POFFIsCIAyL PUcBLhICAToIONtOhF DIVeISIrONa29 pOF Ty HE AMERICAN PSYCHOLOGICAL ASSOCIATION www.divisionofpsychotherapy.org B

In This Issue Diversity Unique Perspective on Diversity: Experiencing U Intersecting Roles of Students in Clinical Training

Student Feature Preventing Distress and Impairment: The Importance L of Self-Care Education and Utilization During Graduate Training in Clinical Psychology

Diversity Disparities in Health and the Potential L Impact of Increased Access to Healthcare

Perspectives on Psychotherapy Integration Introduction To An Integrative Attachment-Based Model of Sexual and Loving Feelings in Psychotherapy E

Ethics In Psychotherapy Psychotherapy and the Suicidal Client: A Brief Introduction T E I 2010 VOLUME 45 NO. 4 N Ⅲ Division of Psychotherapy 2010 Governance Structure ELECTED BOARD MEMBERS President Domain Representatives Science and Scholarship Jeffrey J. Magnavita, Ph.D., ABPP Public Policy and Social Justice Norm Abeles, Ph.D., ABPP, 2008-2010 Glastonbury Psychological Associates PC Rosemary Adam-Terem, Ph.D., 2009-2011 Dept of Psychology / Michigan State University 300 Hebron Ave., Ste. 215 1833 Kalakaua Avenue, Suite 800 110C Psych Bldg Glastonbury , CT 06033 Honolulu, HI 96815 East Lansing , MI 48824 Ofc: 860-659-1202 Fax: 860-657-1535 Phone : 808-955-7372 Fax: 808-981-9282 Ofc: 517-337-0853 Fax: 517-333-0542 E-mail: [email protected] Cell: 808-292-4793 E-mail: [email protected] E-mail: [email protected] Diversity President-elect Caryn Rodgers, Ph.D., 2008-2010 Libby Nutt Williams, Ph.D . Professional Practice Prevention Intervention Research Center St. Mary’s College of Maryland Miguel Gallardo, Psy.D., 2010-2012 Albert Einstein College of Medicine 18952 E. Fisher Rd. Pepperdine University 1300 Morris Park Ave., VE 6B19 St. Mary’s City, MD 20686 18111 Von Karman Ave Ste 209 Bronx, NY 10461 Ofc: 240- 895-4467 Fax: 240-895-2234 Irvine , CA 92612 Ofc: 718-862-1727 Fax: 718-862-1753 E-mail: [email protected] Office: 949-223-2500 Fax: 949-223-2575 E-mail: [email protected] E-mail: [email protected] Secretary Diversity Jeffrey Younggren, Ph.D., 2009-2011 Education and Training Erica Lee, Ph.D. , 2008-2009, 2010-2012 827 Deep Valley Dr Ste 309 Sarah Knox, 2010-2012 80 Jesse Hill Jr. Rolling Hills Estates, CA 90274-3655 Department of Counselor Education and Atlanta, Georgia 30303 Ofc: 310 -377-4264 Fax: 310-541-6370 Counseling Psychology Ofc: 404-616-1876 E-mail: [email protected] Marquette University E-mail: [email protected] Milwaukee, WI 53201-1881 APA Council Representatives Treasurer Ofc: 414/288-5942 Fax: 414/288-6100 Norine G. Johnson, Ph.D., 200 8-2010 Steve Sobelman, Ph.D., 2007-2009 E-mail: [email protected] 110 W. Squantum #17 2901 Boston Street, #410 Quincy, MA 02171 Baltimore, MD 21224-4889 Membership Ofc: 617-471-2268 Fax: 617-325-0225 Ofc: 410-583-1221 Fax: 410-675-3451 Annie Judge, Ph.D., 2010-2012 E-mail: [email protected] Cell: 410-591-5215 2440 M St., NW, Suite 411 E-mail : [email protected] Washington, DC 20037 Linda Campbell, Ph.D., 2008-2010 Ofc: 202-905-7721 Fax: 202 -887-8999 Dept of Counseling & Human Development Past President E-mail: [email protected] University of Georgia Nadine Kaslow, Ph.D., ABPP 402 Aderhold Hall Emory University Department of Early Career Athens , GA 30602 Psychiatry and Behavioral Sciences Michael J. Constantino, Ph.D. , 2007, 2008-10 Ofc: 706-542-8508 Fax: 770-594-9441 Grady Health System Department of Psychology E-mail: [email protected] 80 Jesse Hill Jr Drive 612 Tobin Hall - 135 Hicks Way Student Development Chair Atlanta, GA 30303 University of Massachusetts Sheena Demery , 2009-2010 Phone: 404-616-475 Fax : 404-616-2898 Amherst, MA 01003-9271 728 N. Tazewell St. E-mail: [email protected] Ofc: 413-545-1388 Fax: 413-545-0996 Arlington, VA 22203 E-mail: [email protected] 703-598-0382 E-mail: [email protected] STANDING COMMITTEES Continuing Education Liaisons Program Chair: Rodney Goodyear, Ph.D. Committee on Women in Psychology Chair: Jack C. Anchin, Ph.D. 1100BWPH Rossier School of Education Rosemary Adam-Terem, Ph.D. 376 Maynard Drive Univeristy of Southern California 1833 Kalakaua Avenue, Suite 800 Amherst, NY 14226 Los Angeles CA 90089-0001 Honolulu, HI 96815 Ofc: 716-839-1299 Ofc: 213-740-3267 Tel: 808-955-7372 Fax: 808-981-9282 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] Past Chair: Nancy Murdock, Ph.D. Past Chair: Annie Judge, Ph.D. Membership E-mail: [email protected] E-mail: [email protected] Chair: Asha Ivey, Ph.D. Psychotherapy Research Education & Training Department of Psychology Chair: Susan S. Woodhouse, Ph.D. Chair: Kenneth L Critchfield, Ph.D. Dansby Hall -Morehouse College Dept of Counselor Education, Counseling IRT Clinic 830 Westview Drive, S.W. Psychology and Rehabilitation Services University of Utah Neuropsychiatric Institute Atlanta, GA 30314 Pennsylvania State University 501 Chipeta Way Ofc: 404-681-7561 313 CEDAR Building Salt Lake City, UT 84108 E-mail: [email protected] University Park, PA 16802-3110 Ofc: (801) 585-0208 Past Chair: Chaundrissa Smith, Ph.D. Ofc: 814-863-5726 Fax: 814-863-7750 E-Mail: [email protected] E-mail: [email protected] E-mail: [email protected] Past Chair: Eugene W. Farber, Ph.D. E-mail: [email protected] Nominations and Elections Publications Board Chair: Elizabeth Williams, Ph.D. Fellows Chair : Jean Carter, Ph.D . 2009-2014 5225 Wisconsin Ave., N.W. #513 Chair: Jeffrey Hayes, Ph.D. Professional Awards Washington DC 20015 Pennsylvania State University Chair: Nadine Kaslow, Psy.D. 312 Cedar Bldg Ofc: 202–244-3505 E-mail: [email protected] University Park , PA 16802 Professional Practice Ofc : 814 -863-3799 Fax : 814-863-7750 Chair: Patricia Coughlin, Ph.D. Raymond DiGuiseppe, Ph.D. 2009-2014 E-mail: [email protected] 105 Chestnut St. #412 Laura Brown, Ph.D., 2008-2013 Philadelphia, PA 19107 Jonathan Mohr, Ph.D., 2008-2012 Finance Beverly Greene, Ph.D. 2007-2012 Chair: Bonnie Markham, Ph.D., Psy.D. Ofc: 215-925-2660 William Stiles, Ph.D., 2008-2011 52 Pearl Street E-mail: [email protected] Metuchen NJ 08840 Past Chair: Bonita G. Cade , Ph .D., J.D. Ofc: 732-494-5471 E-mail: [email protected] E-mail: [email protected] PSYCHOTHERAPY BULLETIN PSYCHOTHERAPY BULLETIN Published by the Official Publication of Division 29 of the DIVISION OF PSYCHOTHERAPY American Psychological Association American Psychological Association 2010 Volume 45, Number 4 6557 E. Riverdale Mesa, AZ 85215 602-363-9211 CONTENTS e-mail: [email protected] Editor’s Column ...... 2 EDITOR President’s Column ...... 4 Jennifer A. Erickson Cornish, Diversity ...... 8 Ph.D., ABPP Unique Perspective on Diversity: Experiencing [email protected] Intersecting Roles of Students in Clinical Training ASSOCIATE EDITOR Ethics In Psychotherapy ...... 11 Lavita Nadkarni, Ph.D. Psychotherapy and the Suicidal Client: A Brief Introduction CONTRIBUTING EDITORS Diversity Education & Training ...... 17 Erica Lee, Ph.D. and Personal Therapy for Graduate Trainees in Caryn Rodgers, Ph.D. Professional Psychology Education and Training Student Feature ...... 23 Sarah Knox, Ph.D. and Preventing Distress and Impairment: The Importance Ken Critchfield, Ph.D. of Self-Care Education and Utilization During Ethics in Psychotherapy Graduate Training in Clinical Psychology Jeffrey E. Barnett, Psy.D., ABPP Early Career ...... 29 Practitioner Report Is it Really Ending? Some Reflections on the Miguel Gallardo, Psy.D. and Transition from Early to Mid-career Patricia Coughlin, Ph.D. Psychotherapy Research, 2011 Nominations Ballot ...... 35 Science, and Scholarship Perspectives on Psychotherapy Integration ...... 39 Norman Abeles, Ph.D. and Introduction To An Integrative Attachment-Based Susan S. Woodhouse, Ph.D. Model of Sexual and Loving Feelings in Psychotherapy Perspectives on Psychotherapy Integration Diversity ...... 49 George Stricker, Ph.D. Disparities in Health and the Potential Impact of Increased Access to Healthcare Public Policy and Social Justice Rosemary Adam-Terem, Ph.D. Psychotherapy Research, Science, and Scholarship .... 51 Washington Scene Strengthening Our Science and Enhancing the Patrick DeLeon, Ph.D. Status of Psychology as a STEM Discipline: The Theme of the Science Leadership Conference in 2010 Early Career Michael J. Constantino, Ph.D. and Feature ...... 56 Rachel Gaillard Smook, Psy.D. Should Division 29 Develop Telepsychology Student Features Guidelines? Sheena Demery, M.A. Washington Scene ...... 60 Editorial Assistant The Importance of Visionary Leaders Crystal A. Kannankeril, M.S. References ...... 67 STAFF Membership Application ...... 77 OF PSYCHOTH N E O R Central Office Administrator I A S I P V Y I

Tracey Martin D 29 . A N M S E S R A I Website L C A A www.divisionofpsychotherapy.org N PSYCHOLOGI C 1 EDITORS’ COLUMN Jenny Cornish, Ph.D., ABPP, Editor Lavita Nadkarni, Ph.D., Associate Editor University of Denver Graduate School of Professional Psychology

Once again, the Jenny wishes to thank all the outstanding Psychotherapy Bulletin contributing editors and authors who editors are privileged have submitted a wide range of articles to offer a wonderful with incredibly breadth and depth. These array of excellent arti - three years have seen such amazing con - cles in this issue. There tributions to the field, and Jenny feels are three papers very honored to have been a small part in authored (or co-au - bringing these papers to the Bulletin read - thored) by students on ers. In addition, she is particularly pleased important topics in - to have been the first editor to offer the cluding perspectives Bulletin in electronic-only format. on diversity, prevent - ing distress and im - In fact, just a reminder that you may pairment, and the choose the green option of receiving ethics of working with suicidal clients. your Bulletin by visiting www.divi - We know you will also want to read the sionofpsychotherapy.org/members/go Early Career submission reflecting on green/ and filling out a brief form. the issues involved in transitioning from Thereafter, you will receive an email early to mid career. The article on health with a link to the online Bulletin as soon care disparities is fascinating, as is the as it is available. Of course, you may paper introducing an integrative attach - still download and print out the Bulletin ment-based model of sexual and loving (or any specific articles) if you want to feelings in psychotherapy. The Research read anything in hard copy. submission on strengthening our science To our knowledge, Lavita is the first per - and enhancing the status of psychology son of color to edit the Bulletin. We are as a STEM discipline is also compelling . both greatly excited with her new role, There is an interesting feature on and know that she will do a great job. telepsychology, and of course, the Wash - She has enjoyed working with Jenny to ington Scene again provides us with ensure that Division 29 members receive unique political insight. current information on theory, practice, training, and research in psychotherapy. In this issue you will find President As someone who wears multiple hats Jeffrey Magnavita’s final column, with a and has a passion for the training of stu - helpful overview of Division 29’s recent dents and mentorship of early career initiatives and accomplishments, and psychologists, and is also actively en - several useful recommendations. Please gaged in practice and research, she is de - express your gratitude to him for his out - lighted to promote the D29 domain standing tenure. This issue of the Bulletin structure in the Bulletin. She is a clinical is also Jenny’s last as editor. We are ex - and forensic psychologist, and an Asso - cited to announce that our associate edi - ciate Professor at the University of tor, Lavita Nadkarni, will assume the role of editor as of the first issue in 2011. continued on page 3 2 Denver’s Graduate School of Profes - Wishing everyone a healthy and happy sional Psychology. Lavita is invested in holiday season, and a wonderful new diversity issues on a local and national year in 2011. level, and will strive to continue the Bul - letin’s tradition of creating space for the Jenny Cornish, Editor expression of diverse voices. Lavita Nadkarni, Associate Editor [email protected] As usual, please contact us with your 303-871-4737 ideas, suggestions, criticisms, and comments.

OF PSYCHOTH N E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C

CALL FOR NOMINATIONS APF Rosalee G. Weiss Lecture for Outstanding Leaders The American Psychological Foundation’s Rosalee G. Weiss Lecture honors an outstanding leader in psychology or a leader in the arts or sciences whose work and activities has had an effect on psychology. The lecture is delivered at the annual APA convention; the 2011 Convention will be held in Washington, DC . The APA Divisions of Psychotherapy (29) and Independent Practice (42), ad - minister the lectureship in alternate years . The lecture was established in 1994 by Raymond A. Weiss, Ph.D., to honor his wife, Rosalee G . Weiss, Ph.D. The lecturer receives a $1,000 honorarium . Eligibility Criteria: The nominee must be an: • Outstanding leader in arts or science whose contributions have significance for psychology, but whose careers are not directly in the spheres encom - passed by psychology; or, • Outstanding leader in any of the special areas within the sphere of psychology.

Nomination Materials: Self-nominations are welcomed. Letters of nomination should outline the nominee’s credentials and contribution. Nomination letters and a brief CV should be submitted electronically to the Division 29 2011 Awards Chair: Jeffrey J. Magnavita, D29 Awards Chair Glastonbury Medical Arts Center 300 Hebron Ave. Suite 215 Glastonbury, CT 06033 E-mail: [email protected]

Deadline : January 1, 2011

3 PRESIDENT’S COLUMN Jeffrey J. Magnavita, Ph.D. Glastonbury Psychological Associates PC, Connecticut It is with great excite - our division in their various roles are ment and some sad - quite remarkable for their passion, intel - ness that I am writing lect, scholarship, and devotion. Our di - my last official column vision represents those of us who as President of the continue to value the importance of psy - Division of Psy - chotherapy in the amelioration of chotherapy. Having human suffering and seek to advance just completed my final board meeting our understanding through accumula - during my presidential year, I am very tion of a robust evidence-base. This truly gratified to have had the opportunity to represents a holistic vision, which does work over the year to advance the mis - not limit itself but honors the impor - sion of the division. Many people have tance of relationship, techniques, patient asked me what it has been like serving characteristics, cultural influences, con - as President and I can truly say that it verging lines of evidence, scientific rigor has been a great pleasure and honor for and humanism. which I will always be grateful. It has re - quired time and energy , but the rewards Some of the initiatives that we have un - have been great , adding to the abun - dertaken are immensely rewarding to dance in my life with new relationships, me and I hope will continue to establish projects, and challenges . The Division of our division as a premier organization Psychotherapy serves as a premier or - where one can find the latest informa - ganization for the advancement of psy - tion, be stimulated with relevant con - chotherapy. Our division keeps the fire tent, receive continuing education of psychotherapy burning brightly and credits, find fellowship in being con - leads the way to the future . nected to other devoted psychothera - pists, and participate in shaping our I remember many years before the fall of future. In my last column , I wrote about communism hearing how psychothera - the Presidential Task Force that I estab - pists in the USSR would meet clandes - lished to investigate the issue of efficacy tinely in tents in the woods to try to keep of psychologist-psychotherapists , which their tradition alive. Psychotherapy was under the able leadership of Dr. Jeff apparently viewed as a Western indul - Barnett has completed their report and gence for which the communist party submitted it to the division with recom - had little regard, and even posed a dan - mendations. You will find the full re - ger to those who practiced psychother - port , including an excellent summary of apy surreptitiously. During our current much of the extant research on psy - era , the field of psychotherapy has been chotherapy effectiveness organized top - challenged and eroded on many fronts, ically and presented in a summary form. yet our division remains steadfast in It is a wonderful working document that preserving and expanding what we can be used as a resource and is avail - have to offer to those who suffer and able on our website ( * www. divisionof - seek out expert psychologist-psy - psychotherapy .org/ **) , along with the chotherapists for assistance. recommendations. I can tell you that the people who serve continued on page 5 4 One of the recommendations of the Task bell, our experienced and savvy repre - Force on Psychologist-Psychotherapists sentative, for shepherding me and (TOPPs) is that we establish a research showing me the ropes. grant specifically for those who want to pursue research on factors related to I can also say that we have made great psychotherapy effectiveness. The grant strides in advancing our agenda to use will be awarded to the psychotherapy technology effectively and give us all the research proposal that holds the most advantages that we can reasonably have promise for advancing the field of psy - to be connected with one another and chotherapy research in the area of psy - the latest information in the various do - chotherapist factors that may impact mains that represent our varied interests treatment effectiveness and outcomes, to in psychotherapy. I would like to thank include type and amount of training, Dr. Chris Overtree who worked dili - professional degree or discipline of the gently over the past year to bring our psychotherapist, and the role or impact website up to date. He showed great de - of psychotherapists’ personal character - votion and creativity, working with the istics on psychotherapy treatment out - Technology Task Force under the leader - come. What I am really thrilled about is ship of Dr. Steve Sobelman to create a that the Board of Directors overwhelm - wonderful portal for all of us to access ingly approved $20,000 to be awarded the latest publications, resources, and yearly for someone whose research will advances, as well as be socially con - focus on this topic. I appreciate the fact nected. New features continue to be that we were challenged to be good added to the popular ones such as Ask stewards of our resources and “put what the Ethicist led by Dr. Jeff Barnett and Re - we have to good ” use by Dr. Jeff Young - search Updates by Dr. Mike Constantino. gren our secretary and future President- In the near future you will be able to elect of our sister Division 42, The find a new feature called Psychothera - community for Psychologists in Independ - pists: Face-to-Face , which is an interview ent Practice . I am pleased to tell you that series that I am producing and will fea - this award has been named to honor one ture some of our leading psychothera - of our leading members, Dr. Norine pists. We (Aniko Safran-videographer, Johnson, who was a past president of Tracey Martin, and Cedric Wood, volun - APA and most recently served our divi - teer on camera ) completed four of these sion as a Council Representative. Norine interviews at the APA convention this spearheaded many initiatives including past summer with Drs. Lorna Smith one to have the word “psychotherapy” Benjamin, Laura Brown, Leslie Green - endorsed by APA as the official descrip - berg, and Hanna Levenson,. I think you tion of what our members do, instead of will find them excellent resources for the more generally used term “therapy .” students, as well as wonderful compli - Norine has always been a passionate ments to the APA psychotherapy video protector and spokesperson for our field series that has featured their work. and we are truly pleased to be able to offer this substantial grant in honor of During our very productive board meet - her life long contribution to psychology and psychotherapy. I had the honor to ing we , our President-elect Dr. Libby Presi - step into her role until our new Council Nutt Williams and I , appointed a Representative Dr. John Norcross begins dential Task Force on Telepsychotherapy that his term in January. You can read about will be chaired by Dr. Annie Judge and my experience on council later in this was inspired by the article and encour - issue. I want to thank Dr. Linda Camp - continued on page 6 5 agement of Dr. Norm Abeles, which can our roster. Our social hour, coordinated be read in this issue. Telehealth, telepsy - by our wonderful administrator Tracey chology , and telepsychotherapy are Martin , was a lively and exciting time to evolving so rapidly that psychothera - reconnect with old friends and talk about pists are often unsure about what is a our achievements. We plan to continue reasonable standard of care and in - our suite programming next year in formed practice. Norm , who will serve Washington, DC so please make a note on the committee , felt that we should of this and drop in for some awesome not wait and move on this issue. He also programming and socializing. You may suggested that we use the term telepsy - even run into some of our famous psy - chotherapy to distinguish us from tele - chologists who you can meet in person. health, which is used by medicine. Also serving on this committee are Drs. Jeff As I begin to wind down my Presiden - Younggren and Shane Davis. We look tial term and hand over the reigns to our forward to your input and the commit - able President-elect Dr. Libby Nutt tee would like to hear about your expe - Williams, I remain devoted to serving riences with telepsychotherapy. the division in the capacity of awards committee chair and producer of our Thanks to wonderful financial steward - new video series Psychotherapists: Face- ship over the years and income from our to-Face , which I hope you will enjoy as flagship journal Psychotherapy (the new much as I did making this exciting se - name starting in January, 2011), we are ries. I am also committed to making this enjoying a time of abundance , which is a smooth transition and am looking for - very remarkable given the global and ward to Libby’s initiatives. We are all national economic downturn we are ex - very happy to have Dr. Marvin Gold - periencing. We are able to use our re - fried join us as President-elect in Janu - sources in a manner that will add to the ary. Marv has always been a staunch field of psychotherapy and underscore advocate of psychotherapy and with our commitment to advancing the field whom I have been working on a joint of psychotherapy. I am also eager to see project while he served as President of us begin to consider how we can better Division 12 this year. serve the underserved and address the mental health needs of people with lim - I want to personally and publicly thank ited access to care. I am hoping that fu - Dr. Nadine Kaslow who is finishing her ture leaders will take up this call. term as Past President and has done a remarkable job over her three years of We had an amazing convention in San service in the presidential term. Nadine Diego where we resumed our suite pro - has been an amazing mentor to me , as gramming and I enjoyed meeting with well as many others. She has the capac - many of you. Our convention program ity to inspire people and draw them into was of a high caliber thanks to all your participate. I don’t know of anyone who wonderful submissions and Dr. Jack An - has brought so much new talent to our chin’s excellent work as Program Chair. division. I remember when I was head - We had a very nice balance of research ing the nominating committee and was and practice oriented symposia as well running out of names how Nadine as many other topical areas of interest to would pull out our phone and say call our membership. Our awards ceremony this person , many who are now serving is becoming a major event with new on our board or committees. Nadine’s awards and grants being added yearly to continued on page 7 6 influence spans the globe. Unfortu - of you over the past number of years nately, because she was called to collab - and am always struck by your integrity, orate with the World Health Organization commitment toward education and she was in Switzerland and missed her training, as well as willingness to serve last meeting so the board was not able to those suffering. I have enjoyed many personally thank her but thank her we presentations, dinners and social events do! We will see her next summer in around the country and experienced Washington, DC at our awards cere - your hospitality and fellowship. I want mony to properly thank her. I asked her to thank each and every one of you for to reserve this time because her schedule this opportunity to lead this wonderful is probably already being filled. Please division and hope that I have made a join us to honor her for her service and difference. I look forward to meeting the then afterwards for a celebration at our rest of you in the coming years. I truly social hour. feel privileged in having had the chance to serve and hope that you too will con - We have some of the most remarkable sider joining our movement! people in our division. I have met many

OF PSYCHOTH N E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C

Find Division 29 on the Internet. Visit our site at www.divisionofpsychotherapy.org

7 DIVERSITY Unique Perspective on Diversity: Experiencing Intersecting Roles of Students in Clinical Training Sharlet Anderson, Meena Khowaja, Alvina Rosales, Elizabeth Schroth, Jalika Street Georgia State University

Graduate students in clinical psychol - membership of clinical faculty and staff ogy, as clinicians in training, offer a supervisors, formed the Clinic Diversity unique perspective on not only how Committee to respond to the changing matters of diversity are approached demography of our country, the increas - within the therapy relationship, but also ing need for mental health services for how they are experienced by the student diverse populations (Bernal & Castro, clinicians themselves . The challenge of 1994), and potential systemic barriers to negotiating the demands from the per - creating a sense of safety for the diverse spective of having multiple roles as ther - client population our clinic serves. The apist, supervisee, researcher, and committee took action initiating such student can be difficult, particularly as changes as displaying artwork in the they relate to matters of diversity. Upon clinic that is inclusive of a wide range of entering clinical training, students bring diversity and petitioning to have auto - with them past experiences of dis - matic door openers installed on the rest - cussing or not discussing race and eth - room doors near the clinic to increase nicity among peers, which can serve as accessibility for our clients with varying fodder for rich development if the neces - degrees of physical ability . These and sary supports are in place. other actions were part of a larger goal of increasing effort to develop more un - In 2005, graduate students in the clinical derstanding of life experiences of per - psychology program at Georgia State sons of color (Sue & Sue, 1999), critical University came together to mobilize a in the therapeutic relationship. How - mission to value the differences and ever, changes in the clinic’s physical en - similarities among individuals and to re - vironment were not enough. spect all facets of our therapy clients. The students, with the support and continued on page 9 8 The Clinic Diversity Committee mem - treatment and lead to development of in - bers questioned whether or not matters creased self-esteem for student clini - of diversity were being discussed in su - cians. This phenomenon is not limited to pervision groups such that the needs of work with ethnic minority clients, thera - our clients could be respected and ad - pists, and supervisors, but is a point of dressed appropriately and sensitively. A general clinical competence for all thera - survey assessing the frequency of missed pists and supervisors, according to the opportunities to discuss matters of diver - American Psychological Association’s sity in supervision, and possible con - Guidelines on Multicultural Education, tributing factors was administered to Training, Research, Practice, and Organi - student clinicians. The results indicated zational Change for Psychologists (2002). that students in the program had indeed experienced missed opportunities and Student clinicians have noted that initi - themes of creating more of a sense of ating exploration of diversity-related safety emerged. In response, the commit - topics may be affected by their own tee organized continuing education experience of stereotype threat or dis - workshops, for student clinicians and su - crimination. Those who identify with pervisors, specifically focused on ad - marginalized groups may feel that the dressing diversity within supervisory onus to bring up issues of racism and relationships. The committee members oppression, is on them, rather than on acknowledged that discussing poten - the supervisor . These feelings may be in - tially emotionally salient matters relating tertwined with concerns regarding the to diversity openly and frankly in super - supervisor’s evaluation of the student’s vision can be a difficult experience due performance or potential scrutiny of stu - to a cultural gap, if supervisors have not dent peers in the supervisory group, received diversity training themselves building pressure that can result in a (Constantine 1997, 2001) . This poses a silent crescendo . As the committee dilemma for not only student clinicians heard from the student clinicians, super - of color but also those of the majority vision must strive to create a sense of cultural group, due to the power differ - safety that is actively maintained. ential and evaluative nature of the super - visor-supervisee relationship in vertical In therapy supervision, differences in models of clinician training at the doc - racial or ethnic identity between thera - toral level . The complex relationship pists and clients are common points of among culture, intrapsychic and inter - discussion regarding diversity. How - personal processes, and client sympto - ever, when the therapist and client per - matology affects the supervisory process sonally identify with similar groups, and therefore the quality of treatment. intra-ethnic differences have the poten - Failure to acknowledge that supervision tial to be omitted in the supervision dis - involves multiple cultural interactions cussion . This omission is particularly can lead to mutual avoidance of discus - salient when there is an unspoken as - sion of cultural issues and may prevent sumption that a student clinician of therapists and clients from fully immers - color is versed in multiculturalism and ing into relevant material, such as clients ’ comfortable in openly discussing their individual experience of discrimination experience of it. Individuals in same eth - and oppression (Leary, 2000) . Differing nicity client-therapist dyads are not im - cultural worldviews of the client, thera - mune to the very biases or assumptions pist, and supervisor and the ability to ad - that are thoughtfully brought into equately address issues of race and awareness in didactic diversity training. culture can be critical to change in the continued on page 10 9 For example, student therapists and Similar to how a sense of community can clients from very similar ethnic or racial be created though peer consultation backgrounds can differ greatly in their among seasoned clinicians, a sense of family’s immigration status and history, safety can grow roots among students’ level of and attitudes toward accultura - peers discussing their unique, shared ex - tion, religion or religiosity, socioeco - perience as clinicians in training explor - nomic status, or any number of ing matters of diversity, and may bolster experiences. These differences may the supervision experience to benefit seem nuanced to supervision group both supervisor and student, but most of members, though may be experienced all, the client . Individual members of the as particularly salient within the thera - committee presented the possibility of a pist-client dyad. If these differences are forum, a non-evaluative environment, a missed or avoided, student clinicians discussion among peers, to support one may feel responsible to raise others’ another as clinicians in training . Discov - awareness of them lest they allow erro - ering allies among peers can facilitate neous assumptions to persist, and yet student therapists’ growth in being forth - have difficulty formulating an approach coming in supervision and sensitive in to do so while being evaluated . therapy as matters of diversity arise. To date, the Clinic Peer Support Group has The experience of graduate-level diver - met once, but the hope and momentum sity training specific to clinicians chal - are already palpable. The number of at - lenges students to explore multiple tendees across year levels in the program aspects of identity beyond race and eth - was higher than anticipated by the stu - nicity, and how they can impact values, dent founders, and several suggestions thoughts , and behaviors . This challenge for how to structure the group were may also arise for the client during the made. We have set forth a list of mutually course of therapy. Understanding the in - agreed upon guidelines, aimed at creat - tersections and interactions among dif - ing and maintaining safety in the group. ferent aspects of the therapist and client These guidelines will be amended in re - identity as well as the fluidity thereof sponse to the maturation of the group, as can be crucial in fostering the develop - necessary. There is no designated leader ment of a responsive and solid thera - of the group— only participants who vol - peutic relationship, particularly for unteer to keep track of time and materials individuals of color. Open discussion for that month’s meeting—as it is ac - about these complexities in supervision knowledged that we are all new to the groups precludes anonymity on the part experience of how the roles of therapist, of the student clinician . The Clinic Di - student, and supervisee intersect and im - versity Committee survey revealed the pact our experience of diversity. We com - opportunities for these discussions were mit to use this ongoing conversation being missed. Through the process of about our personal experience to aug - negotiating these factors, the student cli - ment our supervision experience and uti - nicians at Georgia State University have lize our privileged positions to foster taken note of the need to address this positive change in our clients. socio-cultural phenomenon of diversity in therapy relationships as it is experi - REFERENCES FOR THIS ARTICLE enced by the clinician in training. And MAY BE FOUND ON-LINE AT thus, there was another call to action. www.divisionofpsychotherapy.org

10 ETHICS IN PSYCHOTHERAPY Psychotherapy and the Suicidal Client: A Brief Introduction Nicole E. Schechter, M.S. Jeffrey E. Barnett, Psy.D., ABPP, Loyola University Maryland Perhaps no other eral Principles of the Ethical Principles clinical situation is of Psychologists and Code of Conduct more challenging or (APA Ethics Code; APA, 2002) as well as more anxiety arousing with enforceable standards to include for psychotherapists Standard 2.01, Boundaries of Compe - than that of the suici - tence, it is vital that psychotherapists are dal client. Integrating competent to provide needed services to knowledge about risk those with whom they work. This in - factors, warning signs, cludes having a clear understanding of prevention, assessment, the current research that informs ethical and treatment of the assessment and treatment with suicidal suicidal client is clients and the ability to implement it essential for every appropriately and effectively. psychotherapist. Ad - Clinical competence is essential for psy - ditionally, in our efforts to provide com - chotherapists in their work with all petent and ethical services to all clients, clients. Due to the likelihood of meeting psychotherapists must actively stay in - with clients with the potential for sui - formed of ongoing clinical develop - cide risk, comprehensive knowledge of ments and research findings to be able suicidology is a must for every practic - to provide the most current evidence- ing psychotherapist. While much of clin - based clinical services possible. ical competence originates during Available data indicate that approxi - graduate training and pre- and post- mately 32,000 individuals die as a result doctoral internships, a large amount of of suicide each year in the United States competence can be gained and main - (Hoyert, Heron, Murphy, & Kung 2006). tained through continuing education, Further, as Rudd and colleagues (2009) continued clinical work, and consulta - point out, over one half of these individ - tion with colleagues (Jobes, Rudd, Over - uals are involved in some type of mental holser, & Joiner, 2008). This brief article health treatment at the time of their sui - provides psychotherapists with relevant cide and close to 90% of those who com - information to play a small part in the mit suicide suffer from a diagnosable development and maintenance of ongo - mental disorder. Of further relevance for ing competence regarding the treatment psychotherapists is the fact that over 20% and assessment of suicidal clients. of practicing psychotherapists will treat Informed Consent a potentially suicidal client at some point Informed consent, a fundamental ele - in their career (DeAngelis, 2000) although ment of all ethical psychotherapy prac - those working in inpatient settings and tice, is an essential component of how with certain high risk populations will treatment begins for potentially suicidal face an even greater likelihood. clients. Until recently, research showed Competence that informed consent with high-risk In accordance with the aspirational Gen - continued on page 12 11 clients must cover limits of confidential - was developed from the CBT theory. A ity and a plan for coping mechanisms to typical CTS consists of an agreement employ should suicidal ideation arise. that the client will attend and actively More recently, however, specialists in participate in psychotherapy sessions, suicidology recommend that psy - set goals honestly and realistically with chotherapists include discussion of the the psychotherapist, complete any risks of suicide and suicide attempts in homework assignments, take all pre - the informed consent process. Address - scribed medications, and employ a crisis ing these components at the very begin - response plan when necessary. Research ning of the therapeutic relationship has encourages that a CTS is signed by the been shown to enhance treatment com - client and by a witness, who should be a pliance, encourage individual responsi - significant other or a family member. bility and the involvement of family or With family involvement, a client is other social supports, and open a direct more likely to remain committed to his and honest exchange between the psy - or her psychotherapy work and to im - chotherapist and the high-risk client proving his or her life. about the likely risks involved and to ensure a realistic understanding of what The Role of Assessment treatment will require of the client While informed consent is the primary (Rudd et al., 2009). focus of a first psychotherapy session(s) with a suicidal client, it is not the only Additionally, for clients with current component. An objective quantitative suicidal ideation or a history of suicide risk assessment should be administered attempts, psychotherapists should use during the first session and all subse - informed consent processes that are quent sessions thereafter to measure common in Dialectical Behavior Ther - current feelings of hopelessness, worth - apy (DBT) and Cognitive Therapy (CT), lessness, changes in social supports, and as these are the two treatments with current stressors or potential triggers. proven efficacy with suicidal clients (Al - Simply asking a client about ideation, in - thaus & Hegert, 2003; Tarrier, Taylor, & tent, and plan on one occasion is not suf - Gooding, 2008) . The informed consent ficient; however, allowing clients to process from these perspectives involves verbally express their own feelings has a collaborative approach to goal setting, been found to aid in treatment outcomes. a direct statement of expectations of the For this reason, Jobes et al. (2004) recently client and the psychotherapist, and a reconstructed his Suicide Status Form, a primary goal of preventing a suicide at - qualitative measure, so that clients have tempt (Rudd et al., 2009). Current re - the opportunity to express in their own search suggests that high-risk clients words their current experiences. As sug - need a more structured form of treat - gested by Berman, Jobes, and Silverman ment; a structured treatment begins (2006), any qualitative or quantitative as - with informed consent (Jobes, Rudd, sessments given must at a minimum ad - Overholser, & Joiner, 2008). dress four factors including predisposed vulnerabilities, any triggering events that Rudd, Mandrusiak, and Joiner (2006) caused a loss of something valued, cur - recommend using what they have rent mental status, and any protective termed a Commitment to Treatment factors possessed by the client. Statement (CTS) to address in the first session the client’s motivation and com - Generally speaking, most psychothera - mitment to his or her treatment; CTS continued on page 13 12 pists agree on the use of objective assess - work, the clinician will be more able to ments to monitor either active or passive engage them in serving as effective re - suicidal clients; however, current re - sources for the client when he or she is search builds on this conclusion by rec - outside of psychotherapy sessions. Only ommending that the results of these several years ago, psychotherapists be - assessments be updated every few days lieved that above all else, confidentiality if a client is in crisis. Ethically, clinicians must be upheld. However, now it is rec - must be aware that due to the constantly ommended that psychotherapists seek changing mental status of a person with consent from high-risk clients to com - active suicidal ideation, assessments are municate with family members and oth - only valid for one to three days (Simon ers as needed. & Gutheil, 2009). Therefore, when treat - ing an actively suicidal client, psy - Involving the family in a suicidal client’s chotherapists should consider offering treatment also aids in preventing hospi - more frequent assessment and treatment talization and more recently, evidence sessions, and other contacts. Some re - shows that hospitalization is not neces - search also recommends that during an sarily beneficial for clients who threaten initial meeting with any new client, even or gesture suicide. According to Marsha one with little to no history of suicidal Linehan, the creator of DBT, hospitaliza - ideation, a psychotherapist should ad - tion of Borderline Personality Disorder minister a relevant screening tool in patients in response to suicide gestures order to identify if the person is at any or ideation may prove harmful. She and risk for suicide (Bryan, Corso, Neal- her colleagues further explain that hos - Walden, & Rudd, 2009). Giving a brief pitalization can reinforce the attention- screening measure will ensure that nec - seeking behavior by way of attention essary further assessments can be com - from the nursing staff and colluding so - pleted and appropriate treatment plans cial interactions with other patients; are created. DBT trains clinicians to help the client use other resources and coping mecha - Evidence-Based Interventions nisms to avoid hospitalization unless it In addition to the use of weekly or bi - is an absolute emergency (Miller, weekly formal objective assessment, Rathus, & Linehan, 2007). With that, cli - clients who are actively or passively sui - nicians are encouraged to use all mem - cidal require extra treatment supports, bers of a client’s family to provide often including family involvement, cri - support and attention before resorting to sis response plans, or possibly hospital - hospitalization. As well, some psychi - ization. Current research suggests that atric inpatient stays can be negative, significant others or family members overwhelming, non-therapeutic experi - should be involved in the treatment of ences that will not aid in recovery and high-risk clients from day one (Rudd et may in fact make it more likely that the al., 2009). With appropriate consent, psy - client completes suicide. For this reason chotherapists should be sure to speak to as well, recent literature recommends as many involved family members or that clinicians should utilize all other loved ones as possible because often, possibilities prior to hospitalizing a po - they will have important data that the tentially suicidal client. Furthermore, client might not disclose (Simon & practicing clinicians should be aware of Gutheil, 2009). Additionally, if the psy - the bimodal peaks for suicide risk when chotherapist builds relationships with hospitalizing a suicidal client; the client members of the client’s support net - continued on page 14 13 is most at risk during the first week after are fundamental to sound psychothera - admission and the first week after dis - peutic work, it is also important to con - charge. With this, if a clinician hospital - sider how psychotherapists should izes a client, he or she should ensure that ethically protect themselves while pro - the client is well prepared for the inpa - viding suicidal clients with ethical and tient experience and is connected to im - competent care. When working with an mediate outpatient care following active or passive suicidal client or even discharge (Qin & Nordentoft, 2005). an individual who has a history of sui - cide attempts or gestures, psychothera - No-suicide contracts were once the most pists should be sure to document the commonly recommended short-term date, time, and content of each contact treatment method for actively suicidal with the client, including in-person, tele - clients; however, these contracts are no phone, and e-mail contacts; psychother - longer recommended, as they did not apists should do the same for contacts aid in preventing suicide (Rudd, Man - with clients’ family members and signif - drusiak, & Joiner, 2006). Rather, Crisis icant others. Response Plans (CRP) are the newest tools suggested for use by psychothera - Timely and thoughtful documentation pists who are treating actively suicidal should also include all assessments and clients. Typically, a CRP should be out - their results, recommendations made, lined and agreed upon collaboratively and interventions implemented. Fur - between the psychotherapist and the ther, the psychotherapist’s decision client during the first session, as it is in - making process is important to docu - cluded in the CTS discussed earlier in ment as well. This should include op - this article. A CRP involves individual - tions and alternatives considered, how ized steps for the client to pass through treatment decisions were made, and when feeling that he or she is at high- why certain options were rejected. Any risk for suicidal gestures or attempts. consultation with colleagues or others The first part of the CRP involves inter - involved in the client’s care and review nal intervention, how to utilize oneself of previous treatment records should be to alleviate symptoms, and the second documented as well (Barnett, 1999). This part of the CRP involves external man - way, should one’s care of a client be agement, addressing who or what the challenged, the treatment record would client should contact in case his or her provide a tangible record of the psy - self-management skills fail. Research chotherapist’s reasonable good faith recommends that psychotherapists role efforts to meet the standards of care of play enacting the CRP with the client so our profession. that the pair can work collaboratively to build the skills necessary for effectively Conclusions carrying out the CRP (Rudd, Mandru - Even with the incorporation of the pre - siak, & Joiner, 2006). viously discussed recommendations into clinical practice, psychotherapists Risk Management and can never ensure the safety of each Effective Clinical Practice client. The information shared and dis - The recommendations iterated above cussed in this article is simply a sum - focus on how to ethically assess and mary of several of the more important treat suicidal clients so as to prevent a aspects of providing psychotherapy to future attempt or suicide and to protect suicidal and potentially suicidal clients. the client. While all of these suggestions continued on page 15 14 These include clinical competence, in - sideration of one’s ability to meet each formed consent, and assessment and client’s treatment needs should be a reg - treatment based on the most recent em - ular occurrence. When the above men - pirical findings. However, this article tioned steps prove insufficient, referring should only be considered a brief intro - clients to expert colleagues is an impor - duction to the subject. tant action to take. Consistent with the recommendations of Jobes, Rudd, Over - As was discussed earlier, clinical compe - holser, and Joiner (2008) it is hoped that tence is at the heart of psychotherapy the information presented in this brief with suicidal clients and therefore, psy - article will help to promote improved chotherapists should continuously self- clinical practices with suicidal clients by assess, seek ongoing continuing all psychotherapists. professional development, and consult with experienced colleagues. Since deci - REFERENCES FOR THIS ARTICLE sions made about suicidal clients truly MAY BE FOUND ON-LINE AT can be life or death matters, careful con - www.divisionofpsychotherapy.org

OF PSYCHOTH N E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C

OF PSYCHOTH N E O R I A S I P V Y I D 29 . The Psychotherapy Bulletin A N M S E S R A I C L is Going Green: A A N PSYCHOLOGI C Click on www.divisionofpsychotherapy.org/members/gogreen/

15 APA’S DIVISION OF PSYCHOTHERAPY IS PLEASED TO ANNOUNCE: The Distinguished Publication of Psychotherapy Research Award for 2011

In consultation with the Division 29 Board of Directors, the Division 29 Re - search Committee is seeking nominations for The Distinguished Publication of Psychotherapy Research Award. This award recognizes the best empirical (i.e., data-based ) published peer reviewed article on psychotherapy in the preced - ing calendar year . Articles appearing in any journal (i.e., they need not have ap - peared in the Division’s journal) are eligible for this award .

We ask members of the Division to nominate articles for consideration by April 1. Nominations should include the complete citation for the article, and should be emailed to the Chair of the Research Committee, Dr. Jim Fauth, at [email protected] .

A selection committee appointed by the Chair of the Research Committee, in consultation with the President of the Division , will evaluate all nominated articles, and will make a recommendation to the Division’s Board of Directors by May 1. Upon approval by the Board, the author(s) of the winning article will be notified so that they may be recognized and receive the award at the up - coming APA Convention. Accompanying this award is a plaque.

All methods of research will be equally valued (experimental, quasi-experi - mental, qualitative, descriptive/correlational, survey). Current members of the Research Committee and the Selection Committee will not be eligible for the award, so no articles by members of the Research Committee will be con - sidered. Also, committee members will recuse themselves from voting on ar - ticles by current or former students, as well as collaborators. Self-nominations are accepted.

The criteria for the award appear below. • the rationale for the study and theoretical soundness • the methods • the analyses • the explanation of the results • the contribution to new knowledge about psychotherapy (e.g., the work is innovative, creative, or integrative; the work advances existing research in a meaningful way); greater weight will be given to novel/ creative element than to methodological/statistical rigor • relevance to psychotherapy practice.

The Distinguished Publication of Psychotherapy Research Award is accompanied by a $500 cash award sponsored by Wiley and Sons.

16 EDUCATION & TRAINING Personal Therapy for Graduate Trainees in Professional Psychology Eric Everson, M.A., Marquette University

Because of the rigorous trainees (Huprich & Rudd, 2004). Most academic and personal of the literature exploring the use of psy - demands (i.e., self- chotherapy for those in the mental exploration, personal health field, however, focuses on estab - development) of grad - lished professionals as opposed to uate training in profes - trainees (Dearing et al., 2005; Holzman sional psychology, et al., 1996). Thus, while personal ther - trainees are also chal - apy for the trainee has been traditionally lenged to care for themselves throughout viewed as beneficial (Coleman, 2002; their education. Additionally, this self- Williams, Coyle, & Lyons, 1999), there is care must continue beyond the training actually little existing empirical litera - experience, as the counseling profession ture to support such an assertion, nor to presents stressors different from other demonstrate the actual effects, if any, of fields of study (e.g., working with clients such therapy. The profession would ben - who are suicidal). The ability to balance efit, then, from greater attention to the one’s personal and professional well- impact of psychotherapy on profes - being thus remains important through - sional psychology trainees. In an effort out the career, making self-care a vital to stimulate such attention, I first exam - component in maintaining stability. One ine the inevitable stressors of the gradu - method of such self-care is attending psy - ate training experience, stressors that chotherapy, which can enable profession - may spur the use of personal therapy. als and trainees alike to address a range of concerns. The Graduate Training Experience Inherent to training in professional psy - While personal therapy is commonly chology are challenges involving both mentioned as a beneficial method of personal and professional growth. Re - self-care for graduate trainees in profes - search in the area of graduate training sional psychology, the topic has only re - has identified a number of stressors that cently received attention in the empirical are common across disciplines, as well literature (Guy, Stark, & Poelstra, 1988; as those unique to psychology, all of Holzman, Searight, & Hughes, 1996). which might contribute to trainees seek - Psychotherapy as part of the graduate ing psychotherapy. training experience has historical sup - port, as graduate programs once tradi - Practical issues (e.g., finances, time) tionally required psychotherapy for have been found particularly problem - trainees (Garfield & Kurtz, 1976), partic - atic for the graduate trainee, as well as ularly in psychoanalytic training insti - stressors that were viewed as an “intrin - tutes. While it is no longer typical for sic part of postgraduate professional therapy to be a requirement of graduate studies: academic pressure and profes - training, nearly all APA-accredited doc - sional socialization” (Kumary & Baker, toral programs and internships do re - 2008, p. 22). Graduate trainees may also port instances of faculty recommending struggle to develop a new support sys - professional counseling or therapy for continued on page 18 17 tem (Cushway, 1997), for they might be that psychotherapy was “supportive and required to move away from family or reassuring, and therefore of great use friends to begin graduate training, po - while first undergoing the demands of tentially adding stressors on top of those the role of therapist” (p. 643). Other re - associated with their program of study. search has also underlined the impor - It is also possible that trainees may ex - tance of psychotherapy for providing the perience difficulty in personal relation - opportunity for self-exploration person - ships, as emotional and cognitive ally and professionally (Woodside, Ober - resources can be limited during espe - man, Cole, & Carruth, 2007). cially difficult periods of graduate train - ing (Cushway, 1992, 1997). In some cases, therapy for the graduate trainee in professional psychology Psychology graduate trainees are also might be recommended for remediation required to simultaneously expand, of noted difficulties. For example, Prod - maintain, and communicate knowledge icano, Busch-Rossnagel, Reznikoff, and in a given area of expertise, while also Geisinger (1995) found that 29% of pro - developing skills used in a clinical set - grams surveyed recommended that ting (e.g. , active listening, facilitation of students seek psychotherapy for reme - insight). Graduate training in profes - diation of deficiencies, and reported that sional psychology is thus a growth-ori - “follow-up on the efficacy of this ap - ented process that, in research focusing proach seems warranted” (p. 432). In on trainee and professional perspectives some instances , psychotherapy was re - on therapy for trainees, was found to be quired for the trainee, and in others a significantly stressful for the trainee more informal recommendation of ther - (Kaslow & Friedman, 1984) . It may come apy was made. Programs also varied as no surprise, then, that many graduate in their level of involvement in the trainees in professional psychology ex - trainee’s psychotherapy, which was perience a relatively high rate of psycho - largely mediated by factors including logical distress (Cushway, 1992). the perceived severity of the trainee’s Developing self-awareness is also a large impairment and the program’s familiar - part of the professional psychology train - ity with the treating therapist (Elman & ing experience, one also not without dif - Forrest, 2004). Research on the profes - ficulties (Cushway, 1997). For instance, sional psychology training experience trainees may struggle with personal reac - thus illuminates the range of stressors tions to incidents that occur in academic and concerns experienced by trainees, as or clinical settings, or in their personal well as the potential for trainee impair - lives (Howard, Inman, & Altman, 2006; ment, impairment that may be amelio - Skovholt & Ronnestad, 2003). Attending rated by seeking psychotherapy. psychotherapy, perhaps in an effort to ad - dress such reactions, has been found Professionals’ Use of “critical in their development as coun - Personal Psychotherapy selors” (Furr & Carroll, 2003, p. 487), par - As noted above, the bulk of the empir - ticularly with regard to gaining insight ical literature on psychotherapy for into the counseling process as well as those in the mental health field has fo - achieving personal growth. Sank and cused on post-training professionals. Prout (1978), noting that empirical evi - Among the areas investigated are the dence focusing on personal therapy for frequency with which professionals graduate trainees in professional psy - seek therapy and the presenting con - chology was lacking, nevertheless stated continued on page 19 18 cerns they report (Deacon, Kirkpatrick, experience, with Clark also noting that Wetchler, & Niedner, 1999; Deutsch, client outcomes were more related to the 1985; Gilroy, Carroll, & Murra, 2002; experience level of the treating profes - Mahoney, 1997; Neukrug & Williams, sional than to whether or not the profes - 1993; Norcross & Guy, 2005; Pope & sional had sought psychotherapy . In Tabachnick, 1994) , the process and contrast, other research on the processes outcomes of such treatment (Bike, Nor - and outcomes of professionals’ personal cross, & Schatz, 2009; Norcross, treatment has found overwhelmingly Strausser-Kirtland, & Missar, 1988) , and positive effects, with respondents re - the impact of psychotherapy on prac - porting improvement in behaviors, in - tice (Lucock, Hall, & Noble, 2006; sight, or emotions (Bike, Norcross, & Macran, Stiles, & Smith, 1999; Rizq & Schatz , 2009; Norcross et al., 1988 ; Target, 2008; Wiseman & Shefler, 2001) Williams et al., 1999) . Qualitative in - and on awareness of self and others quiry into this topic has also found note - (Coleman, 2002 ). worthy effects, with participants reporting increased awareness of their Early inquiry into the topic of psy - role in the therapy process , an increased chotherapy for practicing professionals level of authenticity in treating clients , revealed that approximately 60% of psy - higher levels of creating a collaborative chologists sought personal therapy at experience with clients, better recogni - some point during their career (Garfield tion of the need to give clients space in & Kurtz, 1976). Subsequent research has counseling , and affirmations of the im - yielded somewhat similar results, with portance of listening to understand anywhere from 54% to 84% of surveyed clients on a deeper level (Coleman, 2002; psychologists reporting that they have Macran et al., 1999; Rizq & Target, 2008; attended psychotherapy at some point Wiseman & Shefler, 2001) . in their career (Deutsch, 1985; Neukrug & Williams, 1993; Pope & Tabachnick, Thus, attending psychotherapy is a rela - 1994). Among the most common pre - tively common experience for estab - senting concerns were relationship con - lished mental health professionals, and flicts, work-related stressors, depression, those who have attended therapy report anxiety, self-confidence, career issues largely positive effects . The majority of (Deutsch, 1985; Pope & Tabachnick, professionals with experience in psy - 1994), personal growth, grief, and child - chotherapy count it as a beneficial influ - hood issues (Deacon et al., 1999; Ma - ence on their personal and professional honey, 1997) . development.

Mental health professionals generally Trainees’ Use of Personal Psychotherapy agree that psychotherapy for individu - In contrast to the relatively substantial als in the field is a valuable experience literature base on professionals’ use of with a range of personal and profes - psychotherapy , few empirical studies sional effects, including positive impacts have examined professional psychology on therapist verbal interactions with trainees’ experiences of therapy . Those clients and skill development (Bellows, that do exist have largely focused on the 2007) . Intriguingly, however, both Clark rates of trainees’ use of therapy, their (1986) and Macran and Shapiro (1998) presenting concerns (Dearing, Maddux, reported that professionals with previ - & Tangney, 2005; Guy et al. 1988; Holz - ous personal therapy were no more ef - man et al., 1996; McEwan & Duncan, fective than those who had no such continued on page 20 19 1993) , and the impact of therapy on gram’s culture seems not to support training and clinical experiences trainees seeking psychotherapy, trainees (Garfield & Bergin, 1971; Gold & Hilsen - may well worry about disclosing their roth, 2009; Kaslow & Friedman, 1984; decision to seek treatment (Dearing et Sandell et al., 2006). al., 2005; Holzman et al., 1996). Further - more, peer relationships also con - A recent survey of clinical and counsel - tributed to trainees’ decision to attend ing psychology graduate students found psychotherapy, as participants reported that a clear majority of participants conflicted feelings about disclosing their (70%) reported that they had attended treatment to others, particularly in in - psychotherapy at some point in their stances in which the therapist was lives, and 47% to 54% of those respon - known to peers (Holzman et al., 1996 ). dents initiated therapy during their When asking specifically about risks graduate training (Dearing et al., 2005). that trainees perceived with regard to This rate of attending counseling differs seeking psychotherapy while in train - somewhat from earlier findings by ing, McEwan and Duncan (1993) found Holzman et al. (1996), who found that that the majority of risks focused on con - 74% of respondents reported seeking fidentiality and ethical dilemmas related psychotherapy. to the decision to seek therapy .

Research on trainees’ use of personal Early research highlighted a correlation therapy has also examined the reasons between trainees’ engaging in therapy that trainees enter psychotherapy and and their efficacy in clinical practice. the factors that might influence this de - Strupp (1958), for instance, found that cision . Among those who did seek per - inexperienced therapists with previous sonal therapy, personal growth (70%) personal treatment had lower levels of and the desire for professional improve - empathy than their colleagues with no ment (65%) were the most common rea - previous treatment. Garfield & Bergin sons for doing so, with 56% endorsing (1971) identified less positive change in adjustment issues, and 38% seeking clients whose primary therapists were treatment for depression (Dearing et al., practicum students with high levels of 2005) . Trainees have also reported enter - experience receiving psychotherapy vs. ing treatment primarily for personal those with little or no experience receiv - (i.e., emotional well-being) as opposed ing therapy. Later research focused on to professional (i.e., learning about the the trainee perspective of the impact of counseling process) reasons (Kaslow & psychotherapy, with participants report - Friedman, 1984) . ing both positive (e.g., increased empa - thy, personal insight) and negative (e.g., Trainees have also reported inconsistent overidentification with the patient role) departmental views regarding attending impacts (Kaslow & Friedman , 1984). psychotherapy as having an influence on their decision (Bruss & Kopala, 1993; In more recent research, Grimmer and Kaslow & Friedman, 1984), with some Tribe (2001) reported that trainees man - participants reporting support for per - dated to attend psychotherapy devel - sonal therapy and others reporting am - oped increased insight into the process bivalence or negative perceptions from of therapy and experienced both valida - faculty as affecting their decision not tion and normalization during their only to seek therapy, but also whether or not to disclose their therapy . If the pro - continued on page 21 20 help-seeking experience. In other re - haviors and experiences of trainees, for search, trainees and faculty rated an in - effective coping strategies developed crease in self-awareness as the highest during training can provide a solid potential benefit, with faculty rating the foundation for self-care later in one’s ca - role of the therapist as a model for the reer (Dearing et al., 2005). As noted trainee as of secondary importance, above, the literature focusing on while trainees rated the opportunity to trainees’ use of personal therapy does deal with their personal issues as the provide some initial information regard - second most important potential benefit ing the rates with which they seek psy - (Strozier & Stacey, 2001) . A later study chotherapy (Deacon et al. 2005), the by Murphy (2005) reported somewhat concerns they bring to the personal ther - similar results, with findings suggesting apy process (Holzman et al. 1996), the that trainees experienced a number of influence of the graduate school setting effects, ranging from personal growth to on trainees’ decisions to pursue treat - realizing the potential impact of the psy - ment, and the impact that psychother - chotherapy experience. Studies have apy can have on the trainee’s also emphasized the need for continued functioning (Kaslow & Friedman, 1984), exploration of this area, with Murphy with results from trainees largely paral - (2005) stating that trainees are “being leling those from professionals (Grim - asked to undergo personal therapy mer & Tribe, 2001; Murphy, 2005; without supporting evidence explaining Strozier & Stacey, 2001 ). Continued re - the benefits” (p. 31). search in this area could expand upon existing findings by exploring trainees’ Thus, research in the area of psychother - perspectives on the whole of the psy - apy for trainees in professional psychol - chotherapy experience; that is, not fo - ogy has yielded information regarding cusing solely on presenting concerns or rates of attendance and presenting con - potential effects on clinical work, but cerns, as well as initial findings regard - rather on the trainee view of the inter - ing the potential benefits and impact of play between their academic, clinical, such therapy. Few studies, however, and personal development while in psy - have focused on the trainee perspective chotherapy. We do not yet have a well- in-depth to illuminate how psychother - developed understanding of this focus, apy is experienced during training and which could provide useful information how trainees view its potential impact . for trainees, for the faculty and staff re - sponsible for delivering the training ex - Conclusions: Focusing on the perience, and for the professionals Experience and Impact of providing such treatment for the Psychotherapy for Trainees trainees . Furthering the profession’s understand - ing of the trainee experience of psy - REFERENCES FOR THIS ARTICLE chotherapy would provide valuable MAY BE FOUND ON-LINE AT information about the help-seeking be - www.divisionofpsychotherapy.org

OF PSYCHOTH N E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C

21 CALL FOR FELLOWSHIP APPLICATIONS DIVISION 29—PSYCHOTHERAPY Clara E. Hill, Chair, Fellows Committee The Division of Psychotherapy is now ac - “recognition” has been beyond the local cepting applications from those who would level of psychology ; like to nominate themselves or recommend • A cover letter, together with your CV and a deserving colleague for Fellow status with self-nominating letter, to each endorser. the Division of Psychotherapy. Fellow sta - tus in APA is awarded to psychologists in Those members who have already attained recognition of outstanding contributions to Fellow status through another division may psychology. Division 29 is eager to honor pursue a direct application for Division 29 those members of our division who have Fellow by sending a curriculum vita and a distinguished themselves by exceptional letter to the Division 29 Fellows Committee, contributions to psychotherapy in a variety indicating in your letter how you meet the of ways such as through research, practice , Division 29 criteria. and teaching . Initial Fellow Applications can be attained The minimum standards for Fellowship from the central office or online at APA: under APA Bylaws are: Tracey Martin Division of Psychotherapy • The receipt of a doctoral degree based 6557 E. Riverdale St. in part upon a psychological disserta - Mesa, AZ 85215 tion, or from a program primarily Ph: 602-363-9211 / Fax: 480 854-8966 psychological in nature; Email: [email protected] • Prior membership as an APA Member for at least one year and a Member of DEADLINE FOR SUBMISSION . The the division through which the nomina - deadline for submission to be considered tion is made; for 20 11 is December 15, 20 10 . The initial • Active engagement at the time of nomi - nominee must enclose a Uniform Fellow nation in the advancement of psychol - Application , self-nominating letter, three or ogy in any of its aspects; more letters of endorsement, updated CV, • Five years of acceptable professional along with a cover letter, and three copies experience subsequent to the granting of all the original materials. Incomplete of the doctoral degree; submission packets after the deadline will • Evidence of unusual and outstanding not be considered for this year. Those who contribution or performance in the field are current Fellows of APA who want to of psychology; and become a Fellow of Division 29 need to • Nomination by one of the divisions send a letter attesting to your qualifications which member status is held. and a current CV. There are two paths to fellowship. For those who are not currently Fellows of APA, you Completed Applications should be must apply for Initial Fellowship through forwarded to: the Division, which then sends applications Clara E. Hill for approval to the APA Membership Com - Chair, Division 29 Fellows Committee mittee and the APA Council of Representa - Department of Psychology tives. The following are the requirements University of Maryland for initial fellow applicants: College Park, MD 20742 Email: [email protected] • Completion of the Uniform Fellow Blank; Phone: 301-405-5791 • A detailed curriculum vita (please sub - mit 3 copies); Please feel free to contact me or other Fel - • A self-nominating letter (self-nominat - lows of Division 29 if you think you might ing letter should also be sent to en - qualify and you are interested in discussing dorsers); your qualifications or the Fellow process. • Three (or more) letters of endorsement Also, Fellows of our Division who want to of your work by APA Fellows, at least recommend a deserving colleague should two of whom must be Division 29 Fel - contact me with their name. lows who can attest to the fact that your 22 STUDENT FEATURE Preventing Distress and Impairment: The Importance of Self-Care Education and Utilization During Graduate Training in Clinical Psychology Ian Goncher, M.S. Loyola University, Maryland

Freud (1905/1933) veyed acknowledged distress in the pre - stated, “No one who, vious three years. Although the experi - like me, conjures up ence of distress is an expected part of life the most evil of those and by itself should not necessarily be a half-tamed demons cause for significant concern, these au - that inhabit the human thors also found that 36.7% of those sur - breast, and seeks to veyed reported an awareness that their wrestle with them, can distress resulted in a reduction of the expect to come through the struggle un - quality of care provided to clients. scathed” (p. 184). This declaration demonstrates the possible toll that pro - The practice of psychology can be a very viding psychotherapy can take on the stressful enterprise by virtue of the pro - practicing psychologist and underscores fession (Laliotis & Grayson, 1985), the need for increased education and which includes the potential for deterio - emphasis of self-care within graduate ration of personal and professional func - training of future psychotherapists. tioning related to symptoms of burnout (Maslach, 1976; Pines & Maslach, 1978; The implementation of self-care strate - Raquepaw & Miller, 1989; Truchot, gies has been referred to as an ethical Keirsebilck, & Meyer, 2000) and second - imperative in the practice of profes - ary traumatization (Figley, 1995; Kas - sional psychology (Barnett, Johnston, & sam-Adams, 1995; Munroe, 1995). Hillard, 2006). However, data suggest Additionally, the job setting of inde - that many psychologists refrain from pendent practitioners may also be a con - utilizing self-care services despite the tributing factor regarding the observed negative impact distress and development of symptoms of distress subsequent impairment have on their and impairment. For example, long ability to function , according to estab - work hours, administrative “red tape,” lished professional standards (e.g., Guy, sizable caseloads, third party payers, Poelstra, & Stark, 1989; Pope, Tabach - and budgeting concerns could be job nick, & Keith-Spiegel,1987; Sherman, setting factors that contribute to the de - 1996). This occurrence is tremendously velopment of symptoms of burnout concerning given the rates of distress (Vrendenburgh, Carlozzi, & Stein, 1999). and impairment reported by psycholo - Furthermore, Raquepaw and Miller gists, (Gilroy, Carroll, and Murra, 2002; (1989) suggest that the potentially isola - Guy, Poelstra, & Stark, 1989; Thoreson, tive nature of independent practice may Miller, & Krauskopf, 1989). In a study of contribute to symptoms of burnout. the prevalence of distress and its impact Although stressful life experiences are on effective professional functioning, not a unique phenomenon specific to in - Guy, Poelstra, and Stark (1989) found that approximately 75% of those sur - continued on page 24 23 dividuals practicing psychotherapy, Kil - programmatic emphasis of self-care on burg (1991) posits that psychotherapists graduate students’ self-care practices. are likely to feel more responsibility and However, in a recent study, Dearing, emotional distress than the average indi - Maddux, and Tagney (2005) found that vidual due to their specific knowledge faculty attitudes toward seeking per - and skills. Psychologists have reported sonal psychotherapy directly and indi - their most distressing personal events rectly predicted student attitudes to include marital difficulties (Kat - toward help-seeking. Additionally, sur - savadakis et al., 2004; Pope & Tabachnik, veying 264 doctoral-level trainees in 1994; Sherman & Thelen, 1998), depres - clinical psychology, Goncher (2010) sion (Pope & Tabachnik, 1994; Sherman found positive correlations between the & Thelen, 1998; Thoreson et al., 1989), sui - perceived emphasis placed on self-care cidal ideation (Katsavadakis et al., 2004), within each graduate trainee’s clinical death of family member and personal ill - psychology program , the use of self-care ness (Sherman & Thelen, 1998; Thoreson strategies by each graduate trainee, and et al., 1989), and financial or legal trouble graduate trainee quality of life. Further - (Freudenberger, 1990; Sherman & Thelen, more, Goncher ( 2010) found a positive 1998; Thoreson et al., 1989). correlation between programmatic self- care emphasis and self-care strategy uti - The aforementioned literature high - lization. These data suggest that lights a very real and concerning self-care education and emphasis of self- dilemma within the practice of psychol - care importance within doctoral level ogy. In particular, this evidence suggests training programs in clinical psychology that the training of future professional results in increased use of self-care psychologists in the development and strategies and enhanced functioning. utilization of positive and empirically Furthermore, by intervening at the early validated self-care strategies is of critical stages of the graduate trainees’ educa - importance . However, the American tional journey it is more likely that the Psychological Association Advisory graduate trainee will employ these Committee on Colleague Assistance strategies as they progress in their train - (ACCA, 2006) surveyed 500 graduate ing (Sussman, 1995). students recruited from the American Psychological Association of Graduate Although the extant literature does not Students (APAGS) and found 82.8% of possess a universal definition of self- students said their training program did care, research has provided several mod - not offer written material on the issue of els. Baker (2003) describes self-care as self-care and stress, 63.4% said their being comprised of three interrelated training program did not sponsor activ - factors: self-awareness, self-regulation, ities promoting self-care, and 59.3% said and balance. Baker (2003) suggests that their training program did not infor - psychologists endeavor to take care of mally promote an atmosphere of self- themselves psychologically, physically, care. Schwebel and Coster (1998) and spiritually. According to Baker concluded , “to summarize planned ef - (2003) , to take care of oneself psycholog - forts, it is fair to say that in most in - ically, one must examine and understand stances, little is offered to all students one’s psychological development, which with the express purpose of preventing includes scrutinizing influences that con - mental health problems” (p. 288). tribute to current psychological function - Currently, there is a paucity of research ing and one’s motivation to enter the examining the influence of faculty and continued on page 25 24 field, understanding one’s own needs (Bellows, 2007; Orlinsky & Ronnestad, and how to fulfill them, optimizing cop - 2005). Furthermore, participation in per - ing strategies and limiting stress, finding sonal therapy has been suggested as an meaning and purpose in personal and essential and ethically imperative aspect professional endeavors, engaging in ac - of graduate training and the independ - tivities such as relaxation, personal ther - ent practice of psychotherapy (Barnett & apy, and leisure activities, and creating Goncher, 2008; Norcross, 2005). meaningful interpersonal connections. For optimal physical health, Baker (2003) This , among many other self-care mod - suggests getting adequate rest, engaging els and activities , should be an essential in physical exercise, good nutrition, gen - aspect of training in psychological prac - eral medical care, cautioning against the tice. Thus, as we train and educate fu - use of substances, and healthy sexuality. ture psychologists it is necessary to Additionally, Baker (2003) asserts that begin to intervene at the primary pre - we must take care of ourselves spiritu - vention stage of development (Caplan, ally through finding our own spirituality 1964). We must not implement self-care and developing spiritual practice. Nor - strategies as strictly reactive measures cross (2000) provides a ten point model against distress and impairment, but comprised of practitioner-tested, re - become proactive in the prevention of search-informed strategies that elo - debilitating physical, psychological, in - quently encapsulate the multifaceted terpersonal, and spiritual distress that nature of practicing self-care as a psy - may result in impairment and subse - chologist. These strategies include recog - quent harm to our clients. nizing the hazards of psychological One way to achieve this goal is by practice, thinking strategies as opposed incorporating education on models of to techniques or methods, beginning self-care within the mandatory curricu - with self-awareness and self-liberation, lum of each accredited clinical psy - embracing multiple strategies tradition - chol ogy program. The future of ally associated with diverse theoretical psychology hinges not only on the re - orientations, employing stimulus control finement of diagnostic instruments and and counter-conditioning when possible, use of empirically supported therapeu - emphasizing the human element , avoid - tic interventions, but also on the physi - ing wishful thinking and self-blame, cal, psychological, and spiritual health diversifying professional activities, ap - of those who represent the future of preciating the rewards of a career in psy - psychology. chotherapy, and using personal therapy . The use of personal therapy by psychol - ogists has been shown as effective in the REFERENCES FOR THIS ARTICLE alleviation of distress and provides MAY BE FOUND ON-LINE AT many personal and professional benefits www.divisionofpsychotherapy.org

OF PSYCHOTH N E O R I A S I P V Y I D 29 . The Psychotherapy Bulletin A N M S E S R A I C L is Going Green: A A N PSYCHOLOGI C Click on www.divisionofpsychotherapy.org/members/gogreen/

25 CALL FOR NOMINATIONS Distinguished Psychologist Award The APA Division of Psychotherapy invites nominations for its 2011 Distinguished Psychologist Award , which recognizes lifetime contributions to psychotherapy, psychology, and the Division of Psychotherapy. Letters of nomination outlining the nominee’s credentials and contributions should be forwarded to the Division 29 2011 Awards Chair:

Jeffrey J. Magnavita, Ph.D., ABPP Glastonbury Medical Arts Center 300 Hebron Ave. Suite 215 Glastonbury, CT 06033 E-mail: [email protected]

The applicant’s CV would also be helpful. Self-nominations are welcomed. Deadline is January 1, 2011

CALL FOR NOMINATIONS Division 29 Award for Distinguished Contributions to Teaching and Mentoring Each year, Division 29 honors a psychologist who has contributed to the field of psychotherapy through the education and training of the next generation of psychotherapists by presenting the Division 29 Award for Distinguished Contributions to Teaching and Mentoring. This award is given annually to a member of Division 29 who exerted a significant impact on the development of students and/or early career psychologists in their careers as psychotherapists. Both self-nominations and nominations of others will be considered. The nomination packet should include: 1) a letter of nomination, sent electronically, describing the individual’s impact, role, and activities as a mentor; 2) a vitae of the nominee; and, 3) letters of reference for the mentor, written by students, former students, and/or colleagues who are early career psychologists. Letters of reference for the award should describe the nature of the mentoring relationship (when, where, level of training), and an explanation of the role played by the mentor in facilitating the student or colleague’s development as a psy - chotherapist. Letters of reference may include, but are not limited to, dis - cussion of the following behaviors that characterize successful mentoring: • helping students to select and work toward appropriate goals • providing critical feedback on individual work • providing support at all times, especially encouragement and assistance in the face of difficulties • assisting students in applying for awards, grants, and other funding

26 • assisting students in building social network connections, both with individuals and within organizations that are important in the field • serving as a role model and leader for teaching, research, and academic and public service in psychology • offering general advice with respect to professional development (e.g., graduate school, postdoctoral study, faculty positions), awards, and publications • treating student/colleagues with respect, spending time with them, providing open communication lines, and gradually moving the student into the role of colleague. The award recipient will receive a cash award of $2 50 to help offset travel ex - penses to the APA convention for the year the award is conferred and an award plaque.

Individuals who were nominated in previous years for the Teaching and Mentoring Award may carry over their complete application to a subsequent year by writing a letter to the Chair of the Professional Awards Committee requesting resubmission of the previous application.

The letter of nomination must be emailed to the Chair of the Professional Awards Committee. Deadline is January 1 , 2011 . All items must be sent electronically . The Award is to be presented at the APA annual convention and we encourage all award winners to attend this ceremony . Division 29 2011 Awards Chair: Jeffrey J. Magnavita, D29 Awards Chair Glastonbury Medical Arts Center 300 Hebron Ave. Suite 215 Glastonbury, CT 06033 E-mail: [email protected]

OF PSYCHOTH N E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C

NOTICE TO READERS Please find the references for the articles in this Bulletin posted on our website: divisionofpsychotherapy.org

27 28 EARLY CAREER Is it Really Ending? Some Reflections on the Transition from Early to Mid-career Michael J. Constantino, Ph.D. University of Massachusetts Amherst

I am a tenured, Asso - dom and direction. I became uncomfort - ciate Professor. I am a ably aware that soon I would be person - tenured , Associate Pro - ally responsible for a student’s training fessor. I really did and professional development. I had in - need to write it twice deed crossed a line. As it turns out, I was to believe it! These la - well trained and prepared for this step, bels, while associated but the notion of when I suddenly be - with tremendous pride (and a lot of came an “expert” was still murky in my work!), also clearly indicate that I am no mind. And now, as I leave early career longer in my early career. Although I behind, I am crossing another one of often still feel junior, I cannot ignore the those invisible lines into “experienced overwhelming number of signs that tell expert,” whatever that means! And, me that I am now entering my mid-ca - again, despite history telling me that I reer. Thus, it is appropriate, although will be prepared for it (or at least that I also somewhat sad, that as of December will survive it), the crossing is a bit un - 31, 2010, I will rotate out of my position comfortable. But it will happen no mat - as Early Career Domain Representative ter what, so I am trying to embrace the to the Division 29 Board of Directors. As loss of my “newbie-ness.” I leave this position after three and a half years, I would like to (a) share some re - As I reflect back, I also recall several flections on my early career, as well as salient early career experiences. Starting this inevitable transition out of it, and (b) a research lab was challenging; however, offer several recommendations for those it was also fun. Part of the fun was the who are entering or will soon enter the ability to use start-up funds to make the early stages of a career in academia. space mine (and ultimately that of my graduate students). I was also fortunate Reflections that the Chair of my search committee Like each stage of training, early career was kind enough to review my start up goes by quickly. And the transition to request and to suggest that I double it. mid-career reflects another one of those It worked—I received the doubled imaginary lines that one crosses whether amount! Such guidance was crucial in they are psychologically ready or not. what was uncharted territory for me. Of When I first obtained my faculty posi - course, as I move into mid-career, I am tion, it was clear, whether or not I be - bummed that my start-up is all gone. lieved it, that I was crossing a line into Like early career (and all stages before the realm of “expert.” I was reminded of that), it went quickly! But, hey, that’s that in many ways. Numerous manu - what grants are for, right? script review requests came rolling in I also recall that I networked a lot (even even before I got settled into my new of - more so than when in graduate school). fice! Both undergraduate and graduate students began looking to me for wis - continued on page 30 29 I worked hard to build connections both reer, I can honestly say, “I am doing within my University and across the okay.” I might not always feel it, but I profession. Running for a Division 29 trust it. Board position was a perfect example, and it was one of the most rewarding Recommendations decisions that I made in my early career. Although I am sure with time I could Connection and collaboration are crucial think of numerous others, here are a few in academia (and many other profes - quick recommendations that I would sions), which reminds me how much I confidently share to an early career, said “yes” to things early on. Although I tenure-track faculty member at a re - still say “yes” to a lot of things, it is inter - search-oriented institution. esting that one of my biggest goals as I enter mid-career is to learn how to po - Accept two graduate students in your litely decline certain invitations in order first year of recruitment. It will help to to preserve my own sanity! I have to say, create a lab environment more quickly my current, and very first, sabbatical has for both you and your students. Further - helped in this regard. more, although it will involve some ad - ditional work, this will be a time when I also learned that getting involved in your energy is at its highest level! Thus, relevant professional associations some - it will feel more enjoyable than strain - times means accepting the less glam - ing. I have to admit that I am simply orous role. For example, I served as the passing this recommendation on from Continuing Education Coordinator for a my graduate advisor with whom I con - research society for several years. Al - sulted on this very issue. Speaking of though the work was not glamorous, which… and even occasionally tedious, the ben - efits to the development of my profes - Stay in touch with your former advisors. sional network were immense. In fact, I They have much wisdom to continue to would say that such benefits were di - offer, and they will be interested in (and rectly associated with my even being in proud of) your development and accom - the conversation for more “glamour” plishments. However, you should also roles (e.g., I was recently nominated and continue to foster your independence, subsequently elected as President-Elect and do so at an even more advanced in the same research society). Paying pace than during internship and post - one’s dues really does matter! doc. Part of this will simply involve trusting your judgment. Of course I I suppose that my most central reflection mean “simple” in theory, but not always as I look back on early career is that practice! there were countless times when I either initiated (e.g., my first solo grant appli - Humility is good, but self-confidence is cation) or was assigned (e.g., to be a good too. Strive for a nice blend, as this search committee chair) something that will invite (more often than not) colle - seemed somewhat beyond my felt readi - giality, friendship, and respect. These ness. However, in most cases, I sur - will in turn promote mental well-being! prised myself. And in the cases where the outcomes were less positive, I real - It is fine, and often necessary, to have a ized that this career is a marathon, “publish or perish” mentality and even which will safely involve some trial, competitive spirit on your way to error, revision, adaptation, and adjust - tenure. However, this should not fully ment. And at the font-end of my mid-ca - continued on page 31 30 translate into a “publish or perish” exis - Appreciation tence ! I know it is cliché, but maintain To reiterate, I cannot believe how your life and your personality outside of quickly my early career has passed. It is academia, i.e., still be you, and enjoy it. a bit frightening to shed the protective For example, grants are incredible, but “junior” label. However, it is also an ex - so are sports, movies, music, friends citing challenge—a challenge in part (perhaps especially those who have very made possible by my involvement in different careers than you!), etc. So, de - important and inspiring endeavors such spite the many demands with seemingly as my term on the Division 29 Board. I impossible deadlines, also say “yes” to appreciate all that the Board has done starting that softball team! Find a local for me, as well as all of the hard work of pub that has the NFL Ticket so that you its members (including those directly can continue to follow your team. Tail - tied to Early Career initiatives). I also gate a local football game. This is a won - look forward to continued mid-career derful collegiate tradition for which you involvement with this Division. I will re - are never too old (not even at mid- or main connected! late-career!). Of course I am leaking here some of my things, but you get the idea.

OF PSYCHOTH N E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C

PSYCHOLOGY DAY AT UN For the past few years the APA–NGO delegation has sponsored a Psychology Day at the United Nations. Next year Psychology Day will be held on April 1 4, 2011. Florence Kaslow, Ph.D., ABPP , a former President of Division 43(Family) and 46 (Media) , a former member of the APA Council, and a member Division 29 who hosted one of our tables at our recent luncheon for graduate students, has been invited to be one of the presenters. The theme for the day is Universal Access to Education: Barriers and In - novations . Florrie will speak about The Pivotal Role of the Family in their Child’s Learning .

Florrie is currently a member of CIRP—the Committee on International Relations in Psychology and will serve as Committee Co-chair in 2011. CIRP works closely with the APA-NGO delegation .

At the recent APA Convention in San Diego, she received the Russell Bent Award for Distinguished Contribution to ABPP at the ABPP Convocation . A number of those Board Certified in Couple and Family Psychology were present to help celebrate this honor.

31 DIVISION 29 2010 AWARDS CEREMONY APA Annual Convention—San Diego California

Division 29 President Jeffrey Magnavita, Past President and Awards Chair Nadine Past President and Awards Chair Nadine Kaslow, Division 29 Distinguished Kaslow, and Psychotherapy Journal Psychologist Award recipient Jeff Barnett, Editor Charles Gelso and President Jeffrey Magnavita

Jeffrey Magnavita, Nadine Kaslow, Distinguished Publication of Psychotherapy Research Article Nadine Kaslow, APF/Division 29 Early Award recipient Antonio Pascual-Leone , and Career Award recipient Tami Jo De Research Committee Chair Susan Woodhosue Coteau, and Jeffrey Magnavita

Jeffrey Magnavita and Mathilda B. Canter Nadine Kaslow, Distinguished Education and Training Student Paper Contributions to Teaching and Mentoring Award recipient Samuel Nordberg Award recipient Louis Castonguay, and Jeffrey Magnavita 32 CALL FOR NOMINATIONS DIVISION 29 EARLY CAREER AWARD American Psychological Foundation (APF) APF provides financial support for innovative research and programs that en - hance the power of psychology to elevate the human condition and advance human potential both now and in generations to come. It executes this mission through a broad range of scholarships and grants. For all of these, it encourages applications from individuals who represent diversity in race, ethnicity, gen - der, age, disability, and sexual orientation. The Division 29 program recognizes an early career psychologist for promising contribution to psychotherapy, psychology, and the Division of Psychotherapy. Its description, application requirements, and procedures appear below.

Description This program supports the mission of APA’s Division of Psychotherapy (Divi - sion 29) by recognizing Division members who have demonstrated outstand - ing promise in this field early in their career. Recognized achievements may be in the areas of psychotherapy.

Program Goals Encourage further development and continuing contributions of early-career professionals in this field

Funding Specifics One $2,500 award presented annually

Eligibility Requirements • Division 29 membership • Within 7 years post-doctorate • Demonstrated achievement related to psychotherapy theory, practice, research or training

Evaluation Criteria • Conformance with stated program goals and qualifications • Applicant’s demonstrated accomplishments and promise

Nomination Requirements • Nomination letter written by a colleague outlining the nominee’s career contributions (self-nominations not acceptable) • Current CV

Submission Process and Deadline Submit a completed application online at http://forms.apa.org/apf/grants/ by January 1 , 2011 .

Questions about this program should be directed to Kim Palmer Rowsome, Program Officer, at [email protected] .

33 N OF PSYCHOTH ER IO A S I P V Y I IVISION OF SYCHOTHERAPY D 29 . D P (29) A N M S

MERICAN SYCHOLOGICAL SSOCIATION E S

A P A R A

I L C A A Enter the Annual Division ofPsychotherapy N PSYCHOLOGI C Student Competitions The APA Division of Psychotherapy offers four student paper competitions: Ⅲ The Donald K. Freedheim Student Development Award for the best paper on psychotherapy theory, practice or research. Ⅲ The DiversityAward for the best paper on racial/ethnic gender,and cultural issues in psychotherapy. Ⅲ The Mathilda B. Canter Education and Training Award for the best paper on education, supervision or training of psychotherapists. Ⅲ The Jeffrey E. Barnett Psychotherapy Research paper Award for the best paper that addresses psychotherapist factors that may impact treatment effectiveness and outcomes, to include type of training, amount of training, professional degree or discipline of the psychotherapist, and the role of psychotherapists’ personal characteristics.

What are the benefits to you? Ⅲ Cash prize of $250 for the winner of each contest. Ⅲ Enhance your curriculum vitae and gain national recognition. Ⅲ Plaque and check presented at the Division 29 Awards Ceremony at the annual meeting of the American Psychological Association (August 4-7, 2011) Ⅲ Abstract will be published in the Psychotherapy Bulletin, the official publication of the Division of Psychotherapy.

What are the requirements? Ⅲ Papers must be based on work conducted by the first author during his/her graduate studies. Papers can be based on (but are not restricted to) a masters thesis or a doctoral dissertation. Ⅲ Papers should be in APA style, not to exceed 25 pages in length (including tables, figures, and references) and should not list the authors’ names or academic affiliations. Ⅲ Please include a title page as part of a separate attached MS-Word or PDF document so that the papers can be judged “blind.”This page can include authors’ names and academic affiliations. Ⅲ Also include a cover letter as part of a separate attached MS-Word or PDF document.The cover letter should attest that the paper is based on work that the first author conducted while in graduate school. It should also include the first author’s mailing address, telephone number, and e-mail address.

Submissions should be emailed to: Doug Wilson Chair, Student Development Committee, Division of Psychotherapy E-mail: [email protected]

Deadline is April 1, 2011

34 2011 NOMINATIONS BALLOT Dear Division 29 Colleague:

Division 29 seeks great leaders! Bring our best talent to the Division of Psychotherapy (29) as we put our combined talents to work for the advancement of psychotherapy.

NOMINATE YOURSELF OR SOMEONE YOU KNOW TO RUN FOR OFFICE IN THE DIVISION OF PSYCHOTHERAPY. THE OFFICES OPEN FOR ELECTION IN 201 1 ARE: • President-elect • Secretary • Domain Representative for Public Interest and Social Justice All persons elected will begin their terms on January 2, 2012 A Domain Representative is a voting member of the Board of Directors. The open position wil be re - sponsible for creative initiatives and oversight of the Division’s portfolio in Public Interest and Social Justice. Candidates should have demonstrated interest and investment in the area of their Domain.

The Division’s eligibility criteria for all positions are: 1. Candidates for office must be Members or Fellows of the division. 2. No member may be an incumbent of more than one elective office. 3. A member may only hold the same elective office for two successive terms. 4. Incumbent members of the Board of Directors are eligible to run for a position on the Board only during their last year of service or upon resignation from their existing office prior to accepting the nomination. A letter of resignation must be sent to the President, with a copy to the Nomina - tions and Elections Chair. 5. All terms are for three years, except President-elect, which is one year. Return the attached nomination ballot in the mail. The deadline for receipt of all nominations ballots is December 31, 20 10 . We cannot accept faxed copies. Original signatures must accompany ballot. EXERCISE YOUR CHOICE NOW! If you would like to discuss your own interest or any recommendations for identifying talent in our division, please feel free to contact the division’s Chair of Nominations and Elections, Dr. Marvin Goldfried at (631) 632-7823 or by Email at [email protected] Sincerely, Jeffrey J. Magnavita, Ph.D . Elizabeth Nutt Williams, Ph.D. Marvin Goldfried, Ph.D. President President-elect Chair, Nominations & Elections

NOMINATION BALLOT President-elect Secretary ______

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Domain Representative for Public Interest and Social Justice ______

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Indicate your nominees, and mail now! In order for your ballot to be counted, you must put your signature in the upper left hand corner of the reverse side where indicated . 35

) d e t n i r P ( e m a N

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e r u t a n g i S

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FOLD THIS FLAP IN.

Fold Here.

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Division29 Central Office 6557 E. Riverdale St. Mesa, AZ 85215

Fold Here. CHARLES J. GELSO, PH.D., PSYCHOTHERAPY RESEARCH GRANT

Brief Statement about the Grant Funding Specifics The annual Charles J. Gelso, Ph.D., One annual grant of $2,000 Psychotherapy Research Grant provides $2,000 toward the advancement of Eligibility Requirements research on psychotherapy process or • In alternating years, graduate students/ psychotherapy outcome. pre-doctoral interns (even-numbered years) or psychologists/postdoctoral Eligibility : In alternating years, gradu - fellows (odd-numbered years) will be ate students/predoctoral interns or doc - eligible. toral level psychologists/postdoctoral • In 2011, doctoral level psychologists fellows will be eligible for the Charles J. and postdoctoral fellows will be eligible. Gelso Grant. In 2011, doctoral level psy - • In 2012, graduate students in psychol - chologists, including postdoctoral fel - ogy and pre-doctoral interns who are in lows, will be eligible . In 2012, graduate good standing at an accredited univer - students in psychology and predoctoral sity will be eligible . interns who are in good standing at an • Demonstrated or burgeoning compe - accredited university will be eligible. tence in the area of proposed work. The grant will rotate biannually between • IRB approval must be received from graduate students/predoctoral interns the principal investigator’s institution and doctoral level psychologists/post - before funding can be awarded if doctoral fellows, such that nominations human participants are involved. will be accepted in even number years • The same project/lab may not receive for the former group and odd number funding two years in a row. years for the latter group. Evaluation Criteria Deadline : April 1, 2011 • Conformance with goals listed above under “Program Goals” REQUEST FOR PROPOSALS • Magnitude of incremental contribu - Description tion in topic area This program awards grants for research • Quality of proposed work projects in the area of psychotherapy • Applicant’s competence to execute process and/or outcome. In alternating the project years the grant is awarded to graduate • Appropriate plan for data collection students (even-numbered years) or doc - and completion of the project toral level psychologists (odd-numbered years). Proposal Requirements for Program Goals All Proposals Advance understanding of psychother - • Description of the proposed project to apy process and psychotherapy out - include goals, relevant background, come through support of empirical target population, methods, antici - research in these areas: pated outcomes, and dissemination • Encourage talented graduate students plans towards careers in psychotherapy • CV of the principal investigator research • Format: not to exceed 3 pages (1 inch • Support psychologists engaged in margins, no smaller than 11-point psychotherapy research font) 37 • Timeline for execution (priority given • Postdoctoral fellows must submit 1 to projects that can be completed letter of recommendation from the within 2 years) mentor who will be providing guid - • Full budget and justification (indirect ance during the completion of the costs not permitted). The budget project and this letter should indicate should clearly indicate how the grant the nature of the mentoring relation - funds would be spent. ship • Funds may be used to initiate a new project or to supplement additional Additional Information funding. The research may be at any • After the project is complete, a report stage. In any case, justification must on how the money was spent must be be provided for the request of the cur - submitted rent grant funds. If the funds will sup - • Grant funds that are not spent on the plement other funding or if the project within two years must be re - research is already in progress please turned explain why the additional funds are • When the resulting research is pub - needed (e.g., in order to add a new lished, the grant should be acknowl - component to the study, add addi - edged tional participants, etc.) • No additional materials are required Submission Process and Deadline for doctoral level psychologists who • Submit a CV and all required materi - are not postdoctoral fellows als for proposal (see above for pro - • Graduate students, predoctoral in - posal requirements) to: Tracey A. terns, and postdoctoral fellows Martin in the Division 29 Central Of - should refer the section immediately fice, [email protected] below for additional materials that are • If the grant is to be used to support a required. thesis or dissertation, the thesis/dis - sertation proposal must be approved Additional Proposal Requirements by the thesis/dissertation committee for Graduate Students, Predoctoral (this should be noted in the letter of Interns, and Postdoctoral Fellows: recommendation from the mentor) • Graduate students, pre-doctoral in - • Deadline: April 1, 2011 terns, and postdoctoral fellows • Questions about this program should should also submit the CV of the be directed to the Division of Psy - mentor who will supervise the work chotherapy Research Committee • Graduate students and pre-doctoral Chair (Dr. Jim Fauth at jfauth@anti - interns must also submit 2 letters of och.edu), or the Division of Psy - recommendation, one from the men - chotherapy Science and Scholarship tor who will be providing guidance Domain Representative (Dr. Norman during the completion of the project Abeles at [email protected]), or Tracey and this letter must indicate the na - A. Martin in the Division 29 Central ture of the mentoring relationship Office, [email protected]

OF PSYCHOTH N E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C

38 PERSPECTIVES ON PSYCHOTHERAPY INTEGRATION Introduction To An Integrative Attachment-Based Model of Sexual and Loving Feelings in Psychotherapy Alan Nathan, Psy.D. Argosy University, Washington, D.C. This paper provides to widen the space between exploitative an introduction to an and unethical sexual acting out and the integrative attachment- forbidden zone to which loving and sex - based model of sexual ual feelings within the psychotherapy and loving feelings relationship are often cast and to within the psycho- broaden the application of effective in - therapy relationship. I tervention strategies across theoretical posit a three dimensional model for un - orientations. A final introductory note derstanding and responding to sexual is that sexual and loving feelings in and loving feelings that includes: (a) psychotherapy result from complex normalization of psychotherapist sexual processes in which both patient and and loving feelings that includes provi - therapist make contributions. While it is sion of a supportive professional beyond the scope of this paper to pres - community; (b) an attachment-based ent a comprehensive typology of this conceptualization of sexual and loving phenomenon, the assumption of co-cre - feelings in psychotherapy; and (c) an in - ation of experience within the psy - tegrated formulation of effective inter - chotherapy relationship serves as a vention that centers on psychotherapist subtext for this discussion. reflective function within a secure ther - apist-patient attachment relationship, Psychotherapist Sexual and the transformation of sexual and loving Loving Feelings as Normative feelings into clinical observations, and There is now a well established body cultivation of a therapeutic form of love. of evidence in the form of large scale Due to space limitations the model is psychotherapist survey studies that briefly presented along with a clinical have confirmed that the experience of vignette . The overarching goal is to con - sexual and romantic attraction toward tribute to the development of a more in - patients is a common but not frequent clusive discourse on this enormously occurrence for psychotherapists , ac - challenging topic within the psychother - knowledged by 78 to 90 percent of re - apy profession. I attempt to address the spondents (Paxton et al., 2001; Pope et therapeutic challenges by first normal - al., 1986; Pope & Tabachnick, 1993; Pope, izing psychotherapist experience of sex - Tabachnick, & Keith-Spiegel, 1987; ual and loving feelings and the anxiety Rodolfa et al., 1994; Stake & Oliver, and avoidance they can provoke (Dal - 1991). While such feelings are typically lenberg, 2000; Gutheil & Gabbard, 1992; not acted upon by therapists in an ex - Ladany et al., 1997; Paxton, Lovett, & plicit way there is a small proportion Riggs, 2001; Pope, Keith-Spiegel, & (approximately 7%) of psychotherapists Tabachnick , 1986; Pope, Sonne, & who engage in sexual relations with Greene, 2006; Pope, Sonne, & Holroyd, their patients. The harm that comes to 1993; Rodolfa et al., 1994) . It is my hope continued on page 40 39 patients, their families, to the profession, mately one fourth of therapists acknowl - and to the public’s view of the profes - edge sexual fantasies about patients sion has been well documented during sexual activity with others (Bouhoutsos, Holroyd, Lerman, Forer, & (Rodolfa et al., 1994; Pope et al., 1986). Greenberg, 1983; Brown, 1988; Parsons When therapist respondents are asked & Wincze, 1995; Pope, 1988, 1990, 2001). more generally about between session Regardless of theoretical orientation we sexual fantasies involving patients can all agree that therapist-patient sex - 46.3% endorse this item as a rare experi - ual activity is a disaster that every psy - ence and 22.4% endorse this item as a chotherapist must be responsible for sometimes experience (Pope et al., 1987). guarding against as part of the commit - ment to do no harm (American Psycho - Dalenberg (2000) in an analogue study logical Association, 2002). and a post-treatment interview study obtained patient and therapist ratings of That said, loving and sexual feelings can therapist responses to patient expressed potentially disrupt the course of psy - sexual attraction to the therapist. Severe chotherapy even when the therapist re - anxiety and angry feelings were re - frains from sexual involvement with the ported by more than half of the thera - patient. Psychotherapists report power - pists in the analogue study and patients ful anxiety laden reactions to sexual at - rated over 70% of therapist responses as traction to patients that may contribute harmful including those described as to confusion and distraction from the punitive and avoidant. In the patient in - clinical work, difficulty managing terview study two thirds of patients re - therapeutic boundaries effectively, pre - ported that issues related to patient mature termination , and negative treat - sexual attraction were left unresolved ment impact particularly if the patient is and of those patients one third felt that believed to be aware of the therapist’s their therapist avoided the issue. There feelings (Ladany et al., 1997; Pope et al., is no direct evidence that the therapists 1987; Rodolfa et al., 1994; Stake & Oliver, in these studies experienced sexual or 1991) . loving feelings. That said, patient ex - pression of sexual material and behavior Psychotherapists have reported that sex - has been found to be associated with ual and loving feelings arise in the fol - therapist sexual attraction in several of lowing forms: (a) in-session sexual the above survey studies (Ladany et al., arousal, (b) between session sexual or 1997; Pope et al., 1986; Rodolfa et al., romantic fantasy, and (c) noticing pa - 1994) and two studies of therapists who tient as physically attractive (Pope et al., became sexually involved with their pa - 1986; Pope et al., 1987; Pope & Tabach - tients (Gabbard, 1994c; Gutheil, 1989). nick, 1993; Rodolfa et al., 1994) . The most common form of sexual feeling is Clearly when sexuality enters the psy - noticing the patient as physically attrac - chotherapy space anxiety and struggle tive with a 96% endorsement rate and follow. Yet the vast majority of therapists approximately three quarters of thera - manage to refrain from sexual activity pists reporting that they notice up to with patients including under these fifty percent of their patients as physi - anxiety provoking circumstances. It is cally attractive. Overall 58% reported noteworthy that perceived negative sexual arousal while in the presence of a treatment impact is correlated with patient at least with 1-2% of patients and belief in patient awareness of therapist most no more than with 20% of patients sexual attraction. It can feel nearly im - (Pope & Tabachnick, 1993). Approxi - continued on page 41 40 possible to maintain an objective and on the issue included fear of negative re - neutral therapeutic frame when the ther - actions from professional peers and su - apist believes that the patient can see her pervisors. On the other hand when most intimate and vulnerable states of psychotherapists did seek professional as - desire. The tendency to equate sexual sistance or consultation the following fac - feeling with sexual action along with the tors were most influential: (a) safe sometimes shaming responses to thera - training environment that included nor - pist sexual feelings within the profes - malization of sexual and loving feelings, sional community can lead any therapist (b) supportive relationship with a super - toward avoidance when the patient is visor, and (c) provision of specific guide - believed to know (Gutheil & Gabbard, lines for management of sexual and 1992; Pope, Sonne, & Greene, 2006 ; loving feelings (Ladany et al., 1997; Pax - Pope, Sonne, & Holroyd, 1993). ton et al., 2001).

That potential sexual and loving feelings It is interesting to compare these factors can provide for deeper understanding of to those described by Dalenberg’s (2000) the patient, creative and effective inter - patient participants in relation to effective vention, and positive treatment outcome therapist response to sexual feelings: (a) is noted via therapist report in the above provision of reassurance to the patient survey studies (Ladany et al., 1997; Pope that therapeutic boundaries would not be et al., 1987; Rodolfa et al., 1994). Factors violated, (b) acceptance of patient’s sex - that contribute to the formulation of use - ual feelings and willingness to help the ful clinical observations include thera - patient to understand the feelings, (c) pist acceptance of such feelings as willingness to help the patient to under - normative, therapist confidence that he stand the therapist’s feelings and the na - will not act upon those feelings, and the ture of the psychotherapy relationship, availability of trusted professional re - and (d) avoidance of transference inter - sources including supervision, peer con - pretation that dismisses and pathologizes sultation, and personal psychotherapy the patient’s feelings. Thus sexual and (Ladany et al., 1997; Paxton et al., 2001; loving feelings can be understood as clin - Pope et al., 198 6; Rodolfa et al., 1994) . ical data and can effectively enter the therapeutic dialogue. It might be said When therapists do not have the neces - that patients can benefit from a therapeu - sary preparation and support to work tic experience in which this distinction with sexual and loving feelings reflec - between sexual and loving feeling, dia - tively it can be easy for them to feel that logue about those feelings, and acting on their only option is to inhibit such feelings those feelings is clarified and internal - and avoid the topic with their patients. ized . The next section works to further ar - Survey studies show that at least half of ticulate these ideas. psychotherapist respondents described their graduate training as inadequate, in - An Attachment Based Conceptualiza - sufficient, or absent in this regard (Paxton tion of Psychotherapist Sexual and et al., 2001; Pope et al., 1986; Pope & Loving Feelings Tabachnick, 1993; Rodolfa et al., 1994). Be - This section examines the psychother - tween 27% and 43% of psychotherapist apy relationship as an attachment rela - respondents did not seek any form of as - tionship by nature in which powerful sistance when faced with sexual or loving emotional, physiological, and visceral feelings toward the patient (Paxton et al., levels of experience are generated for 2001; Pope et al., 1986; Rodolfa et al., 1994). Reasons given for remaining silent continued on page 42 41 the therapist and patient alike. Publica - Mirror neurons are located in the motor tions that conceptualize the psychother - cortex and contain complex synaptic ties apy relationship as an attachment to the emotional centers of the brain. relationship in which therapist reflective They are activated through observation function is a key feature are accumulat - of emotionally charged goal directed ing (Bateman & Fonagy, 2004 , 2009; movements including those displayed Eagle, 2003, 2007; Fonagy, Gergely, Ju - during the course of intimate interaction. rist, & Target, 2004; Fosha, 2009; Thus, it appears that human beings are Mikulincer & Shaver, 2007; Parrish & hardwired to represent the internal expe - Eagle, 2003; Weinstein, 2007). rience of others in a physical modality that creates a sense of being touched, Briefly, the attachment system is de - moved, or as if the observed other has signed to engage distress signaling taken up residence inside of the observer. behaviors that activate protective behav - iors in a caregiver or person who as - Mirror neurons alone can explain why sumes a caregiver role such as a psychotherapists would experience a psychotherapist. Attachment security range of sexual and loving feelings in can be thought of as the smooth transi - response to patient communication of tion from distress that activates the at - sexual material. Returning to the psy - tachment system to distress relief that chotherapist survey studies , patient vul - deactivates the attachment system and nerability is noted as one of the most allows for exploratory and bonding common patient characteristics that con - modes of interaction where reflective tribute to therapist sexual attraction function can thrive (Bowlby, 1969/1982; (Ladany et al., 1997; Pope et al., 1986; Fonagy et al., 2004; Meins, Fernyhough, Rodolfa et al., 1994). Sometimes the dis - Fradley, & Tuckey, 2001; Sroufe, Ege - tinction between tender feelings related land, Carlson, & Collins, 2005). to the desire to nurture and protect and sexual desire can be ambiguous. Thus, Reflective function is a concept that has the act of empathizing with a patient’s emerged within the psychoanalytic and emotional vulnerability can produce a attachment literature and refers to the sexual response even when the patient’s capacity to recognize and process com - communications are not directly sexual plex implicitly communicated inten - in nature. Further support for this claim tional states within oneself and others is derived from experimental studies of (Diamond & Yeomans, 2007; Fonagy et attachment, sexual desire, and romantic al., 2004). It is also thought to be impor - attraction in which tracking of their neu - tant in affective regulation and the estab - robiological and experiential correlates lishment and maintenance of secure have produced evidence that they can attachment including within the psy - be understood as separate and interde - chotherapy relationship (Eagle, 2007 ; pendent systems of emotionally charged Fonagy et al., 2004; Mikulincer & Shaver, intentional states (Eagle, 2007; Fisher, 2007; Weinstein , 2007). In addition, the 2000; Mikulincer & Shaver, 2007; Wein - discovery of mirror neurons has con - stein, 2007). Common to both sexual and tributed to the understanding of the romantic attraction mental states is the mechanisms involved in empathy and deactivation of reflective function (Dia - reflective function as well as the commu - mond & Yeomans, 2007; Fisher, 2000; nication of implicit body-based represen - Mikulincer & Shaver, 2007). Romantic tations of intimate relational experiences attraction is associated with a mental (Gallese, 2009; Gallese, Rochat, Cossu, & Sinigaglia, 2009; Ginot, 2009; Kerr, 2008). continued on page 43 42 state marked by emotional elation, ru - model are three forms of psychotherapy mination and fantasizing about the love that rely upon the psychotherapy rela - object, idealization of the love object, tionship as the primary change agent and alterations in behavior designed to and that are informed by attachment make oneself available to and attractive theory. Exposure is another way to con - to the love object. Sensitivity to signs of ceive of this process in which the patient rejection or separation from the love ob - is helped to experience the presenting ject increases so that emotional elation problem within the psychotherapy rela - can easily shift to anxiety and frantic ef - tionship in a way that allows for extinc - forts to reunite or to despair when those tion of intimacy fear and avoidance and efforts fail (Fisher, 2000). the development of new relational expe - riences and behaviors. Relational psy - This conceptualization can be utilized by choanalysis (RP) refers to this process as psychotherapists to both normalize expe - enactment (Benjamin, 1994; Davies, riences of sexual and loving feelings and 1994a, 1994b , 1998, 2001; Gabbard, to help make the distinction between 1994a, 1994b, 1996; Ginot, 2009; Hirsch, such feelings as clinical observations and 1994; Tansey, 1994 ). Fears and desires as signals that the therapeutic frame concerning intimate contact with others maybe in danger . Distinguishing features are thought to be registered in implicit may include sustained intensity of psy - nonverbal form and accessible via the chophysiological and emotional arousal interpersonal interaction. The analyst at - and inhibited reflective thought versus tends to the bodily rhythms and related the activation of reflective function ac - emotional states evoked within the in - companied by modulated forms of psy - teraction, recognizes and processes how chophysiological and emotional arousal. she has implicitly participated in the Experientially the difference can be char - therapeutic interaction in ways that re - acterized as ruminative or wistful flect the patient’s primary relational thought upon a love object versus reflec - problems, and works to transform the tive thought about a patient. For instance, nonverbal pattern into verbal material a therapist who experiences a sexual fan - that can enter the therapeutic dialogue. tasy about a patient and reflects upon that fantasy resulting in enhanced clinical Functional analytic psychotherapy understanding and new ideas for inter - (FAP) has been applied to treat adult vention is on different ground than a survivors of chronic childhood interper - therapist who experiences such a fantasy sonal trauma (Kohlenberg & Tsai, 1998). and lingers upon it in a manner that pro - It utilizes the psychotherapy relation - vides temporary relief of distress fol - ship as an in vivo exposure field. The lowed by shame and guilt. In the latter therapist attends to clinically relevant case such experiences can signal the ther - behaviors which are defined as subtle in - apist to reflect upon ways in which his or timacy approach and avoidance behav - her attachment and sexual needs might iors. The therapist is required to respond be blurring therapeutic boundaries and authentically to the patient’s fear of inti - to seek professional assistance toward the macy and expressed desire for intimacy reactivation of reflective function and in a way that requires him to cultivate a therapeutic availability to the patient. state of mind similar to that of a parent An Integrative Intervention figure. As articulated by Kohlenberg and Tsai, “FAP theory indicates that, in Next, I briefly introduce the central con - general, the therapeutic process is facil - structs of the proposed integrative ap - proach to intervention. Informing this continued on page 44 43 itated by a caring, genuine, sensitive, uses the concept of potential space to de - and emotional client-therapist relation - scribe an intersubjective process in ship” (p. 312). Technical forms of rein - which patient and analyst transform forcement are thought to be ineffective frightening relational experiences that and referred to as contrived reinforcement. have previously signaled traumatic Contrived reinforcement is thought to boundary violation and invalidation lead the patient to comply with the ther - into manageable relational experiences apist’s agenda while intimacy avoidant that signal reflection and communica - behaviors are maintained. tion (Davies 1994a, 1994b, 1998, 2001; Winnicott, 1971 ). It is like an intersubjec - Accelerated experiential dynamic psy - tive living space for self and other where chotherapy (AEDP) requires the thera - the warmth of security, jubilation of pist to act as an emotion regulating pleasure, and vitality of love can be ex - attachment figure in which her authen - perienced in a way that allows for the tic emotional responses to the patient in fantastical without losing sight of the real time are the central focus. Diana limits of the real. It allows for the psy - Fosha is one of the lead authors of this chotherapist to metaphorically touch process-experiential form of psychother - her patient without literal touching. It is apy (Fosha, 2009). A central premise is a love of the creative and intrinsically re - that emotion itself is adaptive and if al - lational human mind. lowed to emerge fully into awareness previously foreclosed needs and adap - FAP focuses upon parental love while at tive behaviors designed to meet those the same time recognizing that the ther - needs will follow. Physiological and vis - apy relationship cannot literally take the ceral sensations are carefully attended as form of a parental relationship. To quote patient and therapist alike allow them - Kohlenberg and Tsai, “Because the ther - selves to be taken by the momentum of apist-client relationship captures many the experience. It is common for patient essential elements of the parent-child re - and therapist to express feelings of lationship, it has great potential for both warmth and excitement in relation to harm and healing” ( 1998, p. 319). It is the each other and the therapeutic work. therapist’s focus upon utilization of clin - Fosha quoted one AEDP therapist who ical theory and skill in a way that be - reported that a patient said that her ther - comes an authentic living experience for apist’s empathy felt like “warm liquid patient and therapist alike that signifies honey down her esophagus” (Fosha, a form of therapeutic love. At the same 2009, p. 181). Such intimate physically time the therapist’s reflective attention registered experiences are common both to observable and mutually verifiable to attachment bonding and romantic behaviors allows for the distinction be - bonding. The distinction again lies in the tween the therapeutic and the personal therapist’s reflective state of mind di - to be monitored and developed. It can rected toward the patient’s emotional be thought of as a love of knowledge growth interests. that heals.

Each of the above psychotherapies de - AEDP brings the concept of transfor - scribe a form of therapeutic love that al - mance which describes the process of lows for an integrated understanding of change itself as it occurs within the ther - the distinction between intimacy in the apeutic interaction (Fosha, 2009). It oc - psychotherapy relationship and inti - macy in other forms of relationship. RP continued on page 45 44 curs in the moments after exposure in quired her to bolster their self-esteem which the patient and therapist explore and to submit to their sexual and roman - and put into words the emotional states tic desires. Efforts on her part to obtain triggered by relief from fear and anxiety recognition and acceptance of her bud - and the emergence of new experience. ding sense of feminine identity were This process can be thought of as a love sexualized and met with seduction or for the process of growth. shaming rejection. It would have been easy to avoid my own feelings in this Clinical Vignette moment and to interpret her effort to A young female patient of mine had end the psychotherapy in her own way made substantial progress by the end of as avoidance or hostility. That would a yearlong treatment. She had suffered have been a traumatic repetition and a repeated emotional abuse, including missed opportunity to recognize her sexual boundary violations that left her growth. She had withdrawn from the deeply ashamed of her sexual and at - dating scene and most other socializing tachment needs. One of her central pre - for over a year, spending most of her senting issues was her fear that time alone in painful rumination and expressing her desires would be per - self recrimination. ceived as hostility and responded to with retaliation or shaming rejection. In With the above clinical understanding addition, she was rarely able to trust that coming to mind my emotional state and others who did fulfill her desires were attitude toward her rapidly shifted. I no - doing so because they cared about her. ticed how radiant and excited the pa - Relationships typically ended with her tient appeared and realized what an feeling used and discarded. important moment this was for her . I felt like a father seeing his daughter off to At our planned last session she an - the prom. I decided to simply accept her nounced that she could only stay for request to leave the session early and twenty minutes, because she had a date. asked her with excited interest to say I initially felt rejected and disappointed, more about her date. I shared with a a response I had come to be familiar proud smile, “You look radiant and ex - with in our work. Fortunately I was in a cited like a part of you that has been supervision at the time that supported asleep for a long time has awakened”. me in identifying the sources of my The patient smiled and continued to talk countertransference responses in a way excitedly about her date and hopes for that normalized the responses and made the future. Within this interchange the the work of sorting out what was per - enactment, potential space, and love of sonal from what was clinical observa - the human mind can be seen in the ther - tion exciting and secure . That security apist’s ability to welcome painful per - was with me in the moment of my initial sonal experiences in the process of response and allowed me to maintain a understanding the patient. Attention to reflective state of mind. I knew that there was a part of me that wanted the the patient’s intimacy approach behav - patient to see me as desirable and that iors in the form of her excitement about felt jealous that she found someone else. her date was also helpful to the process. I also knew that in that moment we had And transformance can be seen as ther - entered the very relational conflict that apist and patient let go of technical in - had contributed to so much exploitation terventions and enjoyed the process of and suffering for the patient in the past. growth that was emerging. Her father and other men in her life re - continued on page 46 45 Discussion and Future Directions no single school of thought can go it Reacting effectively to sexual and loving alone either. The ways in which we ad - feelings begins with a distinction that dress each other within the literature can be made between how sexual and around this topic are crucial to develop - loving feelings are typically experienced ing a sense of working together and within the context of psychotherapy and being held together in a united purpose how they are experienced within the even if our methods are at odds. The context of sexual and romantic relation - more we are able to heal the splitting ships. Such a distinction can solidify the and accusations that often mark discus - ground between feeling and action that sions about sex and love in psychother - is required in order for effective under - apy the more we will create a sense of standing and intervention to take place. safety and guidance for all psychothera - The attachment state of mind cultivated pists and patients . by the therapist opens her to receive and respond empathically to the patient’s I have provided an outline for an inte - communicated attachment, sexual, and grative model for understanding and intimacy related needs and anxieties. working with sexual and loving feelings The reflective state of mind cultivated in psychotherapy. It might be the case by the therapist modulates this respon - that it is trauma work in which patients siveness and allows for the transforma - often suffer from confusion between at - tion of sexual and loving feelings to tachment and sexual desire that these is - clinical observations. This transforma - sues are most relevant. It might also be tion shapes the therapeutic frame so that argued that short term technical forms therapist and patient alike establish an of psychotherapy do not require such in - implicit sense of the distinction between timate forms of relating within the psy - the therapeutic relationship and sexual chotherapy relationship. Even if both of and romantic relationships. As in the these arguments are true it is well worth above clinical vignette the therapist’s our efforts to examine how we can effec - state of mind helps in creating an im - tively help the patient to discover that plicit relational experience in which the intimacy can be safe and vitalizing in therapist can be authentically respon - multiple forms. Additional issues to be sive to the patient in a situation where explored include self-disclosure of sex - technical interventions are likely to fore - ual and loving feelings and the form close the opportunity to rework prob - such disclosure should take if at all. Fur - lematic attachment and sexual ther research is needed that elicits feed - communication patterns in real time. back from patients as was done in the Dallenberg studies. Sexual and loving feelings are too volatile and fraught with risk for any REFERENCES FOR THIS ARTICLE single psychotherapist to attempt to MAY BE FOUND ON-LINE AT handle alone. In addition, I posit that www.divisionofpsychotherapy.org

OF PSYCHOTH N E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C

46 NORINE JOHNSON, PH.D., PSYCHOTHERAPY RESEARCH GRANT

Brief Statement about the Grant:

The annual Norine Johnson, Ph.D., Psychotherapy Research Grant provides $20,000 toward the advancement of research on psychotherapist factors that may impact treatment effectiveness and outcomes, to include type of training, amount of training, professional degree or discipline of the psychotherapist, and the role or impact of psychotherapists’ personal characteristics on psy - chotherapy treatment outcomes.

Eligibility : Doctoral-level researchers with a successful record of publication are eligible for the grant.

Submission Deadline : April 1, 2011

Request for Proposals NORINE JOHNSON, PH.D., PSYCHOTHERAPY RESEARCH GRANT

Description This program awards grants for research projects in the area of research on psychotherapist factors that may impact treatment effectiveness and outcomes, to include type of training, amount of training, professional degree or disci - pline of the psychotherapist, and the role or impact of psychotherapists’ per - sonal characteristics on psychotherapy treatment outcomes.

Program Goals • Advance understanding of psychotherapist factors that may impact treat - ment effectiveness and outcomes through support of empirical research areas to include: type of training, amount of training, professional degree or discipline of the psychotherapist, and the role or impact of psychotherapists’ personal characteristics on psychotherapy treatment outcomes . • Encourage researchers with a successful record of publication to undertake research in these areas.

Funding Specifics One annual grant of $20,000

Eligibility Requirements • Doctoral-level researchers • Demonstrated competence in the area of proposed work • IRB approval must be received from the principal investigator’s institution before funding can be awarded if human participants are involved • The selection committee may elect to award the grant to the same individual or research team up to two consecutive years • The selection committee may choose not to award the grant in years when no suitable nominations are received

47 Evaluation Criteria • Conformance with goals listed above under “Program Goals” • Magnitude of incremental contribution in topic area • Quality of proposed work • Applicant’s competence to execute the project • Appropriate plan for data collection and completion of the project

Proposal Requirements for All Proposals • Description of the proposed project to include goals, relevant background, target population, methods, anticipated outcomes, and dissemination plans • CV of the principal investigator • Format: not to exceed 3 pages (1 inch margins, no smaller than 11-point font) • Timeline for execution (priority given to projects that can be completed within 2 years) • Full budget and justification (indirect costs not permitted). The budget should clearly indicate how the grant funds would be spent. • Funds may be used to initiate a new project or to supplement additional funding. The research may be at any stage. In any case, justification must be provided for the request of the current grant funds. If the funds will supple - ment other funding or if the research is already in progress please explain why the additional funds are needed (e.g., in order to add a new component to the study, add additional participants, etc.)

Additional Information • After the project is completed , a full accounting of the project’s income and expenses must be submitted within six months of completion. • Grant funds that are not spent on the project within two years of receipt must be returned . • When the resulting research is published, the grant must be acknowledged by footnote in the publication.

Submission Process and Deadline Submit a CV and all required materials for proposal (see above for proposal requirements) to: Tracey A. Martin in the Division 29 Central Office, assn - [email protected]

Deadline: April 1, 2011

Questions about this program should be directed to the Division of Psy - chotherapy Research Committee Chair (Dr. Jim Fauth at [email protected] ), or the Division of Psychotherapy Science and Scholarship Domain Represen - tative (Dr. Norman Abeles at [email protected]), or Tracey A. Martin in the Division 29 Central Office, [email protected]

48 DIVERSITY Disparities in Health and the Potential Impact of Increased Access to Healthcare Jean M. Birbilis, Ph.D. University of St. Thomas

Recently, the editors nature of the workforce providing of Health Psychology care may, both independently and announced a special jointly, influence the quality of care series on health dis - that minorities receive. (p. 80) parities. The themes for 2011 are infectious Disturbing examples of the insidious diseases and cancer. side of the history of healthcare for racial Examples provided by the editors of rel - and ethnic minorities are the Tuskegee evant topics associated with infectious syphilis “biomedical research study” diseases include social determinants of with impoverished black males and infection prevalence/ incidence, predic - the “biomedical experiments” on Jewish tors of protective behaviors, and biopsy - concentration camp prisoners, which chosocial mechanisms relevant to poignantly make clear that racial and infectious disease susceptibility. Exam - ethnic minorities have had good reason ples provided by the editors of relevant historically to distrust healthcare providers (e.g., Thomas & Hersen, 2003). topics associated with cancer include This distrust , in turn , has quite likely randomized clinical trials designed to created a disparity in the willingness of impact prevention or treatment behav - at least some persons of color to access ior, methods to facilitate recruit ment to healthcare and, therefore, a disparity in and participation in cancer treatment their subsequent health . clinical trials, and factors related to ob - taining informed consent for use of Similarly, the history of mental health biospecimens among diverse groups . providers categorizing same sex sexual orientation as a mental illness, the cur - For psychotherapists, the issue of health rent structure of employer-provided disparities is timely and salient with the healthcare insurance which denies ac - extension during the past year of access cess for many LGBT individuals to to health insurance, and therefore to health insurance through their partners, healthcare, to millions more Americans . the sometimes-non-affirming settings in While the extension may give more peo - which mental healthcare is delivered, ple the opportunity to access healthcare and the nature of the workforce provid - and to subsequently experience fewer ing care may influence the quality of health disparities, Unequal treatment: care that sexual minorities receive. For Confronting racial and ethnic disparities in example, even in the best of circum - health care (2002) has pointed out: stances, there may be too few LGBT- The historical evolution of health - identified psychotherapists, and many care for persons of color, the current LGBT individuals express a preference financial and organizational struc - for a similarly identified therapist (e.g., tures of health systems, the settings McDermott, Tyndall, & Lichtenberg, in which care is delivered, and the continued on page 50 49 1989). Furthermore, even though there subsequent health disparities. There may be an adequate number of hetero - have been calls (e.g., Bieschke & Dendy, sexual psychotherapists willing to pro - 2010; Lyons, 2010; Worthington, 2010) vide gay affirming therapy, they may be for increased competency in working ill-equipped to do so. For example, with underserved (and sometimes, Lyons (2010) asserted that, “Generally, badly served) communities through psychologists’ level of training in LGB both formal training and supervised ex - issues and populations may be inade - perience. Psychotherapists with such quate. Murphy, Rawlings, and Howe training and experience are more profi - (2002) reported that 28% of the psychol - cient at identifying the mental health ogists they surveyed reported no formal disparities characteristic of these com - training in clinical work with LGB munities, their etiologies, and the appro - clients.” (p. 425) More disturbing, there priate treatment . are therapists willing to use “treat - ments” that have no legitimate empiri - To provide ethical psychotherapy that cal support to try to change the sexual does not contribute to health disparities orientation of individuals with internal - requires that psychotherapists are ade - ized homophobia. As Cass (1979) noted, quately trained in evidence-based treat - internalized homophobia is the most ments appropriate for the population to significant impediment to a positive gay which those symptoms are applied and identity—arguably a significant imped - for the symptoms that they are intended iment to mental health. to treat with an understanding of the sys - temic variables that may be the etiology The phenomenon of health disparities, of the problem or at least, exacerbating sometimes due to healthcare disparities, the problem. To vilify oppressed individ - can be found among many populations uals and then characterize their reaction who have, at least in the past, experi - to oppression as a disorder requiring enced no care, incompetent care, and/or treatment is not only cynical and cruel, it iatrogenic care. For example, prior to is a misuse of the science of psychology deinstitutionalization, developmentally to assess, conceptualize, and treat indi - delayed individuals were warehoused vidual clients for what are systemic prob - in government institutions, with behav - lems or at least, systemic contributors ior modification the treatment of choice. to individual problems. In this era of Prior to recent advances in geropsychol - increased access to healthcare for previ - ogy, institutionalized elderly patients ously underserved populations, psy - simply received behavior management chotherapists have an ethical obligation rather than affirming approaches , such to be particularly aware of the potential as life review. systemic etiologies of the presenting symptoms of diverse populations, the ev - In short, there are instances in which idence-based treatments for symptoms psychologists who could have offered when treatment of the individual is ap - rich, population-specific interventions propriate, and the responsibility to advo - may have missed these opportunities cate for the elimination of systemic and , consequently, inadvertently con - sources of healthcare disparities and tributed to healthcare disparities and health disparities for these populations.

OF PSYCHOTH N E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C 50 PSYCHOTHERAPY RESEARCH, SCIENCE, AND SCHOLARSHIP Strengthening Our Science and Enhancing the Status of Psychology as a STEM Discipline: The Theme of the Science Leadership Conference in 2010 Susan S. Woodhouse, Ph.D., Pennsylvania State University

This month, as the ways in which a scientific understand - Research Committee ing of human behavior has advanced Chair, I will represent public health, public safety, education Division 29 at the and learning, and national security—as annual APA Science well as examples of technological solu - Leadership Confer - tions that should have worked well but ence to be held in actually did not work well because of a Washington, DC, on November 11 –14, lack of understanding about human fac - 2010. The theme for this year’s Science tors. The report also give a number of Leadership conference is “Strengthening recommendations for promoting the Our Science: Enhancing the Status of role of psychological science in solving Psychology as a STEM Discipline.” national and local problems (e.g., health and mental health disparities), promot - Psychology as a STEM Discipline ing the teaching of psychological sci - The term STEM discipline refers to areas ence, increasing a public recognition of pertaining to science, technology, engi - psychology as a science, and enhance neering, and mathematics. Psychology training in the science of psychology. is officially a STEM discipline, but it is often treated as if it were not actually a As a part of preparing to represent Divi - STEM discipline—i.e., not a science. For sion 29 at the APA Science Leadership example, some funding that is officially Conference I have read this report, and available for research, education, and also learned a bit about the APA Science training in the STEM disciplines is rarely Directorate, the Board of Scientific awarded for psychological research. Affairs (BSA), and the history of the Sci - This is a problem that needs to be ad - ence Leadership Conference. In addi - dressed because psychological research tion, I have been doing some thinking has many important contributions to about psychology as a STEM discipline, make. Without a better understanding of how the public views psychology, and human behavior, the benefits of science how we might be involved in advocacy and technology will be limited. for psychological research in general and research on psychotherapy specifi - In June of this year the APA 2009 Presi - cally. My goal here is to share some of dential Task Force on the Future of Psy - what I have learned and also share some chology as a STEM Discipline published of my initial reflections as I prepare to a report entitled Psychology as a Core attend this conference. Science, Technology, Engineering and Mathematics (STEM) Discipline . You can As a psychologist who is still relatively view a copy of this report at early in my own career, I know that I http://www.apa.org/pubs/info/re - find it very helpful when others talk ports/stem-discipline.aspx . This report about the work they are doing, particu - documents important examples of the continued on page 52 51 larly if it is not something I might other - Leadership Conference. I am pleased to wise have been aware of. It struck me be able to represent the Division and so that the Science Leadership Conference help to ensure that the voice of re - may be one of the areas that others may searchers concerned with psychother - not be aware of. In January, I will begin apy research is a part of the dialogue in my term as the Early Career Domain this national forum. Representative in Division 29, so I thought a discussion about these issues The APA Science Leadership Conference of science advocacy would be a mean - (SciLC) has been an annual event since ingful way to mark my personal transi - 2005. Each year’s conference has had a tion from Research Committee Chair to different theme. Pervious topics in - Early Career Domain Representative. cluded the public face of psychological Because I had not heard about the an - science (2005), supporting and advanc - nual APA Science Leadership Confer - ing the careers of scientists (2006), get - ence prior to being asked to represent ting involved in advocacy and training Division 29 at the conference, I thought civic scientists (2007), innovations in that perhaps others in Division 29, par - methods for dissemination of knowl - ticularly Early Career psychologists, edge for psychological science (2008), may not have heard about it either. and enhancing the nation’s health Thus, I thought it might be a useful through psychological science (2009). topic. It may be that others could be - Information about the documents that come interested in playing a role in en - have emerged from each of the previous suring that those interested in SciLCs are provided at http:// psychological and psychotherapy re - www.apa.org/science/programs/con - search have a place at the table in setting ference/index.aspx . the national agenda. Given this list of topics, it does seem im - The ways in which psychology is per - portant that Division 29 have a voice in ceived by the public and by agencies the SciLC because many of these topics that fund research in psychology are ul - are of crucial importance to our mem - timately very important to all of us. If bership. Clearly, we are very interested psychological research, including re - in promoting the nation’s health, which search on psychotherapeutic interven - was the topic for the 2009 conference. tions, is valued and seen as important The 2009 conference focused on advo - then we can make richer contributions cating for “increased federal funding for to building healthier communities. I basic and translational psychological re - think that it is crucially important that search to contribute to the development we who understand the value of psy - and evaluation of empirically-based in - chotherapeutic interventions, as well as terventions.” This is clearly at the core the value of psychotherapy research, of what we do. have a voice in helping to shape the na - tional research agenda and policy about Science Directorate of APA . The SciLC research. is jointly sponsored by the Board of Sci - The APA Science Leadership entific Affairs (BSA) and the Science Di - Conference rectorate. Many might be familiar with Interestingly, members of the Board of the Science Directorate of APA. The Division 29 recently expressed to me goals of the Science Directorate are to fa - that this is the first year that Division 29 cilitate and promote psychological sci - has been represented at the APA Science continued on page 53 52 ence, and to represent the science of psy - to the APA Science Directorate, and fo - chology to the public. You can get more cuses on psychology as a science. One of information about the Science Direc - the roles of the BSA is to serve as a liai - torate and the programs they offer son with agencies that fund scientific re - through their website: http:// search. The BSA also has a number of www.apa.org/science/index.aspx . Al - awards recognizing scientific achieve - though many may have heard of the Sci - ments. They try to figure out how APA ence Directorate, many may be unaware can support psychological science and of the many services and programs of - they also oversee the scientific program - fered through the Science Directorate. I ming at the annual APA convention. know that I certainly had not been aware of them. The Science Directorate It has been interesting to me to learn has a number of publications on its web - about these aspects of APA that I had not site that focus on how psychological really known about in the past. My own science has made a difference in peo - research agenda focuses on basic re - ple’s lives (http://www.apa.org/sci - search aimed at helping us develop bet - ence/about/publications/index.aspx). ter preventive and psychotherapeutic Some of these publications are very ap - interventions for underserved families pealing and have very interesting exam - with infants and young children, as well ples that could be very useful for as testing new interventions for these educators who are trying to convey the families. So for me, it is heartening to importance of psychology in every day know that APA is concerned about help - life. The Science Directorate has a num - ing psychological science to be included ber of programs (http:// www.apa.org/ in the national research agenda. I am vscience/programs/index.aspx), in - very excited that this year Division 29 cluding programs related to training will have representation at the SciLC, and careers (http://www.apa.org/sci - and I hope that representation will con - ence/resources/index.aspx). There are a tinue into the future. number of training programs, for exam - ple, for advanced training in statistics This year the focus of the SciLC is to gen - for undergraduates, graduate students, erate ideas about how to enhance the sta - postdocs, and faculty at all stages of tus of psychology as a STEM discipline. I their careers. There is also a Career think it is important that the public be Workshop program that is designed to aware that there is an empirical basis for introduce graduate students and post - the treatments we offer, and likewise, it is docs to careers in academia, and help beneficial to society as a whole that fund - them through the practicalities of the ing for research to continue to improve hiring process. There is also a series on psychotherapy interventions. non-academic careers available to psychological scientists that may be of To give you a picture of the kinds interest. I had not realized that these of things that will be discussed at the programs were available through the SciLC, I thought it might be helpful Science Directorate . to walk you through the agenda. Regis - tration will occur in the evening of Board of Scientific Affairs Thursday, November 11. On Friday, The Board of Scientific Affairs (BSA; November 12, conference attendees will http://www.apa.org/science/leader - hear a talk based on the results of an ship/bsa/index.aspx) is a co-sponsor of APA-sponsored survey about how the the SciLC. The BSA is an advisory body continued on page 54 53 public views psychological science, as solve society’s challenges, then we well as an overview of the APA STEM should be inspiring more young people, Task Force Report mentioned earlier. We not fewer, to understand the science of will then hear about what APA and its psychology and how understanding partners have been doing to advocate human behavior is relevant to a variety for psychological science as a STEM dis - of issues. There will be a talk on interdis - cipline and hear from the National Sci - ciplinary research and training. Later we ence Foundation (NSF) about how will go into our breakout groups to psychology is viewed at NSF. There will discuss K-12 psychology education, be a talk by Congressman Brian Baird of undergraduate education, and inter dis- Washington, who worked for many ciplinary research and training. Person - years as a clinical psychologist before ally, I am very interested in inter - becoming a politician. We will then go disciplinary research and training be - into breakout groups to discuss the pub - cause much of my intervention research lic’s understanding of psychological sci - brings together teams of collaborators ence, federal legislation and funding across diverse fields. I think an ability to agency policies, and research and aca - work in an interdisciplinary fashion can demic infrastructure. We will generate help to strengthen the kinds of research recommendations in each of these areas we do and help lead to greater funding and then discuss and prioritize those opportunities for psychotherapy-related recommendations. research. Perhaps there is more we could do to educate our students to be ready The focus on Friday, November 12, will for this kind of interdisciplinary work. be on issues of psychological science in The conference will end with a discus - education at the elementary school, high sion of the recommendations that school, and undergraduate levels. One emerge and work to prioritize the rec - interesting issue that I learned about in ommendations. preparing for the conference is that Pres - ident Obama’s Council of Advisors on Division 29 and Research Science and Technology recommended Division 29 has been very committed to that the social and behavioral sciences, supporting research activity in the area including psychology, not be considered of psychotherapy, and has become in - STEM fields at the K-12 level. This creasingly involved in directly support - group also made a recommendation that ing psychotherapy research. Last year teaching the behavioral sciences will not Division 29 created the annual Charles help children be better prepared for J. Gelso, Ph.D., Psychotherapy Research STEM fields in the future. This group Grant. This grant provides $2,000 annu - admits that psychology is a STEM field ally toward the advancement of research at the undergraduate and graduate lev - on psychotherapy process or psy - els, but that psychology is not taught as chotherapy outcome. This year Division a science at the K-12 level. Essentially, 29 established the Norine Johnson, they are recommending that psychology Ph.D., Psychotherapy Research Grant. not be taught in K-12 because it is not This annual grant program provides taught in a scientific manner. It seems to $20,000 toward the advancement of re - me that a better approach might be to in - search on psychotherapist factors that clude psychology and to do so in a way may impact treatment effectiveness and that is rooted in the empirical basis for outcomes, to include type of training, what we do. If the goal is to prepare amount of training, professional degree young people to be ready to help to continued on page 55 54 or discipline of the psychotherapist, and these efforts. I have greatly enjoyed my the role or impact of psychotherapists’ two years as Chair of the Research Com - personal characteristics on psychother - mittee in Division 29 and I will look for - apy treatment outcomes. Additional in - ward to serving Division 29 next year in formation about both of these grant my role on the Board as the Early Career programs offered through Division 29 Representative. My hope is that others are available at the Division 29 website in the Division, particularly those early (http://www.divisionofpsychother - in their careers, may get interested in the apy.org/ ). exciting opportunities becoming avail - able to advocate for the science we do, I am very excited that this year Division and help others become aware of how 29 will be represented at the SciLC for the research we do is relevant for solv - the first time. I think that Division 29 has ing a variety of the issues we face as a much to offer to the discussion of how society. to help the public and policy makers better understand what psychological science has to offer, not only this year REFERENCES FOR THIS ARTICLE but into the future. I hope that others in MAY BE FOUND ON-LINE AT Division 29 will become involved in www.divisionofpsychotherapy.org

OF PSYCHOTH N E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C

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55 FEATURE Should Division 29 Develop Telepsychology Guidelines? Norman Abeles, Ph.D. , Michigan State University

Let us first look at the psychologists may be at risk for per - definition of telehealth. sonal harm due to the lack of clear and According to APA, defined guidelines (p1). The Guidelines telehealth services in - point out that the APA Ethics Code fails clude all interactions to provide sufficient guidance in the use that are not in person of telepsychology when psychological between health care services are provided . While the Ethics professionals and their patients. It Code considers confidentiality and com - should be noted, however, that regula - petence, there is no provision concern - tors and insurers use more narrow defi - ing disclosure of information to the nitions. APA notes that there is no client when there is no face to face con - universal definition of telehealth serv - tact. Some state laws require that in - ices (APA, 2010). In this paper I include formed consent be given prior to the terms telepsychology, telehealth , teletherapy , but specifics are not clearly telemental health , telecare, and email described. There are also continuing therapy within the APA definition of concerns about limitations regarding the such non face-to-face communications practice of telepsychology across state between mental health providers and re - lines. Some state licensing boards have cipients be they individuals or groups . insisted that practitioners be licensed in However , the major focus should prob - the states where they practice , but this is ably be on videoconferencing and tele - not clearly enunciated by many, if not phone therapy as the prime examples of most state licensing boards. telepsychology. Selected research findings concerning About 10 years ago, Koocher and Mor - telepsychology effectiveness : ray (2000) surveyed the regulation of The lead article in the Journal of the telepsychology by contacting all State American Medical Association on July Attorney Generals. They noted that li - 14, 2010 deals with the effects of telecare censing requirements of ten states serve management on pain and depression in as obstacles to telepsychology . At that patients with cancer (Kroenke, et al, time , four states had regulated the prac - 2010). The authors hypothesized that tice of psychotherapy by electronic telecare management would be superior means , and nineteen states provided to usual care in reducing pain and de - regulatory authority over out of state pression for geographically dispersed practitioners who offer psychological patients in various oncology practices. services via the internet, telephone , or According to their prediction , the au - other electronic means. Ohio (2007) ap - thors found that significant improve - pears to be one of the pioneers for ments were reported for both pain and telepsychology guidelines. In its most depression. The article noted that recent version , the Ohio Psychological telecare was superior to usual care in im - Association Guidelines note that proving outcomes. The trial also demon - telepsychology is practiced by many strated that telephone-based centralized psychologists around the world and continued on page 57 56 symptom management was feasible for More on guidelines , regulatory efforts , dispersed practices in urban as well as and assessment studies : rural areas. In addition , there did not ap - In recent actions, the Board of Directors pear to be any differential rates of health of the American Psychological Associa - care use. tion received a petition to establish na - tional Guidelines for telepsychology. A somewhat different approach was APA’s President-elect, Melba Vasquez , recently reported in the American stated that expanded technologies and Psychiatric Association’s publication of increasing use of telecommunication de - Psychiatric Services (Yellowlees, et al ., vices have presented new venues requir - 2010). Here , a non -psychiatrist research ing refined guidelines (Bradshaw, 2010 ). physician interviewed adults for 20-30 In the latest issue of “Good Practice” minutes. The adults were referred by (APA, 2010) there is a discussion on legal their primary physicians for non-emer - issues for psychologists involved in tele - gency psychiatric problems. These health. It is pointed out that some states recorded interviews were conveyed to prefer that psychologists should be spe - psychiatrists who diagnosed the pa - cially credentialed or licensed in order tients and recommended additional to provide telehealth services. The arti - tests and medication changes. In addi - cle notes that both California and Ken - tion , they recommended psychothera - tucky do have teletherapy definitions in pies and made recommendations for their laws , though California excludes long -term treatment. Most diagnoses in - telephone conversations and email be - cluded depression, anxiety or substance tween patients and providers (p4).Ver - use disorders . Many patients also had mont uses a broader definition and does co -occurring problems. not exclude any telepsychology services. In a study using teletherapy for PTSD, The American Telemedicine Association Stephanie Guay (2010) from the Univer - (2009) has a telemental health standards sity of Montreal, reported that patients and guidelines working group which in the experimental group (teletherapy) has sections on telepsychological assess - benefited from therapy as much as pa - ment which includes the administration tients in the control group (face to face of diagnostic instruments and scales, therapy). 75-80% showed significant de - personality assessment , and neuropsy - crease in stress, depression, and anxiety chological assessment. The paper notes symptoms. Earlier studies (Swinson, that telepsychology opinions for the Cox and Wickwire, 1995) found telether - treatment of patients in underserved apy to be an effective treatment for ago - areas have been widely used though not raphobics living in rural areas where many reliability or validity studies are specialized treatments for anxiety were reported. It is reported that two studies not available. ‘Phone delivered therapy using the SCID (Structured Clinical In - was as effective as face to face therapy terviews) with the DSM IIIR did show in alleviating symptoms. Pat DeLeon high reliability. No examination of the (2010) , former Division 29 and past APA use of telemedicine in personality as - President , recently reported that some sessment is reported (p11). With regard studies indicated no differences between to Neuropsychological Assessments, telemental health and face to face deliv - feasibility has been demonstrated, ery in the perception of the therapeutic but there are few formal studies. While relationship, post session mood or gen - studies have argued for comparability eral satisfaction with services.(Morgan, between remote and face to face assess - Patrick & Magaletta (2008). continued on page 58 57 ments , other studies have noted differ - vision. Only clinics that have been prop - ences on test scores (p11). The authors erly certified for the use of telehealth are recommend that new norms be devel - utilized. Those clinics must use HIPAA oped to compare results with face to face compliant technology. For doctoral pro - administration. Though neuropsycho - grams , telesupervision may account for logical assessment via telemedicine is no more than 50% of the total supervi - often valid with regard to ongoing sion at a given practicum site. In addi - mental health care , the authors review tion , off –site supervisors maintain full psycho-education, individual psycho- professional responsibility for of our therapy , and group therapy efforts via members. telemedicine. Case reports and clinical trials of individual therapies via tele - I have presented a variety of efforts medicine have been reported and it is concerning telepsychology guidelines, concluded that group psychotherapy regulatory efforts and some research appears to be amenable to the video con - findings. Division 29 could be involved ferencing telepsychology health effort. in a more comprehensive effort detailed below. With regard to group therapies, it is rec - ommended that standard practice Why our division should establish guidelines should guide videoconfer - telepsychology guidelines : encing (p12). The authors note that a. Division 29 is the oldest and most re - marital and family therapies could be spected division when it comes to the considered as specialized types of group practice of psychotherapy , so it is therapy (p13). The paper goes on to more likely that our colleagues will discuss populations for special focus pay attention to guidelines we might such as work with older adults , as well develop. as telepsychology with children and b. While there is a business item before adolescents. APA council to develop guidelines, knowing about the governance For older adults , further studies need to process leads me to believe it will be done to provide reliable evidence take several years before such efforts (p15). For adolescents and children , it is will be fully implemented. suggested that the same guidelines used c. Our division clearly needs products for adults could be considered but with (such as guidelines) that will focus at - modifications that include the develop - tention to practitioners and re - mental status of youths (e.g. motor searchers engaged in psychotherapy functioning, speech and language capa - practice. bilities, and relatedness ). In a personal d. I believe we can develop preliminary communication from Sarah Knox, PhD, and credible guidelines in 6 months our Division 29 Domain Representative or less by using a small, dedicated from Education and Training, she noted task force of both junior and senior the telesupervision requirements at members of our division. Initial Marquette University’s (Milwaukee) guidelines should be limited to tele - Department of Counselor Education. phone and videoconferencing therapy. Their telesupervision guidelines are e. Initially our guidelines could be as used only when in-person supervision simple as asking our members to be is not available , and only trainees who familiar with APA’s 50 state review of have completed at least two semesters of telehealth by consulting www.apa - master’s level practicum/internship training can be considered for telesuper - continued on page 59 58 practicecentral.org/advocacy/state/ lines we develop may be helpful at a telehealth-slides.pdf . later date for the development of f. Further , we could ask our members to APA wide guidelines. be familiar with the recently adopted i. Our guidelines might also serve as an inter -jurisdictional practice certificate impetus for states and licensing by the Association for State and boards to proceed more quickly in es - Provincial Psychology Boards (ASPPB). tablishing guidelines or even adopt - These two resources area discussed in ing portions of our guidelines. the recent APA (2010) Good Practice Furthermore we could focus on document. Of course this would have guidelines that are specific to the to be adopted by state licensing work done by psychotherapists . At boards. It might be wise to check state the recent meeting of the Division 29 regulations on the availability of tem - board meeting in Washington, D.C. , porary practice provisions. In addi - the topic of telepsychology guide - tion , the National Register of Health lines for psychotherapists was dis - Service Providers in psychology may cussed. The president of our division, also have relevant materials on this Jeff Magnavita, PhD , appointed a topic . The National Register has a list - Presidential Task Force whose job it ing of states that utilize National Reg - will be to make recommendations at ister credential as an aid in facilitating the February 2011 board Meeting. licensure for practitioners. The task force is chaired by Annie g. Guidelines could provide appropriate Judge, PhD. In the meantime if you and helpful services to psycho-ther - have comments please feel free to apy practitioners and inform them of contact me at [email protected] . potential areas of concern when prac - ticing telepsychology within their REFERENCES FOR THIS ARTICLE state and outside of state boundaries. MAY BE FOUND ON-LINE AT h. It is at least possible that any guide - www.divisionofpsychotherapy.org

OF PSYCHOTH N E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C ADVERTISING RATES Bulletin Full Page (4.5" x 7.5") $300 per issue Deadlines for Submission Half Page (4.5" x 3.5") $200 per issue February 1 for First Issue Quarter Page (2.185" x 3.5") $100 per issue May 1 for Second Issue July 1 for Third Issue Send your camera ready advertisement, November 1 for Fourth Issue along with a check made payable to Division 29, to: All APA Divisions and Subsidiaries (Task Forces, Division of Psychotherapy (29) Standing and Ad Hoc Committees, Liaison and 6557 E. Riverdale Repre sentative Roles) materials will be published at Mesa, AZ 85215 no charge as space allows. 59 WASHINGTON SCENE The Importance of Visionary Leaders Pat DeLeon, Ph.D. Former APA President

International: Last year your neck in alligators, it ’s hard to focus the Institute of Medi - on draining the swamp. ’ However, as st cine (IOM) released we evolve into the 21 century and Pres - its report The U.S. ident Obama ’s vision for implementing Commitment to Global his landmark Patient Protection and Health . “ Global health Affordable Care Act (PPACA) takes is the goal of improving hold, psychology (and the other health health for all nations by promoting well - professions) must accept their societal ness and eliminating avoidable disease, responsibility for providing visionary disability, and death. It can be attained leadership in addressing our nation ’s by combining population-based health and world ’s most pressing needs. This is promotion and disease prevention especially true for our professional measures with individual-level clinical schools. The alternative is to become ob - care. This ambitious endeavor calls for solete, if not irrelevant. Protecting the an understanding of health determi - status quo is not a viable option. ” nants, practices, and solutions, as well as basic and applied research on risk fac - The IOM emphasized that health is inex - tors, disease, and disability.... The U.S. tricably connected to the broader goals of government, along with U.S.-based hastening development and reducing foundations, nongovernmental organi - poverty. Significant progress has been zations, universities, and commercial made in the last 50 years with life entities, can take immediate concrete ac - expectancy increasing more than in the tion to accelerate progress on the urgent preceding 5,000 years. The creation, dis - task of improving health globally by semination, and adoption of knowledge working with partners around the has been one of the main drivers of these world to scale up existing interventions, health gains, delivering marked im - generate and share knowledge, build provements in low- and middle-income human and institutional capacity, in - countries that have invested in sustain - crease and fulfill financial commitments, able and equitable systems to deliver and establish respectful partnerships. proven, cost-effective interventions. Our U.S. leadership in global health reflects nation has an unprecedented opportu - many motives: the national interest of nity to improve global health. The prom - protecting U.S. residents from threats to ise of potential solutions has captured the their health; the humanitarian obligation interest of a new generation of philan - to enable healthy individuals, families, thropists, students, scientists, healthcare and communities everywhere to live professionals, private sector leaders, and more productive and fulfilling lives; and citizens B all eager to make a difference the broader mission of U.S. foreign pol - in this interconnected world. icy to reduce poverty, build stronger The IOM identified five areas for action: economics, promote peace, increase na - • Scale up existing interventions to tional security, and strengthen the image achieve significant health gains; of the United States in the world. As has often been said: ‘When you ’re up to continued on page 61 60 • Generate and share knowledge to ad - the benefit of the global poor. Not sur - dress health problems endemic to the prisingly, Americans traditionally focus global poor; upon conditions that affect people • Invest in people, institutions, and ca - within our own borders and as a result, pacity building with global partners; we often ignore or significantly neglect • Increase U.S. financial commitments diseases or conditions that are over - to global health; and, whelmingly or exclusively incident in • Set the example of engaging in re - low- and middle-income countries. For spectful partnerships. example, globally more than 2 billion people are at risk of malaria each year. The global health community has Despite dramatic reductions in malaria reached a critical juncture. The knowl - incidence and mortality in many parts of edge, innovative technologies, and the world, approximately 500 million proven tools to help millions of people in people still contract the disease, resulting need are within reach. Yet even with in 1 million deaths annually. The IOM demonstrated success in tackling certain expressly noted that global health would health issues, a wide gap remains be - greatly benefit from developing and dis - tween what can be done with existing seminating a variety of novel behavioral knowledge, and what is actually being and biomedical prevention strategies to done. Existing interventions are not combat infectious diseases. Focusing widely used even though many are inex - upon two disease entities for which the pensive and easy to administer. As the behavioral sciences clearly have particu - advocates for PPACA constantly pointed lar expertise: Obesity is escalating world - out, even within our own modern day wide at an alarming pace, along with health care delivery system, the lag be - rates of type 2 diabetes, hypertension, tween the discovery of more efficacious and lipid abnormalities associated with forms of treatment and their incorpora - obesity. More than 1 billion adults are tion into routine patient care is unneces - overweight; 300 million are clinically sarily long, in the range of about 15 to 20 obese. Mental disorders affect millions years. The timeless health problems asso - worldwide; about 14 percent of the ciated with poverty are now coupled global burden of disease has been attrib - with new challenges. Infectious diseases uted to neuropsychiatric disorders, are emerging at the historically unprece - mostly due to the chronically disabling dented rate of one per year. With airlines nature of depression and other common carrying more than 2 billion passengers mental disorders, alcohol-use and sub - annually, and systems of trade more in - stance-use disorders and psychosis. terconnected than in any time in human history, the opportunities for the rapid in - Margy Heldring ’s vision of establishing ternational spread of infectious agents a senior-scientist/practitioner U.S. Pub - and their vectors have vastly increased. lic Health Service Corps is most timely. The rising tide of chronic diseases and in - As she points out, many of our col - juries in low- and middle-income coun - leagues are entering the twilight years of tries, where 80 percent of the world ’s their careers. They want to make a dif - deaths from chronic, non-infectious dis - ference and are not yet ready to fully re - eases now occur, cannot be ignored. tire. How can their considerable One of the greatest contributions we can expertise be effectively utilized? The vi - offer to the global campaign to improve sion expressed by President Lyndon health is to share America ’s traditional Johnson at the University of Michigan strength , “the creation of knowledge” for continued on page 62 61 comes to mind: “The challenge of the “One place to look to as an encouraging next half century is whether we have the story of health care delivery transforma - wisdom to use that wealth to enrich and tion and a way forward for civilian men - elevate our national life, and to advance tal health professionals is the Navy. the quality of our American civiliza - Navy Medicine has successfully imple - tion.... This is the place where the Peace mented two programs providing mental Corps was started.... Will you join in the health care in non-traditional settings: battle to build the Great Society, to prove on the battlefield with Marines and in that our material progress is only the primary care practice. A primary com - foundation on which we will build a ponent of the Navy ’s promotion of a richer life of mind and spirit? There are ‘Culture of Fitness ’ is mental health. those timid souls who say this battle Recognizing their responsibility to effec - cannot be won; that we are condemned tively prevent, identify, and treat all psy - to a soulless wealth. I do not agree. We chological health conditions and the ill have the power to shape the civilization effects of war, Navy Medicine mental that we want.... Those who came to this health stationed with the Marines devel - land sought to build more than just a oped Operational Stress Control and new country. They sought a new Readiness (OSCAR) Teams, which world. ” The following year Medicare embed psychologists, psychiatrists, psy - became the law of the land. chiatric nurse practitioners and psychi - atric technicians as organic assets in Unlike the United States, in low- and operational units. The goal of the middle-income countries, universities, OSCAR teams is to be as far forward science academics, and the research and to spend as much time as possible community are often absent from public with the Marines to build the trust, co - policy engagement. Our government, hesion, and understanding necessary to which is the largest funder of many in - break the stigma of mental health care ternational organizations and a signifi - with military patients. cant donor of bilateral aid, carries considerable influence in shaping the “The concept of OSCAR is to demystify global health environment and thus pos - the whole process of psychiatric treat - sesses the opportunity to be a good ment. The Marines often call the mental steward for health at both the national health provider ‘the wizard. ” The origins and global levels. “Health is a highly of this term were not only because the valued, visible, and concrete investment mental health provider could make peo - that has the power to both save lives and ple disappear, i.e., suddenly remove them enhance the image of the United States from their units without warning, but it in the eyes of the world.... Working with also provoked the image of the mysteri - partners around the world and building ous Wizard of Oz pulling the smoke on previous commitments, the United levers behind the mirror. This is not the States has the responsibility and chance case with OSCAR. The mental health to save and improve the lives of mil - provider interacts with the Marines in the lions; this is an opportunity that the normal routine of the day. In this way the [IOM] committee hopes the United mental health provider becomes a real States will seize. ” person that the Marines can trust and get Integrated/Co-located Care: Retired to know. Being a full member of the Ma - Rear Admiral Chris Bruzek-Kohler re - rine Corps unit, the Marines are more cently shared her vision for the health likely to ask questions about minor issues st care environment of the 21 century. continued on page 63 62 without the stigma of being seen as A report from a 2007 DoD Task Force on patients and before the minor issue be - Mental Health suggested that the inte - comes something major. The OSCAR gration of mental health providers provider is also highly effective when within the Medical Home would im - they are a trusted advisor to mid-level prove access and decrease stigma by leaders who can gain perspective from maximizing the number of interventions the provider, thereby helping them to be - that can be conducted in a primary care come better leaders. There is a heightened setting. “Research supports the Task sense of trust and awareness on both Force ’s assertion and provides evidence sides and a profound improvement in of significant improvement in clinical communication among the warfighters, outcomes and reduced psychological their leaders, and medical. stress among service members served by behavioral health providers in primary “The power of having providers embed - care settings. The Medical Home Model ded is unmistakable. Retired Navy Med - with integrated behavioral health spe - ical Corps Officer, Captain William P. cialists was first implemented at Na - Nash: ‘OSCAR builds a bridge across tional Naval Medical Center (NNMC) in the cultural gap between the warfighter Bethesda, Maryland in 2008, followed and the mental health professional the by Naval Medical Center in San Diego only way a bridge can be built: by draw - and Naval Hospital Pensacola. Building ing the mental health professional as on early successes, the Navy will roll out fully as possible into the culture and life the Medical Home Model at all remain - of the military unit to be supported. ’ ing treatment sites this summer. ” OSCAR ’s success is evident in the en - thusiasm surrounding the program in Innovative Practices: One of the more the Marine Corps and the desire of mil - visionary provisions contained in the itary commanders outside of the regi - President ’s Health Care Reform legisla - mental level to expand it to air wings, tion (PPACA) authorized demonstration logistics groups, and reserve forces for programs to train or employ alternative the benefit of their service members. ” dental health providers in order to in - Navy Medicine is also utilizing mental crease access to dental health care serv - health professionals in innovative ways ices in rural and other underserved on the home front. To improve quality communities. This Fall, the W. K. Kel - and access to care, Navy Medicine has logg Foundation released its report on created integrated Medical Home Teams the Alaska Dental Therapists program, within its Internal Medicine and Pri - which was strongly opposed by organ - mary Care clinics to provide personal - ized dentistry essentially proffering that ized, coordinated, and proactive care to these providers would be “public health patients. The Medical Home initiative is hazards, ” affirmatively harming their unique because it is an integrated care patients if allowed to practice. The Kel - model where primary care services and logg Foundation found that: “dental behavioral health assets are together in therapists practicing in Alaska provide the same clinic space. The embedded be - safe, competent and appropriate dental havioral health consultant provides care. The two-year, intensive evaluation health assessment and intervention ex - is the first independent evaluation of its pertise to primary care managers and scale to assess care provided by dental their patients. Clinical Psychologists are therapists practicing in the United ideally suited for the Navy ’s Medical States. It confirms for us what numerous Home Team model. continued on page 64 63 prior studies of dental therapists prac - lieve pain for people who often had to ticing in other countries have already wait months or travel hours to seek treat - shown: that dental therapists provide ment; patient satisfaction with their care safe care for underserved populations. ” is very high; and, they are will-accepted in tribal villages. The report further noted Dental therapists have been providing that severe shortages of dentists dispro - preventive and basic dental care to chil - portionately affect low-income commu - dren and families in remote Alaska Na - nities and communities of color; that lack tive villages since 2006. Although new to of affordable dental care is putting sorely the U.S., dental therapy has been well-es - needed dental services out of reach for tablished for decades in more than 50 nearly 50 million Americans, particularly countries, including those with advanced those in rural and underserved areas. dental care systems similar to ours. The Hawaii ’s federally qualified community evaluation assessed the work of dental health centers have been particularly therapists in five communities, as well as supportive of this (r)evolution as access the experience of hundreds of patients. to dental care and/or behavioral health They were directly observed performing care has continued to be their top priori - sealant placement, composite and amal - ties over the past decade. The dental ther - gam preparations, stainless steel crown apists are well respected in their placement, and oral health instruction. communities. Because many dental ther - The evaluation relied on examination apists return to practice in their home standards used for assessing clinical com - communities, they typically have the cul - petency for board certification of U.S. tural skills and language fluency needed dental school graduates. Alaskan dental to educate and motivate people towards therapists are technically competent to behavioral change. As role models they perform the procedures within their serve as important oral health advocates. scope of work and do so safely and ap - “Simply training more dentists will not propriately. After graduating and com - solve this problem. The Alaska model is a pleting a 400-hour externship under the community-driven solution that can direct supervision of a dentist, dental work in communities across the therapists are certified to provide a lim - country. ” Aloha, ited scope of dental services under the general supervision of a dentist. They Pat DeLeon, successfully treat cavities and help to re - former APA President, Division 29

OF PSYCHOTH N E O R I A S I P V Y I D 29 . The Psychotherapy Bulletin A N M S E S R A I C L is Going Green: A A N PSYCHOLOGI C Click on www.divisionofpsychotherapy.org/members/gogreen/

64 AMERICAN PSYCHOLOGICAL ASSOCIATION DIVISION 1: THE SOCIETY FOR GENERAL PSYCHOLOGY Call for Nominations 2011 Awards The Consequently, for all of these awards, Society for General Psychology, Division the focus is on the quality of the contri - One of the American Psychological bution and the linkages made between Association is conducting its Year 2011 diverse fields of psychological theory awards competition, including the and research. William James Book Award for a recent book that serves to integrate material Winners will be announced at the an - across psychological subfields or to nual convention of the American Psy - provide coherence to the diverse subject chological Association the year of matter of psychology, the Ernest R. submission. The awardees for the first Hilgard Award for a Career Contribu - four awards will be expected to give an tion to General Psychology, the George invited address at the subsequent APA A. Miller Award for an Outstanding Re - convention and also to provide a copy of cent Article in General Psychology, and the award presentation for inclusion in The General the Arthur W. Staats Lecture for Unify - the newsletter of the Society ( Psychologist ). These Awardees will re - ing Psychology , which is an American ceive a certificate and a cash prize of Psychological Foundation Award man - $1000 to help defray travel expenses for aged by the Society. In addition, there is that convention. an award for graduate students: The Anne Anastasi General Psychology For the William James Book Award, Graduate Student Award (see below for nominations materials should include details). three copies of the book (dated post- All nominations and supporting materi - 2006 and available in print); the vitae of als for each award mus t be received on the author(s) and a one-page statement or before February 15, 2011. With the that explains the strengths of the sub - exception of the William James Award, mission as an integrative work and how you are encouraged to submit your ma - it meets criteria established by the Soci - terials electronically. ety. The award criteria can be found at www.apa.org/div1/awards. Textbooks, There are no restrictions on nominees, analytic reviews, biographies, and and self-nominations as well as nomina - examples of applications are generally tions by others are encouraged for these discouraged. Nomination letters and awards. supporting materials should be sent to Dea n Keith Simonton, PhD, Department The Society for General Psychology en - of Psychology, One Shields Avenue, Uni - courages the integration of knowledge versity of California, Davis 95616-8686; across the subfields of psychology and [email protected] .. the incorporation of contributions from other disciplines. The Society is looking For the Ernest R. Hilgard Award , nom - for creative synthesis, the building of inations packets should include the can - novel conceptual approaches, and a didate’s vitae along with a detailed reach for new, integrated wholes. A statement indicating why the nominee match between the goals of the Society is a worthy candidate for the award and and the nominated work or person will supporting letters from others who en - be an important evaluation criterion. continued on page 66 65 dorse the nomination. Nomination let - 1. There are 2 levels of the Anastasi ters and supporting materials should be Award: Students with 2 years or less sent electronically to John D. Hogan, of graduate study and those with PhD, Psychology Department, St. John’s more than 2 years of graduate study. University, 8000 Utopia Parkway, Ja - Circle the one that best applies to maica, NY 11439 ([email protected] ). you:

For the George A. Miller Award , nomi - a. Two years or less of study be - nations packets should include four yond the baccalaureate. copies of the article being considered b. More than two years beyond the (which can be of any length but must be baccalaureate. in print and have a post-2006 publica - tion date), vitae of the author(s), and a 2. I completed my masters’ degree in statement detailing the strength of the year: ______; or did not complete candidate article as an outstanding con - ______. tribution to General Psychology. Nomi - nation letters and supporting materials 1. Include: should be sent electronically to Nancy a. Name + email: Felipe Russo, PhD, Department of b. Institution: Psychology, Box 871104, Arizona State c. A mentor + email: University, Tempe, AZ 85287-1104 d. Focus of research, title: [email protected] . II. Send the next three as attachments: The 2012 Arthur W. Staats Lecture for Unifying Psychology is to be awarded in 1. Research statement on your 2011 and given at APA’s 2012 annual con - past/present/future work (2-3 vention. Nominations materials should pages, with limited number of im - include the candidate’s vitae along with a portant citations) detailed statement indicating why the 2. Your Curriculum Vitae nominee is a worthy candidate for the e. upporting letter from one mentor, award including evidence that the nomi - either attached or sent separately nee would give a good lecture. They should be sent electronically to Donald These materials should be sent electron - Dewsbury, PhD, Department of Psychol - ically to the 2011 Chair of the committee , ogy, University of Florida, Gainesville, FL Harold Takooshian, PhD, Psychology- 32611 ([email protected]) . 916, Fordham University, New York NY 10023 , [email protected] . The Anne Anastasi General Psychol - ogy Graduate Student Award is in its Each of two recipients of this award will second year and some changes are being receive $300 and a certificate in 2011. The introduced . This nomination must be winner will be decided based on the stu - submitted electronically to Harold dent’s vitae and research plan, plus a sup - Takooshian, PhD, Psychology-916, Ford - porting letter from the student’s advisor. ham University, New York NY 10023 , [email protected] . Requests for further information about Please send the Following Cover Sheet: Division One Awards may be directed to MaryLou Cheal, PhD , Awards Coordi - Candidates for the Anne Anastasi Gen - nator, Society for General Psychology, eral Psychology Graduate Student 127 E. Loma Vista Drive, Tempe, AZ Award should submit the following: 85282 ([email protected]). 66 REFERENCES

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Professional Psychol - Self-care utilization as a mediational ogy: Research and Practice, 20 (1), variable between the relation be - 32-36. tween the perception of program - Schwebel, M., & Coster, J. (1998) Well- matic emphasis on self-care and the functioning in professional psychol - quality of life. Unpublished doctoral ogists: As program heads see it. dissertation, Loyola University, Professional Psychology: Research and Maryland. Practice , 29 , 284-292. Guy, J. D., Poelstra, P. L., & Stark, M. J. Sherman, M. D. (1996). Distress and (1989). Professional distress and professional impairment due to therapeutic effectiveness: National mental health problems among psy - survey of psychologists practicing chotherapists. Clinical Psychology Re - psychotherapy. Professional Psychol - view, 16, 299-315. ogy: Research and Practice, 20, 48-50. Sherman, M. D., & Thelen, M. H. Katsavdakis, K., Gabbard, G., & Athey, (1998). Distress and professional im - G. (2004). 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76 N OF PSYCHOTH THE DIVISION OF PSYCHOTHERAPY E O R I A S I P V

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PSYCHOTHERAPY BULLETIN Psychotherapy Bulletin is the official newsletter of Division 29 (Psychotherapy) of the American Psychological Association. Published four times each year (spring, summer, fall, winter), Psychotherapy Bulletin is designed to: 1) inform the membership of Division 29 about relevant events, awards, and professional opportunities; 2) provide articles and commentary regarding the range of issues that are of interest to psychotherapy the - orists, researchers, practitioners, and trainers; 3) establish a forum for students and new members to offer their contributions; and, 4) facilitate opportunities for dialogue and collaboration among the diverse mem - bers of our association. Contributors are invited to send articles (up to 2,250 words), interviews, commentaries, letters to the editor, and announcements to Jenny Cornish, PhD, Editor, Psychotherapy Bulletin . Please note that Psy - chotherapy Bulletin does not publish book reviews (these are published in Psychotherapy , the official journal of Division 29). All submissions for Psychotherapy Bulletin should be sent electronically to [email protected] with the subject header line Psychotherapy Bulletin ; please ensure that articles conform to APA style. Dead - lines for submission are as follows: February 1 (#1); May 1 (#2); July 1 (#3); November 1 (#4). Past issues of Psychotherapy Bulletin may be viewed at our website: www.divisionofpsychotherapy.org. Other inquiries regarding Psychotherapy Bulletin (e.g., advertising) or Division 29 should be directed to Tracey Martin at the Division 29 Central Office ([email protected] or 602-363-9211).

OF PSYCHOTH N E O R I A S I P V Y I DIVISION OF PSYCHOTHERAPY (29) D 29 . A

N Central Office, 6557 E. Riverdale Street, Mesa, AZ 85215 M S E S R A I L Ofc: (602) 363-9211 • Fax: (480) 854-8966 • E-mail: [email protected] C A A N PSYCHOLOGI C www.divisionofpsychotherapy.org OF PSYCHOTH N E O R I APY DIVIS 29 AMER ASSN. I C L A A N PSYCHOLOGI C DIVISION OF PSYCHOTHERAPY American Psychological Association 6557 E. Riverdale St. Mesa, AZ 85215

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