession for the21st Century Concerns about the future of clinical and scientic psychol-ogy are not new. Many former APA presidents have writ-ten about these issues, and some of their views were trulyprophetic. Over 40 years ago, George Albee (1970) statedin his presidential address, “Clinical psychology has en-tered a paradoxical phase in its development where itsproblems of identity and relevance threaten it with extinc-tion at the same time that its opportunities seem boundless”(p. 1071).

While psychologists are experts at change, it appearsthat we are not unlike other humans in our resistance tochanging our ways and evolving to meet the current needsof our profession and the people we serve. A recent exam-ple of such intransigence is the ght for and against pre-scriptive authority for appropriately trained psychologists.This debate seems similar to the ghts that occurred duringmy early training between psychoanalytically oriented psy-chology and the move toward behaviorally oriented psy-

chology. In both cases psychologists who voiced opposi-tion to change argued that it would ruin our profession anddestroy our eld. Too often we block our own progresswith this type of inghting. As William James, an earlyAPA president, stated in 1879, “A new idea is rst con-demned as ridiculous and then dismissed as trivial, untilnally, it becomes what everybody knows.” I wonder whathe would say about our profession as we move into the 21stcentury!

The APA is in the process of transformational change:a shift in the culture of the profession resulting from a

change in the underlying strategy and processes that theprofession has used in the past. There are several majorshifts and transformations occurring in psychology—someproactive and some reactive to changing environments.APA recognized that it could no longer afford to “doeverything for everybody” and developed a Strategic Planto guide its future. The plan includes three initiatives:maximize APA’s organizational effectiveness, expand psy-chology’s role in advancing health, and increase recogni-tion of psychology as a science. Psychology practitionersare faced with declining income and increased competitionfrom other professionals and recognize that they mustchange the way they practice to survive and thrive. Psy-chological scientists recognize that the landscape for all of science is rapidly changing and that they must modify theirmethods and areas of study to be competitive in the future.

According to futurist Ian Morrison (1996, 2000),whenever there are major shifts in a profession or business,these changes can be understood as a shift from a rst curveto a second curve (see Figure 1). The rst curve is theestablished way of doing business—it is where one’s cur-

rent activities and prots are derived; however, in the longrun it slows and runs its course. The second curve repre-sents a new way of doing business—often radically differ-ent from the rst curve—and the source of future growth.The move from print to electronic publishing and the movefrom paper to electronic health records are examples of shifts from a rst curve to a second curve. One does notwant to get out ahead of the curve, as relevant ideas andprots can be lost, but organizations that do not recognizethe need for change and that simply continue doing more of the same will slide down the rst curve, and some will goout of existence.

According to consulting psychologists Gibson andBillings (2003), some change is fairly easy (reorganizingpeople and ofces, conferring new titles, etc.), and somechange is extremely difcult, such as changing core behav-iors and mindsets. In the rst kind of change, one is

Figure 1Curves of Change

Note. Adapted from The Second Curve: Managing the Velocity of Change byI. Morrison, 1996, New York, NY: Ballantine Books. Copyright 1996 byBallantine Books.

James H.

Bray

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changing something inside an existing system, such aschanging billing systems or getting new ofce furniture(Watzlawick, Weakland, & Fisch, 1974). In the secondkind of change, one is changing the system itself. Trying toeffect this second kind of change is where we nd our-selves at this point in our profession. Second-order changeis necessary given the dramatic shifts in the economy,advances in neuroscience and genetics, and changes insocietal demands and public policies.

In response to these changing environments, manyareas of study are dropping the word psychology from theirnames—for example, developmental science, cognitivescience, neuroscience. Other areas are using the principlesof psychology in creating new and innovative elds, suchas behavioral economics. Working in a medical school, Ifrequently hear my colleagues talking about their neuro-science research, but they identify themselves as membersof their professions—biologist, physician—not as genericneuroscientists. Why don’t psychologists do this?

At the same time, clinical and counseling psycholo-gists compete directly with generic mental health practitio-

ners who perform counseling, psychotherapy, and assess-ments without our extensive training or unique skills. Thischange can be seen in job advertisements, where psychol-ogists are equated with social workers, counselors, andother master’s-level providers. Consulting and industrial–organizational (I/O) psychologists often are not licensed aspsychologists and are referred to as business and organi-zational consultants. Many of these psychologists are alsoteaching in business schools rather than in psychologydepartments. Thus, one can ask, where have all of the psychologists gone (Bray, 2009b)?

What distinguishes psychologists from other practitio-ners is our strong scientic base. While there is signicantvariation in the level of scientic training required forpracticing psychologists (i.e., PhD and PsyD), our scienticfoundation and reliance on empirical evidence make usunique among mental and behavioral health practitioners(Peterson, 2003). Failure to recognize this fact in trainingprograms and practice makes us vulnerable to beinglumped together as generic mental health providers orbusiness consultants, and we will be less competitive in themarketplace. What is clear is that future forms of psycho-logical practice and science will require much more mul-tidisciplinary training as we move forward with more in-tegrated health care models and research based on abiopsychosocial model that integrates neuroscience, genet-ics, and behavior.

Current Context of Health Care in theUnited StatesAs we consider changes in psychological practice, we mustbalance the needs of the current generation of psychologistswith those of our early career psychologists and graduatestudents. The needs of these groups may be different, asolder psychologists tend to provide traditional psychother-apy and assessments in individual or small group practices,but newer practices are more integrated into general health

care settings and utilize more technology in their work. Inaddition, the current generation of psychologists does notreect the ethnic diversity of the world, while the nextgeneration needs to take into account the increasingly eth-nically diverse and multicultural nature of our nation andthe world. There is a strong move toward evidence-basedpractice and assessments and away from psychodynamicand psychoanalytic approaches. Managed care has signi-cantly constrained the use of long-term therapies, althoughthere are still substantial numbers of psychologists whopractice these approaches, and these psychologists arestrongly represented within APA by Division 39 (Psycho-analysis).

Regardless of changes brought about by health carereform, psychologists and their clients/patients will con-tinue to practice in traditional ways for at least anothergeneration or two. Why? Because many psychologists andtheir clients continue to nd value in these approaches andpeople are willing to pay for these services now, even whennot fully covered by their health insurance. People alwaysseem to be willing to pay for things they value, and we

need to remember this in planning our future.Where does psychology t within the current healthcare system? John Saultz (2008) developed a health carepyramid to describe our current system (see Figure 2). Atthe base of the pyramid are primary care, mental health,and public health. At the next level are hospital care andsecondary or specialty care. At the top of the pyramid istertiary care. Specialization, costs, and funding for healthcare increase as one goes up the pyramid. Psychologiststypically practice only in the mental health arena, yet ourskills and services are applicable to all of the areas—andthese are areas for future growth. One of the major shifts

Figure 2Health Care Pyramid

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Note. Adapted from “Something You Somehow Haven’t to Deserve”: A Med- ical Home for Every American, PowerPoint presentation by J. Saultz (2008,Slides 36–38).

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advocated by those promoting health care reform is tomove more resources into the base of the pyramid, espe-cially into primary care. This shift includes increased fund-ing for primary care practitioners and for training moreprimary care providers.

During 2009, the federal government engaged in amassive process to reform our health care systems thatultimately resulted in the passage of the Patient Protection

and Affordable Care Act (2010), commonly known as thehealth care reform bill, which was signed into law byPresident Obama on March 23, 2010. The Paul Wellstoneand Pete Domenici Mental Health Parity and AddictionEquity Act of 2008, implemented in 2010, represents amajor shift in health care provision, and its passage ensuredthat mental health parity was included in the 2010 healthcare reform bill. The parity law species that mental andbehavioral health problems are to be treated and reim-bursed the same as other health problems. The hope is thatthe parity and health care reform bills will end mentalhealth carve-outs, in which people with mental and behav-ioral health problems are treated differently and in separatesystems of care than those with other types of healthproblems. The only way for integrated primary care towork effectively and efciently is if we end mental healthcarve-outs.

The federal health care reform focus in 2009 was on fourareas: increasing access for uninsured and underinsured peo-ple, creating a 21st-century health care system, revitalizingprimary care, and using comparative effectiveness research toinform and drive practice (Clancy, 2009). The mantra fromfederal policymakers is providing health care “faster, better,and cheaper.” However, the real driver of change is econom-ics and money, money, money. President Obama clearlystated that what is driving health care reform is economics. Hestated that our economy cannot be “xed” until we get health

care costs under control. Managed care and other health careoptions have clearly failed in these efforts. Other aspects of reform seem to be secondary to the economics.

At the 2009 APA Presidential Summit on the Futureof Psychology Practice, Richard Frank, a health care econ-omist from Harvard, presented a strong argument for whyPresident Obama’s focus is on economics (Frank, 2009).First, spending on all health care has risen over the past 30years to record levels. Yet the dramatic rise in costs is seenin general health care and not mental health care. Mentalhealth care costs have stayed at roughly about 1% of the

gross national product (GNP), while spending on otherhealth care has doubled to over 17% of GNP in 2009. Therehas also been a dramatic shift in who provides mentalhealth services and what services are provided (Frank,2009; Kessler et al., 2005; Wang et al., 2006). Table 1shows that overall spending on mental health care hasincreased. However, the increases in spending are for psy-chiatry and general medicine, and there has been a decreasefor other types of mental health treatments, such as psy-chotherapy provided by psychologists. What do the in-creases represent? Figure 3 demonstrates that costs forinpatient treatments have declined, while costs for mentalhealth treatments, such as psychotherapy, have remainedgenerally constant. The exponential growth has been in theuse of psychotropic medications for treatments by bothpsychiatrists and general physicians (Agency for Health-care Research and Quality, 2009; Frank, 2009). This situ-ation presents a strong argument for psychologists’ gainingprescriptive authority, both to be able to prescribe medica-tions (or take people off of medications) and to use psy-chological interventions.

Revitalization of primary care is also a high priority inhealth care reform, and there is consensus on how toaccomplish it: through the Patient-Centered Medical Home(PCMH; Patient-Centered Primary Care Collaborative,2007). The PCMH is a model for providing comprehensiveprimary care for children, youth, and adults that facilitatespartnerships between individual patients and their personalphysicians and, when appropriate, the patient’s family. The

Figure 3Mental Health Spending Growth by Treatment Sector,1996–2006

0

50

100

150

200

250

300

350

400

1 9 9 6

1 9 9 7

1 9 9 8

1 9 9 9

2 0 0 0

2 0 0 1

2 0 0 2

2 0 0 3

2 0 0 4

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2 0 0 6

MH IP

MH RX

MH

Note. MH mental health outpatient; MH IP mental health inpatient; MHRX pharmacotherapy. Source: Data are from Medical Expenditure PanelSurvey 1996–2006 (Agency for Healthcare Research and Quality, 2009) andFrank (2009). Spending index (y axis) was constructed through regressionanalysis, available in online appendix (Agency for Healthcare Research andQuality, 2009): 100 represents mean spending in 1996 for each group.Regression included sex, race/ethnicity, region of the country, medical spend-ing account status, health and mental health self-reported status, and age ascontrols. Reported values are the regression analysis coefficients for each year,with 1996 normalized at 100 as a three-year average.

Table 1Distribution of Mental Health Care Users by SpendingProfession 1990–1992 2001–2003

Psychiatry 19.6% 25.8%Other mental health providers 35.4% 29.5%General medical providers 27.1% 40.5%

Note. Data are from Kessler et al., 2005, and Wang et al., 2006.



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21st-century PCMH should include interdisciplinary teams,care management and care coordination programs, qualityassurance mechanisms, and health information technologysystems, and these should lead to improved quality of andbetter access to health care while containing costs (Clancy,2009; McDaniel & Fogarty, 2009; Patient-Centered Pri-mary Care Collaborative, 2007). I prefer the term patient-centered health care home, rather than medical home, butit appears that this term is not open for change at this time.

The question is, “Where do psychology and behav-ioral health t in the PCMH?” As Frank deGruy (1996), anMD, stated in his report for the Institute of Medicine,“Mental health care cannot be divorced from primary med-ical care, and all attempts to do so are doomed to failure”(p. 288). Similarly, Joe Scherger (2004), another MD and aformer president of the Society of Teachers of FamilyMedicine, argued,

Someday, the U.S. health care system will get it. Integratingpsychologists into primary care makes the system more effective,allows for early recognition and intervention in the pervasivepsychosocial nature of health and illness, and will save a ton of

money by avoiding needless tests and treatments. (p. xi)There are compelling data on why psychologists and

behavioral health need to be key components of any healthcare reform system. The determinants of health are behav-ioral factors (50%), genetics (20%), environmental factors(20%), and access to care (10%) (Centers for DiseaseControl and Prevention, National Center for Health Statis-tics, 2003). Research indicates that behavioral factors suchas diet, stress management, exercise, and lifestyle accountfor the largest proportion of variance in health, and over50% of visits to primary care providers are for psychosocialproblems, not biomedical problems (Blount et al., 2007).However, less than 10% of the NIH budget goes to re-searching social and behavioral factors in health. This is aclear growth area for psychological research.

In addition, comorbidities among health problems andmental health problems are common (Petterson et al.,2008). According to data from the Medical ExpenditurePanel Survey (Agency for Healthcare Research and Qual-ity, 2009), more than half of patients with chronic medicaldiseases meet criteria for a coexisting mental disorder. Asshown in Table 2, costs for taking care of patients with acomorbidity are much higher than those for taking care of patients without an accompanying mental health problem.The data also demonstrate that if you treat both problemstogether, it is less expensive and the health outcomes are

better (Petterson et al., 2008). If you treat someone fordepression who has diabetes and depression, the diabetes isbetter controlled.

In most cases, changing health behavior is more im-portant to health than anything else. Whether the focus ison prevention or chronic disease management, it takeshealth behavior change to improve health. This is whypsychologists need to be more involved in the primary carehealth system and patient-centered medical homes (Bray,1996; Frank, McDaniel, Bray, & Heldring, 2004; McDaniel& Fogarty, 2009).

Future of Psychology PracticeInitiativeThere are an estimated 750,000 mental health and sub-stance abuse providers in the United States, most of whomare master’s-level or bachelor’s-level providers, not doc-toral-level psychologists (Substance Abuse and MentalHealth Services Administration, 2007). Much of the public,however, does not understand the difference between theseproviders. Thus, traditional psychotherapy practice is chal-lenged by reimbursement policies and encroachments fromother mental health professions. Psychologists are in dan-ger of losing our unique place and becoming generic men-tal health providers. We need to reafrm our identities,clearly brand our work as psychologists, and evolve ourpractices to utilize the unique training and skills that wehave acquired. To facilitate this process, I convened theAPA Presidential Task Force on the Future of PsychologyPractice.

The Presidential Task Force on the Future of Psychology Practice The task force was created to respond to requests by APAmembers to address the needs of practitioners and thefuture of psychology practice. The goals of the task forcecentered on identifying the following: (a) opportunities forfuture practice to meet the needs of an increasingly diversepublic and to integrate an emerging science; (b) strategies

and tactics to effectively address these opportunities; and(c) sustainable partnerships to implement new opportuni-ties for practice and to develop a common public policyagenda. Margaret Heldring, Carol Goodheart, and I chairedthe task force (see Bray, 2010, for further details on the task force).

2009 Presidential Summit on the Future of Psychology Practice To help develop a plan for the future of practice, APAconvened the Presidential Summit on the Future of Psy-

Table 2Annual Medical Expenditures for Adults With Specific Chronic Health Conditions, With and Without aMental Health Condition

Chronic health condition

Cost without amental healthcondition ($)

Cost with amental healthcondition ($)

All adultsa 1,913 3,545Heart condition 4,697 6,919High blood pressure 3,481 5,492Asthma 2,908 4,028Diabetes 4,172 5,559

Data are from the Medical Expenditure Panel Survey for 2002 and 2003(Agency for Healthcare Research and Quality, 2009).a Refers to all adults with and without chronic health conditions.



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chology Practice in May 2009. The Practice Summit wasdesigned and organized by the aforementioned task force.One of my pet peeves about psychologists is that we spendtoo much time talking and interacting with each other andnot enough time talking and interacting with other profes-sionals and the public we serve. Thus, the design of thisconference was unique for psychology, as we invited asubstantial number of people from outside of psychology tohelp us create our future. This meeting brought together150 thought leaders from psychology, business, consumersof services, economics, insurance, medicine, and politics totransform the practice of psychology. The Practice Summitwas a vehicle for consideration of new types of psycholog-ical practice, settings, and partnerships for practice; thetranslation of science into psychological practice; expandedthinking about practice trends; and conceptualizations of

practice that cross traditional lines.On the basis of work by the task force members andparticipants at the Practice Summit, a number of recom-mendations for the future of psychology practice wereoffered for transforming the profession (Bray, Goodheart,Heldring, et al., 2009). Table 3 provides a list of therecommendations. The creation of clinical treatment guide-lines was approved by the APA Council of Representativesin February 2010 and is in process within the APA Practiceand Science Directorates. The implications of these recom-mendations are discussed in the following sections.

Principles of Psychology PracticeExpand the Focus of Traditional Psychology

Practice If you ask someone off the street, “What is a psycholo-gist?” most people will say either that they do not know orthat we are mental health professionals. This was con-rmed by the research completed during APA’s strategicplanning process. As our consulting and applied psychol-ogists know, psychologists do much more than providemental health services. Helping business and industry copewith the uncertainty caused by global changes in the worldeconomy and helping them maintain psychologicallyhealthy workplaces and workforces present extraordinaryopportunities for our profession (Banks & Brannick, 2009).Psychological practice also includes applying our research

to improve patient safety, designing better airplane cock-pits, and devising better ways to teach students (Durso &Drews, 2010; Newcombe et al., 2009). In addition, with thecompetition from master’s-level providers, it is importantthat as doctorally trained psychologists we become clinicalleaders and use our expertise in research and evaluation todevelop and implement evidence-based psychological ser-vices and programmatic changes in health service deliverysystems and business practices.

The Task Force on the Future of Psychology Practicefound that health service provider psychologists are strug-

Table 3Recommendations From the APA Presidential Task Force on the Future of Psychology Practice Area Recommendation

Economic viability Advocate for adequate and appropriate payment for services on par with thatfor other health professionals

Ensure inclusion of psychologists in the Medicare definition of physician

Accountability measures Develop treatment guidelines and accountability measuresDevelop framework for collection of outcome measures for psychologicalservices

Psychological models for integratedand primary health care

Develop retraining for current psychologistsEnsure inclusion in the Patient-Centered Medical HomeCreate tools for access to research on health promotion, disease prevention, and

management of chronic diseaseMobility and licensure barriers to

practicePartner with Association of State and Provincial Psychology Boards and State,

Provincial, and Territorial Psychological Associations to address barriersDevelop resources for licensure for applied psychologists

Public education and branding Change the face of psychology with the publicDevelop branding of psychology with the publicIncrease public education effortsCollaborate with other professions on public education

Use of technology Advocate for inclusion of psychology practice in electronic health recordsPromote delivery of services via the Internet and other electronic meansDevelop a “PsychTube” for training and dissemination

Education, training, and lifelonglearning

Revamp training programs for the needs of the futureSeek parity for training of psychologists in federal programsPrepare workforce analysis of psychologists in health care and organizational

practice

Source: 2009 Presidential Task Force on the Future of Psychology Practice Final Report (Bray, Goodheart, Heldring, et al., 2009).



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gling economically more than other applied psychologistswith regard to payment for services, competition with otherprofessionals, and educational debt. Consulting, I/O, andapplied psychologists are expanding their work into manynew areas, including into health service delivery systems.For example, research on airplane pilot safety systems andtraining is being adapted to improve patient safety andmedical team functioning (Carayon, 2006; Durso & Drews,2010).

There are legal and regulatory barriers to the expan-sion of these types of practices, as licensure is based on astate regulatory model, and many of these activities requirepracticing in multiple states with national and multinationalcompanies and organizations. The lack of national licen-sure and limitations on the application of technologiesacross state lines are areas that need attention if we are tofacilitate this growth for applied psychologists. There areinternational models for such facilitation, as Australia im-plemented a national licensure process for psychologists in2009–2010 (Littleeld, Stokes, & Voudouris, 2009).

From Mental Health to Health Care Providers: Provide Integrated Health Care To succeed in the future, we psychologists need to broadenour perspectives to be full partners in the health caresystem, and we need to identify ourselves as health care providers (Bray, 1996; Frank et al., 2004). Psychologistsare the only health professionals who are not always trainedin biomedicine, and that lack of understanding can interferewith our participation in these systems of care. We need apsychologist for every medical exam room to help with thebehavioral aspects of health and disease (Farley, 2009).This will require us to practice side by side with ourmedical colleagues and in medical systems of care.

Currently, primary care providers treat over 70% of mental health problems without assistance from psycholo-gists or any other mental health providers (Blount et al.,2007). Primary care providers are the de facto mentalhealth system, a situation due to managed care, changes inreimbursements, and overreliance on medications (Bray,1996). Despite our medical colleagues’ best efforts, pa-tients frequently do not receive adequate care for mentaland behavioral health problems from primary care provid-ers. They often are undiagnosed or undertreated for theirmental and behavioral health issues (Blount et al., 2007;deGruy, 1996).

Research indicates that major health problems, such asdiabetes, heart disease, and obesity, are due to psychosocial

and lifestyle problems—issues that are not effectively ad-dressed by the medical profession or allied health provid-ers. Minority, underserved, and elderly patients suffer evenmore from these systems of care and experience signicanthealth disparities (Agency for Healthcare Research andQuality, 2010; Institute of Medicine, 2003). We are theprofession that knows the most about human behavior andhow to change it, yet psychologists are often not involvedin preventing and treating these problems because we arenot always seen as an integral part of the health care team.There are obvious exceptions to this, health and rehabili-

tation psychologists being prime examples. The need forchanges in this situation points to many growth areas forpsychology practice: primary care psychology, integratedhealth care systems, community health systems, institu-tional practice systems, and clinical leadership.

Primary care psychology is the provision of healthand mental health services that involves the prevention of disease and the promotion of healthy behaviors in individ-uals, families, and communities (Bray, Frank, McDaniel, &Heldring, 2004). Primary care psychologists have a basicunderstanding of the common biomedical conditions seenwithin primary care and of the medical and pharmacolog-ical treatments for those conditions and how they interactand impact the psychosocial functioning of patients andtheir families and communities. Practice in primary care isvery different from practice in usual mental health settings(Bray & Rogers, 1995; Robinson & Reiter, 2007). Ratherthan being seen for the traditional 50-minute psychotherapyhour, patients are often seen more quickly in time framesvarying from a few minutes’ consult to 15–20-minute ses-sions, with brief interventions and a focus on symptom

resolution. Providing such care requires specialized train-ing and experience in these settings (Bray, 2004; Mc-Daniel, Belar, Schroeder, Hargrove, & Freeman, 2002;Robinson & Reiter, 2007).

International Efforts There are positive examples of these kinds of changes inother countries. While attending the 2009 European Con-gress of Psychology, Tor Levin Hofgaard, president of theNorwegian Psychological Association, discussed how evi-denced-based research was used to expand psychologists’scope of practice in Norway. Norwegian psychologistshave treatment rights equal to those of physicians, exceptthey cannot yet prescribe medications. Norwegian psychol-ogists convinced their government to require psychother-apy for the treatment of mild to moderate anxiety anddepression before medications can be used and to fundpsychologists to work in primary care to provide psycho-logical services. Likewise, in Australia, psychologists arefunded to provide collaborative care in general medicalpractice through the Australian Medicare program (Wine-eld, & Chur-Hansen, 2004). We in the United States havea lot to learn from collaboration with our internationalcolleagues.

Integrate Technology Into Practice The U.S. government is committed to transforming health

care through the application of health information technol-ogy (Domestic Policy Council, Ofce of Science and Tech-nology Policy, 2006; Health Information Technology forEconomic and Clinical Health [HITECH] Act, 2009).Through the HITECH Act, Congress specically directedestablished programs under Medicare and Medicaid to pro-vide incentive payments for the “meaningful use” of cer-tied electronic health records (EHR) technology and pro-vided billions of dollars to implement the changes. Toparticipate in these changes and, more specically, to par-ticipate in integrated health care systems, psychologists



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will be required to use EHR and other technological ad-vances. There are hundreds of EHR systems in the market-place; one standard has yet to be adopted. The majorconcerns about EHR are protection of private and sensitivepatient information. APA is working diligently to providepolicies to protect patient information. What is clear is thatif psychologists are to practice in integrated health caresystems, we must participate in and use EHR systems inour practices.

Providing services via the Internet (e.g., Skype) andother electronic means of telehealth is likely to be part of the future of our practice. As Dr. Larry Kutner stated at thePractice Summit, “Imagine Debbie in Mumbai, India, pro-viding psychotherapy via the Internet for $15 a session.”Currently, licensure limitations, condentiality standards,and other ethical issues limit this type of practice for U.S.psychologists, but this may not stop providers in othercountries from providing psychological services in thismanner.

Apply Basic and Applied Scientific Evidence to Inform Practice Evidence-based practice, including prescriptive authority,is the future of psychology practice. The APA has a broaddenition of evidence-based practice (EBP; APA Presiden-tial Task Force on Evidence-Based Practice, 2006) thatincludes the use of all available evidence to inform psy-chology practice. As mentioned earlier, the development of clinical treatment guidelines will help psychologists inte-grate EBP into their work. Consistent with this policy, wealso need to integrate basic scientic evidence, such asneuroscience, and couple and family process research intoour regular practices, not just treatment research. Further,we need to ensure that the unique psychological aspects of assessment and treatment are included in our work. Forexample, Norcross (2002) reviewed the scientic literatureand found that the therapeutic relationship accounts for themost variance in psychotherapy outcome studies, not spe-cic techniques such as cognitive behavior therapy or othertherapies.

Demonstrate Accountability Because of the health care reform legislation, there willsoon be changes in health care payments and reimburse-ments that require practitioners to demonstrate accountabil-ity for their work and to assess outcomes from their treat-ments. This was a clear message from the insurance,business, and legislative delegates at the Practice Summit.

We have the opportunity to dene how we will be evalu-ated by developing our own psychology clinical treatmentguidelines and methods to assess our work. In other coun-tries, such as Australia and Britain, outcome assessmentsare a routine part of practice. In Australia, psychologistsused the data from these assessments to argue for increasedpsychological services (Wineeld, & Chur-Hansen, 2004).

Other medical groups, such as psychiatrists, have de-veloped clinical treatment guidelines that are used by theinsurance industry and policymakers to determine treat-ments and reimbursements for services. According to the

Practice Summit’s insurance and legislative delegates,there are not currently any clinical treatment guidelinesused for psychotherapy and psychological services (Bray,Goodheart, Heldring, et al., 2009). The time has come todene psychological practices, or others will do it for us.The APA Council approved a process for the developmentof clinical treatment guidelines at the 2010 February Coun-cil meeting.

Meet the Needs of a Diverse Society Our society is becoming much more culturally and ethni-cally diverse, and psychologists must be adequately pre-pared to provide services to all. There are important cul-tural differences with implications for our work (APA,2003). For example, the cluster of behaviors that we labelas an anxiety disorder includes psychological symptomssuch as feelings of anxiety and fear of the unknown and of death. In addition, there are the somatic symptoms such asheart palpitations, tachycardia, and breathing changes. Inthe United States, many people focus on the somatic symp-toms but eventually admit to the psychological symptomstoo. However, in Mexico and Latin America, it is sociallyunacceptable to admit to a mental disorder; therefore, manypeople with a Mexican or Latin American cultural back-ground will not tell their doctors about the psychologicalsymptoms and will only admit to the somatic symptoms—unless one uses their terminology—“ataque de nervios.”Understanding these cultural factors is critical for provid-ing high-quality care (APA, 2003).

While many are fortunate to have access to health carethrough private or government-sponsored programs, manypeople have no health insurance or regular access to healthcare. Even when access is available, there often are clearhealth disparities for ethnic minorities, the poor, and home-less people (Agency for Healthcare Research and Quality,

2010; Institute of Medicine, 2003). The number of peoplewithout access to health care is on the rise, and ethnicminorities are less likely to have access to care. In theUnited States and many other countries, this lack of healthcare access is causing a signicant economic challenge, asthe rising costs of health care are creating an economiccrisis. People often resort to emergency rooms and com-munity health centers for their care—again, places wherepsychologists frequently do not practice. We need to en-sure, through multicultural education and policy changes,that psychologists are properly trained to work with diversepopulations and that psychologists are included in fundingfor services designed to reduce health disparities. It ishoped that the implementation of the Patient Protection andAffordable Care Act (2010) by the U.S. Congress willreverse this unfortunate trend of poor access to services andhealth disparities.

In all of these recommendations and changes, psycho-logical science plays an important role and distinguishespsychologists from other professionals.

Future of Psychological ScienceWhat will the future of psychological science look like?Will there be a unique “psychological” science? Psycho-



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logical science is becoming more interdisciplinary, andtraditional areas of science are decreasing while new areasare developing—without psychology explicitly included.For example, the Federation of Behavioral, Psychological,and Cognitive Sciences changed its name in 2009 to theFederation of Associations of Behavioral and Brain Sci-ences. Many psychology departments classied as Re-search 1 institutions in the Carnegie Classication of Insti-tutions of Higher Education are changing their names toDepartments of Psychology and Brain Sciences, and manypsychologists are leaving traditional psychology depart-ments to join others.

These changes beg the question of what the coreidentity of a psychologist is. Kazdin (2009) noted in hisAPA presidential address, “The public as well as policy-makers do not consistently recognize our science. Thechallenge for public recognition is illustrated by the dom-inance of nonscientic depictions of psychology in every-day life” (p. 340). Although there are many types of psy-chologists, our common core includes our methods andscientic rigor. Our methods and scientic rigor are a

double-edged sword, however, as many of our methods(e.g., measurement models and assessments) are strong oninternal validity issues while ignoring external validity andapplication to the solving of social problems. This distinc-tion is exemplied by the efcacy and effectiveness debatein psychotherapy research (Nathan, Stuart, & Dolan, 2000).

A second element of our common core is our relianceon strong measurement principles. Psychologists have beenleaders in test development, and assessment is a core com-petency for applied psychologists. Yet our research in testsand measurement development is complicated by changesin immigration and multicultural perspectives. For exam-ple, over 50 languages are spoken in the cities of New

York, Toronto, and London, and developing valid tests andmeasures for use among such diverse groups is a challenge.We need to collaborate with those from other disciplines,such as linguists, anthropologists, and biological scientists,to deal with these demographic and multicultural differ-ences. However, while multidisciplinary research is essen-tial for our future, it does not require that we give up ouridentities as psychologists.

Growth Areas for PsychologicalScience: Intersections of ScienceWith the advances in genetics, neuroscience, and computertechnology and the current emphasis on translational sci-ence, the psychological sciences have many areas for po-tential growth that are outside of our usual spheres of research. Psychological science is likely to intersect withother disciplines such as biology, economics, genetics,mathematics, computer science, sociology, anthropology,and political science. Table 4 lists a number of thesegrowth areas, and there are many other possibilities. Idiscuss some of these in the next sections. There are someoverarching changes in funding and policies that will im-pact the conduct of psychological science in the future.

The major trend is the increase in multidisciplinaryresearch, big science that includes multisite projects withlarge population-based samples followed over longitudinalperiods to address major health problems (NIH, 2009a;Zerhouni, 2003). As former NIH director Elias Zerhouni(2003) stated, “The scale and complexity of today’s bio-medical research problems increasingly demand that scien-tists move beyond the connes of their own discipline andexplore new organizational models for team science” (p.64). This perspective also certainly applies to behavioraland psychological research, as most health problems havea behavioral component or cause.

This shift is exemplied in the development of the

Clinical and Translational Science Awards (CTSA) Con-sortium in 2006. The CTSA Consortium set forth this effortto

(1) captivate, advance, and nurture a cadre of well-trained multi-and inter-disciplinary investigators and research teams; (2) createan incubator for innovative research tools and information tech-nologies; and (3) synergize multi-disciplinary and inter-disciplin-ary clinical and translational research and researchers to catalyzethe application of new knowledge and techniques to clinicalpractice at the front lines of patient care. (NIH, 2006a, para. 4;NIH, 2006b)

Funding through NIH almost requires a multidisci-plinary team, and the days of solo, single-discipline re-

search labs are declining. In addition, the large clinicaltrials and outcome studies funded by NIH and the Depart-ment of Defense require multidisciplinary teams and oftenuse medical, public health, and epidemiological models andmethods. For psychologists to be competitive in theseareas, we must train our students in these models andmethods. However, psychological methods also can becritical to advances in these areas, as our strengths in theorydevelopment, measurement, and complex statistical mod-eling hold great promise for understanding the interrela-tionships among behavioral, genetic, and biomedical fac-

Table 4Growth Areas for Psychological Science

● Translational science and comparative effectivenessresearch

● Behavior and climate change research● Behavioral aspects of genetic research● Applications of human engineering: Aviation, healthand patient safety, human–machine computer

technology● Psychological science as a core STEM Discipline● Behavioral economics● Cognitive neuroscience● Computational modeling● Data mining● Nonlinear methods



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tors. The National Institute on Drug Abuse (NIDA)Clinical Trials Network is a prime example of how behav-ioral interventions are being studied together with psycho-pharmacological treatments (NIDA, 2010).

Translational Research and Comparative Effectiveness Research Improving the health of our nation requires taking newdiscoveries from basic “bench science” and translatingthem into practical applications that can be used withpeople for disease prevention and health promotion at the“bedside” (NIH, 2006a, 2006b). Psychologists are involvedin many areas of this work, from treating alcohol and drugabuse and childhood problems to preventing and helpingpeople adapt to HIV/AIDS.

The government is also providing billions of dollars tofund comparative effectiveness research (CER) through theAmerican Recovery and Reinvestment Act of 2009(Clancy, 2009; Institute of Medicine, 2009). CER is de-signed to inform health care decisions at both individualand population levels by providing evidence on the effec-

tiveness, benets, and harms of different treatment options.The evidence is generated from research studies that com-pare existing drug therapies, medical devices, tests, surger-ies, or ways to deliver health care. CER is research de-signed to compare the effectiveness of different treatmentsfor the same problem and to determine which treatmentworks best, for whom, and under what circumstances. APAproposed (Bray, 2009a) a number of areas for CER behav-ioral research to the Institute of Medicine’s Committee onComparative Effectiveness Research Priorities; these in-cluded determining the most cost-effective treatment foruse in school-based interventions for preventing and treat-ing overweight and obesity in children and adolescents andnding the best treatment strategies (e.g., symptom man-agement, cognitive behavior therapy, biofeedback, socialskills, educator/teacher training, parent training, pharmaco-logic treatment) for attention decit hyperactivity disorderin children. The results of such studies could be used toguide future practice and reimbursement policies for treat-ments (Patient Protection and Affordable Care Act, 2010).

Behavior and climate change research is also a newarea for our work. The APA Task Force on Psychology andGlobal Climate Change detailed many areas where psy-chologists can contribute to the study of this importantissue (Swim et al., 2009). Kazdin (2009), in his presidentialaddress, also suggested many areas in which psychologistscan provide important answers for people wishing to

change their behaviors to create a more sustainable climate.These areas include conservation psychology, ecopsychol-ogy, environmental psychology, and population psychol-ogy, to name a few. Members of Congress have proposednew funding sources for psychological and behavioral re-search, such as the U.S. Departments of Energy and Com-merce. In 2009, under the leadership of Congressman andpsychologist Brian Baird (D–WA), H.R. 3247, a bill tocreate a social and behavioral sciences program within theDepartment of Energy, was introduced. This bill passedthrough the House Science Committee and is awaiting full

passage by the House and Senate. Even without the passageof this important bill, the APA Science Directorate isworking with the Departments of Energy and Commerce toprovide new funding for psychological and behavioral re-search in these areas (Breckler, 2009).

Behavioral Aspects of Genetics Research

With the mapping of the human genome, there are incred-ible possibilities for understanding the behavioral compo-nents and ethical implications of genetics (Miller, Mc-Daniel, Roland, & Feetham, 2006; Plomin, Defries, Craig,& McGufn, 2003). The current NIH director, FrancisCollins, understands and supports this type of research(Collins, 2006, 2010), in which the behavioral aspects of genetics are explored and utilized to create new healthtreatments and applications. Psychologists can contributeto important basic research on the interactions betweenbehavior and genetics, the applications of these discoveriesthrough genetic counseling, and ethical considerations intheir study and application.

The advent of “personalized medicine,” in which anindividual’s genome is used to determine specic treat-ments, needs to include behavioral and psychological de-terminants (Collins, 2010). Even if a genetic analysis de-termines what medicine will work best for a given problem,there is still the issue of patient understanding and motiva-tion, which determines whether the patient will actuallytake the medicine and comply with treatment recommen-dations. Behavioral and psychological factors cannot bedivorced from such advances, and psychologists are welltrained to improve compliance with these types of treat-ments (National Institutes of Health, 2009b).

Human Engineering and Human Factors Human factors psychologists have already made majoradvances through research in aviation safety and training,human–machine computer interfaces (e.g., Google), andtrafc safety (Durso, DeLucia, & Jones, 2010). An excitingand promising development is the application of safetyresearch conducted in aviation to the health care arena toimprove patient safety during medical procedures. Bothhuman factors and I/O methods in team building and func-tioning are improving medical outcomes through increasedpatient safety (Durso & Drews, 2010). A case in pointinvolved the implementation of a computerized physicianorder entry system that was designed to decrease childmortality. Mortality actually increased from 2.8% to 6.6%with the implementation of the new system because therewas not sufcient training of the staff in how to properlyuse the system. The increased mortality was attributed to alack of attention to human factors (Han et al., 2005).However, when a similar system was introduced in a Se-attle hospital but implementation involved training thatattended to “psychological” aspects of using the system,there was a subsequent substantial reduction in infant mor-tality (Seattle Children’s Hospital, 2006).



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Psychological Science as a Core STEMDisciplineSTEM (science, technology, engineering, and mathemat-ics) is the term used to refer to basic science disciplines.Although psychology is a STEM discipline and contributesto STEM education in other science disciplines, it is notalways considered a core STEM discipline (Domestic Pol-icy Council, Ofce of Science and Technology Policy,2006). The lack of recognition of psychology as a coreSTEM science has major implications for funding andpolicy development (Dovidio et al., 2010; Newcombe etal., 2009). For example, the America COMPETES Act of 2007 was a large funding bill authorizing a variety of federal science, technology, and research programs. Thislegislation doubled the funding for the National ScienceFoundation and the Department of Energy’s Ofce of Sci-ence. After the House version (H.R. 2272) of it was passed,the Senate attempted to exclude psychology and behavioralscience from this funding, because they were not consid-ered core STEM disciplines. In its nal report, the 2009

APA Presidential Task Force on the Future of Psycholog-ical Science as a STEM Discipline articulated the rationalefor identifying psychology as a core discipline; this report(Dovidio et al., 2010) will be used to advocate for changesto enhance psychology as a core STEM discipline and toensure that psychological research is included in all futureSTEM funding opportunities. Further, advocating for psy-chology as a core STEM discipline is part of the 2009 APAStrategic Plan.

To solidify psychological science as a core STEMdiscipline, the task force recommended increased supportfor STEM training of graduate students and early careerprofessionals. To create a pipeline of students, we need toincrease the resources for teaching psychology as a labo-ratory science at the high school, community college, andcollege levels. Psychology can be a gateway to increasingthe participation of women and minorities in STEM activ-ities. To further funding opportunities for psychologicalscientists, we need to increase our presence in STEMagencies such as the U.S. Departments of Commerce, En-ergy, and Transportation and within the National Acade-mies of Science. We need more psychologists who doSTEM work on the boards and review panels of theseinstitutions as well as serving as senior staff members.

With increased multidisciplinary training and work,the focus in future research needs to change from a disci-pline-based orientation to a problem-based orientation. For

example, the treatment of people with cocaine addictioncould benet from multidisciplinary teams that includebiomedical and psychological scientists, who understandthe physiological and behavioral aspects of the substance;geneticists, who can develop markers for addiction; andclinical psychologists and physicians, who can develop andapply successful treatments. Utilizing the strengths of psy-chological methods and theories can enhance the work of many basic sciences, as there is almost always a human andpsychological component in applying new scientic andtechnological advances (Dovidio et al., 2010).

Newcombe and colleagues (2009) articulated how ad-vances in psychological sciences, from developmental tocognitive psychology, are converging to create a new sci-ence of learning. They argued that psychological sciencecan enhance other STEM disciplines through our work on(a) children’s early understanding of mathematics; (b) stu-dent’s understanding of the nature of science and its meth-ods; (c) the application of psychological principles to socialand motivational inuences on learning; and (d) the appli-cation and development of assessments to evaluate theprogress or lack thereof in STEM educational efforts. Therole of psychology in the education and training of studentsin other STEM disciplines has a promising future. New-combe et al. (2009) concluded that psychology

is a key discipline along with cognitive science, neuroscience,computer science, and other elds in the establishment of a newscience of learning that has exciting potential to provide deepinsights into the nature of human learning and how best toenhance it at all ages and in a variety of disciplines. (p. 548)

Moving Forward Into the FutureIn some respects, we as a profession are in unchartedwaters, often unable to see ahead because of the hugeeconomic forces and policy changes at work. Do we remainstatic and slide down the end of our current curve, driftinginto oblivion, or do we make the leap to new curves thathave the potential to revitalize and transform our professionfor the 21st century? In the next few decades we have greatopportunities, and psychology is well positioned to takeadvantage of them, but it will require that we change—andmake a leap to second curves. Those second curves arelikely to be in areas of work very different from our work in the rst 100 years of our profession. We need to engageand embrace these changes so that we can inuence their

processes and outcomes and ensure a vital profession.Multiple levels of engagement are necessary.

Public Policy Engagement At the highest level of engagement is the need to be moreactive in policy development and political processes thatdetermine policy. Without this form of engagement, we areoften left out of critical political decisions that determinefunding for our work and policies that support our practiceand science (DeLeon, 2002). There are many examples of policies that have the potential to undermine our work,from legislation that would have required written parentalinformed consent for children and adolescents to partici-

pate in school surveys (called the Family Protection Act) tothe exclusion of psychology from funding at the NationalScience Foundation because we were not considered a coreSTEM discipline.

Unfortunately, psychologists are less likely to be in-volved in the political process and political giving than aremembers of other related professions, and we suffer as a resultof this lack of involvement. We need more psychologists toserve in elected positions in the U.S. Congress and statelegislatures and in high-level positions in federal agencies,such as NIH and the Departments of Defense and Health and



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Human Services. We need to branch out into new areas of government to secure funding for work in climate change andother applied areas that are governed by the Departments of Commerce, Energy, Transportation, and Housing and UrbanDevelopment (HUD). HUD changed its policy in 2009 tospend 1% of its budget on research to evaluate the effective-ness of its programs. This opens the door for psychologists toengage in program development and evaluation to improvethe lives of the poor and homeless.

We need more psychologists employed by or as con-sultants to agencies that are tackling global problems suchas environmental change, war, displacement, manmade andnatural disasters, and famine (Bray, Goodheart, Heldring,et al., 2009). We can spend billions of dollars to developnew technologies, but in the end, if people do not use themcorrectly they will be underutilized, will not work, or willcontribute to further problems (cf. Han et al., 2005). This isanother area of research in which psychologists can playimportant roles.

More psychologists should be appointed or elected tohonorary professional societies and academies. In 2009

there were more anthropologists in the National Academiesof Science (NAS) than there were psychologists despite thefact that there are substantially more psychologists thananthropologists (Dovidio et al., 2010). As a result, anthro-pology and economics are more often included as coreSTEM disciplines or professions than is psychology. Weneed more psychologists appointed as full members to theNAS, the Institute of Medicine, the National ResearchCouncil, and other groups. Once again, it appears thatpsychologists are responsible for this state of affairs, as weoften do not nominate or stand up for our fellow psychol-ogists to be part of these groups. We should double thenumber of psychologists in the NAS over the next veyears to reect the growing importance of psychologicalscience to our nation’s economic success and to the healthof our population.

Department of Behavioral Health I call for the creation within the federal government of anew Department of Behavioral Health headed by a seniordirector. This department could be located within the De-partment of Health and Human Services (DHHS) or withinthe Surgeon General’s Ofce. The data to support this callare compelling, as behavioral and psychosocial factorsaccount for the largest amount of variance in health anddisease. It is time to recognize this reality with a high-levelposition and department within our government, similar to

what has been done with the Ofce for Minority Health andits undersecretary within the DHHS.Further, NIH funding to investigate behavioral and

psychosocial factors and to develop interventions that pre-vent the development of chronic health problems such asdiabetes and heart disease should be dramatically in-creased. The success of behavioral interventions that fosterbehavior change has been clearly demonstrated in the pre-vention of HIV/AIDS, and similarly effective interventionscan be developed and applied for other health problems(National Institutes of Health, 2009b; Pequegnat, 2009).

Transitioning to New Opportunities inIntegrated Health Care For many established practicing psychologists, making achange to work in integrated health care systems or primarycare will require some retraining. This can be accomplishedthrough continuing education, independent study, andpracticum training in these systems. This was a recommen-

dation of the APA Presidential Task Force on the Future of Psychology Practice, and it is being implemented withinAPA. Training institutions, such as universities and post-doctoral training institutes, are also needed to help psychol-ogists move into integrated health care systems. Thesetraining opportunities may increase as federal training dol-lars, such as those provided by the Centers for Medicareand Medicaid Services (CMS), the Graduate Medical Ed-ucation program, or the U.S. Public Health Service, be-come more available to psychologists. Once again, politicaladvocacy by APA and individual psychologists is requiredto secure these policy changes.

The federal government is moving to a different sys-tem of reimbursement and away from fee-for-service mod-els. Although the public may continue to value psycholog-ical services and pay out of pocket for them, psychologistswho choose to practice in traditional independent practiceswill face increasing pressures from the federal governmentto join organized systems of care and will face additionalcompetition from master’s-level providers, who will pro-vide similar services for reduced costs. Unless we canclearly brand psychology practice and justify higher ratesbecause of our uniqueness among mental health providers,reimbursement rates from insurance companies are likelyto converge among all providers.

Although prescriptive authority for psychologists is inits early stages, this is another area of growth for our

profession. Every health service psychologist should havebasic training in psychotropic medications and commonmedical conditions that are related to mental and behavioralhealth. Some psychologists resist acquiring this authority,as they claim that embracing prescriptive authority willundermine our behavioral methods and profession, make us“junior psychiatrists,” or challenge our independent profes-sional status from medicine. However, human beings arebiopsychosocial creatures, and to fully understand andproperly treat people with behavioral and mental healthproblems, a broader understanding and knowledge base isneeded. Advances in neuroscience clearly substantiate thisperspective, as psychotherapy and medications changebrain functioning and behavior.

Psychology Training for Practice in the 21st Century Current graduate programs in clinical, counseling, andschool psychology need to revamp their curricula to trainstudents for practice in the 21st-century health care systemof interdisciplinary teams, care management, and care co-ordination programs; quality assurance mechanisms; evi-dence-based practice; and health information technologysystems. Education delegates to the APA Summit on the



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Future of Psychology Practice recognized this and arecurrently discussing needed changes for future graduatetraining in professional psychology (Chin, Eby, Rollock,Schwartz, & Worrell, in press).

For health service practice, we need to adopt some of the language and methods of biomedicine, epidemiology,and public health while retaining our distinctive psycho-logical perspectives and methods. For example, in most of medicine, the World Health Organization’s (2007) Inter-national Classication of Diseases ( ICD-10 ) is used fordiagnosis, rather than the American Psychiatric Associa-tion’s (2000) Diagnostic and Statistical Manual of Mental Disorders ( DSM–IV–TR ). Primary care providers do notgenerally use the DSM. Demonstrating foresight, the APAhas invested substantial resources into the development of the next ICD revision because of its increased importancefor future psychology practice.

Training of psychologists needs to be undertaken withother health professionals, such as physicians, nurses, andclinical pharmacists, and in integrated and primary caresettings. In medical and nursing schools, students receive

training in the basic sciences and methods of medicineduring their early years and then move to multidisciplinaryclinical settings for training. Psychologists need more jointtraining with other health professionals, not just mentalhealth professionals, throughout their programs. Havingmore clinical psychology programs located within primarycare departments, rather than psychiatry departments, willhelp facilitate these types of changes.

While there will continue to be a need for specialtyand traditional mental health services, the clear growthareas are in the broader health care arena and in other areasoutside of mental health. The growth areas for practice arein all of the sectors of health care (see Figure 2), especiallyin primary-care, patient-centered medical homes and publichealth; forensic practice, which includes evaluations, ex-pert testimony, and parenting coordination programs; clin-ical and team leadership; and coaching and personal growthservices through the application of positive psychology(Bray, Goodheart, Heldring, et al., 2009; Munsey, 2009;Scott et al., 2010; Seligman, 1999).

General health care settings are quite different inpractice styles and methods from traditional mental healthsettings (Bray & Rogers, 1995; Frank et al., 2004; Robin-son & Reiter, 2007). It is essential for psychologists to haveopportunities to train side by side with other health profes-sionals in a variety of public and private settings. In addi-tion, the use of electronic health records is essential to this

type of practice, as EHR technology will be the method thatlinks health care across disciplines. In addition, the deliveryof services through the Internet and the use of other tech-nologies are likely to impact all types of psychology prac-tice, whether traditional mental health services or behav-ioral health services within integrated and primary caresystems. Similar technologies likely will be used for thepractice of applied psychology and business consulting.

Funding for interdisciplinary training is currentlyavailable through grants from the Health Resources andServices Administration for graduate psychology education

and through CMS for graduate medical education. How-ever, the current Medicare reimbursement rules interferewith the training of psychologists in most primary caresettings because services for trainees cannot be reimbursed.Primary care disciplines have the “primary care exemp-tion,” which allows primary care residents to see patientsindependently, with supervision, and have the servicesreimbursed. A similar rule change is needed for psychologytrainees.Training for the Future of Psychological Science We need to change the way we train our students and, mostlikely, the places in which we train them. These types of changes necessitate that we collaborate with professionsoutside of psychology while maintaining our unique iden-tity as psychologists. For science, we need to collaboratemore with economists, engineers, neuroscientists, and com-puter scientists and to set up joint training programs to takeadvantage of each discipline’s unique strengths. Suchchanges may require that psychologists have more under-

graduate training in other areas of science, such as biologyand chemistry. Psychological scientists who want to obtainfederally funds for research need training in the process andmethods of “big science,” which means they will needsome knowledge of epidemiological and public health ap-proaches, multidisciplinary teams, longitudinal clinical tri-als, translational science, and secondary data analysis of large data sets. This may require new and additional inter-disciplinary training programs that are funded by the Na-tional Science Foundation and other agencies.

In summary, our profession can make a difference that makes a difference, and we can create a future in which ournation benets from the application of our rich and variedscience to the grand challenges of our society and theindividuals we serve. I end this article where I started: “Thebest way to predict the future is to create it.” I look forwardto seeing what futures we create and how psychology willevolve as we progress into the 21st century.

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