Realizing Needs and Opportunities for Leadership:
Advancing Clinical Psychologists as Leaders of Micro and Macro Level Change
By Bradley E. Karlin, Ph.D., ABPP
If ever there was a need, in our profession and the nation, for strong leadership to effect change – at individual, system, and societal levels – it is now. Yet, as important and needed as it is, leadership at various levels is not something most of us receive training on or intentionally plan for. Surely, leadership does not often find its way into the syllabi of many graduate training programs in clinical psychology.
Recently, I was asked to give the commencement address at a psychology internship and postdoctoral training program. This event, the national and international events of the past several weeks, and the closing of the year has had me reflecting on the need and opportunity for strong leadership in clinical psychology, particularly within the next generation of clinical psychologists. A leadership area of particular potential and fit for clinical psychologists is serving as administrative leaders in organizations and government agencies, where the knowledge and skills of a scientist-practitioner can positively inform and be informed by administrative leadership responsibilities and help shape the delivery and quality of psychological services. This was the focus of a Division 12 sponsored symposium at the APA convention this past August that drew significant interest. In this, my last, Presidential column of TCP, I thought it timely to reflect aloud and offer some personal insights and perspective from one individual’s experiences.
Bringing Macro to a Micro World
My paths to becoming and functioning as a clinical psychologist have been anything but “traditional”. The decision to become a clinical psychologist for me was rooted in a deep desire to improve mental health care and reduce unmet mental health need, particularly among older adults, by working at micro and macro levels. Prior to entering psychology, I worked in the field of law and policy (mainly focusing on mental health policy and Medicare mental health reimbursement issues) and had a strong interest in bringing my developed macro level interest and lens to professional psychology, while also bringing interests I had in helping and supporting others in my life to working to promote change at the individual level. I believed, as a clinical psychologist, that I could best advocate for and effect change in mental health care access and delivery. My interest and background in macro level change was, however, at the time met with confusion by a number of clinical psychology training programs. Fortunately, I found a perfect match in a clinical psychology training program (Texas A&M University) and mentors, such as Michael Duffy, David Gleaves, Les Morey, and Doug Snyder, who embraced the notion of effecting change at both micro and macro levels. I then had the great fortune of completing my clinical internship and postdoctoral fellowship in geropsycholgy at the Veterans Affairs (VA) Palo Alto Health Care System. VA (and especially VA Palo Alto) is a terrific place to be for someone with interests in mental health care systems, policy, and administration. Working with mentors, such as Bob Zeiss, Steve Lovett, Gary Hartz, and Keith Humphreys, I had the opportunity to be on an administrative leadership rotation (one of the very first at the time), to further research and write about Medicare mental health policy (including applying a model of policy change to a new Medicare mental health benefit), and to further develop strong clinical interests in evidence-based psychotherapy (EBP) and in psychosocial approaches to managing behavioral symptoms associated with dementia. Thanks to a combination of intentionality, a heavy dose of serendipity, and support and validation of true mentors, my decision one fateful day to leave my former professional world to enter the world of clinical psychology would be increasingly validated.
Dissemination and Implementation to Promote Mental Health Care Quality and System Change
Over the years, my interests in reducing unmet mental health need and in evidence-based psychotherapy led me to become particularly aware of and interested in the large research to practice gap related to EBP and consequent quality problem prominent in the recent mental health discourse (Karlin, 2015). In 2005, as the nation was at the height of war, I had the privilege to join Toni Zeiss, Ira Katz, and others in VA Central Office to be part of an unprecedented effort to help transform VA’s mental health care system to an evidence-based and recovery-oriented system of care. In my role as National Mental Health Director for Psychotherapy and Psychogeriatrics, I and a team of incredibly dedicated mental health professionals (primarily clinical psychologists) developed an initiative nationally disseminate and implement EBPs to realize the promise of these treatments for Veterans cared for in real-world settings. This initiative, which would become the largest dissemination of EBPs in the nation, was a truly challenging and exhilarating undertaking that resulted in significant improvements among many Veterans presenting for care in real-world settings, on par with those reported in RCTs. In many ways, this was the ultimate actualization of my early hope to promote macro and micro level change to reduce unmet mental health need. This work (as the implementation science literature now increasingly emphasizes) required actions on many levels – including policy, provider, local systems, and patient levels. Along the way, I had another strong role model and the trust of a passionate and skilled clinical psychologist administrative leader in Toni.
Witnessing what is possible when implementing broad and strategic dissemination and implementation, I became passionate about realizing the promise of EBPs and promoting system change in other systems. I now work with various private and public systems to promote the dissemination and implementation of EBPs and to improve mental health and dementia care for older adults. Having the opportunity as a clinical psychologist to effect system change and bring dissemination and implementation strategies and processes to other mental health care systems is incredibly meaningful and exciting. And, as one of my SCP Presidential initiatives this year, I have worked to position SCP as a leader in dissemination and implementation within clinical psychology and professional psychology, more broadly!
I am convinced that clinical psychologists have a lot to offer as leaders of individual, systems, and societal change, and I am hopeful that an increasing number of the next generation of clinical psychologists will seek and even create such opportunities. In reflecting on my professional journey over the past several months and throughout the foregoing paragraphs, I formulated a list of tips and lessons learned. I will offer the results of this factor analysis of my reflection for aspiring leaders of tomorrow. Here goes.
1. Do what you care about and care about what you do.
Victor Frankl’s lessons are critical to work and life success.
2. Identify your personal niche and frame it carefully.
Find an area where you feel passionate, where you can make a contribution, and link this to your professional purpose and identity. In so doing, think outside the box – even if just around the borders.
3. Use your signal to penetrate the noise.
According to political scientists, successful policy change is impacted, in part, by the “signal-to-noise” ratio. The signal-to-noise ratio is a measure of the likelihood a constituent’s concern or request (signal) is recognized by one’s representative or elected official. The degree to which the message or request is perceived by the elected official is dependent upon the success of the message in penetrating the thousands of messages (noise) from many other constituents and interest groups. The importance of honing and successfully and strategically communicating one’s message has relevance in many contexts beyond policy change.
4. Seek out and volunteer for opportunities.
An important opportunity for increasing one’s signal to noise ratio and advancing thought leadership, as is publishing and presenting in strategic outlets and venues.
5. Incorporate intentionality and embrace serendipity.
Live and act with focus and intentionality, while at the same time welcoming and embracing the winding path. Watch for (and help to produce) open windows life presents that may lead to opportunities and adventures.
6. Associate yourself with smart and dedicated people.
The most successful leaders are those who are part of (and help reinforce) bright and motivated teams.
7. Find a mentor who gets you and your passion.
Join the new SCP Mentorship Program (as a Mentee and/or Mentor)!
8. Share your care – inspire and motivate.
As leadership expert, Simon Sinek, emphasizes, people don’t care about what you do, they care about why you do it. For this reason, highly successful leaders and organizations focus on the “why” of their work and work product, not just the work itself. As Sinek notes, Martin Luther King, “I Have a Dream Speech,” not the “I Have a Plan” speech.
As 2016 and this column draws to a close, I would like to express my gratitude for having had the experience of serving as your president at an important and challenging time for SCP and professional psychology. This was a year marked by uncertainty and transition in the field of professional psychology and the nation (and world), more broadly. This was also a year of organizational introspection, growth, and excitement. Over the past year, SCP administered its first Needs Assessment of the members and worked to establish itself as an organization of early and mid-career professionals, as well as senior-level clinical psychologists. The development of the SCP Mentorship Program this year, a new membership benefit by which members are paired with other members in specific practice or topical areas across all stages of professional development, is designed to leverage the rich resource of our broad and experienced membership and provide greater membership value to early-, mid-, and later career members (http://www.div12.org/mentor-match/). Another new program, the SCP Campus Representatives Program, focuses on outreach to and engagement of the next generation of leaders in clinical psychology. Led by members of Section 10, the Campus Reps Program works to promote awareness of the field of clinical psychology and SCP on college campuses.
As we looked inward and to external needs and opportunities at a time when membership organizations are increasingly competing and struggling to be relevant and unique (an especial challenge in the broad field of clinical psychology), there was strong recognition and enthusiasm for positioning SCP as a home for and leader of dissemination and implementation science and practice within professional psychology. This is an opportunity that builds on SCP’s rich history in identifying evidence-based psychological treatments. Increasing psychology’s involvement and leadership in advancing the “how” of implementation (e.g., adoption, scaling, and sustainability), moving beyond the development and identification of “what” works, is essential to the future survival of clinical psychology and to finally realizing the potential of psychological treatments. As the leader of an aging services system I have been working with to implement a dementia care intervention for formal care providers and family caregivers of individuals with dementia recently put it, dissemination and implementation is at the intersection of where “rigor meets reality” – a crossroads that providers and systems of many kinds and fields struggle with daily throughout the world. As part of our efforts to promote SCP’s focus on dissemination and implementation, provide a foundation of information and resources for members, and place a stake in the ground of the field of D&I, we have been working to develop an SCP Dissemination and Implementation web portal (www.div12.org/implementation), which I am pleased to first announce in these pages is scheduled for launch in the weeks ahead. I hope you will take an opportunity to check out this new resource and spread the word to colleagues and students. At the same time that the SCP D&I web portal is undergoing its final phase of development, the overall SCP website is undergoing a major re-development to enhance overall design and functionality (incorporating feedback and recommendations for improvement from a number of members in the SCP Needs Assessment). So, please be on the lookout for new SCP real estate and resources on the web soon. The overall SCP website redesign is scheduled for completion in the first quarter of 2017. As this all is underway, we are also working to create a new brand, logo, and look and feel of the Society, to be completed in the months ahead.
There are too many people to thank here for their help with and support of these and other presidential initiatives and developments this past year, but I’d like acknowledge the contributions of a few: Michele Karel, Natalia Potapova, Shannon Wiltsey Stirman, Torrey Creed, Elizabeth Davis, Brandon Gaudiano, Damion Grasso, Michelle Blose, Elaine Burke, Sheehan Fisher, Derek Giannone, Kim Penberthy, Danny Wedding, Huaiyu Zhang, Tara Craighead, and the SCP Board of Directors.
Best wishes for a happy holiday season and a prosperous future for our organization. Good luck to incoming President, Michael Otto, and incoming President-Elect, Gary VandenBos.
Thanks for a great year.
Karlin, B. E. (2015). Realizing missed opportunities for improving mental health care quality:
Bridging the great divide in the delivery of psychosocial treatments. Depression and Anxiety, 32, 805-808.
Sinek, S. (2011). Start with why: How great leaders inspire everyone to take action. New York: Penguin Group.