The Predicted Future of Psychotherapy: A Decennial e-Delphi Poll

Abstract

Whither psychotherapy in the 2030s? Following a decennial tradition, the authors conducted an e-Delphi poll on the future of psychotherapy in the United States. A panel of 56 psychotherapy experts participated in two rounds of predictions and achieved consensus on most items. The experts forecast multicultural, mindfulness, and cognitive-behavior therapies to increase the most, whereas classical psychoanalysis, reality therapy, and gestalt therapy to decrease the most. Technological, relationship-building, strength-oriented, skill-building, and self-change interventions were expected to rise. Master-level clinicians of multiple professions were projected to expand while psychiatrists to decline in the proportion of psychotherapy rendered. Therapy platforms with the highest likelihood of flourishing were videoconferencing, texting, smartphone applications, and multiple or flexible platforms. Short-term therapy, crisis intervention, and very short-term therapy were predicted to increase the most. Forecast scenarios with the highest likelihood were therapy personalization, treatment of health problems, requirement of evidence-based practices for insurance reimbursement, and integration of psychotherapy into primary care. Limitations of the Delphi methodology are elucidated, and practice implications for health-service psychologists are advanced.

Every decade, starting in 1980, colleagues and we have conducted a Delphi poll on the future of psychotherapy in the United States. In the early 1980s, the expert panelists anticipated a shift in theoretical orientation from psychoanalytic to cognitive-behavioral therapy and the replacement of long-term therapy with short-term therapy (Prochaska & Norcross, 1982). Ten years later, experts opined that self-help groups and masters-level practitioners would proliferate and that the proportion of psychiatrists conducting psychotherapy would diminish (Norcross et al., 1992). In the early 2000s, the experts prognosticated that practice guidelines, behavioral medicine, and pharmacotherapy would steadily expand (Norcross et al., 2002). Most recently, in the 2010s, mindfulness therapies and psychotherapy conducted via the Internet were expected to flourish (Norcross et al., 2013). These decennial studies, despite the occasional prognostic miss, have in general accurately predicted the general trajectory of psychotherapy and highlighted core forces that shape its emergent practices.

Research supports that the results of Delphi polls usually render the most accurate answers to complex questions compared to other prognostication techniques (Boronson, 1980; Parente & Anderson-Parente, 2011). The group consensus of Delphi polls also consistently outperforms individual expert opinion (Ascher, 1978; Linstone & Turoff, 1975), even for volatile world events (Parente et al., 2005). For these reasons, the Delphi method is a robust research method, especially in the health sciences (Blease et al., 2020; Donohue et al., 2012; Sundermann et al., 2019) and increasingly in professional psychology (e.g., Bedi et al., 2014; Taylor et al., 2019). Recent advancements in the Internet have encouraged e-Delphi applications that mitigate its limitations and maximize its advantages (Donohue et al., 2012).

Keeping with this decennial tradition, the aim of this updated and expanded e-Delphi poll was to garner expert consensus on psychotherapy in the United States during the next decade. We sought to help illuminate the path forward for psychotherapy.

Delphi Methodology

The Rand Corporation developed the Delphi method in the early 1950 as part of military research on expert opinion. This method was developed to address complex questions and efficiently render reasonably accurate opinions on future events or directions (Linstone & Turoff, 1975). “The Delphi approach is particularly well-suited for emerging areas of inquiry and for building consensus among a group of experts. When it is used for these purposes, few weaknesses exist” (Fish & Busby, 1996, p. 478).

In the Delphi methodology, a panel of experts answer the same questionnaire over at least two rounds. In round one, the experts answer the questionnaire anonymously and without knowledge of their peers’ responses. In subsequent rounds, the experts are provided with their peers’ responses and are given the opportunity to revise their predictions considering peers’ responses. The accuracy of probability forecasts increases over Delphi rounds, up to the second round (Ascher, 1978), and when statistical summaries are provided (Rowe et al., 2005).

The Delphi Survey and Panel

Based on previous Delphi polls, we created a multi-page, electronic questionnaire on SurveyMonkey. Some items were eliminated from previous polls, and new items were added to the current poll to reflect recent developments. Regarding theoretical orientations of the future, for example, we deleted items referring to Adlerian therapy, eclectic therapy, and Jungian therapy, while adding items on Cognitive Processing Therapy (CPT), Emotion-Focused Therapy (EFT), gay-affirming therapies, mentalization-based therapies, Multisystemic Therapy (MST), and supportive therapy. The questionnaire comprised six sections: theoretical orientations (36 items), therapeutic methods/interventions (47 items), psychotherapists (12 items), psychotherapy platforms (6 items), psychotherapy formats (10 items), and forecast scenarios (30 items). The psychotherapy platform section was new to this e-Delphi exercise.

The panel predicted whether each psychotherapy practice would increase or decrease over the next 10 years in the United States. Responses on the first five survey sections were recorded on a 7-point, Likert-type scale where 1 = great decrease, 2 = moderate decrease, 3 = slight decrease, 4 = remain the same, 5 = slight increase, 6 = moderate increase, and 7 = great increase. Responses on the forecast scenarios section were recorded as 1 = very unlikely, 2 = moderately unlikely, 3 = slightly unlikely, 4 = uncertain, 5 = slightly likely, 6 = moderately likely, and 7 = very likely.

In the instructions, we repeatedly emphasized that we sought a “prediction of what will happen, as opposed to what you personally would like to happen.” In this way, we hoped to minimize wishes disguised as predictions or preferences masked as prognostications. Otherwise, many forecasts in the uncertain world of psychotherapy tend to resemble self-fulfilling prophecies or magical wishes (Ekstein, 1972).

Our procedure followed conventional Delphi methodology in which panelists responded to the same questionnaire on multiple rounds. An email containing a link to the questionnaire was sent to each expert in January 2021. Responses were then pooled and analyzed. The same questionnaire, containing the means and medians on all items from the first round, was redistributed to the panelists in March 2021. Individual responses were not (and could not be) identified.

The population of interest was 107 psychotherapy experts: 67 living contributors to the second edition of the History of Psychotherapy (Norcross et al., 2010) and 40 editors of mental health journals routinely publishing articles on psychotherapy. We made a concerted effort to recruit journal editors of color by including eight mental health journals specializing in cultural diversity. Seventy-six of the 107 experts responded to the first round of the questionnaire; however, nine responded that they were retired, and two stated they were no longer working in the field. Thus, the total response rate from round one was 71%, and the usable response rate from round one was 61%.

Fifty-six of those 65 responding experts provided their names and email addresses, along with permission to acknowledge their participation. The 56 responding experts were subsequently emailed the second round of the same poll containing numerical results of each item from the first round. All 56 experts completed the second round of the Delphi poll.

The panel consisted of distinguished and experienced psychotherapists. All panelists held a doctoral degree (93% PhD, 3%, MD, 2%, PsyD, 2% EdD) and reported an average of 36 years (SD = 11.70) of postdoctoral clinical experience. Seventy percent of panelists identified their gender as male, 29% as female, and 1% did not indicate a gender. Most panelists identified their race/ethnicity as White (88%), 5% as Asian or Pacific Islander, 2% as Hispanic or Latino, 2% as Native American or Alaskan Native, 2% as Multicultural or Biracial, and 1% as other. Panelists devoted an average of 38% of their professional time to research/editing, 24% to administration, 22% to teaching, 17% to supervision, 16% to clinical work, and 15% to other activities. The employment setting of most panelists was university departments (55%), followed by independent practices (12%) and medical schools (8%). The experts represented diverse theoretical orientations: cognitive-behavioral (27%), integrative (17%), psychodynamic (14%), experiential (5%), relational (3%), and solution-focused (3%).

Results

A central goal of the Delphi method is to reach a consensus among the expert panel. This goal was probably achieved, as illustrated by decreases in item standard deviations for 121 of the 141 (86%) items from the first to the second round. Thus, providing numerical feedback to the panel of experts reduced disparity concerning the evolution of psychotherapy in the next decade.

The following tables present the item means and medians from both rounds in descending order. The items are rank ordered based on the results from the second round. Bold lines in the table divide them into three categories: items the experts expected to increase (mean of 4.5 or higher), items the experts expected to stay about the same (mean of 3.5 – 4.49), and items the experts expected to decrease (mean of 3.49 or lower) over the next decade.

Theoretical Orientations

Our expert panel predicted the use of a variety of theoretical orientations over the next decade in the United States. Figure 1 portrays these forecasts: nine orientations were expected to increase, 15 were expected to stay about the same, and 12 were expected to decrease over the next decade. The orientations expected to increase the most were multicultural, mindfulness, cognitive-behavior, motivational interviewing, acceptance and commitment, gay-affirming, and dialectical behavior therapies. On the other hand, the orientations expected to decrease the most were classical psychoanalysis, transactional analysis, reality therapy, and gestalt therapy.

Figure 1.

Predicted Changes in Theoretical Orientations in Rank Order

Therapeutic Methods/Interventions

Our expert panel predicted trends for therapeutic methods/interventions; these results are summarized in Table 1. Eighteen therapeutic methods/interventions were predicted to increase, 18 to stay about the same, and 11 to decrease. The methods/interventions expected to increase the most featured computer technologies (online self-help, virtual reality, social networking), relational skills (routine outcome monitoring, fostering the therapeutic alliance), strength-oriented methods (positive psychology, well-being methods), skill-building techniques (teaching emotion regulation, homework assignments, relapse prevention, behavioral activation, cognitive restructuring, and problem-solving techniques), and client self-change (self-change techniques, recommendation of self-help. In contrast, free association, aversive conditioning, encounter exercises, and dream work were predicted to decrease the most.

Table 1.

Predicted Changes in Therapeutic Methods/Interventions in Rank Order

	Round 1		Round 2
Therapeutic intervention	M	SD	M	SD	Rank
Online self-help	5.79	0.99	5.75	0.84	1
Virtual reality methods	5.24	1.10	5.11	1.02	2
Routine outcome monitoring (ROM)	5.03	1.06	5.05	1.02	3
Teaching emotional regulation	4.95	0.97	5.04	0.89	4
Fostering the therapeutic alliance	5.03	0.92	4.98	0.91	5
Acceptance methods	4.94	0.90	4.96	0.78	6
Positive psychology methods	4.94	0.94	4.78	0.91	7
Homework assignments	4.86	0.96	4.75	0.88	8
Relapse prevention	4.84	0.87	4.74	0.91	9
Social networking interventions	4.61	1.05	4.67	0.82	10
Meditation methods	4.87	1.01	4.67	0.84	11
Self-change techniques	4.61	0.94	4.66	0.84	12
Well-being methods	4.73	0.91	4.65	0.80	13
Behavioral activation	4.65	1.05	4.61	0.98	14
Cognitive restructuring	4.56	0.96	4.59	0.85	15
Behavioral rehearsal/in-session roleplaying	4.53	0.85	4.55	0.78	16
Recommendation of self-help	4.84	0.99	4.54	0.95	17
Problem-solving techniques	4.65	0.94	4.52	0.74	18
Communication skills	4.51	1.13	4.48	0.76	19
Interpersonal support	4.62	0.71	4.46	0.76	20
Accurate empathy	4.62	0.85	4.43	0.77	21
Forgiveness methods	4.47	0.92	4.36	0.88	22
Self-control methods	4.37	0.81	4.34	0.79	23
Expressing caring & warmth	4.60	0.77	4.31	0.90	24
Relaxation techniques	4.40	1.12	4.30	0.84	25
In vivo exposure	4.32	1.04	4.23	1.10	26
Therapeutic journaling	4.19	0.82	4.16	0.68	27
Solution-focused methods	4.42	0.98	4.11	0.78	28
Advice/direct guidance	4.11	0.93	4.00	0.80	29
Bibliotherapy	4.24	0.91	4.00	0.96	30
Psychedelic drugs	3.86	1.53	3.96	1.25	31
Therapist self-disclosure	3.97	0.88	3.95	0.96	32
Imagery	4.18	0.92	3.89	0.80	33
Contingency management methods	3.86	1.12	3.64	0.87	34
Metaphors	3.95	0.89	3.68	0.77	35
Challenges/confrontation	3.52	0.98	3.50	0.91	36
Biofeedback	3.73	1.15	3.43	1.01	37
Systematic desensitization	3.33	1.06	3.27	1.01	38
Analysis of resistance	3.16	1.03	3.02	1.04	39
Hypnosis	3.11	1.07	2.93	0.93	40
Transference interpretation	2.89	0.92	2.70	0.87	41
Paradoxical interventions	2.85	1.08	2.62	0.96	42
Cathartic methods	2.71	1.05	2.55	0.81	43
Dream work	2.68	0.96	2.50	0.95	44
Encounter exercises	2.63	1.01	2.38	0.97	45
Aversive conditioning	2.34	1.00	2.09	0.79	46
Free association	2.24	0.82	2.09	0.84	47

Note. 1 = great decrease, 4 = remain the same, 7 = great increase. Bold lines divide the table into three categories: items the experts expected to increase (mean of 4.5 or higher), items the experts expected to stay about the same (mean of 3.5 – 4.49), and items the experts expected to decrease (mean of 3.49 or lower) over the next decade.

Psychotherapists

Our experts predicted that six professions of psychotherapists would expand, five would stay about the same, and one would diminish over the next decade (see Table 2). Master-level counselors and clinical social workers were predicted to increase the most within the next 10 years. Psychiatric nurses, personal coaches, master-level family therapists, and self-help groups were also predicted to increase, but psychologists, peer counselors, and paraprofessionals were expected to remain about the same. Psychiatrists, however, were the only discipline predicted to provide psychotherapy at a decreased rate.

Table 2.

Predicted Changes in Psychotherapists in Rank Order

	Round 1		Round 2
Type of therapist	M	SD	M	SD	Rank
Master-level counselors	5.41	0.98	5.42	0.85	1
Clinical social workers	4.98	0.93	5.05	0.80	2
Psychiatric nurses	4.73	0.83	4.81	0.89	3
Personal coaches	4.65	0.93	4.71	0.85	4
Master-level family therapists	4.78	0.87	4.71	0.94	5
Self-help groups	4.56	0.82	4.59	0.94	6
Psychologists	4.37	1.14	4.38	0.87	7
Peer counselors	4.43	0.98	4.33	0.98	8
Paraprofessionals	4.31	0.90	4.13	1.01	9
Pastoral counselors	4.05	0.75	3.80	0.80	10
Baccalaureate-level therapists	4.02	1.01	3.80	0.97	11
Psychiatrists	3.00	1.09	2.74	0.84	12

Note. 1 = great decrease, 4 = remain the same, 7 = great increase. Bold lines divide the table into three categories: items the experts expected to increase (mean of 4.5 or higher), items the experts expected to stay about the same (mean of 3.5 – 4.49), and items the experts expected to decrease (mean of 3.49 or lower) over the next decade.

Psychotherapy Platforms

New to this Delphi Poll, we asked experts to predict the trajectories of psychotherapy delivery platforms. E-Therapy – videoconferencing, texting, multiple or flexible platforms – and smartphone apps will likely increase the most over the next 10 years (Table 3). Interestingly, no platforms were predicted to decrease over the next 10 years. The frequency of in-person, face-to-face sessions was expected to remain about the same.

Table 3.

Therapy Platforms in Rank Order

	Round 1		Round 2
Type of platform	M	SD	M	SD	Rank
Therapy via videoconferencing	5.98	0.78	5.93	0.60	1
Therapy via multiple or flexible platforms	5.94	0.81	5.76	0.79	2
Therapy via smartphone apps	5.39	0.74	5.07	0.57	3
Therapy via telephone	4.56	1.05	4.67	0.92	4
Therapy via texting	4.69	0.88	4.52	0.79	5
Therapy via in-person, face-to-face	3.58	0.88	3.58	0.76	6

Note. 1 = great decrease, 4 = remain the same, 7 = great increase. Bold lines divide the table into two categories: items the experts expected to increase (mean of 4.5 or higher), items the experts expected to stay about the same (mean of 3.5 – 4.49) over the next decade. The experts did not expect any platforms to decrease (mean of 3.49 or lower) over the next decade.

Psychotherapy Formats

In line with our previous Delphi polls, short-term therapy, crisis intervention, and very short-term therapy were predicted to increase most notable in the next decade (Figure 2). The current Delphi results also showed an increase in population-level interventions and psychoeducational groups for specific disorders. Once again, individual, couple/marital, conjoint family, and group therapy was predicted to remain about the same while long-term therapy was forecast to decline further.

Figure 2.

Predicted Changes in Therapy Formats in Rank Order

Forecast Scenarios

The Delphi experts predicted the likelihood of 30 forecast scenarios; 28 of which were expected to increase or stay about the same and only two to decrease (Table 4). The scenarios with the highest likelihood of increasing over the next decade were therapy personalization to patient’s cultural identity (e.g., race/ethnicity and sexual orientation), transdiagnostic characteristics (e.g., preferences, reactance level, and stage of change), and primary disorder/condition. In addition, the experts prognosticated that treating the behavioral components of health problems and chronic illnesses, insurance carriers requiring evidence-based practices for reimbursement, continued management of reimbursement costs, increased integration of psychotherapy into primary care, standardized practice guidelines for daily psychotherapy, and psychotherapists help with simultaneously changing multiple behaviors.

Table 4.

Predicted Scenarios in Rank Order

	Round 1		Round 2
Scenario	M	SD	M	SD	Rank
Psychotherapists increasingly personalize therapy to patient’s cultural identities (e.g., race/ethnicity, sexual orientation).	5.94	0.90	5.69	0.79	1
Psychotherapists increasingly personalize therapy to patient’s transdiagnostic characteristics (e.g., preferences, reactance level, stage of change).	5.55	0.88	5.35	0.89	2
Psychotherapists routinely treat the behavioral components of health problems and chronic illnesses.	5.31	1.15	5.27	0.76	3
Evidence-based practices (EBP) are required by insurance carriers for reimbursement.	5.16	1.12	5.24	1.04	4
Psychotherapy becomes more integrated into primary care.	5.35	0.93	5.18	0.77	5
Psychotherapists increasingly personalize therapy to patient’s primary disorder/condition.	5.10	1.41	5.07	0.82	6
Practice guidelines become a standard part of daily psychotherapy.	4.97	1.02	5.07	0.88	7
Managing the reimbursement costs of psychotherapy (e.g., limiting the amount, only “medically necessary” services, restricting choices of practitioners and treatments) continues.	5.13	0.97	5.05	0.78	8
Psychotherapists help patients simultaneously change multiple behaviors.	4.95	1.12	5.04	0.75	9
Psychotherapists devote a greater percentage of sessions to cultivating strengths as opposed to treating psychopathology.	4.92	1.00	4.82	0.86	10
A number of additional states legislatively allow psychologists to prescribe psychotropic medications.	4.66	1.17	4.82	1.14	11
The overall length (number of sessions) of psychotherapy decreases.	4.74	1.12	4.74	0.75	12
Psychotherapists spend more time working toward non-abstinence treatment goals for addictive behaviors (e.g., harm reduction).	4.84	0.73	4.71	0.92	13
Psychotherapists become more involved in community action, e.g., politics, social change.	4.66	1.13	4.59	0.94	14
Psychotherapy research provides prescriptive “treatments of choice” for many disorders.	4.63	1.27	4.49	1.12	15
Artificial intelligence and machine learning improve treatment matching/selection and thus the effectiveness of psychotherapy.	4.58	1.25	4.49	1.18	16
Psychotherapists become more involved in advocating for policies to curtail climate change.	4.28	1.32	4.33	1.18	17
Pharmacotherapy/psychopharmacology expands at the expense of psychotherapy.	4.39	1.27	4.33	1.29	18
Psychotherapists increasingly personalize therapy to patient’s biomedical or genetic markers.	4.23	1.42	4.31	1.20	19
The US approves and institutes a national health insurance (including coverage for mental and addictive disorders).	4.08	1.51	4.31	1.24	20
Developments in neuroscience increase the effectiveness of psychotherapy.	4.32	1.60	4.31	1.39	21
Psychotherapists proactively outreach to entire populations at risk for or suffering from behavioral disorders.	4.32	1.21	4.25	1.12	22
Psychotherapists spend proportionally more of their professional time on prevention.	4.16	1.46	4.24	1.12	23
Psychotherapists increasingly integrate spiritual and religious content into treatment.	3.98	1.15	4.14	1.02	24
The overall effectiveness of psychotherapy improves appreciably.	4.11	1.42	4.04	1.18	25
Psychotherapists spend more professional time evaluating requests for emotional support animals and service animals.	3.71	1.22	3.87	1.20	26
The number of full-time positions keep pace with the number of new psychotherapists entering the field.	3.69	1.24	3.84	1.10	27
Psychotherapy expands at the expense of pharmacotherapy/psychopharmacology.	3.50	1.36	3.62	1.25	28
Revolutionary new techniques of psychotherapy are discovered and replace traditional treatments.	3.00	1.55	3.15	1.28	29
Finally, what is the likelihood that a group of expert psychotherapists can accurately predict the future of psychotherapy?	2.56	1.50	2.65	1.24	30

Note. 1 = very unlikely, 4 = uncertain, 7 = very likely. Bold lines divide the table into three categories: items the experts expected to increase (mean of 4.5 or higher), items the experts expected to stay about the same (mean of 3.5 – 4.49), and items the experts expected to decrease (mean of 3.49 or lower) over the next decade.

The two scenarios expected to decrease over the next decade were the discovery and replacement of traditional treatments with revolutionary psychotherapy techniques and the likelihood of expert psychotherapists accurately predicting the future of psychotherapy.

Impact of Theoretical Orientation

Despite our repeated instruction for experts to predict what would happen rather than what they would like to happen, they may still forecast their own preferred theories in a more favorable light. For that reason, we compared the predictions on theoretical orientations among panelists who endorsed cognitive-behavioral (n = 18), integrative (n = 10), psychodynamic/relational (n = 10), and other (n = 21) orientations. Panelists who subscribed to cognitive-behavioral theories rated their future significantly more favorably (M = 5.78) than did panelists who endorsed integrative (M = 4.80), psychodynamic/relational (M = 4.40), and other (M = 4.86), p = .02. Similarly, integrative therapists rated the future of integrative therapy significantly higher (M = 5.50) than cognitive-behaviorists (M = 4.11), psychodynamic/relational therapists (M = 4.10), and other (M = 5.10), p = .004. However, no differential predictions were made on the future of psychodynamic therapy, p = .30. When we compared ratings on all 36 theoretical orientations, we determined that only six were significantly different due to the panelists’ orientations. Thus, there was robust convergence in predictions but modest allegiance bias.

Discussion

Delphi and its Discontents

Before expounding on these e-Delphi results, we consider several of their limitations. First, the demographics of our expert panel (and journal editors, in general) were not sufficiently representative in terms of gender (70% identified as male) or race/ethnicity (88% identified as White). These percentages do not reflect the profession of psychotherapy as it is developing or the populations it seeks to serve. The absence of Blacks or African Americans suggest a biased perspective in psychology’s editorial process (Roberts et al., 2020), as in other disciplines Second, our expert panelists’ predictions reflect relative increases and decreases within the field rather than absolute changes. Third, we found in this poll, as in previous incarnations (Norcross et al., 2002, 2013), a modest allegiance bias in favor of the experts’ own theoretical orientation. Fourth, overestimating the exactitude of forecasts can lead to overconfidence and inaccuracy (Silver, 2012). The “prediction paradox” holds that the humbler we are in our prediction making abilities, the more successful we can be in planning the future (Silver, 2012).

As was the case in all of our Delphi polls, the panelists believe it is somewhat unlikely that a group of expert psychotherapists can accurately predict the future of psychotherapy. This pattern of incredulity embodies the humble approach to forecasting and probably reflects the converse of the Dunning–Kruger effect, whereby people with low ability at a task overestimate their ability. These psychotherapy experts have indeed correctly predicted the future of psychotherapy in our previous Delphi exercises.

Practice Implications

We aimed in this e-Delphi study to help illuminate the path forward for psychotherapy. What’s hot and what’s not in the next decade?

In 2031, expect continued movement toward e-practice. That will entail technologically based methods, such as online self-help, virtual reality, and social networking, conducted increasingly via online delivery platforms, such as videoconferencing, multiple platforms, texting, and smartphone apps. In-person, face-to-face therapy was expected to remain about the same, rather than decrease, despite the ascendancy of online platforms. This trend likely reflects our COVID-19 social environment, as many psychotherapists adopted “hybrid” delivery formats to practice during the pandemic. The trend may also reflect continuing increases in psychotherapy demand and ongoing destigmatization of mental health concerns given that the experts predicted an increase in e-practice without a corresponding decrease in face-to-face practice.

Personalizing services will also characterize psychotherapy in 2031. Similar to the premise of precision or personalized medicine, patients will progressively expect psychotherapy tailored to them, be that their gender identity, sexual orientation, or cultural identities. The two most probable forecast scenarios in this Delphi exercise were psychotherapists increasingly personalizing therapy to patient’s cultural identities and to patient’s transdiagnostic characteristics (e.g., preferences, reactance level, stage of change). These findings suggest keen recognition of social and cultural factors in personalizing care.

The treatment approach forecast to thrive most in our study was multicultural therapies. Given the underrepresentation of racial/ethnic experts in our Delphi poll, this result suggests a wider embrace of cultural impact than we might have otherwise expected.

In addition to technology, personalization, and multiculturalism, we interpret these results as prioritizing “the biggest bang for the smallest buck” in mental health. Cost-effectiveness and other economic forces underlie our panelists’ predictions. A future emphasizing short-term and very short-term therapies, masters-level clinicians, self-help resources, declining number of sessions, and management of reimbursement costs speaks to obvious financial drivers.

What of psychologists in 2031? The experts predict that psychologists will provide about the same proportion of psychotherapy, but the increasing numbers of master-level clinicians now – and forecast in the future – clearly suggest a loss of market share. Masters-level counselors, clinical social workers, psychiatric nurses, and family therapists will likely thrive, with psychologists languishing at least as psychotherapy providers. Of course, psychologists can and will conduct their distinctively psychological services – including psychological testing, neuropsychological assessment, prescriptive authority, clinical research, psychotherapy supervision – but not only psychotherapy in a competitive market. That is, health service psychology may prosper, but not only as comparatively more expensive psychotherapists.

The future of psychotherapy will bring new practice opportunities, as our experts view them in forecast scenarios. As with our previous Delphi poll (Norcross et al., 2013), we predict increases in treating health problems and chronic illnesses, helping patients simultaneously change multiple behaviors, devoting more time to cultivating strengths, prescribing psychotropic medications (in select jurisdictions), and becoming more integrated into primary care. These would all mark a shift in practice responsibilities and continued expansion of psychologists into multiple healthcare settings. These developments will influence all clinicians, but some clinicians will choose to embrace them as new opportunities while others curse them.

With intentionality, planning, and advocacy, psychologists can transform some of these unfavorable predictions into alternative futures and implement the desirable predictions into self-fulfilling prophecies. We shall see…

Public Significance Statement:

This Delphi poll garnered expert consensus on the future of psychotherapy in the United States over the next decade. Experts predicted that multicultural theories, technological interventions, electronic therapy platforms, and short-term therapy will increase the most. Experts also predicted the ascendancy of master-level clinicians and psychotherapy personalization.

Biographies

JOHN C. NORCROSS received his PhD in clinical psychology from the University of Rhode Island and completed his internship at the Brown University Medical School. He is Distinguished Professor and Chair of Psychology at the University of Scranton, Clinical Professor of Psychiatry at SUNY Upstate Medical University, and a consultant to numerous organizations. His research interests include psychotherapy relationships, integrative treatments, clinical training, and clinician self-care.

RORY A. PFUND received his PhD in clinical psychology from the University of Memphis. He is currently a postdoctoral fellow at the Center on Alcohol, Substance use, And Addictions at the University of New Mexico. His areas of professional interest include treatments for addictive disorders and treatment engagement.

DANIELLE M. COOK received her BS in psychology from the University of Scranton. She is currently a Behavioral Health Technician for Children’s Service Center of Wyoming Valley. Her areas of professional interest include childhood stress, trauma, and maltreatment.