Presidential Column

Stepping outside of our comfort zones: Expanding the reach and scope of clinical psychology in the 21st Century

By Jonathan S. Comer, Ph.D.

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Friends and colleagues—I hope that your new year is off to a terrific start. And I want to thank you for your great dedication to the field of clinical psychology. By being a member of the Society of Clinical Psychology (SCP), you are affirming your identity as a clinical psychologist. Although the field now has more professional societies than ever before—each with increasingly narrow subspecialty foci and targeted missions—SCP stands unique in its deep and mutually respectful embrace of a true integration of clinical psychological science and applied practice. SCP is one of the original divisions of the APA and remains one of the largest and most valuable resources and networks for clinicians, educators, researchers, trainees, policymakers, and the general public. I thank you for making SCP your professional home!

It’s a tremendous honor to lead SCP this year, at such a critical time for our field and for our profession. As I begin my SCP presidential term, I am truly humbled (and admittedly intimidated) by the extraordinary impacts that so many esteemed individuals have made over the years in their roles in key positions in SCP governance. For example, the field’s efforts to systematically identify evidence-based practice in psychology started in earnest in SCP in 1993, when then-president Dave Barlow launched the Division 12 Task Force on Promotion and Dissemination of Psychological Procedures (chaired by Dianne Chambless). The results of this seminal SCP task force sparked a decade of animated and productive debate in the field about how to best conceptualize indicated psychological practices—and this dialogue, in turn, paved the way for a formal definition of “evidence-based practice in psychology” that has since been adopted as official APA policy (APA Presidential Task Force on Evidence-Based Practice in Psychology, 2006).

Indeed, since our Society was founded 101 years ago(!), the field has witnessed remarkable scientific and professional advances that have so powerfully and positively improved the lives of countless individuals in need and that have firmly established clinical psychology as a sophisticated and rigorous discipline. And yet, at this time, we are faced with novel challenges and exciting opportunities that promise to meaningfully transform the landscape of clinical psychology and the role of the clinical psychologist for years to come. Against a backdrop of unacceptable and worsening disparities in care access and quality, a shifting health care system with an uncertain future, large gaps between treatment outcomes observed in research settings versus routine community care settings, threats to the traditional role of the clinical psychologist, and the reducing prominence of psychological treatment in mental health care (e.g., Le Cook et al., 2017; Merikangas et al., 2011; Olfson & Marcus, 2010; Weissman & Cuijpers, 2017), it’s clear that innovative solutions are needed to solve today’s problems.

Most of our leading psychological treatment orientations emphasize how patients must step outside of their “comfort zones” for productive change to unfold. Whether it’s the exposure therapist having patients confront feared objects or environments, the cognitive therapist helping patients consider new and non-automatic ways of thinking, the mindfulness-based therapist having patients learn to tolerate inner experiences in nonjudgmental ways, or the psychodynamic psychotherapist helping patients examine past influences and work through unresolved conflicts to achieve difficult self-awareness—a clear transtheoretical theme is that a patient’s “comfort zone” is not fertile ground for transformation or growth.

Likewise, as a field, it’s increasingly clear that we will need to step outside of our “comfort zones” as we navigate the difficult clinical and professional challenges of our time. Kazdin and Blase (2011) noted that, despite considerable transformations in the focus of psychological interventions, the techniques used, and the evidence supporting particular intervention strategies, the field has exhibited rather minimal evolution and creativity with regard to the format and delivery of psychological intervention. Specifically, since the days of Freud’s earliest clinical work, our field has retained a principal reliance on the traditional 1:1 patient-provider, office-based meeting. There are now clear indications that—in the context of our predominant attachment to this intervention format “comfort zone”—clinical psychology’s potential for true public health impact (i.e., the extent to which we can make meaningful changes at a population-level) is approaching a ceiling (see Kazdin & Blase, 2011).

Accordingly, a guiding theme of my presidential year will be helping our field step outside of our “comfort zone”—to incorporate innovative intervention formats and novel treatment redesigns that may help us better achieve and sustain a consequential public health impact. For example, I’m gearing up to launch a Division 12 Task Force focused on Technology and Mental Health that will work to advance the roles of technology in responsible clinical practice and in promoting mental wellness in the general population. This Task Force will have 5 intersecting work groups—1) Telemental Health, focused on the use of remote technologies to provide real-time intervention (e.g., videoconferencing treatment), (2) mHealth Intervention (focused on mobile technologies, mental health apps, and asynchronous treatments), 3) Technology-Based Dissemination and Public Information; 4) Machine Learning, Artificial Intelligence, and Just-In-Time Adaptive Interventions; and 5) Social Media, Screen Time, and Mental Health. In addition, to further broaden the reach of our work beyond traditional mental health office-based settings, I will use my presidential term to advance efforts to better incorporate clinical psychological science into non-mental health settings (e.g., patient-centered medical homes, school settings, employment settings).

I certainly want to thank the most recent two presidents of SCP—Michael Otto and Gary VandenBos—both for their strong leadership, and for directly modeling how SCP presidents can use their terms to energize our Society and to pursue vital and consequential initiatives that address critical issues that confront society and our field.

But perhaps most importantly, throughout my time serving in various capacities on the SCP Board, it has become clear to me that our greatest accomplishments are only achieved together—in full partnership and collaboration with an active and engaged SCP membership. I invite you all to step outside of your own “comfort zones,” make your voices heard, and even consider volunteering to serve SCP in some capacity. We are buzzing with opportunities, including education and training, a mentorship program, linking science and practice, publications, membership and recruitment, a growing webinar program, conference planning, development of special interest groups—please just reach out (jocomer@fiu.edu) if you’d like to get involved. I hope that you do – I’m looking forward to working with you!

– Jon

References

APA Presidential Task Force on Evidence-Based Practice in Psychology (2006). Evidence-based practice in psychology. American Psychologist, 61, 271-285.

Kazdin, A.E., & Blase, S.L. (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6, 21-37.

Le Cook, B., Trinh, N.H., Li, Z., Hou, S.S.Y., & Progovac, A.M. (2017). Trends in racial-ethnic disparities in access to mental health care, 2004-2012. Psychiatric Services, 68, 9-16.

Merikangas, K.R., He, J.P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., Georgiades, K., Heaton, L., Swanson, S., & Olfson, M. (2011). Journal of the American Academy of Child and Adolescent Psychiatry, 50, 32-45.

Olson, M., & Marcus, S.C. (2010). National trends in outpatient psychotherapy. American Journal of Psychiatry, 167, 1456-1463.

Weissman, M, & Cuijpers, P. (2017). Psychotherapy over the last four decades. Harvard Review of Psychiatry, 25, 155-158.