Managed care has become the dominant economic force in health care delivery and has challenged many of professional psychology's training concepts and cherished attitudes. Organized psychology has not kept pace with the rapid industrialization of health care during the past decade and has been overlooked as a participant in health economic decisions. A number of changes need to be made in professional education and training if psychology is to be a major player in the new health systems. Additionally, professional psychologists must reexamine some of their most generally accepted attitudes and beliefs if they are to survive. These are described with a number of recommendations for the survival of an embattled profession.The illiterate of the future are not those who cannot read or write, but those who cannot learn, unlearn and relearn.-Alan TofflerPsychotherapists have long been conditioned to believe that more is better, "self actualization" is the real goal of psychotherapy, and, consequently, the most prestigious practitioners are those who see a limited number of clients over a long period of time (Bloom, 1992). Managed care, with its emphasis on brief therapy, is changing all of this. A growing body of outcomes research demonstrates that efficient therapy can also be effective therapy (Bennett, 1994). For the past several years, it has been argued that most psychotherapists must receive retraining to become skillful in the efficient-effective therapies (Budman & Gurman, 1983, 1988. Over the past decade I have retrained literally hundreds of psychiatrists, psychologists, social workers, and counselors in a 130-hour module over a 2-week period and observed that for retraining to be successful, there must be significant changes in the practitioners' attitudes and belief systems. This "enabling attitude" has now only begun to receive the attention of those who are engaged in retraining practitioners (Bennett, 1994;Friedman & Fanger, 1991). Yet this point of view is now new. Balint (1957), in his monumental work, said,A further reason for the failure of traditional courses is that they have not taken into consideration the fact that the acquisition of psychotherapeutic skill does not consist only of learning something new: It inevitably also entails • • • a change in the doctor's personality, (p. 23) J. G. BENEDICT served as action editor for this article. NICHOLAS A. CUMMINGS received his PhD from Adelphi University in 1958. He is the founding chief executive officer (retired) of American Biodyne (now MedCo Behavioral Care Systems, a subsidiary of Merck). He is president of the Foundation for Behavioral Health and a former president of the American Psychological Association.
