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Book Forum: Primary Care   |    
Primary Care Psychology
MARVIN W. ACKLIN, Ph.D.
Am J Psychiatry 2005;162:414-a-414. doi:10.1176/appi.ajp.162.2.414-a
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Edited by Robert G. Frank, Ph.D., Susan H. McDaniel, Ph.D., James H. Bray, Ph.D., and Margaret Heldring, Ph.D. Washington, D.C., American Psychological Association, 2004, 343 pp., $49.95.

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Primary Care Psychology is a program manual defining professional psychology’s continuing evolution as a discipline and profession. Established as a laboratory/academic discipline in 1879, psychology has gone from the laboratory to schools and clinics as an independent mental health profession, having served for a time as handmaiden of psychiatry. The framers of Primary Care Psychology outline an emergent vision of professional psychology as a health service profession "reflecting a movement from the profession’s traditionally narrow focus on mental health diagnoses and treatment to a more generic psychosocial and behavioral orientation to health-care" (p. 317). A psychologist who works in primary care is

a general practitioner who has skills in the psychological assessment of and intervention with common health problems of patients and families throughout the lifespan. Primary care psychologists work collaboratively with other health care professionals to provide continuity of care and to help identify important questions for research using a biopsychosocial model. (p. 64)

Although psychology’s interface with the field of medicine is not new—previously it was considered under the rubrics of medical psychology, health psychology, or behavioral medicine—professional psychology appears poised to move directly into the field of primary care medicine (general practice, family practice, and internal medicine). The economic impact of linking psychology services to common medical conditions (called "cost offset") is well-known. The edited chapters of Primary Care Psychology, originating in the Committee for the Advancement of Professional Psychology of the American Psychological Association, outline the conceptual, educational, practical, and economic dimensions of psychology practice tied to rapid and continuing changes in the health care industry.

It is not merely coincidental that these efforts to broaden and diversify professional psychology’s reach have been linked to the American Psychological Association’s controversial efforts to include prescriptive authority within the scope of professional psychology’s identity. The chapters focus on collaborative practice models and address the common colds of behavioral health—anxiety and depression—as well as pediatrics, women’s health issues, chronic illnesses, lifestyle conditions such as diabetes and obesity, geriatric psychology, and practice in rural settings. Primary Care Psychology envisions goals whose practical significance and ultimate success face formidable obstacles related to retooling professional psychology’s educational and training structure, reimbursement, uncertainties about the future of the American health care system, and opposition from other health service providers who have a vested interest in maintaining the status quo.

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