Division 29

Domain of Social Justice and Public Policy

People often ask about this domain in two rather disparate ways: “Why do we need this
domain? What relevance is there for psychotherapy?” and “That’s a huge area to cover.
How can we attend to all those issues?” The first suggests that there is no need and the
second that there is too much need! The latter is clearly more in keeping with my
experience.

So, why do we need the domain of social justice and public policy?
Public policy is perhaps more obviously relevant to the field of psychotherapy, training,
research, and of course practice.

APA and our Division 29 have to work to support efforts that would otherwise be
severely affected by governmental and institutional changes. A pressing example is the
cut in the Medicare reimbursement rate, which we are trying to persuade Congress to roll
back. The significance of this change is far-reaching not only for our profession but also
(and here we step across into the other half of the domain) for service and access for the
underserved. Including psychologists in the Medicare definition of physician is another
step we need to make.

Another current issue is whether psychology interns and residents can be included in the
eligible list for the Graduate Medical Education fund, important for creating funding
pathways for training our doctoral students.

A persistent challenge is the need for legislation state by state to alter the sequence of
training to permit all internship/residency hours to be completed before the doctoral
degree is awarded. The purpose of this change is to protect graduate students from
postdoctoral exploitation, and to permit them to gain their licenses sooner. This affects
the earning capacity of the new graduates, and their ability to participate in loan
forgiveness programs.

Of help to recent graduates is the HRSA National Health Service Corps program, which
provides employment for psychologists in federally qualified health care shortage areas
and allows for tuition debt repayment – but only for licensed psychologists.

Affecting research as well as training opportunities are the cuts in public spending in the
form of university and research budgets. Channeling of research funding is another
important area.

For practitioners, probably the biggest current issue likely to affect the practice of
psychotherapy is Health Care Reform. While there are serious concerns for the nature and
place of psychotherapy in a new health care system, there is also optimism and creativity
as new delivery systems are envisioned. Of particular interest is the growth in telehealth,
which raises issues of practicing across state and sometimes national boundaries, and
spawns concern for the safety and confidentiality of remote provision of psychotherapy.
At the same time, this may provide a useful solution to the challenges of access to care in
remote, rural areas and assist clients who are unable to travel to their therapist’s office for
any reason.

Social Justice is not a clear-cut arena. In many cases it intersects public policy issues, and
often there are political underpinnings. For APA and Division 29, social justice is part of
our mission, embedded in our Code of Ethics, and general value system.
Some hot topics on the legislative front include the abolition of the “Don’t Ask, Don’t
Tell” policy for GLBT military personnel, and marriage equality. California’s Proposition
8 was judged unconstitutional, and the case is now proceeding to the higher court. These
issues affect the psychological health and self-concept of many individuals and their
families.

War on two fronts and the deep recession in the national – and global – economy span the
public policy and social justice domains, creating widespread distress and a pressing need
for more psychotherapy.

Poverty and disaster frequently go hand-in-hand. There are of course many reasons for
this, including substandard housing in disaster–prone areas, crowding, and a general lack
of resources that makes any crisis worse. Recent examples of the earthquakes in Haiti, the
mine collapse in Chile, and the floods in Pakistan demonstrate the point. Psychotherapy
has to take different forms under such conditions. Often when disaster strikes an area
psychotherapists themselves suffer loss, damage, and trauma along with their community.

We also need to think about marginalized members of society, whether they be from
disadvantaged minority groups, or broad cross-cutting cohorts like the elderly. Our
population is aging and the Boomer generation is hitting retirement now. They will need
– perhaps demand - more services and in more creative ways. The needs of caregivers are
also a high priority. As the “old old” grow in number, so does the charge of families,
partners, and other caregivers. We know that this is stress-filled and complex situation
requiring more than just personal attention.