Psychotherapy B OFFICIAL PUBLICATION OF DIVISION 29 OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION U In This Issue The Added Value of RxP Training L In Conversation with Dr. Al Mahrer L Clinical Coaching: A Paradigm for Supervision

The Unseen Diagnosis: Addiction Assessment E Candidate Statements T

E O I

C N

VOLUME 38 NO. 1 SPRING 2003 Division of Psychotherapy Ⅲ 2003 Governance Structure ELECTED BOARD MEMBERS

President Past President Alice Rubenstein, Ed.D., 2001-2003 Patricia M. Bricklin, Ph.D. 2002-2004 Robert J. Resnick, Ph.D., 2002-2003 Monroe Psychotherapy Center 470 Gen. Washington Road Department of Psychology 20 Office Park Way Wayne, PA 19087 Randolph Macon College Pittsford, New York 14534 Ofc: 610-499-1212 Fax: 610-499-4625 Ashland, VA 23005 Ofc: 585-586-0410 Fax 585-586-2029 [email protected] Ofc: 804-752-3734 Fax:804-270-6557 [email protected] [email protected] President-elect Sylvia Shellenberger, Ph.D., 2002-2004 Linda F. Campbell, Ph.D., 2001-2003 Board of Directors Members-at-Large 3780 Eisenhower Parkway University of Georgia Norman Abeles, Ph.D. , 2003-2005 Macon, Georgia 31206 402 Aderhold Hall Michigan State Univ. Ofc: 478-784-3580 Fax: 478-784-3550 Athens, GA 30602-7142 Dept. of Psychology [email protected] Ofc: 706-542-8508 Fax:770-594-9441 E. Lansing, MI 48824-1117 [email protected] Ofc: 517-355-9564 Fax: 517-353-5437 APA Council Representatives [email protected] John C. Norcross, Ph.D., 2002-2004 Secretary Department of Psychology Abraham W. Wolf, Ph.D., 2002-2004 Mathilda B. Canter, Ph.D., 2002-2004 University of Scranton Metro Health Medical Center 4035 E. McDonald Drive Scranton, PA 18510-4596 2500 Metro Health Drive Phoenix, AZ 85018 Ofc:570-941-7638 Fax:570-941-7899 Cleveland, OH 44109-1998 Ofc/Home: 602-840-2834 [email protected] Ofc: 216-778-4637 Fax: 216-778-8412 Fax: 602-840-3648 [email protected] E-Mail: [email protected] Jack Wiggins, Jr., Ph.D., 2002-2004 15817 East Echo Hills Dr. Treasurer Patricia Hannigan-Farley, Ph.D. 2003 Fountain Hills, AZ 85268 Leon VandeCreek, Ph.D., 2001-2003 Office: 440- 250-4302 Ofc: 480-816-4214 Fax: 480-816-4250 The Ellis Institute Fax: 440-250-4301 [email protected] 9 N. Edwin G. Moses Blvd. Email:[email protected] Dayton, OH 45407 Alice F. Chang, Ph.D., 2003-2005 Ofc: 937-775-4334 Fax: 937-775-4323 Jon Perez, Ph.D., 2003-2005 6616 E. Carondelet Dr. [email protected] Washington, D.C. 20002 Tucson, AZ 85710 [email protected] Ofc: 520-722-4581 Fax: 520-722-4582 [email protected] APPOINTED BOARD MEMBERS

STANDING COMMITTEES Education & Training TASK FORCES Fellows Chair: Jeffrey A. Hayes, Ph.D. Task Force on Policies & Procedures Chair: Roberta Nutt, Ph.D. Associate Professor and Director of Chair: Mathilda B. Canter, Ph.D. Training Counseling Psychology Program Diversity Membership Pennsylvania State University Chair: Craig N. Shealy, Ph.D. Chair: Dan Williams, Ph.D., FAClinP, 312 Cedar Building ABPP James Madison University University Park, PA 16802 School of Psychology 185 Central Ave- Suite 615 Ofc: (814) 863-3799 East Orange, New Jersey 07018 Harrisonburg, VA 22807-7401 [email protected] Ofc: (540) 568-6835 Fax: 540-568-3322 Ofc: 973-675-9200 Fax: 973-678-8432 [email protected] [email protected] Continuing Education Pager - 1-888-269-3807 Chair: Jon Perez, Ph.D. Student Representative to APAGS: Anna McCarthy Interdivisional Task Force on Health Student Development Care Policy 2400 Westheimer #306-W Chair: Open Houston, TX 77098 Chair: Jeffrey A. Younggren, Ph.D. [email protected] [email protected] Psychotherapy Research Chair: Clara Hill, Ph.D. Task Force on Children, Adolescents Nominations and Elections Dept. of Psychology & Families Chair: Linda F. Campbell, Ph.D. University of Maryland Chair: Sheila Eyberg, Ph.D. College Park, MD 20742 Professor of Clinical & Health Professional Awards Ofc: (301) 405-5791 Psychology Chair: Robert J. Resnick, Ph.D. [email protected] Box 100165 University of Florida Finance Program Gainesville, FL 32610 Chair: Leon VandeCreek, Ph.D. Chair: Alex Siegel, Ph.D., J.D. FEDERAL EXPRESS ADDRESS 915 Montgomery Ave. #300 1600 SW Archer Blvd. Narbeth, PA 19072 [email protected] Ofc: 610-668-4240 Fax: 610-667-9866 Fax 352-265-0468 [email protected] Co-Chair: Beverly Funderburk, Ph.D. PUBLICATIONS BOARD

Chair: John C. Norcross, Ph.D., 2002-2008 Publications Board Members, continued Department of Psychology George Stricker, Ph.D., 2003-2009 University of Scranton Institute for Advanced Psychol Studies Scranton, PA 18510-4596 Adelphi University Ofc:570-941-7638 Fax:570-941-7899 Garden City , NY 11530 [email protected] Ofc: 516-877-4803 Fax: 516-877-4805 [email protected] Publications Board Members: Jean Carter, Ph.D., 1999-2005 3 Washington Circle, #205 Washington, D.C. 20032 Ofc: 202-955-6182 Psychotherapy Journal Editor [email protected] Wade H. Silverman, Ph.D. 1998–2003 Lillian Comas-Dias, Ph.D., 2001-2007 1390 S. Dixie Hwy, Suite 1305 Transcultural Mental Health Institute Coral Gables, FL 33145 908 New Hampshire Ave. N.W., #700 Ofc: 305-669-3605 Fax: 305-669-3289 Washington, D.C. 20037 [email protected] [email protected] Psychotherapy Bulletin Editor Raymond A. DiGiuseppe , Ph.D., 2003-2009 Linda F. Campbell, Ph.D., 2001-2003 Psychology Dept University of Georgia St John’s University 402 Aderhold Hall 8000 Utopia Pkwy Athens, GA 30602-7142 Jamaica , NY 11439 Ofc: 706-542-8508 Fax:770-594-9441 Ofc: 718-990-1955 [email protected] [email protected] Internet Editor Alice Rubenstein, Ed.D. , 2002-2003 Abraham W. Wolf, Ph.D., 2002-2004 Monroe Psychotherapy Center Metro Health Medical Center 20 Office Park Way 2500 Metro Health Drive Pittsford, New York 14534 Cleveland, OH 44109-1998 Ofc: 585-586-0410 Fax 585-586-2029 Ofc: 216-778-4637 Fax: 216-778-8412 Email: [email protected] [email protected]

DIVISION OF PSYCHOTHERAPY (29) Central Office, 6557 E. Riverdale Street, Mesa, AZ 85215 3 Ofc: (602) 363-9211 • Fax: (480) 854-8966 • E-mail: [email protected] OF PSYCHOTH N E O R I DIVISION OF PSYCHOTHERAPY APY Non-Profit American Psychological Association Organization DIVIS 29 6557 E. Riverdale U.S. Postage

AMER Mesa, AZ 85215 Paid Utica, NY ASSN. I Permit No. 83 C L A A N PSYCHOLOGI C PSYCHOTHERAPY BULLETIN Official Publication of Division 29 of the American Psychological Association PSYCHOTHERAPY BULLETIN Volume 38, Number 1 Spring 2003 Published by the DIVISION OF PSYCHOTHERAPY American Psychological Association CONTENTS President’s Column ...... 2 6557 E. Riverdale Mesa, AZ 85215 Student Column ...... 3 602-363-9211 Research Corner ...... 6 e-mail: [email protected] Feature: The Added Value of RxP Training ...... 12 APA Council Report ...... 15 EDITOR Linda Campbell, Ph.D. Division 29 Social Hour ...... 16 Practitioner Report ...... 17 CONTRIBUTING EDITORS Division 29 Member Gathering ...... 20 Washington Scene Patrick DeLeon, Ph.D. Feature: In Conversation with Dr. Al Mahrer...... 21 Practitioner Report Division 29 Mid-Winter Meeting ...... 25 Ronald F. Levant, Ed.D. Feature: Clinical Coaching: A Paradigm Education and Training Corner for Supervision ...... 26 Jeffrey A. Hayes, Ph.D. Candidate Statements ...... 30 Professional Liability Feature: The Unseen Diagnosis: Leon VandeCreek, Ph.D. Addiction Assessment ...... 38 Finance Call for Nominations: Editor of Jack Wiggins, Ph.D. Psychotherapy Bulletin ...... 43 For The Children Free Division of Psychotherapy Continuing Sheila Eyberg, Ph.D. Education Workshop at APA Convention ...... 44

Psychotherapy Research Feature: Was the Competencies Clara E. Hill, Ph.D. Conference 2002 a Competent Conference ...... 45

Student Corner Washington Scene ...... 49 Anna McCarthy Call for Papers...... 55 APA Membership Application ...... 56 STAFF Central Office Administrator Tracey Martin

OF PSYCHOTH N E O R I APY DIVIS 29 AMER ASSN. I C L A A N PSYCHOLOGI C PRESIDENT’S COLUMN

Patricia M. Bricklin, Ph.D.

I am writing this column the first week in and challenges April, 2003. I’m in Washington, D.C. at the raised by our APA building. There are signs of spring continuing con- everywhere. The cherry blossoms are out. versations. We This is the season of growth and develop- would welcome ment. Relationships strengthen. In the all of you into the midst of this seasonal rebirth we are at war. conversations. There is violence, hurt, and pain. There is The current and also courage and strength and a need for future role of healing. The need for the healing power of psychotherapy in psychotherapy in all its forms is all around psychology is an us. It is always there but the need is inten- ambitious endeavor but it is one in which sified in troubled times. We must be ready we are already involved whether as to meet such a need. researchers, academics or practitioners. We can proceed in this endeavor thought Several months ago Linda Campbell, our fully and planfully. We can discover and president elect, and I began some long organize where we are and move from conversations about the state of the field of there. psychotherapy in terms of research, teach- ing and practice in psychology. What do I know the economic challenges of managed we know in each of these areas? What are care have created a depressive, pessimistic psychologist psychotherapists excited about? perspective in many psychologists. This is Where are the innovations? What are real but I also know that when we have the graduate students in psychology being conversations about substance and content taught about psychotherapy? What do the people are energized. changing demographics of our society tell us about the need for diverse models of As I watched TV, read the paper, talk to psychotherapy to meet the needs of students, patients and colleagues, here and diverse populations? What are the external now in April, 2003, I know the world is a challenges, political, economic? Is psy- different place from when Linda and I chotherapy practice for psychologists in started to talk. I cannot find a place in the danger of slipping away from us? world where we as psychologists doing psychotherapy are not sorely needed Our conversations increased in length and whether it is psychotherapy in health excitement. At the most recent Division 29 promotion, psychotherapy to cope and Board meeting we continued the conversa- prevent world crisis, psychotherapy to heal tion with others. People commented “We and psychotherapy to live more fully. We haven’t talked this way in a long time— are needed. about the research, the teaching and prac- tice—the content, the ideas, the future.” Despite the challenges how can we as Linda and I began to formulate what psychologists-psychotherapists let such a would be our joint presidential initiative. valuable tool of healing and health such as We would begin to gather data, informal psychotherapy slip through our hands? and formal, about the state of the field of Please join us in saying, “we can’t and we psychotherapy in psychology, the issues won’t.”

2 STUDENT COLUMN When Are We Competent Enough to Kiss Student Status Goodbye and Embrace the Professional World? Anna McCarthy

Anna McCarthy is currently the Graduate emerge from the conference (see Student Liaison for Division 29, and a first year www.appic.org for additional information). student in the clinical psychology Ph.D. pro- gram at the University of Houston. Prior to 1. Scientific Foundations and Research moving to Houston she graduated from emphasized the need for a scholarly California State University, Long Beach, with a foundation to the practice of psychology, master’s degree in psychology. Additionally, she while also recognizing that science had spent nearly half a decade working in inpa- occurs within a specific socio-cultural tient and outpatient settings with children, context. I interpreted this to mean that adolecents, and adults with a broad range of studies based on white male college stu- mental health problems. Anna intends to write dents won’t suffice, and that cross-cul- her dissertation on the effects of maternal depres- tural differences are being taken seri- sion on children of depressed mothers, and to ously. Further, the group proposed that pursue a career as a clinician and researcher. professional and scientific psycholo- gists communicate with each other. This is an interesting point. It seems that aca- When do we stop being a student and demic psychologists view a career as a become an employable being? When does clinician as the poor relative of psycholo- this metamorphosis occur and what know- gists, while clinicians frown on academic ledge areas, skills, and values define the psychologists for conducting research “competent” professional psychologist? that frequently lacks clinical signifi- How do we assess the presence of such cance. However, the working group competencies? What competencies are wisely suggested that an exchange of “core” to all professional psychologists? A ideas, reciprocity, is a necessity. recent conference at APPIC, entitled “Future Directions in Education and 2. Ethical, Legal, Public Policy/ Advocacy, Credentialing in Professional Psychology,” and Professional Issues concluded that attempted to formulate answers to these training should be formative (ongoing) and related questions. Chaired by Nadine rather than summative (a single ethics Kaslow, Ph.D., ABPP, the Competencies exam), and in vivo (in the “real world”) 2002 Steering Committee assembled in addition to classroom-based educa- working groups comprised of some of the tion. Again there was emphasis on the country’s leading psychologists—and fact that legal/ethical issues take place representing a wide spectrum of relevant within a multicultural context, thereby constituencies—to discuss ten dimensions making it essential that professional psy- that were determined (via survey informa- chologists understand their own values tion) to be at the core of competency for and biases. A final, most interesting, rec- professional psychologists. The delibera- ommendation from this group was for tions of these ten working groups (listed in students to be exposed to good model- bold below)—and subsequent discussions ing throughout their training pro- by various training councils in our field— grams—professors, supervisors, and may well shape the future of graduate advisors must practice what they preach. training programs and the nature of graduate Although this sounds like a moot point, student evaluations. This article is a thumb- the reality of training programs is often nail sketch of some of the key points to far removed from such an ideal. From 3 false advertisement when recruiting new euro-centric bias in psychology, the idea students to substandard patient care at that culturally salient aspects of a client internship sites, it seems that the “ideal” can change from situation to situation, does not always trickle down from the the overarching need to demonstrate textbook to the trainers. necessary and sufficient self-awareness, the importance of professional psycholo- 3. Supervision grappled with issues gists recognizing their own value-laden regarding those who supervise students judgments and fears when working with and students who are learning to super- diverse populations, and the importance vise. The group decided that legal and of educating oneself about specific ethical issues must be of the utmost concern, in addition to viewing supervi- groups of people. Being educated in an sion as a life-long process whose goal environment full of diversity is a first must be proficiency rather than mere step to addressing many of these issues. competence. This, in turn, brings up the Faculty and students with a range of issue of the nature of graduate training. backgrounds, abilities, histories, and eth- Many graduates go on to supervise nicities makes for an enriched learning people in some form or other, yet little experience. focus is paid to the development of 6. Intervention emphasized the importance supervision skills in graduate pro- of keeping abreast of relevant scientific grams. Just as many graduate programs literature, the need to be familiar with assume their students spontaneously innovative and empirically supported acquire teaching skills, so to do they treatments, the importance of self- assume that their students sponta- awareness (a consistent theme through- neously acquire supervision skills. out the conference), and the overlap 4. Psychological Assessment proposed between intervention and assessment that students should be competent in among many other areas. They proposed the use of multiple methods of assess- that treatment should stem from a ment and evaluation in a manner that is theoretically solid base, and should sensitive to the individuals, families and encompass self- and client- evaluations groups being tested. This requires stu- during treatment. An interesting topic dents to have a basic understanding of discussed was what constitutes a psychometric principles; the flexibility sound measure of competence in this to assess multiple domains of human arena. Is competence having the knowl- functioning; an understanding of the edge, skills and values to enable importance of assessing treatment out- employment as a professional psychol- comes; and of the interplay between ogist? Is it the amount of income and psychologists and clients, and assess- professional psychologist generates? Is ments and interventions. They questioned it the number of clients retained over a whether students are receiving the given period of time by a professional training they need during graduate psychologist? Although no consensus school to be viable competitors in was reached, this question is certainly internship and professional realms. worthy of further thought. Undoubtedly, assessment skills are important, marketable, and constitute 7. Consultation and Interdisciplinary the historical essence of psychological Relations agreed that good consultative practice. In an age of managed care, and and inter-professional relationships of justifying diagnoses, the appropriate (across the practice areas in psychology, application of reliable and valid assess- and with allied disciplines) were core ment tools can only be an asset. components of professional competency. Indeed, there has been growing minority 5. Individual and Cultural Diversity of psychologists who hypothesize that considered multiple issues such as the the future of our field entails greater 4 respect, appreciation, and exposure to knowledge, skills, values, and attitudes the different practice areas in our own professional psychologists have). As field as well as professionals from other with many of the other groups, disciplines—so that, for example, inter- Specialties and Proficiencies also noted disciplinary teams of psychologists, that these core competencies would medical doctors, psychiatrists, and social be expected of all professional psychol- workers located in the same office space ogists, and that “additional preparation” will be used to provide more integrated beyond the post-doctoral level “is and holistic treatment for individuals in required for specialty practice.” In need. Among other recommendations, addition to other recommendations, this group suggested that graduate stu- they also indicated that the three dents engage in in-vivo experiences, practice areas of clinical, counseling, role-plays and “pre-practice” pertaining and school psychology should be to consultations. “identified as general health service practice in psychology.” 8. Professional Development focused on issues pertaining to professional devel- 10. Assessment of Competence discussed opment, broadly defined to include the overarching issue of how to assess social judgment and critical thinking the attainment of overall competence in skills. The group acknowledged that professional psychology—the afore- there is much overlap between compe- mentioned metamorphosis from being tencies in social judgment and cultural a student to an employable being. They diversity (previously discussed by the reiterated the need for formative 5th working group). The group proposed assessments (across the student and that professional development was professional lifespan) and summative most aptly conceptualized as a capacity assessments (such as licensing exams). to engage in certain behaviors, rather Ethical, multicultural, and professional than a defined set of skills. Further, values issues were revisited. However, they suggested that such development the group also suggested that “personal is synonymous with “professional suitability or fitness to the profession” socialization” and “professional identity (both inherent and taught) is an impor- development”—an all-encompassing tant domain to add to an assessment of state of “thinking, doing, and being.” A competence. They also proposed that pertinent suggestion from the working more research is needed on the assess- group on ethics and legal issues is cer- ment of professional competence in all tainly applicable here: that students of its multiple forms. need to be exposed to exemplary role In conclusion, this article attempts to models throughout their training. Just provide a thumbnail sketch of the many as children are shaped by their parents’ hours of discussion that took place at behaviors, so too are students shaped the Competencies Conference (go to by their trainers’ behavior. www.appic.org for further information). It was offered as food for thought, and a 9. Specialties and Proficiencies developed tool with which to evaluate your own a wonderfully intricate “competencies training. Obviously, many questions cube”—a diagrammatic representation remain untouched. How do you, as a of their summations. The height of the consumer, evaluate someone’s level of cube depicts stages of professional competence? What qualities, traits or development (i.e., education, internship, elements do you admire in professional post-doctoral positions etc.), the width psychologists close to you? Lastly, and depicts “functional competencies” (i.e., most importantly, when you kiss student the roles professional psychologists status goodbye and embrace the can assume), and the length depicts professional world what characteristics “foundational competencies” (i.e., the and competencies will you embody? 5 RESEARCH CORNER When is a Case Study Scientific Research? William B. Stiles Miami University

William B. Stiles is a professor of clinical psy- WHAT I MEAN BY SCIENTIFIC RESEARCH chology at Miami University in Oxford, Ohio. Scientific research compares ideas with He is a psychotherapy researcher and a psy- observations. In good research, the ideas chotherapist. He received his Ph.D. from UCLA are thereby changed. The observations in 1972. He taught previously at the may be said to permeate the ideas (Stiles, University of North Carolina at Chapel Hill, 1993, in press): Sometimes the observations and he has held visiting positions at the simply confirm or disconfirm the ideas and Universities of Sheffield and Leeds in England, make them stronger or weaker. More often, at Massey University in New Zealand, and at the observations lead to extensions, elabo- the University of Joensuu in Finland. He is the rations, modifications, or qualifications of author of Describing Talk: A Taxonomy of the ideas. The ideas change to better fit the Verbal Response Modes. He is a past presi- observations; in effect, aspects or qualities dent of the Society for Psychotherapy Research, of the observations become part of the and he is currently North American Editor of ideas. Science is cumulative because obser- Psychotherapy Research. vations permeate ideas in this way. Author Note: I thank Meredith J. Glick, Theories are ideas stated in words (or num- Michael A. Gray, Carol L. Humphreys, bers or diagrams or other signs), which Katerine Osatuke, and Lisa M. Salvi for com- communicate ideas between people— ments on drafts of this article. Correspondence between author and reader in the case of should be addressed to William B. Stiles, research reports. To the extent that commu- Department of Psychology, Miami University, nication is successful, the reader experi- Oxford, OH 45056. Fax 1-513-529-2420. ences something similar to the author’s Email [email protected]. understanding. Empirical truth—the goal toward which theoretical statements strive—can be understood as a correspon- I propose this answer to the title question: dence between theories and observed When observations of the case are explicit- events. Of course, it is a nonsense to sup- ly brought to bear on a theory. I will first pose that the words in a theory (e.g., print try to describe briefly what I mean by sci- on a page, spoken sounds) literally corre- entific research and how case studies can fit spond to the concrete objects or events the description. Then, as an illustration, I described. However, both the words and will describe the assimilation model, a the- the events are experienced by people; that ory of how people change in therapy is, they produce ideas and observations. (Stiles, 2001, 2002; Stiles et al., 1990), and Because both of these are human experi- give some examples of how case studies ences—composed of the same stuff—they have been brought to bear on it. can be compared and judged as similar or different (Stiles, 1981). In this article, I focus on the scientific purposes of case studies. I acknowledge, Empirical truth is never general or perma- however, that case studies may be interest- nent because different people experience ing or enriching independently of their words and events differently, depending contribution to scientific theory (Stiles, in on their biological equipment, culture, life press). history, and current circumstances. 6 Nevertheless, it is often possible to distin- In a case study, instead of trying to assign a guish better from worse theories or decide firm confidence level to a particular which parts of theories need changing, derived statement, an investigator simulta- based on their experienced correspondence neously compares a large number of obser- with events. As new observations permeate vations based on a particular individual at theory, the theory changes to better with a correspondingly large number of match the observations. For example, the theoretically-based statements. Each state- theory may be explained differently, using ment that describes some aspect of the case different words or perhaps using the new in theoretical terms represents a compari- observations as illustrations. son of the theory with an observation. At issue is how well the theory describes the To summarize my view: Theory can be con- details of the case. For a variety of familiar sidered as the principal product of science. reasons (selective sampling, low power, The work of scientists can be considered as potential investigator biases, etc.), the quality control, insuring that the theories increase (or decrease) in confidence in any are good ones by comparing them with one theoretical statement may be very observations. Good theories are useful. By small. That is, isolated descriptive state- accurately representing the process of psy- ments drawn from a case study can’t be chotherapy, for example, a good theory can confidently generalized. Nevertheless, help practitioners understand their clients because many statements are examined, and how to be effective in helping them. the increase (or decrease) in confidence in the theory may be comparable to that stem- TESTING THEORIES WITH CASE STUDIES ming from a statistical hypothesis-testing In contrast to statistical hypothesis-testing study. A few systematically analyzed cases research, case studies characteristically that match a theory in precise or unexpect- yield results mainly in words rather than ed detail may give people considerable numbers, use empathy and personal confidence in the theory as a whole, even understanding rather than detached obser- though each component assertion may vation, place observations in context rather remain tentative and uncertain when than in isolation, focus on good examples considered separately. I think the most con- rather than representative samples, and vincing support for the assimilation model sometimes seek to empower participants has been the detailed fit between the model rather than merely to observe them (Stiles, and observations in a series of intensive case 1993, in press). I suggest that case studies, studies (e.g., Honos-Webb, Stiles, as well as statistical hypothesis-testing Greenberg, & Goldman, 1998; Knobloch, research, can permeate scientific theory Endres, Stiles, & Silberschatz, 2001; Stiles, and contribute to quality control. 1999b; Stiles, Meshot, Anderson, & Sloan, 1992; Stiles et al., 1991; Varvin & Stiles, 1999). In statistical hypothesis-testing research, an investigator extracts or derives one statement (or a few statements) from a CASE STUDY RESEARCH ON THE theory and attempts to compare this state- ASSIMILATION MODEL ment with a large number of observations. At the core of the assimilation model is an If the observed events tend to match the observational strategy: identifying prob- derived statement (that is, if the scientists’ lems and tracking them across sessions, experience of the observations resembles using tape recordings or transcripts (Stiles, their experience of the statement), then 2001, 2002; Stiles & Angus, 2001). Drawing people’s confidence in the statement is cases from a variety of therapeutic substantially increased, and this, in turn, approaches, we have observed how expres- yields a small increment of confidence in sions of a problem differ from time to time, the theory as a whole. we have inferred a process of change, and 7 we have developed concepts to describe izes the degree of assimilation of particular this process. problematic content. The names of the lev- els describe the state of the problematic According to the model, people’s experi- voice (traces of a problematic experience) ence leaves traces, which can be re-activat- from the viewpoint of the community. In ed by events that have related meanings. case studies, the APES has typically been That is, thoughts, feelings, and actions, used not by independent raters but by tend to re-emerge in related circumstances, investigators who have used APES ratings and they then be come linked to the traces to precisely convey their context-informed of the new experiences. As a result, traces assessment of each problem’s degree of of related experiences occurring at differ- assimilation. Using assimilation analysis ent times tend to form interlinked constel- (Stiles & Angus, 2001; Stiles & Osatuke, lations, providing the experiences are 2000), investigators become familiar with a unproblematic. We call the traces of experi- case, identify a problematic voice, excerpt ence voices to emphasize that they are passages representing that voice, and then active agents, which can act and speak use the APES to help describe whether and (Honos-Webb & Stiles, 1999; Stiles, 1997, how it was assimilated. The APES is a sum- 1999a, 2002). The process of interlinking is mary of our current understanding of the called assimilation. Assimilated voices serve sequential process of assimilation, and the as a repertoire of resources, drawn upon to scale continues to evolve. deal with life’s demands. For example, cooking skills (traces of previous cooking Although there have been some statistical experiences) tend to emerge, appropriately, hypothesis-testing studies addressing the in the kitchen. assimilation model (see Stiles, 2002, for a review), the model has grown mainly from Some experiences are problematic, howev- the case studies (e.g., Honos-Webb et al., er, for example, traumatic events or 1998; Knobloch et al., 2001; Stiles, 1999b; destructive important relationships. The Stiles et al., 1990, 1991, 1992; Varvin & problematic traces, or voices, are not Stiles, 1999). The gradual development of smoothly integrated, but are treated as the APES illustrates how the case observa- unwelcome or foreign. Triggering them tions have permeated the model, refining, is signaled by negative emotion. Psycho- elaborating, and clarifying it: therapy, according to the assimilation model, is a process of turning such The development of the APES began with a problematic experiences into resources. For list of immediate therapeutic impacts example, in one case (Debbie; Stiles, (Stiles et al., 1991), which were derived 1999b), an angry, rejecting voice that was from clients’ open-ended descriptions of responsible for violent verbal and physical helpful and unhelpful events within thera- outbursts was assimilated and gradually py sessions (Elliott, 1985; Elliott et al., transformed into a capacity for appropriate 1985). Based on our initial case observa- assertiveness. tions, we listed the impacts in sequence to reflect our understanding of the assimila- On their way to becoming resources in suc- tion process, and we modified and expand- cessful therapy, problematic experiences ed the impact descriptions to construct the appear to pass through a sequence of anchored eight-point scale. As an example stages or levels of assimilation, described of modification and expansion, although in the Assimilation of Problematic the original “personal insight” impact cate- Experiences Scale (APES). As shown in gory was characterized as a “task impact” Table 1, the APES includes 8 levels num- (Elliott et al., 1985, p. 622), we observed bered 0 through 7. Applied to passages that therapeutic insight events were from therapy, each APES rating character- accompanied by intense but mixed (posi- 8 tive and negative) emotion in the first cases gered, may emerge in flashback phenome- we studied (Elliott et al., 1994; Stiles et al., na, such as film-like reliving of the trauma 1990). Consequently, we included affective (Varvin & Stiles, 1999). Thus, the alteration features in our characterization of APES based on new case observations strength- level 4, understanding/insight (see Table ened the model. 1). As another example, although APES level 2 was originally called simply “vague SOME IMPLICATIONS awareness” (Stiles et al., 1991, p. 199), even In summary, I suggest that case studies early case studies showed a quality of offer an alternative that can complement emergence at this level (e.g., describing the hypothesis-testing research. By simultane- case of Joan at APES level 2: “the intense ously bringing many observations to bear psychological pain signaled the emergence on a theory, case studies offer both a way to of the unwanted thoughts”; Stiles, 1991, p. test and an opportunity to improve the the- 202). As this pattern was repeated across ory. I acknowledge that other people may cases, the term emergence was eventually mean something by scientific research added to the name and description of level besides comparing ideas with observa- 2 (see Table 1). tions. My meaning implies that, for exam- ple, Freud’s case studies, such as Dora If a case fits the theory in a great many (Freud, 1905/1953) and Schreiber (Freud, respects but fails to fit it in a small and spe- 1911/1958) qualify as scientific research. In cific way, this can point to something in the my view, Freud’s case studies permeated theory that needs changing, as in the fol- psychoanalytic theory (that is, the theory lowing example: In the earlier versions of was altered by them), and the detailed fit the APES (e.g., Honos-Webb et al., 1998; between the theory and the cases helped Stiles et al., 1991, 1992), which were based increase confidence in the theory. In the mainly on studies of depressed but other- same way, our assimilation case studies wise well-functioning clients, the APES have both changed the assimilation model level 0 was called simply warded off. More and built our confidence in it. recently, in considering cases with border- line features, we observed material that An implication of my argument is that case was clearly problematic and unassimilated study authors can make their research sci- but not warded off. On the contrary, these entific by articulating their case’s detailed unassimilated voices emerged all too force- relation to an explicit theory. In principle, fully in state switches, in effect, taking over this could be a new theory, developed from the person. Despite this discrepancy, there the case at hand, as long ago suggested in were many aspects of these cases that fit the grounded theory approach (Glaser & the model’s account well. For example, the Strauss, 1967). Arguably, psychoanalysis opposing states were at first mutually inac- and many other theories of therapy began cessible, encounters between them tended as accounts of cases. Constructing a new to be emotionally painful, and in successful theory for each case, however, forgoes the therapy, they seemed to go through the benefits of cumulative improvements, and sequence described in Table 1. Thus, the fewer readers may be interested in a theo- observations did not justify abandoning ry developed for one-time use. the theory, but instead led to some alterations (e.g., Osatuke & Stiles, in preparation, Of course, neither Dora, nor Schreiber, nor Stiles, 2002), such as the addition of the the assimilation case studies, nor any sin- term “dissociated” in the label of APES gle piece of scientific research—case study level 0 and rewriting of the level 0 descrip- or otherwise—can overcome all the ambi- tion (Table 1). This reformulation also guities and doubts in a theory. Like other offered an improved fit with dissociated theories, the assimilation model is far from traumatic experiences, which, when trig- a precise or complete account; I hope and 9 expect it will continue to be permeated by Osatuke, K., & Stiles, W. B. (in prepara- observations on new cases. All good scien- tion). On different kinds of problematic tific theories, I believe, remain open-ended, internal voices: Elaboration of the assim- stimulating new research while they accu- ilation model. mulate, summarize, and convey previous Stiles, W. B. (1981). Science, experience, and observations. truth: A conversation with myself. Teaching of Psychology, 8, 227-230. REFERENCES Stiles, W. B. (1993). Quality control in qual- itative research. Clinical Psychology Elliott, R. (1985). Helpful and nonhelpful Review, 13, 593-618. events in brief counseling interviews: Stiles, W. B. (1997). Signs and voices: Joining An empirical taxonomy. Journal of a conversation in progress. British Journal Counseling Psychology, 32, 307-322. of Medical Psychology, 70, 169-176. Elliott, R., James, E., Reimschuessel, C., Stiles, W. B. (1999a). Signs and voices in psy- Cislo, D., & Sack, N. (1985). Significant chotherapy. Psychotherapy Research, 9, 1-21. events and the analysis of immediate Stiles, W. B. (1999b). Signs, voices, meaning therapeutic impacts. Psychotherapy, 22, bridges, and shared experience: How talking 620-630. helps. Visiting Scholar Series No. 10 (ISSN Elliott, R., Shapiro, D. A., Firth-Cozens, J., 1173-9940). Palmerston North, New Stiles, W. B., Hardy, G. E., Llewelyn, S. P., Zealand: School of Psychology, Massey & Margison, F. R. (1994). Comprehensive University. process analysis of insight events in cog- Stiles, W. B. (2001). Assimilation of problem- nitive-behavioral and psychodynamic- atic experiences. Psychotherapy, 38, 462- interpersonal psychotherapies. Journal of 465. Counseling Psychology, 41, 449-463. Stiles, W. B. (2002). Assimilation of problem- Freud, S. (1905/1953). Fragment of an atic experiences. In J. C. Norcross (Ed.), Analysis of a Case of Hysteria. In J. Psychotherapy relationships that work: Strachey (Ed. and Trans.), The standard Therapist contributions and responsiveness to edition of the complete psychological works patients (pp. 357-365). New York: Oxford of Sigmund Freud, Vol. 7 (pp. 3-122). University Press. London: Hogarth Press. Freud, S. (1911/1958). Psycho-analytic notes Stiles, W. B. (in press). Qualitative research: on an autobiographical account of a case Evaluating the process and the product. In of paranoia. In J. Strachey (Ed. and S. P. Llewelyn & P. Kennedy (Eds.), Trans.), The standard edition of the complete Handbook of Clinical Health Psychology. psychological works of Sigmund Freud, Vol. London: Wiley. 11 (pp. 9-55). London: Hogarth Press. Stiles, W. B., & Angus, L. (2001). Qualitative Glaser, B. G., & Strauss, A. L. (1967). The research on clients’ assimilation of prob- discovery of grounded theory: Strategies for lematic experiences in psychotherapy. In J. qualitative research. Chicago: Aldine. Frommer & D. L. Rennie (Eds), Qualitative Honos-Webb, L., & Stiles, W. B. (1998). psychotherapy research: Methods and method- Reformulation of assimilation analysis ology (pp. 112-127). Lengerich, Germany: in terms of voices. Psychotherapy, 35, 23-33. Pabst Science Publishers. Honos-Webb, L., Stiles, W. B., Greenberg, Stiles, W. B., Elliott, R., Llewelyn, S. P., L. S., & Goldman, R. (1998). Assimilation Firth-Cozens, J. A., Margison, F. R., analysis of process-experiential psycho- Shapiro, D. A., & Hardy, G. (1990). therapy: A comparison of two cases. Assimilation of problematic experiences Psychotherapy Research, 8, 264-286. by clients in psychotherapy. Psychotherapy, Knobloch, L. M., Endres, L. M., Stiles, W. B., 27, 411-420. & Silberschatz, G. (2001). Convergence Stiles, W. B., Meshot, C. M., Anderson, T. and divergence of themes in successful M., & Sloan, W. W., Jr. (1992). psychotherapy: An assimilation analysis. Assimilation of problematic experiences: Psychotherapy, 38, 31-39. 10 The case of John Jones. Psychotherapy Assimilation analysis. Unpublished man- Research, 2, 81-101. uscript. Department of Psychology, Stiles, W. B., Morrison, L. A., Haw, S. K., Miami University, Oxford, Ohio 45056 Harper, H., Shapiro, D. A., & Firth- Varvin, S., & Stiles, W. B. (1999). Emergence Cozens, J. (1991). Longitudinal study of of severe traumatic experiences: An assimilation in exploratory psychothera- assimilation analysis of psychoanalytic py. Psychotherapy, 28, 195-206. therapy with a political refugee. Stiles, W. B., & Osatuke, K. (2000). Psychotherapy Research, 9, 381-404.

Table 1 Assimilation of Problematic Experiences Scale (APES)

0. Warded off/dissociated. Client is unaware of the problem; the problematic voice is silent or dissociated. Affect may be minimal, reflecting successful avoidance. Alternatively, problem may appear as somatic symptoms, acting out, or state switches. 1. Unwanted thoughts/active avoidance. Client prefers not to think about the experience. Problematic voices emerge in response to therapist interventions or external circum- stances and are suppressed or avoided. Affect is intensely negative but episodic and unfocused; the connection with the content may be unclear. 2. Vague awareness/emergence. Client is aware of a problematic experience but cannot formulate the problem clearly. Problematic voice emerges into sustained awareness. Affect includes intense psychological pain—fear, sadness, anger, disgust—associated with the problematic experience. 3. Problem statement/clarification. Content includes a clear statement of a problem— something that can be worked on. Opposing voices are differentiated and can talk about each other. Affect is negative but manageable, not panicky. 4. Understanding/insight. The problematic experience is formulated and understood in some way. Voices reach an understanding with each other (a meaning bridge). Affect may be mixed, with some unpleasant recognition but also some pleasant surprise. 5. Application/working through. The understanding is used to work on a problem. Voices work together to address problems of living. Affective tone is positive, opti- mistic. 6. Resourcefulness/problem solution. The formerly problematic experience is a resource, used for solving problems. Voices can be used flexibly. Affect is positive, satisfied. 7. Integration/mastery. Client automatically generalizes solutions; voices are fully inte- grated, serving as resources in new situations. Affect is positive or neutral (i.e., this is no longer something to get excited about).

Note. Assimilation is considered as a continuum, and intermediate levels are allowed, for example, 2.5 represents a level of assimilation half way between vague awareness/emer- gence (2.0) and problem statement/clarification (3.0).

11 FEATURE The Added Value of RxP Training John L. Caccavale, Ph.D., M.S. Clinical Psychopharmacology

John Caccavale, Ph.D. is a licensed, clinical neu- practice in 1995. All of my psychology ropsychologist practicing in Downey, CA in an partners are trained in psychopharmacolo- injury practice and is the managing partner at gy. The physicians and other medical spe- The California Occupational Injury Center. His cialties that we deal with generally have no doctoral degree is from the University of further training in psychopharmacology Southern California and he has since completed beyond medical school and residency. an M.S. in clinical psychopharmacology from Typically, the patients I see have at least Alliant University. His current projects include three other specialties providing treatment. writing in the area of adverse drug events and Many times there may be in excess of seven psychotropic medications and recently published providers. Invariably, all these specialties in the Journal of Clinical Psychology on pre- prescribe one or more medications and scriptive authority. rarely know what the others have pre- scribed. Generally, my patients have no idea of even why they were prescribed any The true added value of psychopharmacol- one medication let alone several. Because ogy training (RxP) may be difficult to of my RxP training and because I am the ascertain at this time because training is one specialty who actually sees the patient relatively new and the number of psychol- on a regular basis, I am in the unique posi- ogists who have completed level II training tion of being able to evaluate the drug- are relatively few. Perhaps, four to five drug interactions and the medication hundred, at best. Nevertheless, the experi- errors of the many medications being pre- ences of individual psychologists can pro- scribed for an individual patient. It is the vide a sort of template showing trends that norm that I find potential and real harmful no doubt will be shared among those who side effects due to interactions. Medication will complete RxP training and integrate errors are frequent. I am able to communi- psychopharmacology into their practices. cate this information to the patients and to From personal experience and those of the other specialties. I am able to recom- psychologists similarly trained, I have con- mend which medications should be dis- cluded that RxP training can be the single continued or changed. The majority of most factor to benefit both practitioners, times physicians ask me to monitor and patients and psychology. I have delineated manage the medication regimen. Without several key areas where I personally have RxP training both my patients and myself experienced the added value of RxP train- would be at a terrible disadvantage. RxP ing: Increased Patient Safety; Enhanced training has helped me to become a far bet- Patient Services; Professional Growth & ter practitioner. I am sure that this experi- Recognition; Enhanced Practice Revenues; ence extends to many others who have and Reduced Treatment Costs. There are completed psychopharmacology training. other factors beyond these that can also be attributed to RxP training, such as the ENHANCED PATIENT SERVICES impact of training on mental health policy. Because I now integrate psychopharmacol- However, I’ll leave that for another time. ogy factors into my evaluations, I am able to provide a needed and valuable service INCREASED PATIENT SAFETY to my patients. My evaluations are more I am a partner in an injury practice and I complete. I provide every patient who is integrated psychopharmacology into my taking a medication with a simple state- 12 ment showing the interactions and side recognition that we will need to realize our effects of their medication regimen. I have national RxP goal. Besides the recognition found that few patients read or understand obtained from medical practitioners, psy- the literature given to them by pharma- chologists trained in psychopharmacology cists. I am a fluent Spanish speaker and can expect being consulted by other col- over 85% of my patients are Spanish speak- leagues and new referrals from existing ing, I provide them with important health patients. This is particularly true in areas information that they have difficulty get- lacking a diversity of other specialties. RxP ting elsewhere. I can say that many of these training has also given me the opportunity patients are prescribed medications with- to speak and write on subjects from a dif- out the benefit of anyone being able to ferent perspective. All of these have con- communicate with them. I have seen jani- tributed to both my personal and profes- tors “translating” for physicians. In the sional growth. My discussions with other world of English speaking practitioners RxP trained psychologists indicates that all anyone who can read a menu can be a have enjoyed what I am experiencing. translator. While all patients benefit from psychopharmacology training, under ENHANCED PRACTICE REVENUES served populations greatly benefit from From an economic perspective, I have long having a psychologist trained in psy- ago recovered my investment in RxP train- chopharmacology. There are many other ing. I calculate that my RxP training examples that I can cite with respect to accounts for an additional 35% of my over- increased patient services but for now all revenues on a yearly basis. I base this on these should suffice. increased referrals, additional charges for medication recommendations, increased PROFESSIONAL GROWTH & fees for my forensic evaluations, increased RECOGNITION visits for patients on medications, and the Anytime a professional can obtain an development of novel services, e.g., per- added proficiency, professional growth is forming medication case reviews for insur- enhanced. However, with RxP training ance companies of patients that they sus- there is the added value of being recog- pect are not getting the right medications. nized by both peers and other specialties, With RxP training one can expect seeing particularly physicians. Medications is the increased revenues from the above sources currency of communication with the med- as well as any number of other areas ical profession. When a non-physician can depending upon geographical location, communicate using this currency the artifi- type of practice and other training. cial line separating the two becomes much However, no matter how one looks at the smaller. In some cases it even disappears. issue, RxP training will allow one to recoup On a daily basis, I am called upon by their investment. I know that there are physicians to evaluate and recommend some critics who believe that this is the psychotropic medications. After a contact, I main thrust for prescriptive authority. The always follow up with a simple report, fact that we can recoup our investment is many times only one page, showing the great. There should be no shame in earning particulars of the medication discussed. a good honest living. The fact that RxP also pays is just another added value. I have been requested by physicians to rec- ommend medications to their family mem- REDUCED TREATMENT COSTS bers. Clearly, these physicians have access Overall treatment costs, whether paid by to psychiatrists but my experience is that an insurance carrier, employer or individ- non-psychiatric physicians prefer to speak ual, can be significantly reduced when a and deal with a psychologist trained in psychologists is trained in psychopharma- psychopharmacology. This is the type of cology. RxP training greatly reduces over- 13 all office visits to physicians because the In conclusion, from whatever perspective patient gets diagnosed appropriately and one looks at the issue, RxP training pre- quicker. They get an appropriate recom- sents a lot of added value to any psycholo- mendation for medications, when neces- gist choosing to make the relatively small sary. Many studies have already demon- sacrifice associated with training. The strated that it can take a significant amount gains to patients, practitioners, psychology, of time for general practitioners to correctly and society as a whole, can be significant. diagnose and subsequently appropriately Although I have addressed only a few of treat patients with depression and anxiety. the issues associated with the value of RxP The costs associated with this no doubt are training, I am sure that many more will significant. surface as we proceed to enter into an area that is the proper domain of psychology. If one were to factor all the costs, including The public interest is served with RxP and the impact on the national economy from I strongly recommend and advocate to all absenteeism and other down time, we psychologists that they take the time to could probably fund and extend full health investigate the many programs now avail- insurance coverage to the uncovered from able to become trained and gain a profi- these savings. RxP training has the poten- ciency in an area vital to our patients and tial to significantly reduce the costs associ- profession ated with bad diagnoses and adverse drug events associated with medication errors, REFERENCES which is estimated by the FDA to be in the Reducing and Preventing Adverse Drug range of 72 billion to 120 billion dollars Events to Decrease Hospital Costs. annually. RxP training can significantly Research in Action. Issue Number 1. reduce costs associated with symptoms Agency for Health Care Policy and resulting from side effects from polypharma- Research, Rockville, MD. Center for cy and inappropriate medication regimens. Research Dissemination and Liaison.

RxP training can significantly reduce over- Testimony on Medical Errors: all costs for mental health because those so Understanding Adverse Drug Events trained know when medications are appro- by Janet Woodcock priate. For the year ending 2001, the com- Director, Center for Drug Evaluation and bined costs for all medications in the Research, Food and Drug Administration United States exceeded 132 billion dollars. U.S. Department of Health and Human RxP trained psychologists can significantly Services. Before the Senate Committee on reduce this expenditure because experi- Health, Education, Labor, and Pensions. ence shows that we tend to recommend February 1, 2000. reducing or discontinuing overall use of psychotropic medications. In practice, this Health Financing and Public Health Issues can also equate to better efficiency and U.S. General Accounting Office effectiveness. Its a “win-win” situation. February 1, 2000

14 APA COUNCIL REPORT Report on APA Council Meeting of February 14–15, 2003

By John C. Norcross, Ph.D. Council Representative Division 29

The APA Council of Representatives met • Devoted several hours of discussion to on February 14 and 15, 2003 in APA’s financial situation and to the Washington, DC. Dr. Alice Chang, Dr. Jack recognition that the reduced number of Wiggins, and myself — the Division 29 APA staff will not be able to accomplish team — represented the Division of as much as in prior years. Psychotherapy. • Approved the recognition of Sport The original plan called for a 20-hour Psychology as a proficiency and the packed agenda across three days; however, Assessment & Treatment of Serious a raging snowstorm reduced it to 16 hours Mental Illness as a proficiency in profes- across two days. We managed to escape sional psychology. the ravages of the weather on Saturday • Honored psychologist Dr. Daniel afternoon, but many of our colleagues Kahneman for his recent receipt of the were not as fortunate. They were stranded Nobel prize in economics. in the District of Columbia for two addi- • Approved the impressive refinancing of tional days due to airport closings. APA’s two Washington, DC buildings at lower mortgage rates. Here are 10 highlights of Council’s agenda • Held extended discussions in Council and actions: and in the breakout groups on the con- • Heard President Bob Strernberg review tinued plans for a shorter APA conven- his 2003 initiatives, principally his cen- tion and cluster programming. tral priority of fostering unity within • Discussed plans for the 2004 APA con- psychology. vention to be held in Hawaii. Now is • Applauded Dr. Norm Anderson’s the time to prepare for this exciting approach to his new position as APA opportunity in July 2004! CEO. • Reaffirmed APA’s commitment to the As always, please contact Alice, Jack, or designation of health-service psycholo- myself directly ([email protected]) if gists as primary health care providers you would like to speak about the actions in relevant regulations and in funding and directions of the APA Council of programs. Representatives. • Approved the final 2003 APA budget containing a modest surplus, after sever- al years of serious deficits.

15 DIVISION 29 SOCIAL HOUR

John Norcross and Don Freedheim

Larry Beer and Bob Resnick Matty Canter and Harry Wexler

Jim Calhoun, Marv Goldfried, Georgia Calhoun, John Dagley, Clara Hill, Andy Horne, Linda Campbell, Louis Castonguay, and Charles Gelso 16 PRACTITIONER REPORT

The Problem of Licensure Mobility Ronald F. Levant, Ed.D., ABPP Nova Southeastern University APA Recording Secretary

Ronald F. Levant, Ed.D., A.B.P.P., is a candi- Boards of Nursing has endorsed a model date for APA President. He is in his second based on the driver’s license, in which term as Recording Secretary of the American mechanisms exist for mutual recognition Psychological Association. He was the Chair of and reciprocity. Licensure is recognized the APA Committee for the Advancement of across state lines, with the nurse subject to Professional Practice (CAPP) from 1993-95, a the laws and rules of the new state. So too, member of the Board of Directors of Division 29 the pharmacists facilitate mobility through (1991-94), a member at large of the APA Board uniform licensure requirements and a clearinghouse program which transfers the of Directors (1995-97), and APA Recording pharmacists license to the new state, Secretary (1998-2000). He is Dean, Center for verifying background information and Psychological Studies, Nova Southeastern screening for disciplinary actions. University, Fort Lauderdale, FL. APA has been attempting to address this problem. The APA Council of Representa- Psychologists seeking to obtain a license in tives at the February 2001 meeting gave another state, whether for purpose of formal approval to an ongoing strategic relocation, for a multi-state practice, or for plan developed by the Committee for the engaging in tele-health, might find them- Advancement of Professional Practice selves facing a real nightmare. The Board (CAPP) for helping to provide a climate of Psychology in the new state might ask within which existing mechanisms for pro- the psychologist to jump over many hurdles, fessional mobility can continue to develop. such as producing notarized supervision forms, when some of the supervisors have CAPP, at Council’s request, had been retired or passed on. As former APA implementing a strategic plan to provide a President Pat DeLeon (2000) has observed, supportive environment for giving visibility “few psychologists realize how difficult it to the existing mechanisms for professional is to get relicensed in a new state.” mobility available through the National Register of Health Service Providers in The problem arises because each state Psychology (National Register), the determines the qualifications for profes- Association of State and Provincial sional licensure. By 1977, all states had Psychology Boards (ASPPB), and the enacted a psychology licensure law, American Board of Professional however with a great deal of variation in Psychology (ABPP). CAPP conducted pro- the requirements. The APA Practice grams at the annual State Leadership Directorate, using the APA Model Conference, disseminated invited articles Licensure law, has attempted to reduce to state and provisional psychological some of this variation in order to promote association newsletters, and took other mobility. However, many variations remain. strategic actions. In February, Council approved the continuation of this plan, and Other professions have addressed this as a result, additional articles on the status problem. The National Council of State of the various mobility mechanisms have 17 been, and will continue to be published, as gists moving to different states. Of consid- appropriate, in APA and Practice erable importance, the participants on the Directorate publications (e.g., Smith, 2001, call noted that there are two different Sullivan, 2000-01), additional conference mechanisms for promoting professional programs will be arranged, and meetings mobility: Reciprocity, which refers to among parties of interest will be facilitated. agreements between jurisdictions in which In addition, the author and Jay Benedict, states are willing to recognize each other’s Associate Editors of the journal, licensees based on comparable require- Professional Psychology: Research and ments for licensure, and Endorsement, Practice, are preparing a special section on which is a vehicle to recognize individuals this issue. as having met a high standard qualifica- tion, such as the Certificate of Professional BACKGROUND Qualification (CPQ) developed by ASPPB The information in this section of the col- which is accepted by jurisdictions as meet- umn has been drawn from various APA ing most of the qualifications for licensure. governance documents. In February 2000 In the past 10 years only 10 states have Council suspended its rules and approved entered into reciprocity agreements. This a new business item, titled “Reciprocity of makes endorsement the more promising Licensure Among States”, introduced by mechanism for promoting mobility since Dr’s. Carol Goodheart, Ron Levant, and 20 more than two dozen states are in various other Council Representatives. This item stages of recognizing the more recently affirmed that the attainment of reciprocity developed CPQ. of licensure and other mechanisms for pro- In July, 2000, CAPP continued discussion fessional mobility are urgently needed. It of this issue with representatives of ASPPB directed CAPP, as the lead group, and BPA and the National Register. CAPP noted that to work in collaboration with ASPPB to decisions about licensure reciprocity and develop a plan to achieve this goal. mobility are not the province of APA but rather of state and provincial psychology In March, 2000, CAPP and the Practice boards. CAPP also noted that BPA has a Directorate made time available before the work group examining tele-health issues, start of the State Leadership Conference for and that these issues are clearly relevant to representatives of state psychology licens- any consideration of reciprocity and mobil- ing boards and state psychological associa- ity. CAPP felt that it could take two addi- tions to meet to discuss mobility, in a tional actions supportive of reciprocity and forum coordinated by ASPPB. This was mobility at the present time: 1) provide a the second consecutive year for this partic- climate and create an environment in ular forum. which existing mechanisms for mobility can flourish, by informing members about At its meeting later in March, 2000, CAPP the various mechanisms for mobility discussed the Council item and decided to offered by ASPPB, the National Register, convene a conference call among represen- and the American Board of Professional tatives of CAPP, BPA, and ASPPB to deter- Psychology (ABPP); 2) inform Council of mine what would be most helpful in pro- the distinctions between reciprocity and moting mobility. This call took place in endorsement, and the status of the latter as June, 2000. It highlighted several relevant being the mobility mechanism more wide- issues, including the type of support that ly accepted by states and provinces. APA could provide, the potential implica- tions of technology changes and tele-health As part of providing a climate to support for licensure, and the recognition that other existing mechanisms for mobility, CAPP organizations have also developed initia- offered to compile and disseminate to state tives to facilitate licensure for psycholo- and provincial psychological associations 18 (SPPAs) invited articles written by ABPP, really don’t know how events will unfold ASPPB, and the National Register about in the future, all of the vehicles for increas- the various mechanisms and initiatives ing psychologists’ mobility should be sup- each has developed to promote licensure ported. We need all of our “oars in the reciprocity and mobility. Each of the organi- water,” so to speak. Readers are encour- zations was contacted and agreed to prepare aged to contact the sponsoring organiza- a brief article suitable for publication in tions to learn more about each of the SPPA newsletters. These 3 articles were mobility mechanisms: the National circulated in September, 2000, and have been Register, the ASPPB , and ABPP. reprinted in various SPPA newsletters. As always, I welcome your thoughts on In October, 2000, CAPP reviewed the this column. You can most easily contact progress made in publicizing the various me via email: [email protected]. mechanisms for promoting mobility and the increasing acceptance which these REFERENCES mechanisms are receiving, and decided DeLeon, P. (2000). The critical need for that a continuation of the current strategy licensure mobility. Monitor on Psychology, would be recommended to the Board and 31(4), 9. Council. In December, 2000, the Board of Smith, D. (2001, May). Helping psycholo- Directors approved the strategic plan pre- gists on the move: States and provinces pared by CAPP. make professional mobility easier for psychologists. Monitor on Psychology, MECHANISMS TO MOBILITY: 32(5), 73. IMPLICATIONS FOR PRACTITIONERS Sullivan, M. J. (2000-2001, Winter). At this point in time it seems clear that the Directorate helps to promote mecha- need for mobility for psychologists will nisms for mobility. Practitioner Focus, 13, continue to increase. However, since we 4, 16.

Bulletin ADVERTISING RATES

Full Page (8.5” x 5.75”)$300 per issue Deadlines for Submission Half Page (4.25” x 5.75”)$200 per issue August 15 for Fall Issue Quarter Page (4.25” x 3”)$100 per issue December 1 for Winter Issue February 15 for Spring Issue Send your camera ready advertisement, May 1 for Summer Issue along with a check made payable to Division 29, to: All APA Divisions and Subsidiaries (Task Forces, Standing and Ad Hoc Committees, Division of Psychotherapy (29) Liaison and Representative Roles) materials 6557 E. Riverdale will be published at no charge as space Mesa, AZ 85215 allows.

19 DIVISION 29 MEMBER GATHERING

Larry Beer, Shirley Glass, and Leon Hoffman

Jeffrey Barnett and Cynthia Sturm

Matty Canter and Alice Rubenstein 20 FEATURE In Conversation With Dr. Al Mahrer: Innovations in psychotherapy - having your own therapeutic session Howard Gontovnick, Ph.D.

If I were to ask you, what is it you do on a has been acknowledged as one of the regular or irregular basis to become the “Living Legends in Psychotherapy” and person you can become? In other words, recipient of the American Psychological what is it you do to helps you grow or Association Division of Psychotherapy’s develop as a person? Is there some particular Distinguished Psychologist Award. Dr. thing or activity that aids you in what some Mahrer is “internationally renowned either might call—personal transformation? Then as a visionary or as psychotherapy’s Don again, maybe this question has little mean- Quixote.” His endeavors in personality ing to you since you do not practice or theory, psychotherapeutic training, experi- engage in any transformational activity? ential psychotherapy and more recent ses- Whatever your reply, I invite you to read this sions of self-transformation are always interview and consider the possibilities of thought provoking and innovative. a new development in understanding and enhancing personal self-transformation. (HG = Howard Gontovnick Whether you are somewhat interested or AM = Dr. Alvin Mahrer) genuinely curious, I hope you at least take a moment to consider these ideas herein as HG: Dr. Mahrer, for the past few years you just another possibility how one can have been working with a four step engage in a kind of self-transformation. method to help a person have their own session during which they could discover As you will learn from this interview, what they have the capability of becom- Dr. Alvin Mahrer is confident that each one ing? This being the case, what was your of us can learn a great deal about who and thinking behind this idea of having one’s what we can be, by having our own thera- own therapy session alone? And could you peutic session. The method described describe what is involved in order for one below is based on years of his extensive to do this? work in experiential psychotherapy cumu- AM: Let me see, I have a session by myself lating in his current work Becoming The for two reasons. First, I think it is possible Person You Can Become: The Complete Guide for me to become much more the kind of To Self Transformation (Bull Publishing, person I’m capable of becoming. In this 2001). For Alvin Mahrer, this way of hav- way, I would like to be a qualitatively new ing an experiential session is just another person. Does this make sense to you? option for personal transformation. His HG: So far, so good. encouraging confidence simply invites AM: I want to have my own session and by others to discover what he himself has the end of that time I hope I can become a found helpful. lot more of this kind of person —whatever it is—that I am capable of becoming. That Alvin R. Mahrer is a Professor Emeritus of means I am willing to become a whole new the School of Psychology, at University of person if that what happens. That’s one Ottawa. He is the author or 12 books and thing. The other is, there are all sorts of more than 200 publications. Recently he times when I feel rotten, I mean really rot- 21 ten, scared, depressed or something. I have AM: Your question is one that I have often lots of ways I can feel terrible. And when I here when I speak in public or every now am done with a session, what I want to do and then it pops up at the workshops I give is to be free of those times when I feel so in other different countries. They often say, rotten. If those scenes or if those times are “that’s scary right?” And all I can do is say still in my life, like crossing a street or look; if the whole idea of probing down driving a car or something, I do not want to within yourself and discovering something have such rotten feelings in those scenes. that you don’t know is deep inside you is So those are the two things I want to scary, then maybe you shouldn’t do it. You accomplish in every single session. don’t have to do it. If it’s scary to you stay HG: Here is what I understand so far. I can away from it. I’m not forcing people to do picture you teaching a group of people just this, but rather it’s like as an opportunity. If how to discover a deeper quality about you are interested in discovering more themselves. An important consideration and question you ask these people is—are about your self and your own abilities, they ready and willing to really do this? then this may be something for you. Would they like to become a whole new HG: Very simply, what you are talking person? It also seems clear, that by having about is an opportunity for a person to learn this kind of session, a person can learn how how to help them self and that’s all. This to eliminate an awful feeling that has been being the case, let’s talk more specifically on associated with a particular past scene? the method. How does one actually go How is this done? about doing this? AM: In each session or a time when you AM: The best place to start learning about would set aside to do this, one of the first having your own session is to read my new things that you can do is to close your eyes, book: Becoming The Person You Can Become— sit back and look deep down inside your- The Complete Guide to Self Transformation self and find qualities, things about or (Bull Publishing, 2001). In the first step, things that are possible for you to experi- you will use scenes of strong feelings to ence. Things you weren’t even aware of discover something deeper inside you, like and that’s the first maybe scary thing you the quality I discovered in my session of discover something about yourself. Here is being really alone. It was something like an example from a session that I’ve just being separated or apart from everyone. had by myself a couple weeks ago. At that Being all by your self. This is something time, I came across a sense, a quality, possi- that I discovered a couple of weeks ago in bility in me of being really alone by myself, me. That was the first step. In the second away from people, totally isolated. This step, after discovering this new quality you was one thing that scared me and was sort try to welcome this new feeling by putting of new. And that’s the first thing you do in your arms around this quality and saying; a session. You discover something that you “my God, you’re not so bad”—“I like this probably did not know about, a feeling that is new and different. Something you are new quality.” It is a big step to at least able to undergo, to experience. It is akin to admit that there is something like that is an opportunity to be different. deeper inside you. You probably spent HG: As I think about what you have just your whole life hiding it, or not knowing said, a question comes to mind that I am anything about it. Well now you have a sure is often asked. What about the scenario chance to say, “hello, I know you, you’re when there is a person who is inexperi- pretty nice, I like you.” This then becomes enced or unprepared to discover something an opportunity for you to kind of accept about them self? Is there a sense of hesitancy this new quality you discovered. Now, or scariness to change such a situation? does that make any sense? 22 HG: Yes, in the first two steps you discov- or whatever you find inside you in the real er a new and deeper quality about one self, world. For a few minutes, or forever. And if followed by a time to get to know what it is you could do this and do it well, then by like to be this way. To welcome this new the end of that session whatever scene you aspect as a real part of who one is and the started with originally that may have been possibility of what can be. So let’s go on to scary or frightening, bothersome and made the third next step. you feel rotten, will disappear. The bad AM: OK, in the next step the person having feeling is gone—it’s out of your world, fin- a session is going to have do something ished. You’re really a totally new changed really big. Here is where you have to let go person. Now I’m scaring myself, that really of who you are, while you get ready to ambitious isn’t? Its being totally trans- playfully wallow in or throw yourself into formed to whatever extent your ready to becoming what you had previously discov- be totally transformed in one session. To ered deeper inside you. And you do that in become this way, you would playfully the context of past scenes of situations that practice being this new person within the may have happened yesterday, last week, or context of some imagined situation where even two years ago or earlier in your life. you are this way. You would create these HG: In other words, you are looking for possible hypothetical scenarios while having some past time when you might have been the opportunity to live in these circum- like this or maybe a little like this newly stances. To practice being this way and discovered quality. Is that what your saying? seeing what it is like to be this new person. AM: Yes, your right. You have to essentially HG: I’m intrigued, what a powerful and let go of the kind of person you are and transforming exercise. How would a person drench yourself, wallow, play being, this learn to do something like this? whole other person that you discovered AM: Right now there are several ways to earlier. That’s the third step. Ok? learn how to have a session by and for one- HG: Yes. Now I guess everything comes self. First and most important way, is one together in the fourth and final step? should read “Becoming The Person You AM: That’s right. The forth step is the last Can Become..,” this is essential. Other one. Now at this point you’re being a options such as attending a workshop whole new person and your ready to where someone will show you how to have essentially face the world outside the room a session or listening to audio-tapes of that you are in. In this step you can live in someone having a session can be enhance- specially created moments when you see ments, once you have first read the book. what it is like to actually be this way in sit- HG: That sounds easy enough. Yet how do uations more in line with your actual I know if I am going about having a session world. In this step, you have an opportuni- in the right manner? ty to pretend and experience what it is like AM: Once you have tried having your own being this whole new person in a real session, a nice thing that a lot of people do world. Whether it is 10 minutes after you is to send me an audio recording of the ses- open your eyes or an hour after the session, sion. I will listen to tape and then send my the experience of what it’s like, what it can comments back to you with things like you be like to be a whole new person in a real- did this pretty well. Or you didn’t do this istic setting is a very powerful event! For pretty well try this. That’s what I can do to example, to experience being this newly help you learn how to do this. discovered quality of someone who loves HG: Looking ahead in the future at a to be alone, being all by them self in this hypothetical situation. What if this idea of playful reality provides a taste of what it is having a session were to become quite like to actually be this qualitatively new popular and really take off, would the role person. Being separated from everybody of the psychotherapists become obsolete? 23 AM: Let me tell you what I think. I train doc- of the blue, it kind of evolved over time. toral students and give workshops where During my university years, when in the there are a lot of professionals, social workers, doctoral program I wasn’t so concerned psychologist, psychiatrist, etc. And my first about becoming a psychotherapist. I went invitation is—instead of doing therapy on into the psychology program to discover your clients or patients, how about doing how to feel better. So from the beginning I something to make you feel better. To help just wanted to find some way I could learn you become what you can become. So the to feel better and become whatever I am first thing I want to do, is to take all the ther- capable of becoming. apists in the world and see how many of HG: If you could isolate one important them want to learn how to have their own outcome of having your own session, what experiential sessions. That’s the first thing. would, should or could it be? More importantly, I would really like a fair AM: If I had to choose one goal? It would proportion of psychotherapists to start hav- be to enable the person, in each session, to ing their own experiential sessions for the become more of the person that the person rest of their lives. And that’s a lot of people is capable of becoming. Find a deeper learning how to have their own experiential potential for experiencing, and allow it to sessions. Look, if you don’t like the idea of become an integral part of a qualitatively having your own experiential session then new person. maybe something else appeals to you. Maybe HG: If a person was interested in contact- you would like to learn how to do medita- ing you with comments or questions, how tion or something else you can do regularly could they go about it? by yourself so that you can really feel better AM: Please write to Dr. Alvin R. Mahrer, and become whatever sort of person you are School of Psychology, University of Ottawa, capable of becoming. Not feeling so rotten, Ottawa, Ontario, K1N 6N5 Canada. Or scared, depressed, tense or whatever it is. e-mail: [email protected]. HG: All this considered, how did you come HG: Thank you for taking the time to talk about developing this? How did it come to about this and explain your current work. you? Now, I think I am ready and willing to go AM: This new method didn’t just come out and have my own experiential session.

Find Division 29 on the Internet. Visit our site at www.divisionofpsychotherapy.org 24 DIVISION 29 MID-WINTER MEETING

Tracey Martin, John Norcross and Jean Carter

Alice Chang, Norman Abeles, and John Norcross

John Norcross, Leon VandeCreek, Wade Silverman, Pat Bricklin and Matty Canter

Kal Heller, Andy Steinbrecher, and Bob Resnick

25 FEATURE Clinical Coaching: A paradigm for supervision Lori S. Katz, Ph.D.

Dr. Katz is a staff psychologist at the Long The ten trainees have had multiple super- Beach VA Medical Center‚s, women‚s health visors and felt that regardless of therapeutic clinic. She is the military sexual trauma coordi- orientation, their supervisor’s personality nator and specializes in treating issues of trau- was the most important factor in making ma. She is currently writing a book, the experience more or less comfortable. "Holographic Reprocessing: A cognitive-expe- Outcome studies on supervision concur riential psychotherapy for the treatment of that the quality of the supervisory relation- trauma" which will be published by Brunner- ship is the most important factor to predict Routledge in 2004. She may be reached at: effectiveness of supervision (Unger, 1996; [email protected] Kilminster & Jolly, 2000; Sloan, 1999; Shanfield, Heatherly, & Matthews, 2001). Clinical coaching is a paradigm for supervi- There appears to be two categories of sion designed to address evaluative aspects attributes that predict positive outcomes: of traditional supervision that can interfere 1) trainees feel a sense of autonomy, control, with training. Eight pre-doctoral interns and input into their training (Unger, 1996; (seven female, one male) and two Kilminster & Jolly 2000), and 2) supervisors practicum students (one female, one male) are supportive, committed to supervision, from university-based psychology training good listeners as well as provide knowledge programs gave verbal and written comments and guidance (Sloan, 1996; Shanfield, about their opinion of clinical supervision. Heatherly & Matthews, 2001). Although this is a small sample of trainees, five of them independently voiced that The proposed paradigm of clinical coaching they felt they were in a double bind as incorporates these positive outcome find- recipients of clinical supervision. On the one ings by shifting the role of passive trainee hand, they needed to appear competent to an active participant in the training since they were being evaluated, and yet process and shifting the role of supervisor on the other hand, they needed help from to that of a coach. Coaching as a form of their supervisors. This conflict promoted training is not new and is traditionally anxiety and a constriction of self-expres- thought of as a model to train athletes. sion. Trainees also reported feeling unsafe Typically, the athlete engages in a sport to personally disclose or disagree with while the coach advises, trains, and gives some supervisors. feedback to the athlete. A coach recognizes that athletes have different strengths and Trainee: ”I felt that downplaying the personally weaknesses and encourages each athlete to difficult aspects of being a therapist achieve his or her personal best. Similarly, (e.g., lack of confidence and feelings in training psychology students, what is of counter-transference) was necessary taught depends on the uniqueness of the to earn positive evaluations. I felt trainee. Clinical coaching allows trainees to that I could not express my true enhance their own identity, style, and thoughts and feelings about my skills. This is particularly important for work, my patients or the quality of more advanced trainees such as pre and the supervision that I was receiving post-doctoral interns who are transitioning for fear of being perceived negatively.” to an independent professional role. 26 Clinical coaching can best be understood in mutual humanization. (The educator’s) efforts contrast to traditional models of training, must be imbued with a profound trust in people namely supervision and mentoring. The and their creative power. To achieve this, they must definition of a supervisor in the Random be partners of the students in their relations House College dictionary is “a person who with them.” is responsible for and oversees a process, work, or workers during a performance.” Of course, it is appropriate for a clinical Asupervisor monitors, evaluates, and coach to incorporate aspects of traditional makes sure there are no difficulties or clinical supervision and mentoring. problems. A supervisor ensures that cer- However, these can be added in a context tain minimal standards or criteria are met. of mutual agreement without the added The goal for a supervisor is for a trainee to pressures associated with the other styles meet the requirements for competency as by emphasizing individual development well as to handle clinical issues in a satis- and valuing the trainee’s personal experi- factory manner. ence. For example, it is appropriate for a coach to supervise and ensure certain criteria Amentor is defined in the Random House are met. As in sports, clinical trainees must College dictionary as “a wise entrusted follow certain rules and standards in order counselor, advisor, guide, or guru.” A men- to participate. Also, it is appropriate for a tor cultivates a “watch me-follow me” or coach to model techniques for a trainee to “be like me” relationship. This is similar to observe and emulate, but not demand that an apprentice model where a novice is this is the only or best technique. Whitman paired with a highly skilled person to learn & Jacobs (1998) stated that supervisors have a trade. A trainee and mentor may co-lead a to balance the hierarchical and collaborative group or therapy session where the trainee aspects of the supervisory relationship. They observes the master and then emulates him suggest offering evaluations in an educa- or her. The mentor may correct the trainee tional framework and for supervisors to by saying how he or she would have done responsibly self-examine their supervision it differently. The goal for a mentor is one to foster this balance. of emulation. Coach: “Two interns were struggling to par- It may seem that the difference between ticipate in a group that we co-led coaching and these other styles is merely because they felt too intimidated to semantic. However, to make such an “perform.” I asked them to imagine assumption denies the impact of these that they hired a coach to give them words. “Supervisor” and “mentor” assume pointers. I said, ‘think of me as your a hierarchical relationship that can easily clinical coach. I am here for your ben- be entrenched in criticism, evaluation, and efit, so take advantage of all that I can domination. These roles make trainees offer you. I am working for you.’ compliant, passive, and submissive and by This simple reframe, empowered the the nature of the relationship, may hinder trainees to take a more active role in independent thought. In contrast, clinical their training.” coaching assumes a mutually accountable relationship where both participants HOW TO BE A CLINICAL COACH, actively create the experience of education. FROM THE PERSPECTIVE OF The role of coach as “educator” is well HOLOGRAPHIC REPROCESSING summarized in Paulo Freire’s “Pedagogy of Holographic Reprocessing (HR) (Katz, the oppressed” (1997), “(The educator’s) efforts 2001) is a cognitive-experiential psy- must coincide with those of the students to chotherapy, based on Epstein’s cognitive engage in critical thinking and the quest for experiential self-theory that distinguishes

27 two processing systems: the rational sys- of communication. tem (logical and linear) and the experien- 3) Listening instead of fixing. Instead of tial system (imagistic, associative, and quickly addressing presenting symp- emotional) (see Epstein, 1991, 1998). In toms, trainees are coached to resist the HR, information about maladaptive pat- urge to fix or be helpful in the first few terns is accessed and reprocessed in the sessions. Instead, trainees are taught to experiential system. HR supports a coach- listen and label the communication that ing approach to supervision as it focuses is being presented. For example, trainees on the experience of the client and pro- are asked to discern if a client’s commu- motes individuality and creativity on the nication is about an implicit belief, a part of the trainee. The HR clinical coach compensation strategy, or an avoidance focuses on training the following five steps: strategy. Step 1: Teach the “Don’t Know” attitude 4) Eliciting information. Clients may not Step 2: Teach how to be an “Experiencing be able to verbally communicate signifi- Therapist” cant information that keeps them Step 3: Teach how to “listen instead of fix” blocked or trapped in maladaptive pat- Step 4: Teach how to “elicit information” terns. HR coaching encourages thera- Step 5: Encourage trainees to develop their pists to elicit such information, by own techniques exploring emotions, images, and associ- ations experienced by the client. 1) The “Don’t Know” attitude. Novice According to HR, therapists can focus on therapists are often afraid of being here and now events or events from found out that they really do not know childhood as both sets of events would what to do. In HR, “not knowing” is bare a similar “fingerprint” or repeating reframed as a strength. Adopting the theme of a maladaptive pattern. Don’t Know attitude encourages thera- pists to focus on generating questions 5) Techniques. Choosing which technique rather than on producing answers (or to use and when is part of developing looking good, competent, and all-know- clinical instinct as well as personal style. ing). Trainees are encouraged to learn a variety of clinical techniques as well as to create “Trainees are asked to imagine that they are variations of their own using information driving in a place where they are that is relevant for the client (i.e., their not sure which direction to go. What do own images, metaphors, and assign- they do? They pay attention, ask for ments). This encourages trainees to listen directions, and explore different routes. and be present, rather than focusing on When lost in therapy, it is the perfect “performing.” opportunity to pay attention, ask questions, Other Coaching Tips: and explore different routes.” 1. Offer feedback on a frequent basis. A coach offers feedback on a frequent 2) The Experiencing Therapist. If trainees basis. Constructive feedback is honest, adopt the Don’t Know attitude, then direct, and couched in a growth-oriented they need to rely on “road signs” along context without judgment. Positive feed- the therapy path for guidance. The back is also valuable and a coach can be Experiencing Therapist reads these generous with both. signs by staying in the moment and sensing, feeling, imagining, and associ- 2. Explore trainees’ experience of being ating right along with the client. This coached. Ask trainees about their expe- facilitates rapport and deepens the level rience of being coached. Encourage per-

28 sonal reflection and ask how their train- Epstein, S. (1991). Epstein, S. (1991). ing can be enhanced. Cognitive-Experiential Self-theory: An integrative theory of personality. In R. 3. Explore supervisors’ experience of Curtis (Ed.), The relational self: being a coach. The supervisor’s experi- Convergences in psychoanalysis and social ence is often overlooked, as typically psychology (pp. 111-137). New York: there are no structured opportunities for Guilford Press. discussion, reflection, or exchange of ideas. Ideally, training programs would Epstein, S. (1998). Cognitive-experiential facilitate this. Nonetheless, clinical self-theory: A dual-process personality coaches have the responsibility to theory with implications for diagnosis engage in self-reflection and seek to and psychotherapy. In Bornstein and improve their coaching skills. Masling (Ed.), Empirical perspectives on the psychoanalytic unconscious (pp. 99- 4. Show respect for cultural contexts and 140). Washington DC: APA. personal differences/preferences. Katz, L. (2001). Holographic reprocessing: Everyone has a different set of life experi- Acognitive-experiential psychotherapy, ences and someone else’s preferences or Psychotherapy, 38(2), 186-197. the meaning of someone’s actions cannot be assumed. Kilminster, S.M., and Jolly, B.C. (2000). Effective supervision in clinical practice Trainee: “Instead of making assumptions settings: a literature review, Medical about me (and my culture), and then Education, 34(10): 827-840. imposing those assumptions on my training, I appreciated when my Shanfield, S.B., Hetherly, V.V., and (coach) made an effort to find out my Matthews, K.L. (2001). Excellent super- perspective.” vision: the residents’ perspective, Journal of Psychotherapy Practice and In conclusion, clinical coaching is offered Research, 10(1): 23-27 as a paradigm that values collaboration and mutual respect. Both coach and trainee Sloan, G. (1999). Good characteristics of a are responsible and accountable for the clinical supervisor: A community men- training experience. The success of this tal health nurse perspective, Journal of model depends on both participants’ will- Advanced Nursing, Sep; 30(3):713-722. ingness to actively participate, give and receive feedback, seek opportunities for Unger, D.B. (1996). Core problems in clinical skill enhancement, and engage in self- supervision: Factors related to outcome, examination of one’s own performance. Dissertation Abstracts International, 56 (11-B): p. 6411.

REFERENCES Whitman S.M. and Jacobs, E.G. (1998). Freire, P. (1997). Pedagogy of the Responsibilities of the psychotherapy oppressed. The Continuum publishing supervisor, American Journal of company, New York. Psychotherapy, 52(2): 166-175.

29 CANDIDATE STATEMENTS

PRESIDENT-ELECT

William Fishburn, Ph.D. I am especially honored to be a president- ances focused on critical elect nominee for Division 29. I seek your societal issues and pro- support and vote in order that I may pro- fessional psychology and vide a continuation of the outstanding past psychotherapy practice. president leadership. I want to promote the Psychotherapy as an strongest possible role for Division 29 in essential foundational APA and in the larger public sector in base of practice must be issues essential for the involvement and preserved and enhanced. development of doctoral level psychologist Divisional leadership must be responsive psychotherapists. I will promote psy- to membership issues and concerns. I chotherapy contributions to the well being encourage the active involvement of all and quality of life in health service, per- members in asserting the strongest possi- sonal growth and development experi- ble role in the development and implemen- ences, specific problem resolution, and tation of member contributed proposals, specific behavioral changes. I am commit- ideas and visions to achieve the goals of ted to Division 29 as the primary voice for Division 29. This can be optimally accom- the integration of psychotherapy practice, plished through town hall meetings and training, and research in APA. It is imper- direct contact with divisional leaders. ative that we are involved in a concerted My background and experience in leader- public relations/educational effort to ship roles includes having been Past inform the public that psychotherapy is President and Charter Fellow in the New better provided by well-trained doctoral Mexico Psychological Association, Past level psychologist psychotherapists. President and Division 39 Representative of Psychotherapy must be a covered service the New Mexico Psychoanalytic Society, in all managed care activities and propos- Past President of the New Mexico Group als. The assurance of the highest quality of Psychotherapy Society. I have been an oral patient care is directly related to patient examiner for the New Mexico Board of freedom of choice of doctoral psychologist Psychologist Examiners since 1973. I was a psychotherapists. We must be proactive in founder of and have been chief of the psy- informing the public, state, national, and chology section in the largest hospital com- local policy makers about the contributions plex in New Mexico. I have been a private of professional psychologists and the man- practitioner specializing in psychotherapy ner in which we use our unique clinical with individuals, couples, families and skills in diagnosis and treatment. Division groups for 35 years. I have been actively 29 leadership must be aware of and involved in Division 29 activities for over 20 encourage an ever-expanding role for psy- years. I have been Mid-Winter Convention chologists and psychotherapists in diverse Coordinator, and served on the Golden and non-traditional settings. Anniversary Committee for Division 29. I am a charter member of the National It is essential that psychotherapists be sen- Register. I am Professor Emeritus in sitive to issues of cultural diversity. As a Counseling Psychology at the University of psychotherapist in a state known for its New Mexico. I have the experience, energy diversity, I have been involved in the pro- and enthusiasm to provide active, involved motion of professional psychology by fre- leadership for our Division and I respectfully quent radio, TV, and print media appear- request your vote. 30 CANDIDATE STATEMENTS – PRESIDENT-ELECT, Continued

Leon VandeCreek, Ph.D.

It is an honor to have been nominated to categories, including run for President Elect of Division 29. those who are members Psychotherapy is in the midst of a of other professions, and challenging struggle. On the one hand, that would increase and psychotherapy offers wonderful opportu- diversify our member- nities for change for our patients, but on ship. the other hand, the reimbursement systems in society press for ever shorter courses of Theory, Research, treatment and fewer options of care. The Practice, and Training: We should increase Division is in a good position to exercise our attention to theory and research, and leadership in the training, research, and we need to place much stronger emphasis practice of therapy. on training. Some of our members fear that psychotherapy as we know it is losing If elected President Elect, I would work for ground in training programs because of the following goals: their needs to provide students with broader training for the marketplace. Fiscal Responsibility: For the past many years, the Division has spent money each Sections in Division 29: Sections are per- year that should have been earmarked for mitted by our By-laws to create their own the next year. We have modified our governance structures, levy assessments on accounting practices, and beginning in their members, hold meetings, develop pro- 2004 the Division should be better able to gram proposals, and publish a newsletter. I support initiatives and again develop a would ask the Division to explore the reserve fund. development of Sections as a tool to in- crease membership and to sustain initiatives. Membership: The average age of our mem- bers is among the oldest of any divisions in My experience in the Division includes APA. Not surprising, we are losing mem- Membership Chair, Board of Directors, and bers at a faster rate than we are gaining Treasurer. At the state and national levels, I them. We must continue the strong mem- have served as President (Pennsylvania bership drives of the last two years that Psychological Association), Financial Affairs have increased the numbers of new mem- Officer (Ohio Psychological Association), bers, especially student members. Member of the APA Council of Representatives, Associate Member of the What Do New Members Want? As we APA Ethics Committee, Member of the APA attract new and younger members, we Board of Educational Affairs (chair in 1999), need to know how the Division can be of and Member of the APA Insurance Trust service to them. The needs of our aging (chair in 1997). I have been an author or co- membership may not match well the inter- author/editor of more than 90 journal arti- ests of newer and younger members. cles, book chapters and books and 70 profes- Consider a Society of Psychotherapy: sional presentations. I served as Dean of the Many psychotherapists are not eligible for School of Professional Psychology at Wright membership in Division 29. We should State University, and I am currently explore shifting the Division into a society employed there as a Professor. that would permit a variety of membership

31 CANDIDATE STATEMENTS – TREASURER

Jan L. Culbertson, Ph.D. Jan L. Culbertson is Professor of Pediatrics Program Chair of and Clinical Professor of Psychiatry & Division 29 in 2001. Her Behavioral Sciences at the University of research has focused on Oklahoma Health Sciences Center neuropsychological func- (OUHSC), Oklahoma City, OK. She also is tioning of children with Director of Neuropsychology Services at complex learning disabil- the OUHSC Child Study Center. She ities, attention deficit received her Ph.D. in psychology from the hyperactivity disorder, University of Tennessee (Knoxville), and and pervasive developmental disorders. had a faculty appointment in the She is the author of numerous articles and Department of Pediatrics at Vanderbilt co-editor of three books, and is an active University School of Medicine prior to participant in presenting Division 12 moving to Oklahoma in 1982. Her leader- Postdoctoral Institutes and various other ship roles in APA include Secretary and training seminars nationally and interna- President of Division 53 (Clinical Child tionally. Psychology) when it was Section 1 of Division 12, Member-at-Large and I am pleased to be nominated for treasurer President of Division 37 (Child, Youth, and of Division 29. My past involvement with Family Services), and Secretary of Division the Division has shown me that there are 54 (Society of Pediatric Psychology) when many important initiatives and projects to it was Section V of Division 12. She was be carried out, and having a strong finan- appointed to the APA Committee on cial base is imperative for realizing these Children, Youth, and Families 1998-2000, goals. All APA Divisions are struggling at and served as Committee Chair in 2000. this time to retain their membership, stem This was followed by an appointment to the trend toward dwindling revenue, and the APA Working Group on Children’s still maintain an active agenda of profes- Mental Health in 2000-01, representing the sional activities. Division 29 has had strong Board for the Advancement of Psychology fiscal leadership in the past and continues in the Public Interest. She was editor of the to need this strong leadership in the future. Journal of Clinical Child Psychology (1991-96) I would be honored to help fulfill this role and the Child, Youth, and Family Services in support of the Board and members of Quarterly (1986-90). She also served as Division 29.

32 CANDIDATE STATEMENTS – TREASURER, continued

Jeffrey Younggren, Ph.D.

I very much appreciate being nominated to From a financial per- run for Treasurer of Division 29. As a full- spective, I believe that time private practitioner in clinical and our Division, and APA, forensic psychology, I am committed to need to be prudent in the our profession and to the practice of psy- management of their chotherapy. I believe I have demonstrated finances. The expendi- that commitment in the past through my ture of the Division’s membership on the APA Ethics funds needs to be made with foresight Committee, having chaired that committee such that the programs the divisions in my final year, and now through my chooses to implement are those that are the membership on APA’s Committee on most cost effective and of the greatest ben- Accreditation. In addition to my clinical efit to the most members. In addition, we practice, I also work as a consultant to the need to embark on a program to increase APA Insurance Trust where I provide membership and revenues in order to workshops throughout the country to our make the division more effective in influ- colleagues on risk management and the encing APA policy. It is through member- standards of care. Finally, I am also on the ship and revenue growth that we can make clinical faculty of UCLA’s School of sure that the division continues to be a Medicine where I supervise residents and vibrant and effective force within our pro- provide consultation services. My contri- fession. I believe that I am well qualified to butions to our profession have resulted in serve as treasurer of Division 29. my receiving fellow status in two divisions of APA.

33 CANDIDATE STATEMENTS – MEMBERS-AT-LARGE

Jean Carter, Ph.D. Although it may sound cliché, my goals as role of psychotherapy member at large of Division 29 are 1) to and its protection in the enhance the Division’s ability to support healthcare system. and enhance psychotherapy — theory, Relevant experience research and practice; 2) to enhance the includes service on the Division’s ability to be responsiveness to Publications Board for needs of members; 3) to return the Division Division 29; Vice to fiscally sound position that allows better President for Professional Practice and responsiveness to the issues and to mem- President (1999-2000) of Division of bers. As member-at-large on the Board I Counseling Psychology (Division 17); would bring the perspective of a full time Secretary and President (2002) of independent practitioner of psychothera- Psychologists in Independent Practice py, as well as considerable experience in (Division 42). I am in my 2nd term on Division and APA governance. CAPP (Committee for the Advancement of Professional Practice). I have a history of Issues that the Division faces include 1) the publication on the psychotherapy relation- impact of empirically based treatments, ship and on the integration of science and which have the potential to control the practice, and I serve as an Adjunct member practice of psychotherapy and stifle cre- of the Graduate Faculty in the counseling ativity; 2) maintaining influence within psychology program at the University of APA to ensure appropriate attention to the Maryland—College Park.

Susan Corrigan, Ph.D. Division 29 has so much to offer psycholo- Although the Division’s gists. From an excellent journal, local and initiative to attract both national presentations to excellence in psychologists and stu- teaching, research, and practice, we all dents has been very suc- participate in ensuring the future of cessful, tough economic psychotherapy. Although we are one of the times affect efforts to largest divisions in APA, we must continue recruit and retain mem- to address challenges that could limit our bers. Clearly conveying future growth and effectiveness. the value of Division 29 membership to •As psychology expands and becomes current and new members becomes even increasingly specialized, it is critical that more crucial. we promote the central role of psycho- I served the Division as the program chair therapy in the field of psychology. In addi- for the 2001 and 2002 APA Conventions. In tion, the scope of our practice is changing that role, I witnessed the talent in our divi- with new applications in areas such as sion and the appeal that psychotherapy has health care and business. We need to to so many in psychology. As a supervisor endorse Division 29 as home to all those of psychology interns and graduate students committed to behavior change practicing as well as a provider at the University of in traditional and non-traditional settings. Oklahoma Health Sciences Center, I pro- •The current economic and political climate mote psychotherapy each day. I would creates many challenges. The Division has welcome the opportunity to embrace these made great efforts to remain solvent, but challenges and advocate for our profession this continues to be a difficult task. and Division 29 as a member-at-large. 34 CANDIDATE STATEMENTS – MEMBERS-AT-LARGE, Continued

Irene Deitch, Ph.D. I appreciate the opportunity to serve our Helping Women; appoint- division. My style is proactive, inclusive ed by International and energetic. I work collaboratively to Council Ppsychologists promote psychotherapy. My commitment: NGO delegate– United achieving diversity, public interest con- Nations, (Mental Health cerns and professional growth Committee)

INITIATIVES: APA-SERVICE •advance research in psychotherapy •active “public education” campaign •outreach to academics,researchers, •cadre of violence experts practioners, and graduate students •chair: public information committee •share professional and scientific •president: running psychologists information: bulletins journals •president: media psychologists •build and retain membership •chair: APA membership committee •offer continuing education programs •member:committee international •increased visibility divisional activities relations in psychology •publicize achievements of membership •task force ”helping psychologists work- •expand opportunities membership ing with older adults” (publication) involvement •public education via print &electronic DIVISIONAL SERVICE media •chair: interdivisional task force psy- •establish liaison with state associations chotherapists working with older adults •chair: interdivisional committee- psy- CANDIDATE BACKGROUND chotherapists enhancing quality of life Professor at College of Staten Island, City issues University of NY; licensed psychologist, •organized, chaired, presented continuing psychotherapist, certified in thanatology, education (death, dying and bereavement.) producer/ •convention, mid winter programs host – making connections (cable tv program •recipient divisional award featuring-psychological issues) fellow: divisions 29, co-edited: Counseling the Support Irene Deitch — member-at-large Aging and Their Families; chapter: Treating demonstrated commitment, service the Changing; chapter: Women Therapists and leadership

35 CANDIDATE STATEMENTS – MEMBERS-AT-LARGE, Continued

Charles J. Gelso, Ph.D. Throughout my career (doctorate form the Bulletin. I believe we Ohio State in 1970), I have been immersed all understand that the in theory, research, practice, and training field of psychotherapy is about and of psychotherapy. Much of my at a crossroads. Just as sci- theoretical and research efforts have entific evidence has final- focused on the therapeutic relationship in ly accrued that clearly both brief and longer-term therapy. points to the efficacy of a Another part of my work has dealt with range of therapies, the the question of how to turn professional specter of managed care has appeared and psychology students on to science and sought to force treatments into progressively research. In this work, I have sought to briefer formats that are more and more understand the factors in the training envi- focused on less and less. To say that this and ronment that serve to facilitate or impede other forces have created a crisis for the field students’ interest and efficacy around of psychotherapy and Division 29 (including scholarly activity. its role in APA) is an understatement. As member-at-large I would work vigorously to Division 29 has been near and dear to me protect and enhance both the field of psy- throughout my career. I have been a member chotherapy and its place in APA. My efforts and fellow for 30 years and most recently would be aimed at each of the key aspects of have served as Chair of the Education and psychotherapy that the Division has histori- Training Committee, which included orga- cally prized—theory, practice, research, and nizing the Education and Training Corner of training.

Patricia S. Hannigan-Farley, Ph.D. It is an honor to be considered for nomina- governance in order to tion for the position of Member-at-Large pursue family and other for the APA Division of Psychotherapy professional areas some- NO PHOTO AVAILABLE (29). Division 29 has been my "home" in what removed from psy- APA since I was a student. As a student chology. Most recently, member I was so impressed with the work my attention and ener- that the Division conducted on behalf of gies are turning more the theory, research, and practice of psy- and more to the basic chotherapy. Since that time, I continue to important contribution of psychotherapy be impressed with the wealth of knowl- in the lives of so many. edge and expertise that exists within the Division membership. Because I believed As a Member-at-large, I would hope to that the Division gave so much to me, I renew my contributions to the Division contributed by serving in various capaci- membership and strive to bring an updated ties within the Division including Chair, perspective to the activities of the Division. Women's Committee, Chair of Hospitality Suite Program; Secretary, and President. Thank you for your consideration of my candidacy. And regardless of your choices, Following my tenure as Past-President of please exercise your privilege to vote! the Division, I took some "time off" from Everyone's contribution is very important.

36 CANDIDATE STATEMENTS – MEMBERS-AT-LARGE, Continued

Alice Rubenstein, Ed.D. In recent times the Division of Psycho- between the Board of therapy, along with so many other organi- Directors and the mem- zations, has been forced to respond to bership, creating oppor- these difficult economic times by carefully tunities for members to reexamining our priorities and making share their expertise cutbacks. We have had to make hard deci- with one another, and sions about which projects and initiatives offering members more to support and those that must wait. tools with which to mar- However, in spite of these constraints we ket their services to the public. To this end have accomplished a great deal. Our stu- I have developed several proposals, includ- dent membership has soared, the Brochure ing exploring the feasibility of the division Project, which I have directed for many sponsoring qualified members to offer CE in years, has expanded its scope and, begin- their hometowns and states and the intro- ning this year, will offer CE programs on duction of a mentorship-writing project some of our most popular Brochure Project aimed at encouraging and supporting prac- topics, during the APA convention. This titioners to publish in journals such as In year, you will be able to attend a free CE Session: The Journal of Clinical Psychology. program on ADHD, led by one of our most This journal, which is published in collabo- esteemed members and a national expert ration with the Division of Psychotherapy, on ADHD, Dr. Robert Resnick. Our publi- focuses on the challenges facing practition- cations board, on which I have served over ers by introducing new therapeutic innova- the past several years, has been revitalized tions and identifying treatment methods and and is focusing on several new initiatives relationship stances that work with different which will offer members easier access to patient populations. These are just a few of timely information about psychotherapy the proposals I have developed to better education, research and practice, along serve you, our members. As an active mem- with tools to help members educate the ber of the Division of Psychotherapy for public about the ways in which psy- more than twenty-five years I have been chotherapy can help them. Looking ahead, honored to serve as your President, I propose the introduction of a member ser- Treasurer, and chair of numerous commit- vices initiative, a priority that I believe is tees and task forces. I ask for your vote so long overdue. This member services initiative that I might continue to work on your behalf will be aimed at increasing communication as a Member-at-large.

37 FEATURE

The Unseen Diagnosis: Addiction Assessment Marilyn Freimuth, Ph.D.

Marilyn Freimuth is on the faculty of the Fielding their knowledge. Even if a given patient is Graduate Institute and has a private practice in fearful about revealing the full extent New York City where she works primarily with of use, there is little danger in asking. people in recovery from addictions. She began to However, not all psychotherapists hold this study this topic about 14 years ago after an addic- belief. Some are concerned that merely ask- tions counselor began referring her patients in ing about substance use will be met with early recovery. Working with this population hostile reactions. This and other beliefs stimulated her interest in better understanding about who is addicted and how an addict- how to treat addictions within a private practice ed individual presents for therapy hinder setting and how the addiction treatment model accurate recognition. For example, the typ- and psychotherapy can be integrated. ical alcoholic does not fit the down and out drunk stereotype but rather, is likely to be married and employed. Finally, some pro- Signs of addiction may not be readily fessionals shy away from addressing addic- apparent in those seeking mental health tions given the ambiguity around distin- treatment. Psychotherapy patients rarely guishing recreational use from abuse and exhibit the poor health and pervasive func- dependence. The more like oneself the tional impairments of those entering a hos- client is, the harder it seems to be to make pital for detoxification. Level of use may these distinctions. not appear to be an issue for dually diag- nosed patients who use less drugs and Having argued in Part One for the impor- alcohol relative to the addicted patient with tance of routinely assessing for addiction, no co-0ccuring psychopathology (Wolford this article examines a variety of formal and et al., 1999). Further complicating accurate informal approaches to addiction assess- diagnosis is the fact that the consequences ment. There are a myriad of instruments for of addiction can mimic the symptoms of such purposes but few are used routinely. In psychological disorder—especially depres- alcohol treatment centers, the clinical inter- sion and anxiety. view remains the most frequently used means of assessment (Myerholtz & Given that substance use and abuse is Rosenberg, 1997). Likewise, for many psy- prevalent but not necessarily apparent chotherapists, information about substance among those seeking psychological ser- vices, one would expect that mental health use will evolve out of the clinical dialogue. professionals would routinely do a careful However, knowing the major instruments assessment for potential problems. In Part and their usefulness in mental health set- One, I argued how mistaken beliefs about tings gives direction about what is useful to and discomforts with addictions impede ask. After reviewing a number of standard- accurate assessment. Interviews with clini- ized screening/assessment tools, this paper cians who do not routinely assess for addic- will consider some interview-based tion indicate that some feel it is useless to approaches to addiction assessment. ask about substance use because any one with a real problem will be in denial. STRUCTURED SCREENING QUESTIONS While some patients will hide their use, The CAGE is the best known and most most will answer questions to the best of often used screening instrument in medical 38 and health care settings. It consists of four there is the MAST (Michigan Alcoholism questions directed at the use of alcohol. Screening Test) and AUDIT (Alcohol Use 1. Have you ever felt you should cut down Disorder Identification Test). The MAST on your drinking? (Selzer, 1971) is composed of 25 common 2. Have people annoyed you by criticizing behaviors and symptoms associated with you about your drinking? alcoholism along with the negative conse- 3. Have you ever felt guilty about your quences of use in the areas of health, work, drinking? and social life. A score of 4-10 is consid- 4. Have you ever had a drink first thing in ered indicative of possible problematic use the morning to steady your nerves or while scores greater than 10 indicate alco- get rid of a hangover (i.e., eye opener)? holism. Shorter forms of the MAST are available with as few as 10 items. Some Ascore of two or three is indicative of a sample questions are: Have you ever got- substance related disorder. However, in ten into trouble at work because of your psychiatric populations where even low drinking? Have you ever gone to anyone levels of alcohol use can have adverse con- for help with your drinking? Have you sequences (e.g., disrupt the effectiveness of ever attended an AA meeting? This scale is psychotropic medications, lower compli- not appropriate for use with adolescents ance, exacerbate symptoms), a score of one but a similar tool, the PEI (Personal merits further assessment. Experience Inventory) by K.C. Winters and To address the CAGE’s limited focus on G.A. Henley is available through the alcoholism, the CAGE–AID has been Western Psychological Association. developed and validated incorporating ref- erence to drug use into the four questions. The AUDIT (Saunders, Aasland, Babor, De Another alternative, the TICS, is a two- LA Fuente, & Grant, 1993), consists of 10 item screen for both drugs and alcohol that items asking respondents to indicate their has been found to have good predictive degree of alcohol use such as how often ability in medical settings (Brown, one has a drink (never, monthly, 2-4 times Leonard, Saunders, & Papasouliotis, 2001). a month, 2-4 times a week, 4 or more times Apositive response to either question war- week) and how much is consumed on any rants further investigation. one occasion. This instrument also assess- 1. In the last year, have you ever drunk or es feelings about and reactions to one’s used drugs more than you meant to? drinking. How often have you felt guilt or 2. Have you felt you wanted or needed to remorse? Has anyone been injured due to cut down on your drinking or drug use your drinking? Have significant others in the last year? asked you cut down? The CAGE, CAGE-AID, and TICS ques- The value of self-report measures has been tions are easily incorporated into a clinical called into question by the belief that most interview or therapy session. They are also persons with addiction problems resort to easily modified to inquire about behavior- denial. Denial may be less pervasive than based addictions. Have people annoyed generally assumed. In Part One, it was sug- you or criticized you about the way you gested that many with addiction problems spend money? Have you felt you wanted fail to link the life problem, for which they or needed to cut down on your use of the seek therapy, to addictive behaviors. Internet in the last year? Although these When the psychotherapist makes such instruments are not validated for other connections, most patients are open to con- uses, the answers still provide useful sidering it. Research on the validity of self- clinical information. report measures within an alcoholism treatment context shows that alcoholics STRUCTURED ASSESSMENT INSTRUMENTS can report accurately on their drinking For clinicians interested in self-administered behavior (Sobell and Sobell, 1990). self-report instruments for alcoholism Whether this accuracy applies to self 39 reported drug and alcohol use in a mental providers are attuned to addiction issues, health context has yet to be determined. they are likely to glean information during For those concerned that denial or a con- the clinical dialogue. Some may ask direct scious desire to fake will adversely affect questions about addictive behaviors, oth- assessment, there are several instruments ers may ask indirect questions about life where the questions’ intent is less apparent. style and social relationships and still oth- ers may not ask any questions until the For many years the MAC, which consists patient’s report suggests that an addictive of 49 MMPI items, has been considered a behavior is likely. good measure that avoids the problems associated with high face valid instru- For those comfortable with more direct ments. Like the MMPI, the MAC does not questioning, it is easy to incorporate CAGE yield a specific diagnosis but rather detects or TICS questions into a clinical interview. patterns of responding characteristic of These questions elicit information about alcoholics. However, the MAC needs to be the consequences of substance use. Or one used cautiously in light of recent research can ask directly about degree of use. As showing low predictive validity when most know, it is not recommended to ask a used in clinical settings (Myerholtz and “yes” or “no” question such as “Do you Rosenberg, 1997). drink?” Given that some use is normative, ask, “How much do you drink?” or simply Those interested in instruments with low state, “Tell me about your drinking.” face validity still can turn to the Substance Abuse Subtle Screening Inventory or Many working in clinic settings are SASSI (Miller, 1994). The first part consists required to ask directly about substance of a series of questions related to a variety use but regretfully do it in a perfunctory of needs, interests, values, health concerns, manner without following up on an social interactions, and emotional states answer such as, “Oh, just a couple of which are considered “subtle” because drinks on the weekend.” Clinical wisdom they do not appear to be asking about sub- suggests that one never stop the inquiry at stance use. These 62 T-F items have been this point. For example, a couple of drinks found to reliably distinguish drug and regularly on a weekend may hide a binge alcohol dependent persons from others. drinker. Binge drinking is defined as at The second part consists of 26 items asking least five drinks for men and four for the usual questions regarding the frequen- women on a single occasion within a two- cy and amount of drug and alcohol use and week period. The importance of doing a the consequences. careful inquiry is reflected in one physi- cian’s experience with a patient who unex- The SASSI can take as little as 15 minutes to pectedly began to seizure post-operatively. complete and has good validity in identify- The chart dutifully noted that the patient ing chemically dependent persons even if had two alcoholic drinks a day. However, they wish to conceal their use. A special a follow up with family members revealed version of the scale has been developed for that these two daily drinks were of vodka use with adolescence, a population most sipped from a beer stein. Given that alco- likely to present an inaccurate picture of hol dependence is associated with life their drug and alcohol use. The only draw- threatening withdrawal symptoms, any back to the scale is that it must be pur- suspicion of addiction should be followed chased from the owner. by gathering information about the fre- quency, amount, and length of use includ- INFORMAL CLINICAL INTERVIEW ing time between drinking episodes. A APPROACHES thorough inquiry will also collect informa- Most psychotherapists, especially those in tion about the context of use (alone, with private practice settings, are not mandated friends, at home, a bar), the experience of to do a formal screen for addiction. If use (is it always pleasurable?) and conse- 40 quences (e.g., legal, health, social or work ual addiction who was quite open about problems). his activities. In the process of telling about the previous week’s sexual experiences, he Some psychotherapists avoid direct ques- would occasionally mention that he had tioning until they hear signs in the clinical smoked marijuana. No further inquiry was material that there may be a problem. made. When, later in treatment, a referral Signs that can indicate a more thorough was made to a psychopharmacologist who addiction assessment is warranted include did a thorough substance use assessment, a family history of addictive behaviors, a this man’s degree of use was found to be history of trauma, evidence of sociopathy, consistent with a diagnosis of abuse. social isolation or a peer group where sub- stance use is a common part of socializing. Thus, any time a patient makes an explicit Evidence of borderline personality charac- reference to some type of substance use, teristics, anxiety or depression also war- the topic merits further exploration by rant further investigation given that such simply asking the person to say more. characteristics and symptoms can be a con- Quite often, I find that patients have not sequence of substance dependence. My thought much about their use and whether research interviewing clinicians well it is problematic. Continued questioning versed in addiction treatment indicates can help the two of you decide together if that they look and listen very carefully there is a problem. One follow up question when the topic of substance use comes up. I have found very useful is: How much They are sensitive to any changes in behav- enjoyment/pleasure do you get from the ior such as a brief acknowledgement of use substance? Recently, a man who came to followed by a change of topic, a sudden see me for problems achieving his profes- joking attitude, or an increased level of sional goals expressed surprise at how he excitement or enthusiasm when talking responded to this question; he had not real- about use. ized until asked how long it had been since he enjoyed drinking. This led to further As discussed in Part One, some psy- explorations into his desire to drink and his chotherapists are uncomfortable asking increasing lack of control over alcohol. For directly about addictive behaviors out of others, I have found that this question concern that the patient will experience stays with them and they will come back at such questioning as a criticism or insult. a later time to report how they no longer For those who are uncomfortable with enjoy the substance and are conflicted direct questions, there are a number of less about continued use. transparent questions that can indicate whether further inquiry into an addictive FROM ASSESSMENT TO DIAGNOSIS AND behavior is warranted. Some possible TREATMENT questions are: What do you do after work? In a therapy setting, in contrast to an alco- What do you do for pleasure? How do you holism treatment center, the initial out- have a good time/relax? Have you ever come of an assessment need not be a for- behaved in a way that was not consistent mal diagnosis. Instead the assessment goal with your value system/that you regretted may be to introduce the idea of substance later? Follow a patient’s reference to a trau- use as a topic for discussion. For others, the ma or stressful situation with the question: intent may to understand the degree to How do you cope or deal with that situation? which drinking is enjoyable or not, prob- lematic or not, along with a determination Over and over again, treatment of risk. This material then becomes part of providers—even those familiar with addic- the therapy content. If the therapist tions—can recall a time when they wished believes that the criteria for substance they had not taken a patient’s casual refer- dependence or abuse have been met, s/he ence to substance use at face value. One will want to share this information with therapist recalled a young man with a sex- the patient, ensure that substance use is not 41 endangering others (e.g., driving under the joint screen for alcohol and other drug influence) and discuss implications of con- problems. Journal of the American Board of tinuing to use in this way. Family Practice, 14, 95-106. In those instances where the patient dis- Miller, G.A., (1994). The Substance Abuse agrees or the therapist prefers to avoid the Subtle Screening Inventory Manual: Adult possibility of arguing about the diagnosis, SASSI-2 Manual Supplement. Spencer, IN: one can help the patient become aware of Spencer Evening World. the negative effects of his/her substance Miller, W.R. & Brown, S.A. (1997). Why use (Miller and Rollnick, 1991). One can psychologists should treat alcohol and explore if there is any remorse by asking if drug problems. American Psychologist, the person has ever done something or had 52, 1269-1279. something happen while under the influ- Miller, W.R. & Rollnick, S. (1991). ence which would not have happened if Motivational interviewing: Preparing people they were not. Has anyone important in to change addictive behavior. New York: your life ever complained about your use? Guilford Press. Have you ever thought of slowing down? Myerholtz, L.E. & Rosenberg, H. (1977). Stopping? What would that be like? At Screening DUI offenders for alcohol what point do you think your drug or alco- problems: Psychometrical assessment of hol use would be a problem? the Substance Abuse Subtle Screening Another simple approach that avoids the Inventory. Psychotherapy of Addictive therapist labeling the patient is to ask: Behaviors, 11, 155-165. Have you ever worried/thought that you Saunders, J.B., Aasland, O.G., Babor, T.F., might be an alcoholic? A mere acknowl- De La Fuente, J.R., Grant, M. (1993). edgement of worry helps bring the issue Development of the Alcohol Use into the therapy room. Even if the patient Disorders Identification Test (AUDIT): says “no”, the therapist who is concerned WHO Collaborative Project on early about possible abuse or dependence will detection of person with harmful alcohol remain attuned to negative consequences consumption. Addiction, 88, 791-804. of the patient’s substance use and point Selzer, M.L. (1971). The Michigan these out as they arise in treatment. While some may want to make a referral for spe- Alcoholism Screening Test: The quest for cialized addiction treatment, Miller and a new diagnostic instrument. American Brown (1997) strongly argue that psycholo- Journal of Psychiatry, 127, 1653-1658. gists are suited to treat addictions. Sobell, L.C. & Sobell, M.B. (1990) Self- report issues in alcohol abuse: State of the SUMMARY art and future directions. Behavioral Psychologist may be aware of the frequency Assessment, 12, 77-90. with which those seeking mental health ser- Wolford, G.L., Rosenberg, S.D., Drake, vices have co-occurring addictive disorders. R.E., Mueser, K.T., Exma, T.E., Hoffman, However, mistaken beliefs and uncomfort- D., Vadaver, R. M., Luckoor, R., & Carrieri, able feelings about addictions impede accu- K.L. (1999). Evaluation of methods for rate recognition. No matter what approach detecting substance use disorder in per- one takes to addiction assessment—be it for- sons with severe mental illness. Psychology mal or informal, direct or indirect ques- of Addictive Behaviors., 13, 313-326. tions— it is critical that the topic be addressed and that the assessment not be done in a perfunctory manner. The author would like to express apprecia- tion to the Fielding Graduate Institute for REFERENCES research funds to support the collection Brown, R.L., Leonard, T., Saunders, L.A. & and analysis of the interview data on Papasouliotis, O. (2001). A two-item con- which this article is based. 42 Call for Nominations: Editor of Psychotherapy Bulletin

The Publication Board of the APA Division of Psychotherapy is seeking applications for the position of Editor of the Psychotherapy Bul l eti n. Candidates should be available to assume the title of Incoming Editor on or before January 1, 2004.

The Psychotherapy Bul l eti n is an official publication of the Division of Psychotherapy. As such, it serves as the primary communication with Division 29 members and publishes archival material and official notices from the Division of Psychotherapy. It is also designed as an outlet for timely information on psychotherapy and professional psychology. Now in its 38th year of publication, the Bulletin reaches more than 4,000 psychologists and students with each issue.

Prerequisites: Be a member or fellow of the APA Division of Psychotherapy An earned doctoral degree in psychology Support the mission of the APA Division of Psychotherapy

Responsibilities: The editor of the Psychotherapy Bul l eti n is responsible for its content and production. The editor maintains regular communication with the Division’s Central Office, Board of Directors, and contributing editors. The editor is responsible for managing the page ceiling and for providing reports as required. The editor must be a conscientious manager, deter- mine budgets, and administer funds for his or her office. As an ex officio member of both the Publication Board and the Executive Committee, the editor attends the governance meetings of the Division of Psychotherapy. An editorial term is three years.

Oversight: The Editor of the Psychotherapy Bul l eti n reports to the Division of Psychotherapy’s Board of Directors through the Publication Board.

Search Committee: Jean Carter, PhD, Lillian Comas-Diaz, PhD, Raymond DiGiuseppe, PhD, John C. Norcross, PhD (chair), Alice Rubinstein, EdD, and George Stricker, PhD.

Nominations: To be considered for the position, please send a letter of interest and a copy of your curriculum vitae no later than July1, 2003 to: John C. Norcross, PhD, Publication Board, Department of Psychology, University of Scranton, Scranton, PA 18510-4596. Inquiries about the position should be addressed to Dr. John Norcross (570-941-7638; norcross@scranton. edu) and/or to the incumbent editor, Dr. Linda Campbell (706-542-8508; [email protected]).

43 Free Division of Psychotherapy Continuing Education Workshop at the 2003 APA Convention

Join Robert J. Resnick, Ph.D. for An Update on Pharmacological Interventions for ADHD Across the Life Span

Saturday, August 9th, 9:00 AM – 10:50 AM Metro Toronto Convention Center Constitution Hall Room 106

You must pre-register in order to receive continuing education credit. All pre-registrants will receive 10 copies each of the Division of Psychotherapy Brochures, “Attention Deficit Hyperactivity Disorder in Children and Adolescents” and “The Hidden Problem: ADD/ADHD in Adults.”

Continuing Education Policy: The number of Continuing Education credits is equal to the number of contact hours. Full attendance is a prerequisite for receiving CE credit. Partial credit will not be given. Sign-in for each workshop begins 20 minutes before start time and continues 10 minutes after start time. After that, CE cannot be granted. It is the responsibility of the attendee to determine whether these CE credits are valid in his/her state of licensure.

Name ______Phone (_____)______

Address ______

City ______State ______Zip ______

Email ______

44 FEATURE Was the Competencies Conference 2002 a Competent Conference? Jack Wiggins, Ph.D.

Jack Wiggins is a Division 29 Council Relationships group. The attendees at the Representative, a Past-President of Division 29, Conference were very able, articulate indi- and the Division’s representative to the vidually, and collectively represented a Competencies Conference. broad spectrum of psychological interests. Each workgroup had a written charge and The Association of Psychology Postdoctoral the facilitators, recorders and member of the and Internship Centers (APPIC) held its Steering Committee were very familiar with Competencies Conference 2002: “Future this charge. They worked diligently to com- Directions in Education and Credentialing in plete the assigned tasks of the workgroups. Professional Psychology” in Scottsdale, Minutes of each workgroup meeting were Arizona on November 7–9. The ten-person distributed the following day to all atten- Steering Committee, chaired by Dr. Nadine dees. On Saturday, the final day, facilitators J. Kaslow, did excellent work in planning of each workgroup gave oral rather than and organizing the Conference and making written summaries of the meetings. These site arrangements for the 130+ attendees’ meetings consisted of an integration meet- comfort and participation. ing where one member of the assigned workgroup attended one of the other nine Attendees were assigned to one of these workgroups. I chose last and attended the ten (10) groups: untaken Scientific Foundations and • Scientific Foundations and Research Research Integration group meeting. After • Ethical, Legal, Public Policy/Advocacy, lunch we reassembled back in our assigned and Professional Issues workgroup and reported our experiences in the integration groups. • Supervision • Psychological Assessment Following this feedback meeting of the • Individual and Cultural Diversity workgroups, there was a large group dis- • Intervention cussion in which group facilitators present- • Consultation and Interdisciplinary ed their summaries followed by a question Relationships and answer period. It was apparent there • Professional Development was a great deal of overlap in the presenta- • Specialties and Proficiencies tion of the facilitators. There was no attempt to arrive at a consensus of the • Assessment of Competence attendees as whole on any particular point. The overlap among the groups of the con- In addition to the attendees each group sensus reached in each assigned group will had a facilitator, a recorder and a member apparently be the basis of recommenda- of the Steering Committee. Division 29 was tions coming from the conference. A draft well represented by officers: Pat Bricklin, Summary of the Conference is due in President-Elect; and Lee VandeCreek, December. Treasurer. As a Council Representative for Division 29, I was the official representa- The reader will have to make up his/her tive for the division as a late substitute for mind as to the value of the conference 2002 President Bob Resnick. I was assigned based on findings that are to be reported in to the Consultation and Interdisciplinary December. Some attendees were disap- 45 pointed there was no opportunity to dis- APA Educational Directorate, alluded to cuss and vote on salient points of the dis- the need to take a fresh look at training cussions. I have attended both types of competencies but was less explicit in her conferences where the attendees attempted remarks than was Cummings. Dr. Derald to reach consensus through voting and Wing Sue, the discussant of the plenary through consensus building by the overlap panel, did not attempt a summary of the of opinions among the various work- panel comments. Instead, he made his own groups. Neither model is completely satis- presentation with a plea for cultural com- factory or satisfying to attendees. The petence as a core competency. model used in this conference tends to have attendees leave “feeling good” Psychology needs to determine training that though wondering if anything was really is “good enough” for specific purposes. It is accomplished. The conferences where con- not clear that this conference addressed that sensus is attempted through voting let question directly and created some difficul- attendees know what the conference did or ty is reaching consensus in workgroups. did not do. This latter model also causes Competency comes from the same root many to feel like winners and losers on words meaning “to compete.” Thus, the issues. Attendees leave with hard feelings meaning of competency will shift some- when their personal positions were not what according to where the competition is supported by the conference. While there taking place. The marketplace is where may be a place for both types of confer- practitioners of the discipline of psychology ences, it is my obligation to report on my must compete with other professions and impressions about the Competencies other approaches to problem solving. Conference 2002. Psychology must compete for students and its training must enhance practitioners’ abil- The leaders of the Competencies ity to compete in the world marketplace Conference 2002 acknowledged at the out- with their psychological skills. As a value- set there is no consensus about what a adding discipline, our profession must “competency” is. It was recognized that identify opportunities to compete and we the word “competency” is used in a variety must train our graduates to compete suc- of ways in psychological circles; sometimes cessfully. Through our advocacy, we must referring to excellence, sometimes simply create jobs for our graduates to contribute to meaning a skill set and sometimes mean- solving individual and societal problems ing that something is “good enough.” and be compensated sufficiently to justify These meanings are illustrative of the vari- their training in psychology. Thus, my posi- ous connotations of the word “competen- tion is closer to that of Cummings since the cy” and are not intended to be exhaustive. marketplace is the ultimate determiner of Dr. Kaslow in her opening remarks sug- competency in psychology. gested for purposes of this conference, “competency” would be understood as It is my view that psychology as a profes- “good enough.” I cannot disagree with sion has continued to be based on an acad- such a definition, but it does raise the ques- emic economy. There, success is measured tion of “what is good enough in the educa- by the numbers of students with high tion and training of professional psycholo- SAT/GRE scores that can be attracted; the gists.” Dr. Nicholas Cummings was unique number of publications of the faculty; the in his remarks in the plenary session. He size and number of grants that are accrued; said we must train psychologists to be able and the success in placement of their grad- to take advantage of new opportunities in uates on highly esteemed university facul- the market place and not be limited by tra- ties. These measures have merit in acade- ditional training that may have been good mia but little or no value or cachet in the enough in the past. Dr. Belar, director of the global marketplace. 46 It is time for psychology to think more responsive to marketplace issues. The idea globally and consider a market-based of a practice-based research network was economy for psychology as a discipline. brought up. The fact that doctoral level psy- For example, in the integration discussion chologists are required to compete with group dealing with the Scientific master’s level trained personnel was noted. Foundations and Research it became The economic consequences for both the apparent that the concept of a market- practitioners and the discipline of psycholo- based economy for psychology had not gy of this doctoral/ master’s level competi- been considered. One of the principle peo- tion were briefly discussed. The need for the ple of this workgroup let it slip that they discipline of psychology to be on a market- had used an Aristotelian dichotomy of based economy fell on deaf ears and was “researchers and technicians.” In their not included in the summary remarks of the “future directions” it was proposed to Scientific Foundations and Research work- write a book on what a scientifically mind- group. Let us hope the critical need for a ed practitioner looks like. I argue that the shift away from an academic-based econo- practitioner of today accurately reflects the my to a market-based economy will appear scientific training he has experienced. somewhere in the final text. Psychologist practitioners are true profes- sionals and merit this recognition. I did hear that some were considering Practitioners do not merely assume a “sci- teaching “history and systems” of psychol- entific technician role” that academicians ogy at the undergraduate level for those aspire for them. interested in graduate training in psychol- ogy. This could open up opportunities of Dr. Jane Halonen articulated eight domains additional competency training at the of proficiencies from the Psychology graduate level. Perhaps we could also Partnerships Project task force including: enhance our skill sets in graduate training 1.Descriptive Skills; 2. Conceptualization by reformatting current courses. A market- Skills; 3. Problem Solving; 4. Ethical Reason- ing course could simultaneously teach ing; 5. Scientific Attitudes and Values; marketing skill sets and statistics using the Communication Skills; 7. Collaborations case study approach found in MBA pro- Skills; and, 8. Self Assessment Skills. grams. A course in intervention assessment could have similar utility. Training in sta- The Scientific Foundations and Research tistical outcome evaluations is essential for workgroup recommended these eight psychologists to become program man- domains be tested to see if they make a dif- agers and directors. If the case study ference. They also wished to determine method were applied to health field, where ways that practitioners are held accountable 70% of psychologists earn some portion of for the science they practice. Also, they their incomes, we could find specific exam- wished to encourage the continuing educa- ples of how competencies could be deter- tion about the scientific practitioner. The mined and implemented in training. participants from other workgroups to this Graduate programs could also offer a integration group pretty much agreed on course in epidemiology for statistical train- the eight domains of skills but questioned ing. Then, Murray and Lopez’s Global the narrow one-way focus of involving Burden of Disease epidemiological data research for practice but not considering the could serve as an outline of clinical training feedback of practice to science and training. for the next 20 years. Depression, Road traffic accidents, Cerebrovascular disease, This workgroup did recommend a confer- War and HIV (health conditions with psy- ence that holds training programs account- chological underpinnings) will become able. There was a lively discussion of this five of the 10 leading causes of disability as and the need to make academia more measured by Disability-Adjusted Life 47 Years (DALYs). Self inflicted injuries will required to fulfill these job qualifications. rise from the 33rd to the 15th cause of Grant money could be obtained to do this DALYs. It is reasonable to ask what com- since it would be within ASPPB’s mission petencies (skill sets) will be useful to to protect the public. The Council of address these societal needs. This data has Credentialing Organizations in been public for six years but we see little Professional Psychology (CCOPP) will evidence that this information has publish its evaluative work on competen- enhanced psychology training programs. cies in January 2003. Perhaps the CCOPP’s report will offer additional guidance and The Scientific Foundations group did rec- serve as another reference point. ommend that the APA Committee on Accreditation and other regulatory bodies There were many excellent discussions and not just “count” courses in evaluating core valuable contributions that were made at competencies. Currently, the Committee on the Competencies Conference 2002. Accreditation, lacking measures of needed Without some means to rank the value competencies, uses a “truth in advertising” added by various competencies (skill sets) or “let a thousand flowers bloom” stan- suggested at the conference, we will not dard for accrediting academic training pro- know how to establish priorities for imple- grams. This allows any academic program menting these skill sets into training pro- to be accredited as long as it trains accord- grams. My concern is that the excellent dis- ing to the way the faculty says they are cussions that the various workgroups had training. Is this good enough? will become psychocentric rhetoric with- out some external criterion to judge what is Without market-based criteria, the “good enough.” “Good enough” can not be Committee on Accreditation lacks defensi- based solely on the standards of an acade- ble standards to evaluate the adequacy of mic economy. The marketplace is the final training programs. It was pleasing to see arbiter of the ability to compete as the mea- this workgroup endorse a “conference sure of competence and competencies. involving regulatory bodies to determine Until psychological training programs rec- what processes and groupings of core ognize the marketplace as the measurer of knowledge areas are needed to evaluate their value-added training, our competen- core competencies.” They asked the right cy training may feel good but may do less questions but to the wrong group. Again, than we desire. as in this conference, psychologists are asked to answer market-based questions The Competencies Conference 2002 contri- that are typically addressed by marketing butions have been outlined and its limita- experts. APA has a Division of Consumer tions detailed. Suggestions for market mea- Psychology. Perhaps, they could provide sures for competencies and next steps to some answers from a market-based per- taken were addressed. The offensive spective or direct us how to obtain answers emailed conference follow-up question- to what jobs need to be done and what naire, which permitted only positive skills are necessary. I doubt that another answers to the questions asked, was com- conference will accomplish this desired pleted. My comments are offered to serve as result. Another, potential resource would benchmarks for readers when they review be to empower the Association of State and the proceedings of this conference. It is left Provincial Psychology Boards (ASPPB) to to the reader of the proceedings to judge study where the job opportunities are for whether the Competencies Conference 2002 psychologists and what training is was a competent conference.

48 WASHINGTON SCENE ARange of Interests and Highly Relevant Expertise Pat DeLeon, Ph.D.

Pat DeLeon is a contributing editor for the APA President-Elect Bob Sternberg and Psychotherapy Bulletin in the area of legal and Ray Fowler for making my attendance on legislative issues. He is a past president of behalf of the entire Association possible. It Division 29 and a recipient of the Distinguished was a very special evening. Mahalo. Psychologist Award, and 2000 President of APA. It is interesting to reflect upon psychiatry’s observations (Clinical Psychiatry News): “‘New Mexico should be seen as a sad Dedicated Individuals Can Make A anomaly, not the start of a perverse trend... Difference: Perhaps the most rewarding There is no reason to believe that the peculiar aspect of serving as APA President is the set of factors that determined the outcome in opportunity to interact on a face-to-face New Mexico will recur elsewhere...’ (The) basis with colleagues across the nation who President of the New Mexico chapter of the are genuinely excited about the future and American Psychiatric Association, said who are personally involved in making rural access became the lobbying mantra of society “just a little bit better.” And, not sur- psychologists, and legislators readily prisingly, experiencing the growing affir- picked up on it. She and other psychia- mation that the behavioral sciences, includ- trists met with the governor on several ing participating in data-based program- occasions, but their testimony did not matic decision making, truly are the key to appear to phase legislators, who had previ- successfully addressing many of our coun- ously granted prescribing privileges to try’s most pressing public health concerns. nurse-practitioners, physician assistants, and clinical pharmacists... ‘(T)he ultimate This Spring, although no longer in the APA passage of the bill was not due to any lack governance, I was invited by New Mexico of effort on the (ApA’s) part...’ But the New Psychological Association President Bob Mexico lobbying efforts by the (ApA) were Ericson to attend their dinner in celebra- deemed too late by some of its own mem- tion of the “Enactment into Law the bers, who called for a more intense and Psychologists’ Authority to Prescribe.” widespread campaign to prevent the APA’s Mike Sullivan, Past-President Jack extension of prescribing privileges. ‘Those Wiggins, and I had a wonderful time. In psychiatrists who are in leadership posi- attendance that evening were the bill’s tions, especially those who are leaders in House and Senate sponsors, the New the American Psychiatric Association, are Mexico Secretary of State, the psychiatrist wholly to blame for this disaster...’ ‘This is who had met twice with the Governor on a wake-up call...’ Psychiatrists need to behalf of the Association, and, of course, work with primary care providers, provid- our heros Elaine LeVine (accompanied by ing consultation and support. Patients do her son Marshall, appropriately dressed in not know the differences between psychol- tux and top hat) and Mario Marquez and ogists and psychiatrists, but they do know his lovely wife, Diana. These dedicated their primary care providers. The (ApA) and far-sighted colleagues have truly has failed to embrace primary care moved professional psychology into the providers as essential caregivers in mental 21st Century. My sincerest appreciation to health even though it is well known that 49 more than 80% of psychotropic medica- health of the fifty states on these and simi- tions are prescribed in primary care... (I)f lar social conditions, will make a small con- all the states allow psychologists to pre- tribution to that important national dia- scribe, nothing will distinguish them from logue... By using a set of sixteen key social psychiatrists. ‘Thirty years ago, we had indicators that represent conditions of psychotherapy to distinguish ourselves; well-being at critical times of life, from now we don’t...’ ‘This aggression has more childhood to old age, we have been able to to do with guild economics than with real provide an overall picture of America not concerns or rationalizations concerning previously available... This document quality or access. It has been particularly reveals that, like the nation’s geography, exacerbated as the medical model of psy- there is great variety in the social health of chiatric disorders has become dominant, the states. Some states have high levels of the role of psychological models has performance with exceptional achievement become diminished, and managed care has on numerous indicators. Other states are increasingly disenfranchised psychology experiencing significant social deteriora- by reimbursing psychiatrists for medica- tion, with most indicators pointing to con- tion management and preferred less-costly ditions requiring immediate attention...” social workers to provide psychotherapy. Psychology has sought to cloak the The report strongly urges “extensive com- motives for this territorial campaign in the munity participation in evaluating the self-serving and altruistic-sounding lan- state’s social health performance and guage of greater access for ‘clients,’ greater developing ways to improve it.” It is a economy, equivalent (if not superior) qual- tremendous understatement to suggest ity, and even, in California, a cynical but that Elaine and Mario excelled at commu- transparent concealment within so-called nity participation. Never during my years mental health parity legislation...’” of service within the APA governance have I ever experienced such genuine “grass- Former New Mexico Psychological roots support” for a psychology agenda, Association President Julie Lockwood the way that it materialized on behalf of noted a full page advertisement, taken out the RxP — movement in New Mexico. by the ApA’s Patient Defense Fund, in the Vocal public support was expressed by Santa Fe New Mexican: “You wouldn’t do numerous physicians and other health care it to your dog, So why would you do it to providers (including clinical pharmacists), your child?... Letting psychologists pre- the President of the University of New scribe is bad medicine — a HIGH RISK our Mexico; representatives of the legal com- families cannot afford...” munity, including the State Attorney General and various local Bar Association ABroader Public Policy Perspective: An representatives; and even the local chapter interesting ApA perspective. Nevertheless, of NAMI. Psychology’s voice was heard in as Mike continues to emphasize, the public legislative testimony; on the radio, Practice Directorate’s Southern-Rural RxP- television and in the print media; the New strategy nicely parallels the findings of the Mexico Medical Society endorsed their bill; Fordham Institute for Innovation in Social and perhaps equally impressive, was the Policy: The Social Health of The States nearly unanimous support that surfaced (2001). “As we Americans strive to protect within the New Mexico Psychological our way of life, we need to pay sustained Association. There can be no question that attention as well to our standard of living. this inclusive and collaborate approach Issues such as health and housing, educa- made all of the difference in the world. tion and income, need to remain on-going Whereas the Fordham Institute found the concerns. It is our hope that this document, top-ranked state (e.g., the healthiest) to be which assesses and compares the social Iowa, the bottom ranked state was New 50 Mexico. Focusing upon society’s real and landscape: “On May 16 or 17, the New pressing needs is the key to legislative suc- Mexico State Medical Board expects to hear cess. This is a lesson we should take to a report from a recent meeting in San Diego heart and never forget. of the Federation of State Medical Boards, where preliminary discussions concerning Some of the report’s more graphic high- prescriptive authority for psychologists lights: the child abuse rate in Montana is were to take place, and to appoint a com- more than ten times that of Pennsylvania; mittee to study the prescription issue. The teenage suicide in Alaska is nine times that Board of Psychologist Examiners already of New Jersey; the percentage of people in has appointed its subcommittee, headed New Mexico with no health insurance is by Tim Strongin. The development of a nearly four times higher than in Rhode national examination for ‘any mental Island; and the homicide rate in Louisiana health provider prescribing psychotropic is seven times that of Iowa. Eight states are drugs,’ may be a consideration.” We can considered to be in “social recession”, with see Mike and Russ Newman smiling. This an overall rank in the bottom ten and poor is a major development for all of profes- performance in more than five individual sional psychology. indicators. These include: Arizona, California, Louisiana, Mississippi, Family Comes First: On a highly personal Montana, Nevada, New Mexico, and level, I have always felt it was important to Texas. Those colleagues who have closely take the time to watch our two children followed the maturation of the RxP- agen- participate in athletic events during their da will note that six of these states have grammar and high school careers, regard- very active RxP- task forces. Of the bottom less of how pressing work or psychology overall ranked twenty-five states, psycho- agendas might appear at the time. Like all logical leaders in at least 11 are currently involved parents, the sight and sounds aggressively pursuing RxP- action. From a accompanying injuries, for example on the public policy perspective, we would sug- soccer field, are never forgotten. gest that perhaps New Mexico does not Accordingly, I was intrigued by the recent really reflect a “peculiar set of factors,” as Institute of Medicine (IOM) report—Is wished by our medical colleagues. Soccer Bad For Children’s Heads? And, I was proud to learn that APA colleagues We were particularly pleased to learn from were intimately involved, serving on the Steve Tulkin that Elaine may be the IOM Board on Neuroscience and keynote speaker for this year’s Alliant Behavioral Health (e.g., Nancy Adler, (CSPP) University’s clinical psychophar- Jerome Kagan, Beverly Long, Karen macology graduation ceremony. She is an Matthews, and staff Michelle Kipke). inspirational role model. Undoubtedly, one of her fundamental messages to the gradu- To explore whether soccer playing puts ates will be that in order to truly serve their youths at risk for lasting brain damage, the patients well, they must have faith in them- IOM brought together experts in head selves and be personally and actively injury, sports medicine, pediatrics, and bio- involved in the public policy (i.e., political) engineering for a one day workshop. The process. Her insider view of the now ongo- experts presented the scientific evidence ing discussions between New Mexico’s for the possible long-term consequences of Psychology and Medical Boards and their head injury from youth sports, possible efforts to develop the specifics of the pre- approaches to reduce the risks, and policy scribing and supervision protocols will be issues raised. “(S)ports concussions are in fascinating, to put it mildly. As the Health fact far more serious than most people real- Policy Tracking Service (i.e., the literature ize. There are many... examples of former A of state legislators and their staff) reports, students struggling to pass high school Mario and Elaine have revamped the RxP- after experiencing concussions on the soc- 51 cer or football field. Many student athletes backwards... Compared to other contact have been forced to abandon both their sports, head injuries are common in soccer. sports and their career aspirations because In neuropsychologist Dr. Jill Brooks’ study they never fully recovered from concus- of high school soccer players, she found sions. These disturbing examples counter that more than one quarter of them had the common belief that a concussion is just experienced one or more concussions. a bump on the head with no lasting effects. Neuropsychologist Dr. Ruben Echemendia Indeed, recent research reveals that a con- reported that in his study of college ath- cussion unleashes a cascade of reactions in letes, over 40 percent of the soccer players the brain that can last for weeks, and make had at least one concussion prior to attend- it particularly vulnerable to damage from ing college. By comparison, only 30 per- an additional concussion. There is also evi- cent of the incoming football players.. had dence that youths who experience concus- a concussion.. (M)any high school soccer sions may be at more risk for brain damage players neglected to report experiencing a than adults because their brains are still concussion, because they didn’t think it developing and have unique features that was serious or wanted to continue playing heighten their susceptibility to serious con- in the game... sequences from head injuries. Even though people generally think of soccer as a safer “X-rays and other imaging of the brain sport than football, soccer players experi- often cannot detect signs of a concussion.... ence concussions about as often as football (M)any of the symptoms of concussions players... Soccer is probably the most rapid- also occur in people without the condition, ly growing team sport in this country, espe- and... some of the most widely known cially for girls and women. Millions of chil- symptoms, such as amnesia or loss of con- dren and adolescents participate in youth sciousness, are frequently lacking in con- soccer leagues and there are hundreds of cussed individuals... Loss of consciousness thousands of adolescents on high school soc- frequently lasts only seconds to minutes, cer teams. The growing popularity of soccer so it is often not even detected because of among youth... has fostered concern that the delay in stopping a game and assessing children who play soccer may not be ade- the condition of a player following a head quately protected from head injury.... collision... Some symptoms do not appear until days to weeks following a concus- “Although soccer balls can be kicked to sion.... (S)ubtle signs of a concussion that occur later and appear to be more persis- speeds as high as 70 miles per hour, even tent than the traditional symptoms. Two most professional players cannot kick a neuropsychologists, Drs. Barth and ball that fast and most soccer players Echemendia, reported evidence at the would not attempt to head a ball moving workshop that brain functions are that fast... (Y)ouths rarely have enough impaired even after the obvious symptoms force to kick a ball to speeds higher than 40 of concussion disappear... If people are miles per hour... (C)alculated the impact of unfortunate enough to experience a second a soccer ball on the head of youths of vari- concussion before they have fully recov- ous sizes, based on the likely speed of the ered from their first, they can experience a ball, and concluded that the force of impact life-threatening swelling of the brain, no is well below the force that is thought to be matter how minor the first or second bang necessary to cause a concussion in heading to the head appeared to be... a soccer ball. But.... concussions do occur in soccer when the ball hits an unprepared “The notion that soccer might put youths player in the head... when players acciden- at risk for brain injury has circulated in the tally knock their heads into other players popular media and that has led some to while attempting to head the ball, particu- suggest that soccer players wear protective larly if they are attempting to flick the ball headgear. But.. no protective headgear cur- 52 rently on the market is designed to protect stress and other psychological factors trans- against concussion. Today’s helmets are late into risk for diverse diseases, including designed to meet standards for reducing heart disease. the risk of serious and fatal brain injury and these standards are limited to reducing “Today I would like to make four points: injury caused by a linear acceleration, or a 1. Psychological stress is typically consid- ‘straight on’ blow to the head. But a blow ered to be a process and not a single event. that causes concussion typically includes Stress management techniques can inter- rotational acceleration, in which the brain vene in multiple ways in the stress process. gets twisted. Current helmets and stan- 2. Psychological stress can trigger ischemia, dards are not designed to take this type of heart attack, and premature death. It may blow into account... ‘We talk to trainers, to also accelerate the rate of atherosclerosis equipment managers, and they are very prior to the first heart attack or other clini- surprised when I say that no helmet is cal event, especially among those who designed to prevent concussions’... already have high levels of ‘subclinical or silent disease.’ Thus, effective stress man- “As to federal policies, safety issues in chil- agement techniques should theoretically dren’s sports are often covered by the be able to prevent a first or second heart Consumer Products Safety Commission attack. 3. Adequate tests of the impact of (CPSC) insofar as sports equipment is stress management interventions in heart involved. In May 2000, the Commission disease patients have been few in number, held a workshop to examine the possible but combining together the data from use of helmets in youth soccer players, but small clinical trials shows that psychoso- did not find that the available evidence cial interventions can be a useful adjunct to warranted the mandatory adoption of hel- other therapies. (And), 4. The science of mets. The Centers for Disease Control and behavior change and practical knowledge Prevention (CDC) also monitors childhood of how to conduct clinical trials have injuries and funds research on injury pre- advanced sufficiently so that now is an vention, but has not recommended against opportune time to conduct high quality heading in youth soccer. Finally, the studies on the impact of stress reduction on National Institutes of Health is the major preventing or reversing heart disease.... federal supporter of medical research, but “We know that the combination of not currently supports fewer than half a dozen smoking, having a healthy diet, higher lev- grants related to head injuries in children’s els of physical activity, moderate alcohol sports... (W)ithout definitive data there can be no conclusive resolution about the dan- consumption, and not being overweight is gers of heading...” associated with very low risk of heart dis- ease in the Nurses’ Health Study. The First Of Many Appearances: In mid- Unfortunately, only 3% of the nurses were May, Karen Matthews drove down from the in this category. Very few people in the University of Pittsburgh to testify for her United States have adopted life styles that first time, along with APA colleague David are associated with very low risk for heart Abrams of Brown University, before the U. disease, in part because of the difficulty in S. Senate Appropriations Committee regard- changing well-practiced behaviors later in ing the “Impact of Stress Management In life and in part because stress may interfere Reversing Heart Disease.” Both were out- with altering behaviors to more health-pro- standing. Highlights from Karen’s testimo- moting forms. We need a better under- ny: “My own research is on the role of stress standing of the role of stress in accelerating in the development of heart disease, with an disease risk early in life and how stress emphasis on young adults and on women management interventions might impact during the menopausal transition. Our early risk trajectories. Stress management Center is dedicated to understanding how combined with promoting healthy life 53 styles in adolescence and young adulthood importance of health care reimbursement may have long term economic and social mechanisms (e.g., health insurance) cover- advantages.” During the question-and- ing preventive clinical services. Aloha. answer session, the witnesses stressed the

Ca ll fo r Pa p ers

The North American Society for Psychotherapy Research (NASPR) is happy to invite Division 29 regular and student members to submit a presentation at (and/or attend) its next meeting, which will be held in: Newport RI, on November 5-9 2003

The submission deadline is April 30, 2003. For more information about submissions (posters, papers, symposia, workshop, open discussion), the conference, and stu- dent travel awards, please contact Louis Castonguay, Ph.D.(President, lgc3@ psu.edu), Lynne Angus, Ph.D. (Program Chair, [email protected]), or visit our web site (www.naspr.org) We hope to see you in Newport! Louis G. Castonguay, Ph.D. Associate Professor President, North American Society of Psychotherapy Research 308 Moore Building Department of Psychology Penn State University University Park, PA 16802 Phone: 814-863-1754 / Fax: 814-863-7002

54 My pat i ent s get al l of my at t ent i on

I never spend time worrying about my malpractice insurance because I’m with the Trust

The Trust takes the worry and guesswork out of man- aging my professional liability insurance. For more than 30 years the APA Insurance Trust has been the source of innovative insurance cover- age anticipating the needs of The onl y Psychologists like you and me. Even Jana N. Martin, Ph.D. prof essi onal in this tough insurance market I can liability program count on them to safeguard my liveli- Dr. Martin is President of the California sponsored by t he hood! What I get with the Trust is Psychological Association, APA' s Public Amer i can Education Campaign Coordinator for comprehensive state-of-the-art cover- age that keeps pace with the con- Psy chol ogi cal California, Past President and current Board Associ at i on member of t he Los Angel es Count y stantly changing environment with- Insurance Psychological Association, and Member and out having to worry about it. Tr u st Past Chair of the CPA Marketing Trust sponsored Professional Liability Insurance was the first to provide coverage for things we all needed and didn’t even know to ask about like licensing board defense and employment practices liability insurance. I never had to ask; the coverage was made available automatically.

My patients get 100% of my time with no distrac- tions...thanks to the Trust. All it takes is one click at www.apait.org for the peace of mind and security they offer. Or call them at (800) 477-1200 for details. www. apai t . or g

(800) 477-1200 * Underwritten by Chicago Insurance Company, rated A (Excellent) by A.M. Best Co. ** Administered by Trust Risk Management Services.

55 DIVISION OF PSYCHOTHERAPY Ⅲ MEMBERSHIP APPLICATION

Please return the completed application along with payment of $40 (or $29 for Student membership) by credit card or check (Payable to: APA Division 29) to: Division 29 Central Office 6557 E. Riverdale Mesa, AZ 85215

Code _____ FD _____

56