Psychology at a Crossroads: The Role of Town Halls in Building Bridges

Introduction to Town Halls and the Town Hall Speaker

Attendees of the Presidential Town Hall from across the US and around the globe were excited to hear from the speaker, Lynn Bufka, PhD, ABPP. She was introduced to prospective attendees in advance, and registrants were encouraged to submit their questions during registration or prepare to ask questions during the hour-long session. The first half of the session consisted of Dr. Bufka’s commentary on four prepared questions developed by the event organizers. The second half was devoted to a question-and-answer portion where attendees submitted questions and Dr. Bufka responded.

Lynn Bufka, PhD, ABPP, became Head of Practice at the APA in 2024 after working within the APA for more than 20 years. The practice team is now part of a larger psychology team that applies psychological knowledge to develop solutions for many of the nation’s pressing challenges. Practice staff’s primary aim is the development and implementation of efforts to ensure psychology is an integral aspect of meeting the public’s mental health needs and addressing barriers facing psychologists in their provision of services. Dr. Bufka’s career has focused on using psychological knowledge to inform programs and policies about ways to improve the quality of care delivered by psychological professionals. Her contributions include helping develop various guidelines, including the APA Guidelines on Evidence-Based Psychological Practice in Health Care (American Psychological Association [APA], 2021a). Additionally, Dr. Bufka frequently serves as a media spokesperson for the APA on current events and policy matters relevant to mental health and psychological practice.

Four Initial Questions About Pressing Issues Facing Psychotherapy Today

1) How is the APA advocating for psychotherapy at the national level?

As the leading scientific and professional organization for psychology in the US, the APA, and its companion 501(c)(6) organization, APA Services, Inc. (APASI), advocate for the research, education, and practice of psychology. APA broadly advocates for psychology, psychologists, and psychological services provided, including psychotherapy and funding to continue to innovate and evaluate targets such as outcomes, dissemination, and effectiveness.

As legislative challenges emerge, they continue to provide commentary, equipping professionals with guidance and lawmakers with information. For instance, the APA/APASI’s response center has detailed many of these actions, including partnering with the Committee for Education Funding to draft a letter to the US Education Secretary and 8,000 messages to Congress opposing efforts to eliminate the Department of Education (American Psychological Association Services, Inc. [APASI], n.d.). Schools are a primary mental health access point in many communities, including those with geographic and economic challenges. In a meta-analysis, Duong and colleagues (2021) found that schools were the most common location of mental health services for children in the general population and children with established mental health diagnoses. Considering this, the threat to educational resources that the dismantling of the Department of Education would pose will impact the ability of many youths to access services. 

Additionally, APA/APASI are working alongside other organizations to educate psychologists and other mental health community members and stakeholders about the anticipated impact of the One Big Beautiful Bill Act (2025), its nearly $1 trillion in cuts to federal health care spending, and the resulting reduction in access to behavioral health services (APASI, 2025a). Further, when paired with the limitations placed on graduate loans and provider shortages in fields like psychology, mental health counseling, and social work, access to care is likely to be significantly impacted (APASI, 2025b). APA/APASI are working with counterparts at both the federal and state levels to prepare for the implementation of the One Big Beautiful Bill Act (2025) over the coming months and to protect Medicaid’s vital role in providing access to care for millions of Americans.  

2) What are some emerging pressures impacting clinical practice, training, and supervision?

When considering emerging pressures, Dr. Bufka expressed cautious optimism. More specifically, Dr. Bufka anticipates challenges with the limited opportunities offered to prospective students and trainees in psychology. Most students pursuing graduate level education in psychology rely on federal loans and assistantships to fund their education (Doran et al., 2016). With recent threats to funding opportunities, even fewer people will have the privilege or ability to pay for their education without financial support. An additional concern is regarding the closure of training sites (where students earn clinical training hours and receive specialized training) as a result of funding prioritization changes. SAP President Stewart Cooper, PhD, ABPP, recalled the recent closure of an internship placement site in his local community that is expected to decrease the number of training sites and opportunities available to trainees, potentially prolonging the time to licensure for early career professionals and creating the loss of services for many community members in need.

Another significant area of concern is the sweeping cuts to Medicaid, which covers nearly one in three U.S. adults with a diagnosed mental illness. Medicaid provides insurance coverage to many vulnerable populations, including children, disabled individuals, low-income individuals and families, and older adults with Medicare. With vulnerable populations representing the majority of individuals who receive Medicaid, these cuts will increase out-of-pocket expenses and significantly reduce access to essential care and services (Buchmueller et al., 2015). Furthermore, agencies and providers that rely on Medicaid to operate may no longer be able to afford to remain open – thereby further limiting opportunities for individuals to obtain care. This could exacerbate the access divide in psychotherapy, where high-income Americans can more easily access private practice therapists while low-income Americans may struggle to afford therapists with availability and necessary expertise (Delgadillo et al., 2016; Kugelmass, 2016).

3) What are the implications of psychology’s evolving professional structure for both doctoral and master’s level providers?

The U.S. has seen an increase in the number of practicing mental health professionals who hold a master’s degree (BLS, 2022; Robiner, 2006). As of 2022, some estimates suggest as many as 84% of mental health professionals in the U.S. have terminal master’s degrees as opposed to doctoral degrees (Comer & Comer, 2022). According to the Bureau of Labor Statistics, the projected employment growth for substance use, behavioral disorder, and mental health counselors is expected to be 18% between 2022 and 2032 (Strong growth projected in mental health-related employment, 2024). Alternatively, the projected growth for clinical and counseling psychologists is at 11%. While most master’s level clinicians (MLC) are trained in programs with areas of specialty, including counseling, social work, and marriage and family therapy, a growing number of programs now offer the opportunity to gain state licensure in clinical psychology after earning a master’s degree (Stringer, 2025). Dr. Bufka noted there are currently 19 U.S. jurisdictions that provide psychology licensure or registration for MLCs. These jurisdictions differ in the responsibilities granted to MLC’s : 6 allowing for independent practice (e.g., Texas), 11 requiring supervised licensure/practice (e.g., Michigan), and 2 offering a combination (e.g., Kansas). Depending on the state, MLCs vary in their earned title, though the term “psychologist” has traditionally been restricted to doctoral-level practitioners. Although graduates of these programs often desire to practice in psychology, state regulations vary greatly. This shift is the first step towards addressing the structural barriers that MLCs often encounter when attempting to access the APA and its resources (see Jackson-Wolf & Nutt Williams, 2025).  

Acknowledging this change, the APA established a task force focused on the accreditation of master’s-level clinical, counseling, and school psychology programs to demarcate core competencies differentiating MLCs from those who hold a doctoral degree (Larson, 2019). Given the lack of such guidance outside of the Standards of Accreditation (APA, 2021d) including those delineating responsibilities and services appropriate for MLCs, the APA has since updated its Model Act for State Licensure of Psychologists (APA, 2010; Model Licensure Act; Stringer, 2025). Open questions remain about the types of client populations, presenting problems, interventions, etc. appropriate from MLCs and how this might differ (if at all) from doctor degree psychologists. In the future, it will be up to individual jurisdictions to determine whether to adopt a process for licensure of MLCs within psychology or to modify existing regulations to align with proposed national models.

The authors make note of the absence of research or evidence indicating doctorate-level psychologists are more effective psychotherapists than MLCs. Studies clearly outline the psychotherapeutic benefits to patients when working with properly trained and licensed providers compared to working with paraprofessionals or graduate students (Johnsen & Friborg, 2015; Walsh et al., 2019). However, when comparing licensed PhD/PsyD providers and licensed MLCs (and especially those with equivalent clinical experience), research has not demonstrated evidence of patients having a preference to work with doctorate-level or master’s level therapists. For example, Grainger and colleagues (2022) found no significant differences in trauma-focused cognitive behavioral therapy treatment outcomes based on practitioner education level.

Dr. Bufka anticipates several trends with regard to the evolving professional structure in the field. First, she anticipates greater specialization among doctoral-level psychologists. Second, more complex cases may find themselves routed to these specialized PhD/PsyD psychologists. Third—and considering that a greater proportion of clinical supervisors and trainers may come from a PhD/PsyD background—Dr. Bufka anticipates doctoral-level psychologists will increasingly fill the role of supervisors for MLCs and trainees, shifting away from direct practice and into leadership positions, program development and implementation, community connections, and adoption of innovations.

4) What is the future of equity, diversity, and inclusion in psychotherapy amidst changing state and national policies?

There is a creeping erosion of values in the field of psychology that has the ability to significantly impact mental health and psychotherapy services in the immediate future, particularly with regard to equity, diversity, and inclusion. One of the recent changes with the greatest potential impact is the rollback of EDI initiatives. Recent legislative and executive actions, such as Executive Order No. 14168 (Exec. Order No. 14,168, 2025) regarding gender ideology and Executive Order No. 14151 (Exec. Order No. 14,151, 2025) regarding government EDI programs, have fostered unease among professionals, across domains concerned with mental health care, who recognize the potential impact of these orders and the need for equity, diversity, and inclusion (American Psychological Association, 2025; NASW responds to trump administration executive orders 2025).

Even as external pressures grow, Dr. Bufka asserted that tailoring psychological services to the individual patient with focused consideration on sociocultural factors will remain essential. Empirical evidence supports this stance, demonstrating in multiple studies that culturally adapted interventions outperform their standard version in reducing symptoms of psychopathology while increasing client satisfaction (Ellis et al., 2022; Griner & Smith, 2006; Hall et al., 2016). However, the ability to effectively adapt interventions effectively requires continued trainings in cultural humility and comfort. Trainings that are invaluable to providers at every experience and education level are, yet another significant consequence of EDI rollbacks voiced by Dr. Bufka. The faculty responsible for instilling the next generation of mental health professionals with a multicultural orientation may feel academic and legal pressure to reduce cultural training opportunities out of fear of legal repercussions. The APA continues to argue for equal access to training and education (American Psychological Association Services, Inc., n.d.), including the engendering of an appreciation for cultural differences among training professionals.

Evidence suggests that cultural formulation assignments can improve graduate students’ multicultural orientation during training. These formulations provide greater understanding of critical concepts, including power and privilege in the therapy dynamic, varied intersectional identities among clients, culturally considerate approaches to addressing mental health, and balancing cultural norms of clients and their individualized lived experiences (Tormala et al., 2018). These policy changes present a clear threat to such assignments: If faculty are prevented from explicitly addressing identity, the next generations of clinicians will enter the field without the critical skills required to treat those who differ from themselves. This subsequently impacts the ability of supervisors to teach and guide their supervisees in developing these skills (Watkins et al., 2019).

Finally, these executive orders have concerning implications for practice, especially by opening the door to discredited and harmful “treatments” like conversion therapy. Conversion therapy, or “practices to change sexual orientation or gender identity/gender expression,” was commonly used before the removal of homosexuality from the Diagnostic and Statistical Manual in 1973 (APA, 2024b). The practice has shown no efficacy and carries significant risks to participants (APA, 2009). The APA has clearly condemned its use, denied any empirical support, and encouraged practitioners to affirm clients’ sexual orientations (APA, 2021c) and gender identities (APA, 2021b). Additionally, members of APA have advocated for state laws banning conversion therapy (e.g., Dr. Lucy Homans of Washington State; Homans, 2018). The recent federal changes have caused increasing concern that such practices may become more prominent. For example, Indiana passed a state law preventing the government or professional organizations (e.g., APA) from legally banning conversion therapy or other potentially harmful interventions (SB 350, 2023). Reports suggest that at least 1,300 individuals are currently practicing conversion therapy in the U.S.; state laws like this could result in more practitioners (The Trevor Project, 2023). Collectively, these changes warrant psychologists and state organizations to contact their state representatives to stop harmful practices.

Where Does the Field Go from Here?

Changes at the national level have led to rising ambiguity for many practicing professionals in the field of psychology. To clarify some of this ambiguity, the recent town hall was organized by APA Division 29 and in partnership with APA Head of Practice, Lynn Bufka, PhD, ABPP. Dr. Bufka prioritized connecting an APA representative and frontline providers in order to provide insight into the current climate within the APA and to provide a space for attendees to suggest new areas of focus and advocacy. If APA hopes to maintain trust with practitioners during uncertain times, town halls may become critical, offering a forum for direct communication. As argued here, APA/APASI’s and Division 29’s response to legislative and professional shifts will be important in shaping the accessibility, integrity, and future directions of psychology in the U.S. Deliberate and conscious communication through methods such as town halls like this one will be needed to ensure APA’s mission is sustained and to maximize impact.