Competencies for psychological
practice in primary care
BY DR. SUZANNE BENNETT JOHNSON • APA PRESIDENT
Increasing psychology’s role in health is one of APA’s strategic goals —
a goal that is particularly important in light of the paradigm shift occurring
within medicine from the biomedical to the biopsychosocial model (see
my September Monitor column). U.S. health care is moving from provider-
centered care focused on biologic aspects of disease to patient-centered care
characterized by interdisciplinary teams addressing all of the
patient’s needs — both medical and psychological. The Patient
Protection and Affordable Care Act seeks to stimulate and
support this important change in health-care delivery.
Patients enter the health-care system through primary care.
Primary-care physicians include family practitioners, internists,
pediatricians and sometimes obstetrician/gynecologists, who
address all of their patients’ health-care concerns. They see
their patients regularly, often for many years, and refer them
to specialists as needed.
1 It is not surprising that most patients
bring their mental health concerns to their primary-care
providers, yet these doctors are often ill-equipped to address
mental health concerns appropriately.
2 For this reason, there is
great interest in transitioning primary care to a patient-centered
interdisciplinary team delivery model, with teams constituted to
include mental and behavioral health expertise.
Medicine’s paradigm shift to the biopsychosocial model
and primary care’s shift to patient-centered integrated care
open many opportunities for psychologists, who could become
important members of the interdisciplinary care teams of the
future. However, to serve in such a role, psychologists must
be trained to practice in integrated care. Unfortunately, most
psychologists have not received such training.
For the past year, an inter-organizational work group
has been meeting to articulate the essential competencies
needed for psychologists to practice in primary care. The nine
organizations participating in this work group include three
APA divisions with considerable expertise in integrated care:
Div. 20 (Adult Development and Aging), Div. 38 (Health) and
Div. 54 (Society of Pediatric Psychology) plus the Association
of Psychologists in Academic Health Settings, the Council of
Directors of Clinical Health Psychology Programs, the Veterans
Administration Training Council, the Collaborative Family
Healthcare Association, the Society of Behavioral Medicine and
the Society of Teachers of Family Medicine (STFM).
Each organization selected up to two members to serve
on the work group; APA member Susan McDaniel, PhD,
representing STFM, ably chaired the group. I had the
opportunity to join the group in September as it finalized its
report; I was very impressed with the group’s recommendations.
Inter-organizational collaboration is important because it
brings many voices together, avoiding multiple statements and
recommendations from many different groups. APA is one voice
for psychology. When APA partners with other groups, it avoids
duplication of effort with the confusion and dissension that may
bring. It also broadens impact by allowing multiple organizations
to speak with one voice, disseminating the inter-organizational
work group’s product beyond the reach of a single organization. It
also sets the stage for additional collaboration as efforts are put in
place to make the group’s recommendations a reality.
The report of the Inter-organizational Work Group on
Competencies for Psychological Practice in Primary Care
is expected to be available this winter. Once it’s ready, we
will announce where to access it. The report will serve as a
foundational effort for psychologists to position themselves as
players in patient-centered integrated primary care. It will guide
professional psychology training programs by identifying the
core competencies students must have to function effectively on
interdisciplinary care teams. It will guide continuing education
for practicing psychologists who want to acquire the necessary
skills to move into this exciting area of patient care. It will
guide other health professionals by articulating the special
competencies psychologists bring to team-based integrated care.
I am grateful to all the organizations and their representatives
for producing this important report. Now, it is up to our
graduate education and professional practice communities to
put its recommendations into action. n
2 Psychosomatic Medicine, 2010, 72:511–518