Issues Of Advocacy and Social Justice

Advocacy: The Key to the Survival and Growth of Professional Psychology

Ronald E. Fox The Consulting Group of HRC

Active participation in professional advocacy activities is essential for psychology to have a viable future. Advocacy efforts thus far in professional psychology are reviewed, and a discussion of how strong advocacy efforts will be required to advance the interests of the profession in the future is presented. Making psychology a true health profession, securing legislative authority to prescribe in all states, confronting and overcoming business and regulatory constraints on practice, and providing sufficient services to meet the growing diversity of the general population are discussed as examples of professional issues whose resolution will require significant advocacy efforts. Recommended steps are provided for developing a strong, national advocacy program.

Keywords: advocacy, political action, prescriptive authority, professional involvement

The very survival of psychology as a profession may well depend on the development and implementation of a successful advocacy program. Without it, psychology is destined to remain a minor player in the nation’s heath care market. Unfortunately, psychology is poorly positioned to conduct the comprehensive, coordinated, and expensive effort that is needed.

Despite their many political successes over the past several decades, psychologists remain reluctant participants in the advo- cacy process (DeLeon, Loftis, Ball, & Sullivan, 2006). For the present purpose, advocacy is defined as the use of political influ- ence to advance the profession through such means as political giving, legislative lobbying, and other active participation in the political decision-making process. Psychologists’ level of giving for advocacy has not increased with their growth in numbers and remains far below that of comparable health care professions (Pfeiffer, 2007). The need is manifest, the potential rewards are there for the taking, but the will to act often lies dormant.

Successfully addressing each and every one of the issues dis- cussed in this special section of the journal are cases in point. Establishing psychology as a primary health care profession al- ready has required a great deal of advocacy effort and even more will be needed in the future (Wright, 2001). The same is true for prescriptive authority (RxP) legislation and the management of its impact on both society and the profession. Managed care and the evidence-based practice movements have brought major opportu- nities and threats to psychology that will require strong political advocacy to establish appropriate boundary conditions for cost and

accountability measures whose unintended consequences can be disastrous. The increasing diversity of patients requires expanded skills and training for practitioners and the creation of better access to services.

Political action will be necessary to put in place the policy changes and funding opportunities needed. The future of our profession can be bright. The road to it runs directly through the social and political arenas. A brief review of some of the history and background of these issues will help clarify why the need for major advocacy mechanisms is so critical to the future develop- ment of the profession of psychology.

Psychology as Health Care Profession

Several presidents of the American Psychological Association (APA) have created initiatives to help establish psychology as a health profession (e.g., Jack Wiggins, Pat DeLeon, Norine John- son, Ron Levant), which is very good and necessary. But much remains to be done. In order to make psychology a true health care profession providing services that are both accessible to the gen- eral public and affordable, those services will need to be reimburs- able in the same manner as other health care. This requires the inclusion of psychological care in the myriad health and rehabil- itation services reimbursed by public and private carriers.

Early advocacy efforts to gain recognition and reimbursement were first initiated in the 1970s by a group of activist practitioners known as the “Dirty Dozen” (Fox, 2001). This group also founded psychology’s first advocacy organization outside of APA, the Council for the Advancement of the Psychological Professions and Services, or CAPPS (not to be confused with CAPP, or the Committee for the Advancement of Professional Practice, the oversight group for the APA Practice Directorate, which was established much later). These psychologist advocates also suc- cessfully pressured APA to establish a Committee on Health Insurance (COHI) and ultimately an advocacy program within APA itself, thus recognizing the legitimacy of such efforts by psychologists.

Based on the authors’ own clinical experiences, these seventeen comprehensive case histories reflect the most common psychological disorders. Rich in detail, inte- grated in approach, and fully updated for the DSM-5, each case describes patient symptoms and history, the formulation and implementation of a treatment plan, and results. Each case also includes the perspective of a family member or friend. This unique viewpoint emphasizes the impact of psychological disorders on those closest to the patient as well as the importance of considering sociocultural factors in diagnosis and treatment. Each case study concludes with assessment questions that help students check their understanding of the symptoms, diagnosis, and treatment of the disorder exhibited by the patient. Three additional cases provide opportunities for students to identify disorders and suggest appropriate therapies. Diagnostic information and treatment strategies for the patients in these “You Decide” cases are provided in appendices for students to check their assessments.

About the Authors Ethan E. Gorenstein is clinical director of the Behavioral Medicine Program at Columbia-Presbyterian Medical Center and a professor of clinical psychology in the department of psychiatry at Columbia University. He is also the author of The Science of Mental Illness (Academic Press). He has an active clinical practice de- voted to the use of evidence-based psychological treatment methods for problems of both children and adults.

Ronald J. Comer is a professor in the psychology department at Princeton Univer- sity and director of clinical psychology studies. He is also chair of the university’s Institutional Review Board. A clinical psychologist, he is the author of the text- books Abnormal Psychology and Fundamentals of Abnormal Psychology (Worth Publishers), Psychology Around Us (John Wiley and Sons Publishers), and producer of numerous educational videos on subjects ranging from abnormal psychology to introductory psychology and neuroscience. Issues Of Advocacy and Social Justice

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