From the President

Back in the day, when I first started my private practice, insurance paid 80% to 100% of psychotherapy fees. Most of us had flourishing practices and became accustomed to our successful careers. Then one day, the “monster” disguised as HMOs descended upon our profession. While steeped in controversy, it became clear to all of us in private practice that our work lives had now dramatically changed. We suddenly had to answer about length and quality of treatment; our confidential therapeutic relationships became open books to the insurance industry and we were made to accept reimbursement under a “usual and customary” fee schedule that appeared to be more appropriate for psychologists who lived in the 19th century than today.

After many battles with the insurance industry, our profession was able to undo some of the managed care damage by legislatively disallowing gag orders, phantom panels and many other unfair practices. And, many of us gave up on managed care and refused to participate in their system any longer. Then we fought for parity and recently won that battle!

But where are we now? With our current economic crisis and our damaged health care system, what has been “normal” for so many years is dramatically changing. Our patients are losing their jobs, homes, financial security and their health insurance. We’re uncertain what psychology’s role will be in health care reform. We don’t know how insurance reimbursements will change, how evidence-based practice will affect our work, how to adapt to our country’s changing demographics, how to educate our graduate students so that they are prepared for all aspects of private practice, including learning “the business of practice.” We are in the midst of experiencing imposed change. The loss of “what used to be” requires us all to go through various phases of the grief cycle. At first we might deny that there would be change to our practices. Now many of us have become angry, thinking: “This is NOT why we became psychologists.” Then we might begin to feel panic and/or depression. Some of us will even become resigned to our plight. But once we accept that there is a “new normal”, we can begin to see possibilities and build opportunities so that we continue to flourish, albeit in a way that may look somewhat different from what we were used to.

So how do we thrive in this “new normal?” I believe that there are many opportunities awaiting us if we decide to work with change rather than just fight against it. A few ideas include:

• INNOVATIVE PRACTICES: Rather than rely solely on the traditional psychotherapy model, we may want to develop innovative specialty niches such as gastric bypass surgery evaluations, PTSD treatment with war veterans or grief counseling for those who have lost their beloved pets. Our imagination is limitless to the myriad of opportunities before us.
• BUSINESS EXPERTISE: In private practice, we not only treat patients but it is also imperative that we develop our business acumen in areas such as finances, marketing our practices, and the general “business of practice.” We need to accept the idea that we not only are in a helping profession, but that there is no shame in acknowledging our need to run our practices in an efficient and profitable manner. In fact, it becomes a win-win for patient and psychologist alike!
• TECHNOLOGY: As difficult as it may be for many of us who began our practices 20+ years ago, we may need to enter the age of technology. Telehealth, websites, podcasts, virtual treatments and social networking are just a few of the areas of technology that are becoming “normal” models of treatment and marketing tools. This may be an area where role reversals will see students and early career psychologists mentoring many of us senior psychologists!
• TRANSLATING RESEARCH INTO PRACTICE: I’m not talking about manualized treatments. I’m talking about our responsibility to keep up-to-date with current research pertaining to our treatment modalities. It is important to know why we’re doing what we’re doing, why it works and how we know that it works. This knowledge does not have to come from randomized treatment research.  Rather, it can come from understanding factors that affect treatment such as the therapeutic alliance, motivation of the patient, allegiance of the therapist to a treatment orientation, psychologist effects, patient characteristics and the difference between efficacy and effectiveness. The more we can prove our effectiveness, the more credibility we will engender not only to the public but to legislators and insurance companies that have been able to dictate how to do what we do.
• CULTURAL COMPETENCE: Given the undeniable fact that our country’s demographics are changing, we must become culturally competent to keep up with our new patient populations. This means that our way of conceptualizing patient issues may have to change in order to deal with cultures different from our own. We cannot assume that one size fits all.
• ADVOCACY: We can no longer live in the ivory tower of our private offices. We must all become active advocates for our profession so that we can help change or create laws, regulations and policies that range from issues such as health care reform, anti-trust law as it affects our practices, prescriptive authority legislation and licensing board issues. We can no longer leave this important work to others. We must stand up and advocate for better mental health care for everyone.
• PUBLIC EDUCATION: We must make public education a priority so that consumers, the public-at-large and legislators understand how psychology and psychological issues affect every aspect of human life and welfare. We must individually and collectively speak to the public, media and government about how our special skills help in all aspects of life.

Division 42 is dedicated to addressing these issues and more. But our division 42 leadership cannot do these things alone. We need you to become active in the division by helping us make these changes that we need to enhance our profession. We need your ideas; participation in work groups and proposals that you are willing to present to your 42 leadership.

We need you to help us help you thrive in the new normal.