Dr. John Norcross talks about Public Health approach to psychotherapy.
LF: How would you take a Public Health approach to psychotherapy? I’m curious about how you see that being implemented.
JN: Well, in two or three ways. One is to be proactive, rather than waiting for people to call us, we go out and get them. Now, that’s very different, and most psychotherapists say, “What? What about professional etiquette, boundaries and confidentiality?” Well, all those can be maintained. But a Public Health perspective says, “We’re not going to wait for late stage diabetic, heavy smokers, morbidly obese people to wander into our office. If we know about them and respecting their choices and value systems, we can proactively find them and offer them services. Through, for example, primary care physicians, school networks, work place settings – so rather than sitting and waiting for them, we go out and invite them to the party.
And we’ve been doing that for 30 years when it comes to the Stages of Change. And they do come, as long as you don’t try to move them immediately to Action. If they’re in Pre-Contemplation, we say, for example, “Are you smoking? Want to think about changing but not ready to be forced yet?” Those people are ready to talk to us, though they may be in Pre-Contemplation and Contemplation.
The second thing to do, is not to focus on one-on-one psychotherapy. Even though that’s what you and I practice and I teach. We know that’s not the most efficient way of reaching the entire population: No epidemic was solved by treating one person at a time. So instead, we may have to become more creative with computerized therapies, self-help resources, large groups, community networks. I don’t find any of these to be incompatible with psychotherapy. I think, again, about a continua. The new terminology these days is Step Care.