Psychotherapy OFFICIAL PUBLICATION OF DIVISION 29 OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION www.divisionofpsychotherapy.org B

In This Issue Interview U Abraham Wolf, Ph.D.

Psychotherapy Research, Science and Scholarship L Engaging Underrepresented, Underserved Communities in Psychotherapy-Related Research: Notes from a Multicultural Journey

Ethics in Psychotherapy L Psychotherapy, Online Social Networking, and Ethics

Education & Training Prioritizing Case Formulation in E Psychotherapy Training

Feature 2009 Presidential Summit on the Future of Psychology Practice: Collaborating for Change T

E I

2009 VOLUME 44 NO. 3 N Division of Psychotherapy Ⅲ 2009 Governance Structure ELECTED BOARD MEMBERS President Professional Practice Diversity Nadine Kaslow, Ph.D., ABPP Jennifer Kelly, Ph.D., 2007-2009 Caryn Rodgers, Ph.D., 2008-2010 Emory University Department of Psychiatry Atlanta Center for Behavioral Medicine Prevention Intervention and Behavioral Sciences 3280 Howell Mill Rd. #100 Research Center Grady Health System Atlanta, GA 30327 Albert Einstein College of Medicine 80 Jesse Hill Jr Drive Ofc: 404-351-6789 Fax: 404-351-2932 1300 Morris Park Ave., VE 6B19 Atlanta, GA 30303 E-mail: [email protected] Bronx, NY 10461 Phone: 404-616-4757 Fax: 404-616-2898 Ofc: 718-862-1727 Fax: 718-862-1753 E-mail: [email protected] Education and Training E-mail: [email protected] President-elect Michael Murphy, Ph.D., 2007-2009 Jeffrey J. Magnavita, Ph.D. Department of Psychology Diversity Glastonbury Psychological Associates PC Indiana State University Erica Lee, Ph.D., 2008-2009 300 Hebron Ave., Ste. 215 Terre Haute, IN 47809 55 Coca Cola Place Glastonbury, CT 06033 Ofc: 812-237-2465 Fax: 812-237-4378 Atlanta, Georgia 30303 Ofc: 860-659-1202 Fax: 860-657-1535 E-mail: [email protected] Ofc: 404-616-1876 E-mail: [email protected] E-mail: [email protected] Membership Secretary Libby Nutt Williams, Ph.D, 2008-2009 APA Council Representatives Jeffrey Younggren, Ph.D., 2009-2011 St. Mary’s College of Maryland Norine G. Johnson, Ph.D., 2008-2010 827 Deep Valley Dr Ste 309 18952 E. Fisher Rd. 13 Ashfield St. Rolling Hills Estates, CA 90274-3655 St. Mary’s City, MD 20686 Roslindale, MA 02131 Ofc: 310-377-4264 Fax: 310-541-6370 Ofc: 240- 895-4467 Fax: 240-895-4436 Ofc: 617-471-2268 Fax: 617-325-0225 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] Treasurer Steve Sobelman, Ph.D., 2007-2009 Early Career Linda Campbell, Ph.D., 2008-2010 2901 Boston Street, #410 Michael J. Constantino, Ph.D., Dept of Counseling & Human Baltimore, MD 21224-4889 2007, 2008-2010 Development – University of Georgia Ofc: 410-583-1221 Fax: 410-675-3451 Department of Psychology 402 Aderhold Hall Cell: 410-591-5215 612 Tobin Hall - 135 Hicks Way Athens , GA 30602 E-mail: [email protected] University of Massachusetts Ofc: 706-542-8508 Fax: 770-594-9441 Past President Amherst, MA 01003-9271 E-mail: [email protected] Jeffrey E. Barnett, Psy.D., ABPP Ofc: 413-545-1388 Fax: 413-545-0996 1511 Ritchie Highway, Suite 201 E-mail: [email protected] Student Development Chair Arnold, MD 21012 Sheena Demery, 2009-2010 Phone: 410-757-1511 Fax: 410-757-4888 Science and Scholarship 728 N. Tazewell St. E-mail: [email protected] Norm Abeles, Ph.D., 2008-2010 Arlington, VA 22203 Dept of Psychology 703-598-0382 Domain Representatives Michigan State University E-mail: [email protected] Public Policy and Social Justice 110C Psych Bldg Rosemary Adam-Terem, Ph.D. East Lansing , MI 48824 1833 Kalakaua Avenue, Suite 800 Ofc: 517-353-7274 Fax: 517-432-2476 Honolulu, HI 96815 E-mail: [email protected] Tel: 808-955-7372 Fax: 808-981-9282 E-mail: [email protected] STANDING COMMITTEES Fellows Education & Training Psychotherapy Practice Chair: Jeffrey Hayes, Ph.D. Chair: Eugene W. Farber, PhD Chair: Bonita G. Cade, ,Ph.D., J.D. Pennsylvania State University Emory University School of Medicine Department of Psychology 312 Cedar Bldg Grady Infectious Disease Program Roger Williams University University Park , PA 16802 341 Ponce de Leon Avenue One Old Ferry Road Ofc: 814-863-3799 Fax: 814-863-7750 Atlanta, Georgia 30308 Bristol, Rhode Island 02809 E-mail: [email protected] Ofc: 404-616-6862 Fax: 404-616-1010 Ofc: 401-254-5347 E-mail: [email protected] E-mail: [email protected] Membership Chair: Chaundrissa Smith, Ph.D. Past Chair: Jean M. Birbilis, Ph.D., L.P. Associate Chair: Patricia Coughlin, Ph.D. Emory University SOM/ E-mail: [email protected] E-mail: [email protected] Grady Health System Continuing Education Psychotherapy Research 49 Jesse Hill Drive, SE FOB 231 Chair: Annie Judge, Ph.D. Chair: Susan S. Woodhouse, Ph.D. Atlanta, GA 30303 2440 M St., NW, Suite 411 Department of Counselor Education Ofc: 404-778-1535 Fax: 404-616-3241 Washington, DC 20037 Pennsylvania State University E-mail: [email protected] Ofc: 202-905-7721 Fax: 202-887-8999 313 CEDAR Building Past Chair: Sonja Linn, Ph.D. E-mail: [email protected] University Park, PA 16802-3110 E-Mail: [email protected] Associate Chair: Rodney Goodyear, Ph.D. Ofc: 814-863-5726 Fax: 814-863-7750 E-mail: [email protected] E-mail: [email protected] Nominations and Elections Chair: Jeffrey Magnavita, Ph.D. Program Past Chair: Sarah Knox, Ph.D. Chair: Nancy Murdock, Ph.D. E-mail: [email protected] Professional Awards Counseling and Educational Psychology Liaisons Chair: Jeff Barnett, Psy.D. University of Missouri-Kansas City Committee on Women in Psychology ED 215 5100 Rockhill Road Finance Rosemary Adam-Terem, Ph.D. Kansas City, MO 64110 Chair: Bonnie Markham, Ph.D., Psy.D. 1833 Kalakaua Avenue, Suite 800 Ofc: 816 235-2495 Fax: 816 235-5270 52 Pearl Street Honolulu, HI 96815 E-mail: [email protected] Metuchen NJ 08840 Tel: 808-955-7372 Fax: 808-981-9282 Ofc: 732-494-5471 Fax 206-338-6212 Associate Chair: Chrisanthia Brown, Ph.D. E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] PUBLICATIONS BOARD EDITORS Chair : Jean Carter, Ph.D. 2009-2014 Psychotherapy Journal Editor 5225 Wisconsin Ave., N.W. #513 Charles Gelso, Ph.D., 2005-2009 Washington DC 20015 University of Maryland Ofc: 202–244-3505 Dept of Psychology E-mail: [email protected] Biology-Psychology Building College Park, MD 20742-4411 Raymond A. DiGiuseppe, Ph.D., 2009-2014 Ofc: 301-405-5909 Fax: 301-314-9566 Psychology Department E-mail: [email protected] St John’s University 8000 Utopia Pkwy Mark J. Hilsenroth Jamaica , NY 11439 Derner Institute of Advanced Ofc: 718-990-1955 Psychological Studies Email: [email protected] 220 Weinberg Bldg. 158 Cambridge Ave. Laura Brown, Ph.D., 2008-2013 Adelphi University Independent Practice Garden City, NY 11530 3429 Fremont Place N #319 E-mail: [email protected] Seattle , WA 98103 Ofc: (516) 877-4748 Fax (516) 877-4805 Ofc: (206) 633-2405 Fax: (206) 632-1793 Email: [email protected] Psychotherapy Bulletin Editor Jenny Cornish, PhD, ABPP, 2008-2010 Jonathan Mohr, Ph.D., 2008-2012 University of Denver GSPP Clinical Psychology Program 2460 S. Vine Street Department of Psychology Denver, CO 80208 MSN 3F5 Ofc: 303-871-4737 George Mason University E-mail: [email protected] Fairfax, VA 22030 Ofc: 703-993-1279 Fax: 703-993-1359 Associate Editor Email: [email protected] Lavita Nadkarni, Ph.D. Director of Forensic Studies Beverly Greene, Ph.D., 2007-2012 University of Denver-GSPP Psychology 2450 South Vine Street St John’s Univ Denver, CO 80208 8000 Utopia Pkwy Ofc: 303-871-3877 Jamaica , NY 11439 E-mail: [email protected] Ofc: 718-638-6451 Email: [email protected] Internet Editor Abraham W. Wolf, Ph.D. William Stiles, Ph.D., 2008-2011 MetroHealth Medical Center Department of Psychology 2500 Metro Health Drive Miami University Cleveland, OH 44109-1998 Oxford, OH 45056 Ofc: 216-778-4637 Fax: 216-778-8412 Ofc: 513-529-2405 Fax: 513-529-2420 E-mail: [email protected] Email: [email protected]

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

OF PSYCHOTH N E O R I A S

I DIVISION OF PSYCHOTHERAPY (29) P V Y I D 29 Central Office, 6557 E. Riverdale Street, Mesa, AZ 85215 . A N M S E S

R Ofc: (602) 363-9211 • Fax: (480) 854-8966 • E-mail: [email protected] A I C L A A N PSYCHOLOGI C www.divisionofpsychotherapy.org PSYCHOTHERAPY BULLETIN PSYCHOTHERAPY BULLETIN Published by the DIVISION OF PSYCHOTHERAPY Official Publication of Division 29 of the American Psychological Association American Psychological Association

6557 E. Riverdale 2009 Volume 44, Number 3 Mesa, AZ 85215 602-363-9211 e-mail: [email protected] CONTENTS EDITOR Editors’ Column ...... 2 Jennifer A. Erickson Cornish, President’s Column ...... 2 Ph.D., ABPP [email protected] Interview ...... 7 Abraham Wolf, Ph.D. ASSOCIATE EDITOR Lavita Nadkarni, Ph.D. Psychotherapy research, science and Scholarship ...... 10 CONTRIBUTING EDITORS Engaging Underrepresented, Underserved Diversity Communities in Psychotherapy-Related Erica Lee, Ph.D. and Research: Notes from a Multicultural Journey Caryn Rodgers, Ph.D. Education and Training Ethics in Psychotherapy...... 15 Michael Murphy, Ph.D., and Psychotherapy, Online Social Networking, Eugene Farber, Ph.D. and Ethics Ethics in Psychotherapy Education & Training ...... 21 Jeffrey E. Barnett, Psy.D., ABPP Prioritizing Case Formulation in Practitioner Report Psychotherapy Training Jennifer F. Kelly, Ph.D. Perspectives on Psychotherapy Integration ...... 25 Psychotherapy Research, Making Evidence-Based Practice Work: Science, and Scholarship The Future of Psychotherapy Integration Norman Abeles, Ph.D. and Susan S. Woodhouse, Ph.D. DIVISION 29 ~ 2009 APA PROGRAM ...... 29 Perspectives on Early Career...... 33 Psychotherapy Integration Building a Private Practice by Being Public: George Stricker, Ph.D. From Social Networking Circles to Public Policy and Social Justice Psychotherapy Groups Rosemary Adam-Terem, Ph.D. Feature ...... 37 Washington Scene Patrick DeLeon, Ph.D. 2009 Presidential Summit on the Future of Psychology Practice: Collaborating for Change Early Career Michael J. Constantino, Ph.D. and Feature ...... 41 Rachel Gaillard Smook, Psy.D. Ethics and the Interrogation of Prisoners Student Features Student Feature ...... 47 Sheena Demery, M.A. Journey to Adulthood in the 21st Century Editorial Assistant Feature ...... 50 Crystal A. Kannankeril, M.S. Psychotherapeutic Treatment Implications for Obese Adolescents STAFF Central Office Administrator Call for Fellowship Applications Tracey Martin Division 29—Psychotherapy...... 54 Website Membership Application...... 56 www.divisionofpsychotherapy.org 1 EDITORS’ COLUMN Jenny Cornish, Ph.D., ABPP, Editor Lavita Nadkarni, Ph.D., Associate Editor University of Denver Graduate School of Professional Psychology We are excited that dence-based practice and integrative this issue is too full to models of psychotherapy, an interesting fit in more than a short early career paper on social networking paragraph from the and private practice, and three student editors. There is papers on a variety of topics, including something for every- an interview with Abraham Wolf, one: two timely pa- former D29 President and outgoing In- pers on ethics (one ternet Editor. In addition, be sure to related to online social read the President’s Column, and an im- networking and the portant report on the Psychotherapy other to interroga- Summit. Finally, information about our tions), an important many award winners and the upcoming article on research and APA convention is included. We hope to multicultural issues, a see you soon in Toronto! helpful piece on case formulation in train- Jenny Cornish and Lavita Nadkarni ing, a thoughtful submission on evi- (303-871-4737, [email protected])

PRESIDENT’S COLUMN Nadine J. Kaslow, Ph.D., ABPP Emory University Department of Psychiatry and Behavorial Sciences, Grady Health Systems Culture of Competence comes and training in key competency The current zeitgeist domains. Professional credentialing in professional psy- bodies are expected to certify individu- chology is competency- als as competent. Policy makers laud based. Competence competence and consumers increasingly refers to knowledge, demand it. Thus, the time has come to skills, and attitudes, embrace a culture of competence. There and their integration. must be a shift within professional psy- Competencies are complex and dynam- chology toward the acquisition and ically interactive clusters of integrated maintenance of competence as a pri- knowledge of concepts and procedures, mary goal. skills and abilities, behaviors and strate- gies, attitudes/beliefs/values, disposi- Many recent efforts have led to this shift tions and personal characteristics, self- to a culture of competence and its assess- perceptions, and motivations that enable ment, including the identification of the a person to fully perform a task with a key foundational and functional compe- wide range of outcomes. tencies and their essential components. Foundational competencies are those Educational programs are expected to knowledge, skills, and attitudes that produce competence. Programs are ac- credited based in part on program out- continued on page 3 2 serve as the foundation for the functions structured oral examinations, and writ- a psychologist is expected to carry out. ten examinations. Given the tremen- The foundational competencies include: dous strides that have been made with professionalism, reflective practice/self- regard to evaluating competence, it is assessment/self-care, scientific knowl- also time to embrace a culture of the as- edge and methods, relationships, sessment of competence. The assess- individual and cultural diversity, ethical ment of competence fosters learning, and legal standards and policies, and evaluations progress, assists in deter- interdisciplinary systems. Functional mining curriculum and training pro- competencies refer to the major func- gram effectiveness, advances the field, tions that a psychologist is expected to and protects the public. carry out. The functional competencies that have emerged by consensus within Psychotherapy Competence professional psychology include: Intervention, which includes psy- assessment, intervention, consultation, chotherapy at its core, is one of the func- research/ evaluation, supervision, tional competencies. This competency teaching, management-administration, has been defined as interventions that and advocacy. are designed to alleviate suffering and to promote health and well-being of in- In an upcoming article, a Competency dividuals, groups, and/or organiza- Benchmarks Document (Fouad et al., in tions. The essential components that press) will appear that delineates the es- have been delineated for this compe- sential components that comprise each tency include: knowledge of interven- of these core foundational and func- tions, intervention planning, skills, tional competencies. The Competency intervention implementation, and pro- Benchmarks Document also articulates gress evaluation. Benchmarks for each benchmarks, behavioral indicators that of these essential components have been reflect the expected level of perform- determined with regard to readiness for ance at each stage of professional devel- practicum, readiness for internship, and opment for the essential components of readiness for entry to practice. each competency domain. As a compan- ion to the Competency Benchmarks I believe that members of the Division Document, another soon to be pub- of Psychotherapy, those psychologists lished paper will describe a Compe- with a passionate commitment and tency Assessment Toolkit for dedication to the conduct of effective Professional Psychology (Kaslow et al., psychotherapeutic interventions, should in press). This toolkit builds on a grow- take a leadership role in fleshing out ing and long history of competency ini- the intervention/psychotherapy compe- tiatives, both within the profession and tence, including its essential compo- in other healthcare disciplines. The nents and benchmarks indicating methods include: 360-degree evalua- competent performance at each stage of tion, annual/ rotation performance re- training and credentialing and in terms views, case presentation reviews, of life-long learning. I am excited to read client/patient process and outcome the papers that will soon be published data, competency evaluation rating in Psychotherapy: Training, Research, Prac- forms, consumer surveys, live or tice, Training in which leading authors recorded performance ratings, objec- discuss the essential components of the tive structured clinical examinations, psychotherapy competency and the foundational and functional competen- portfolios, record reviews, self- cies informing the psychotherapy com- assessment, simulations/role plays, standardized client/patient interviews, continued on page 4 3 petency from various theoretical per- wonderfully responsive to the members spectives: cognitive behavior, psycho- of the governance in terms of their web- dynamic, family systems, and site and listserv needs, and with regard existential/humanistic perspectives. I to Psychotherapy ENews. He has been believe that these papers will represent very thoughtful in his approach to re- an important effort toward advancing a sponding to the various challenges and shared articulation of the essential com- decisions associated with the website ponents of the psychotherapy compe- and listservs. As most of you know, Dr. tency unique to each theoretical Wolf is a Past-President of the Division, orientation, as well as ways in which as well as a fellow of the division, recip- various foundational and functional ient of the division’s Jack Krasner Award competencies are linked to this compe- for distinguished early career, and a tency and how these linkages may be member of the division’s journal’s edito- unique depending on the theoretical rial board (Psychotherapy Theory, Research, frame and associated modality(ies). Practice, Training). Dr. Wolf is on the staff Hopefully, other scholars, practitioners, of the Department of Psychiatry at and educators from different orienta- MetroHealth Medical Center, the coun- tions can build on these contributions to try hospital for Cleveland, and Associate further hone our understanding of the Director of Adult Outpatient Services. psychotherapy competency across theo- He is Professor of Psychology in Psychi- retical perspectives. It also behooves us atry at the School of Medicine, Case to consider how this competency would Western Reserve University. Dr. Wolf has appear from other theoretical frame- a very active psychotherapy practice and works, including an integrative model. he lectures and supervises psychiatry Further, we need to consider bench- residents in individual psychotherapy. marks that move beyond licensure, as He has published in the areas of devel- this will support the significant role that opmental behavioral pediatrics, the use lifelong learning must play in our pro- of technology in psychotherapy, and the fession. Of course, most of us do not just application of psychometric theory to in- strive to be competent, but rather we are struments used to measure psychother- dedicated to being capable. Capability apy outcome. He is interested in the role refers to the extent to which competent of therapist factors in psychotherapy individuals adapt their skills, generate process and outcome, especially thera- new knowledge, and continue to im- pist self-awareness of countertransfer- prove their performance. The confluence ence reactions. He loves doing psycho- of competence and lifelong learning is therapy. We are extremely grateful to capability. I hope that you will join the Dr. Wolf for his wonderful contributions Division and the field as we continue to to our division and we will miss him as advance the competencies movement, he transitions out of his role as internet and help us bring to bear our expertise editor. However, he will remain an in the psychotherapy competency. extended member of the Division 29 governance family. What’s New In Division 29? We are in the midst of a changing of the I am delighted to introduce our new in- guard in terms of our internet editor. On ternet editor, Chris Overtree, PhD. Dr. behalf of Division 29, I want to publically Overtree received his doctorate in clini- thank Abe Wolf, PhD for doing a fantas- cal psychology from the University of tic job for many years as our internet ed- Massachusetts-Amherst. At the present itor. He is the founding editor of our time, he is the Director of the Psycholog- division’s website and Online Psy- ical Services Center (PSC) and the Asso- chotherapy Editor. Dr. Wolf has been continued on page 5 4 ciate Director of Clinical Training for APA Convention the Clinical Psychology Program at the You will be receiving the Psychotherapy University of Massachusetts-Amherst. Bulletin just a few days before the annual His scholarship is focused on psy- convention. In the Bulletin, we have pro- chotherapy effectiveness in a naturalistic vided you details of our wonderful di- setting, as well as more effective meth- visional programming. I am eager to ods of service provision in the commu- interact with each of you at the meeting nity mental health system. He is a in Toronto. I particularly hope to see child/adolescent/adult and family ther- everyone at our Business Meeting/ apist with specialties in anxiety disor- Awards Ceremony and Social Hour, ders, depression, cognitive-behavior which will be held on Friday. These therapy, and family conflict. He also events afford us the opportunity to serves as a consultant to schools regard- honor our awardees; meet, talk, and so- ing bullying/harassment, climate re- cialize with one another; and enjoy some form, and improving academic special entertainment put on by mem- outcomes. Dr. Overtree has hit the bers of the Division 29 Board. ground running. He is already livening up our website, so check it out. In addi- Feel Free to Get in Touch tion, he will work with our Task Force I have really appreciated the chance to on Strategic Initiatives to significantly interact with so many members of our enhance our website, so that it truly be- division since assuming the presidency. comes a creative and engaging informa- I really value everyone’s input and tion portal. We are so pleased to have Dr. ideas. Feel free to email me at Overtree on board. Do not hesitate to [email protected] with questions, contact me or Dr. Overtree if you have concerns, and suggestions. Please enjoy suggestions about ways to make the Di- the rest of your summer! vision 29 internet presence more mem- ber-friendly, accessible, and valuable. (References available on-line.)

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

5 JOIN THE DIVISION OF PSYCHOTHERAPY ON-LINE! Please visit our website to become a member, view back issues of the bulletin, join our listserv, or connect to the Division: www.divisionofpsychotherapy.org

6 INTERVIEW Abraham Wolf, Ph.D. Crystal A. Kannankeril, M.S. Doctoral Student at Loyola College in Maryland For many psychologists, to 2002. Moreover, Dr. Wolf served two joining a professional terms as the Secretary for Division 29, organization is another which led up to his terms as President- time-intensive respon- Elect in 2005 and President of Division sibility added to the 29 in 2006. several demands in- volved in our profes- Among these achievements and leader- sion and our already ship roles, one of the hallmarks of Dr. busy lives. For Dr. Abraham “Abe” Wolf, Wolf’s service to Division 29 occurred in a job requirement for his faculty position 1997 when he became Division 29’s first at Case Western Reserve University Internet Editor and World Wide Web turned into a 15 year partnership with the Coordinator. Dr. Wolf’s interest in com- Division of Psychotherapy (29). When puters and statistics began early in high looking for a professional organization to school when he was offered to take part join, Dr. Wolf was invited to join the Divi- in a special computers program in 1967. sion by Dr. Gerry Koocher, the incoming During graduate school, these interests president. Dr. Wolf related that Division once again came to the forefront as he 29 was a “natural Division for me to be- became more involved with statistical come involved with” given his interests analysis and computers. Once the in psychotherapy and research. Internet hit in 1994, Dr. Wolf “jumped on that right away as it was the most Since 1993, Dr. Wolf has been an active amazing thing I’ve ever seen.” What member and leader in Division 29, often made Dr. Wolf a true asset and pioneer using his interests and innovation as a was his determination to bring his early way to propel Division 29 into the fore- interest and involvement with the front of APA. Dr. Wolf began his service Internet to Division 29. “No doubt, the to Division 29 as the Co-Chair of the Division needed to jump on this band- Student Development Committee, a wagon—the sooner the Division had an position he held for five years. During Internet presence, the better,” Dr. Wolf this time, he aimed to increase student remarked during our interview. membership which he successfully accomplished with several hundred His foresight and hard work over the new student members. His committee next eight years as webmaster made selected the winner of the student paper Division 29 a front-runner among the awards, which has seen several success- APA Divisions with many Internet- ful recipients including Dr. Louis based activities. His initial goal as Inter- Castonguay of Pennsylvania State Uni- net Editor was for Division 29 to have versity. Pursuing even more leadership a web-based presence; this included roles, Dr. Wolf became coordinator of creating a website and listserv for mem- APA’s Mid-Winter Convention Commit- bers. Dr. Wolf described these early tasks tee, a joint Convention with Division 42 as a “Mom and Pop operation.” The first (Independent Practice) and Division 43 website was originally attached to Case (Family Psychology) in 1998. From 1996 Western Reserve University where he to 1998, he served as a Member-at-Large has been a professor of psychology in for Division 29 and was a member of the the school’s Department of Psychiatry Division’s Publication Board from 1996 continued on page 8 7 for the past 30 years, hired right out of much experience with these technologi- internship. After many versions of the cal advancements as compared to their website, Dr. Wolf was able to create a younger counterparts. He indicated that separate URL for Division 29 in 2004 younger psychologists or students may (www.divisionofpsychotherapy.org), take the Internet for granted, just as allowing for easier access to users. older members may take radio and tele- vision for granted. So, for members who Dr. Wolf’s other achievements in his did not grow up with the Internet, hav- eight-year term as Internet Editor ing these new online features may be included creating and editing APA’s On- more complicated; getting them to uti- line Academy (www.apa.org/ce), mak- lize this medium thus becomes more of ing Division 29 one of the few Divisions a challenge. One of Dr. Wolf’s goals was to post online CE credits. This website to help the older membership move into allows members to watch archived the 21st century. He remarked that “it is conferences through web-streaming, still a challenge to get people to join the making them easily accessible to mem- listserv and effectively use the medium, bers. Such CEs include Evidence-based which will be a continuing challenge to Psychotherapy Relationships: What Works leadership and members [in the fu- in General (2006), Treating the Hated ture].” He did note that members are ex- and Hateful Patient (2006), The Proper cited and interested in this movement, Focus of Evidence-Based Practice (2006), though “it is hard to make those ideas and Evidence-based Psychotherapy Re- into realistic applications.” lationships: Customizing the Treatment Relationship to the Individual Patient When asked about his reflections on in- (2007). This movement towards utilizing volvement with the Division, Dr. Wolf and pairing technology with psychology indicated that he has no regrets. He also became part of Dr. Wolf’s presiden- noted that it has been “truly one of the tial initiative in 2006 and serves as one most rewarding activities I have ever of his favorite memories as Internet done – [it has allowed me] to exchange Editor. He recognized the importance of ideas, collaborate on research projects, the Internet in psychology’s future and and be involved with great people worked hard towards keeping psychology whose articles you have been reading current and relevant in this new age and for years - and then get to have dinner growing field of technology. In addition, with them.” Dr. Wolf also joked, “for all Dr. Wolf was named a Guest Editor for a the meetings, it is really worth it.” He special edition of Division 29’s Journal also wanted to acknowledge that he Psychotherapy: Theory/Practice/Research/ could not have accomplished all that he Supervision which focused on the tech- has without the support of his family. nology of psychotherapy. Division 29 formally created the position Dr. Wolf’s achievements, however, did of Internet Editor in 2005. With Dr. Wolf not come without their fair share of hur- serving as Chair-Elect that year, Dr. dles. He explained that what makes the Bryan Kim from the University of position of Internet Editor unique and Hawaii became the next Internet Editor often challenging is facilitating commu- from 2005 to 2008. After Dr. Kim’s three nication and making this new medium years of service, Dr. Wolf returned as meaningful to all the members of Divi- Interim Internet Editor in 2008. The In- sion 29. Specifically, Dr. Wolf noted that coming Internet Editor is Dr. Christo- having a website, listserv, and online pher Overtree from the University of newsletter may not be as simple or rele- Massachusetts Amhearst. In looking to- vant for older, more well-established wards the future, Dr. Wolf is confident members who may have not have as continued on page 9 8 in the direction of this position. He of members to get involved and “show explained that the website is due for “a up for our meetings—it will be a deci- more professional makeover” as it is sion they will never regret!” On behalf now five years old. His words of wis- of the members of Division 29, I would dom for Dr. Overtree were to have a like to thank you, Dr. Wolf, for all that vision of where he sees the website you have given to us—we will miss you growing and continually work towards as Internet Editor but look forward to those goals. As Dr. Wolf’s leadership your continued involvement with the role in Division 29 come to a close, he Division of Psychotherapy. also wanted to express the importance

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Give an Hour: Shifting Our Nation’s View of Mental Health and Psychology Care

Saturday, August 8, 2009 5:00 PM - 5:50 PM Metro Toronto Convention Centre, Meeting Room 706

BARBARA VAN DAHLEN ROMBERG Barbara Van Dahlen Romberg, founder and president of Give an Hour, is a licensed clinical psychologist who has been practicing in the Washing- ton, D.C., area for 16 years. She specializes in the diagnosis and treatment of children. Dr. Romberg has spent her career interacting with and coor- dinating services within large systems, including school districts and men- tal health clinics. In addition, for many years, she served as an adjunct faculty member at George Washington University, where she trained and supervised developing clinicians. She received her Ph.D. in clinical psy- chology from the University of Maryland in 1991. Concerned about the mental health implications of the Iraq War, Dr. Romberg founded a nonprofit organization called Give an Hour in 2005. The organization is creating a national network of mental health profes- sionals who are providing free services to U.S. troops, veterans, and their loved ones. As of February 2009, the network currently has over 3,600 providers. As part of her work with Give an Hour, Dr. Romberg has participated in numerous panels, conferences, and hearings on issues facing veterans. She also writes a monthly column for Veterans Advantage and is con- tributing to a book on post-traumatic stress and traumatic brain injuries. She is quickly becoming a notable source and expert on the psychological impact of war on troops and families. 9 PSYCHOTHERAPY RESEARCH, SCIENCE AND SCHOLARSHIP Engaging Underrepresented, Underserved Communities in Psychotherapy-Related Research: Notes from a Multicultural Journey Susan S. Woodhouse, Ph.D., The Pennsylvania State University

Dr. Janet Helms, well- problems and psychopathology (see known for her re- Greenberg, 1999, and Kobak, Cassidy, search on racial Lyons-Ruth, & Ziv, 2006, for reviews). identity development While we were collecting data for the (e.g., Helms, 1990), larger RCT, a group of investigators de- once said, “If you stay cided to conduct a smaller, qualitative with any question study focused on better understanding long enough, it will the precursors to infant attachment become a multicultural question.” She (Cassidy, Woodhouse, Cooper, Hoffman, said this when I was still a graduate stu- Powell, & Rodenberg, 2005). Our think- dent in Counseling Psychology at the ing was that outcomes of mother-infant University of Maryland. I had an intel- psychotherapy could be greatly improved lectual appreciation for what she was if we could better understand the most saying, but only later developed a important precursors of attachment that deeper understanding as my research should be targeted in treatment. progressed. Much of my current re- search focuses on how to improve brief After three decades of research, there is psychotherapy with parents and infants, still some degree of controversy about including basic research on important exactly how parental behavior serves as aspects of the parent-infant relationship a precursor to attachment. Research has that should be targeted in such psy- found via meta-analysis that there is a chotherapy. I would like to share the robust link between mothers’ attach- story about how my psychotherapy- ment representations and their infants’ related research questions became mul- attachment security: mothers who are ticultural questions, and how the jour- secure tend to have babies who are se- ney has led to my current efforts to cure (van IJzendoorn, 1995). Attachment engage underrepresented, underserved theory would suggest that the mecha- through which minority group members in my psy- nism this link should occur is maternal sensitive responsive- chotherapy-related research. ness to the infant (Bowlby, 1969/1982). The story begins with a randomized In fact, there is meta-analytic evidence controlled trial (RCT) of a brief, three- that maternal sensitivity serves as a me- session, home visiting, preventive, psy- diator of this link between mothers’ and chotherapy intervention for first-time, infants’ attachment (van IJzendoorn, economically stressed mothers of irrita- 1995). The problem, however, is that the ble infants and their babies (Cassidy, effect sizes for the mediation model Woodhouse, Sherman, Stupica, Ziv, & are much lower than theory would pre- Lejuez, 2009). The goal of the brief psy- dict; van IJzendoorn termed this issue chotherapy was to reduce the risk of in- the transmission gap. In fact, the connec- secure attachment. Attachment was tions between maternal behavior and targeted at an outcome because of the infant attachment are generally weaker empirical evidence that insecure infant in low-SES families (De Wolff & van attachment is associated with behavioral continued on page 11 10 IJzendoorn, 1997). The transmission gap sensitivity. We made extensive written raised many questions for us that we qualitative notes on interactions. Based thought were important to resolve, par- on our observations we attempted to ticularly if our goal was to make psy- predict the infant 12-month Strange Sit- chotherapy for low-income, at-risk uation (Ainsworth et al., 1978) attach- mothers and their infants as efficacious ment classification and the maternal and efficient as possible. If it is impor- Adult Attachment Interview (AAI; tant for infant-parent psychotherapy to George, Kaplan, & Main, 1996) classifi- work with parents on changing behav- cation. After independently making our iors, we need to make sure that we predictions, we individually read the know which behaviors really make a AAI and looked at the attachment classi- difference in later attachment outcomes. fication score, watched the 12 and 18 months Strange Situation videos and The Cassidy et al. (2009) RCT was con- looked at the scores, and made notes ducted in a large, metropolitan area that about what we had learned from the had a very diverse population; that di- dyad. The team then met for a two-hour versity was reflected in the sample of the discussion of each dyad. study. Participants were 169 infants and their economically-stressed mothers, in- We were surprised at how few mothers cluding 42.6% African American/Black, were rated as sensitive according to the 27.2% White, 19.5% Hispanic, and 10.7% Ainsworth et al. (1978) conceptualiza- mixed race or other. For the smaller, tion of sensitivity, especially given the qualitative study we examined 18 rather moderate level of sensitivity re- mother-infant dyads (78% racial or eth- quired to be assigned to the sensitive nic minority group members) who were group. Of the 18 mothers, only 3 were a part of the control group in the larger classified as sensitive and 15 were classi- RCT. As mentioned earlier, our goal in fied as insensitive. All of the mothers the qualitative study was to try to figure who were deemed sensitive had babies out which maternal behaviors most mat- who were later classified as secure in the tered in predicting later attachment, so Strange Situation. Of the 15 mothers as to close the transmission gap. We who were classified as insensitive, how- hoped to be able to make suggestions ever, 6 had babies who were later classi- about which maternal behaviors were fied as secure and 9 had babies who most important to support and which were later classified as insecure in the were most important to target for Strange Situation. The proportion of in- change in psychotherapy. fants that were categorized as secure (50%) via the Strange Situation was con- Each research team member watched all sistent with the proportion secure in of the available videotape (approxi- comparable samples (Spieker & Booth, mately 90 minutes of tape) from a lab 1988). Also, the 67% match of sensi- visit (at 4.5 months) and three 30-minute tive/secure and insensitive/insecure in- videotapes of naturalistic home observa- dicates that even in a small sample there tions (7 to 9 months). We assessed ma- is evidence for a connection between ternal behaviors by focusing on the maternal sensitivity and infant attach- mother, but attended to the dyad for ment. Of greatest interest to us, how- context using the Ainsworth, Blehar, ever, were the 6 infants with mothers Waters, and Wall (1978) conceptualiza- who would be deemed insensitive ac- tion of sensitivity. Mothers were classi- cording to traditional measures of sensi- fied as either insensitive or sensitive tivity but who later turned out to be according to the Ainsworth et al concep- secure. What we learned from this qual- tualization of sensitivity. In order to be itative study was that what seemed to in the sensitive group mothers had to meet only a minimum, moderate level of continued on page 12 11 best predict attachment outcomes was secure base provision measure avoids not sensitivity as typically conceptual- emphasizing the importance of certain ized, but instead whether the mother culturally-bound parenting practices was willing to serve as a secure base for found in white, middle class samples the infant. Insensitivity, per se, was not (e.g., sweet tone of voice, affectionate antithetical to security. In other words, comments, moment-to-moment affective mothers could engage in a larger num- attunement) and does not pathologize ber of insensitive behaviors as long as in other culturally-based parenting prac- the end, at least 50% of the time, the tices (e.g., what might be termed “no- mother relented and allowed the baby to nonsense parenting”). Instead the coding come in for comfort when distressed, system focuses on behaviors that appear did not activate the attachment system to predict later infant attachment across while the child was exploring, and re- groups. Frequently, differences between frained from certain particularly nega- racial groups are cast as an indication that tive behaviors (e.g., frightening the baby, minority group children deviate from harsh/hostile responses to infant dis- typically developing children, and there tress). It was as if one central thing the is a lack of research on adaptive strategies infants were learning from all their ex- and pathways to success (Garcia-Coll, periences with their mothers was 1990). Use of assessments of parenting whether, on the whole, their mothers that are based on white, middle class would provide a secure base for them norms frequently results in the patholo- when they most needed it. Instead of gizing of minority group parents’ care- taking an “average” of the mothers’ sen- giving. In order to design culturally sitive/insensitive behaviors in terms of appropriate and relevant preventive a moment-by-moment matching to in- psychotherapy, it is crucial to avoid fant signals, infants seemed to be think- pathologizing culturally-based parenting ing about how episodes of distress tended practices (e.g., “no nonsense parenting”) to turn out in the end when they most that are not detrimental to children’s needed something (Cassidy et al., 2005). attachment security.

Based on these qualitative findings we When I moved from my postdoctoral developed a quantitative, observational fellowship position in a major metropol- measure of secure base provision and found itan area to my current position at the empirical evidence that secure base pro- Pennsylvania State University, I was vision predicted later infant attachment very excited to continue my work in this whereas a traditional measure of sensitiv- area. Because there is not a great deal of ity did not in a low-income, diverse racial diversity in rural Pennsylvania, I sample (Woodhouse & Cassidy, 2009). I decided to pursue my research in the thought that these findings were very im- nearest urban area, Harrisburg, Pennsyl- portant because we need to understand vania. I found lab space and was able to which parenting behaviors make a differ- obtain university seed money to pursue ence in child outcomes and to have cul- a pilot project there that focused on ex- turally-appropriate ways to assess those amining relations between observations parenting behaviors. The Woodhouse of mothers’ caregiving behavior and (a) and Cassidy (2009) findings supported mother and infant emotion regulation the idea that secure base provision is a (as indexed by heart rate variability), as more culturally-appropriate measure of well as (b) mother and infant stress re- parental responsiveness in a racially/eth- sponses (as indexed by cortisol and nically diverse, low-income sample of alpha-amylase in saliva), during times of parents than was sensitivity because se- infant distress. The goal was to try to un- cure base provision allowed for predic- derstand the role of mothers’ own emo- tion of attachment security, whereas tion regulation in the process of caring sensitivity did not. I would argue that the continued on page 13 12 for their infants, as well as to under- Using seed money from our university stand how maternal caregiving was Children, Youth, and Family Consor- linked to infant emotion regulation and tium we established Parents and Chil- later attachment. My hope was that such dren Together (PACT): A Place for basic research could help us better un- Learning about Children and Families. derstand potential targets for interven- We met individually with a variety of tion, so as to design better a better community leaders including pastors, mother-infant psychotherapy protocol nurses, physicians, youth arts educators, that could later be tested. The demo- agency administrators, social workers graphics of Harrisburg (e.g., 50% and others and invited them to join a African American) struck me as ideal for Task Force to help guide our efforts to continuing to explore parenting across engage the community in research and cultures in order to help design mother- find meaningful ways to give back to the infant psychotherapy interventions that community. The Task Force gave us were culturally appropriate. Very many helpful ideas including hiring quickly, though, I began to realize that from the community and finding ways doing research in underrepresented, un- to partner with community groups to do derserved communities outside of the the research itself. We started to attend major metropolitan areas was going to community events to talk about our re- be unexpectedly challenging. search in the community and we hired a research coordinator/recruiter from the When we tried to recruit mothers to par- community. We began providing work- ticipate in the pilot study we found that shops for community members and the minority group mothers simply did building a database of families inter- not trust us or research in general. I real- ested in research participation. ized that we needed to build bridges with the community and find a way to All of our efforts in the community have build trust. helped us to engage the community in our individual research projects. How- I partnered with two other Penn State ever, the most recent step we (Kristin researchers (Kristin Buss and Laureen Buss, Laureen Teti, Chalandra Bryant, Teti) who were also interested in African and Susan Woodhouse) have taken is to American families. Together we met develop a research partnership with a with three African American Harrisburg church-affiliated, non-profit community community leaders that we knew development corporation, Holistic through our Penn State connections. Hands Community Development Corpo- These community leaders served as cul- ration (led by Brenda Alton and Robin tural informants for us, telling us about Perry-Smith). We are using community the history of racism in Pennsylvania based participatory research methodol- and a community memory for the his- ogy to develop a specific research ques- tory of misuse of research findings. They tion related to children’s anxiety. advised us to get to know a variety of Eventually, we expect to work with the community leaders who could help in- community to develop a culturally ap- troduce us to the community. They propriate intervention that can help to re- talked about the importance of incorpo- duce the risk of anxiety disorders. The rating tangible ways of giving back to work is in process, but very interesting the community into our efforts, includ- themes have already begun to emerge. It ing community workshops and finding is very exciting to watch community ways to bring the results of the research members become engaged in thinking back to community members. They gave about research at a grassroots level. us a great deal of advice on how to talk about what we were doing and how it (References available on-line.) could be relevant to the community. 13 14 ETHICS IN PSYCHOTHERAPY Psychotherapy, Online Social Networking, and Ethics Jeffrey E. Barnett, Psy.D., ABPP and Allison Russo, M.S.

With each passing day the ethical challenges and dilemmas technology plays an often associated with utilizing the Inter- increasingly important net. Further, the International Society for role in the lives of both Mental Health Online has promulgated psychotherapists and the Suggested Principles for the Online Pro- those we serve. The In- vision of Mental Health Services (2000). ternet, E-mail, social Thus, it is clear that psychotherapists networking sites, chat should give thought to the role and im- rooms, professional pact of the use of electronic media in E-mail lists, and the their professional roles and use these like each impact how documents to inform these decisions. we live, work, com- Familiarity with relevant ethical stan- municate, and relate to dards and practice guidelines and care- each other. While it ful consideration of the impact of the use may seem that how of various online media are important psychotherapists uti- for each practicing psychotherapist. lize various technologic advances in our personal lives is not an ethical issue, in Even with thoughtful utilization of the digital world in which we now live available resources, psychotherapists there is no clear boundary or line of may face a myriad of ethical challenges separation between our personal and and dilemmas regarding the role of so- professional lives. As will be presented, cial networking sites in our professional the use of social networking sites by and personal lives that will require our psychotherapists (professionally and/or careful consideration. Examples include: personally) and by their clients presents • A seasoned psychotherapist receives a unique set of ethical challenges and an E-mail invitation to join a social dilemmas. networking site. The site obtained his name and E-mail address from one of Ethics and the Internet his clients, who hoped to learn more The Ethical Principles of Psychologists and about the clinician by “friending” Code of Conduct (Ethics Code; APA, 2002) him on the site. states clearly that: “The Ethics Code ap- • A supervisor performs a Google plies to (professional) activities across a search on one of her graduate student variety of contexts, such as in person, supervisees and finds a link to a pro- postal, telephone, Internet, and other file he keeps on a social networking electronic transmissions” (p. 1061). Ad- site. She views his profile and finds ditionally, the APA Ethics Committee many pictures of him in bars holding has promulgated the Statement by the and drinking alcoholic beverages. Ethics Committee on Services by Telephone, Teleconferencing, and the Internet (APA, • An early career psychologist who uti- 1997) in recognition of the growing role lizes a social networking site to keep technology plays in clinical practice. The in touch with family and friends re- Canadian Psychological Association ceives a “friend request” from a for- (2008) developed the Ethical Guidelines mer client she treated for six months for Psychologists Providing Psychological during her graduate training. Services Via Electronic Media to address continued on page 16 15 Social Networking Sites ated a fraudulent profile, has made the Social networking sites (SNSs) are de- potential impact of SNSs in users’ lives scribed as “interactive websites de- and social functioning devastatingly ap- signed to build online communities for parent. Conversely, it appears as though individuals who have something in SNS usage may also have positive social common - an interest in a hobby, a topic, effects. Ellison, Steinfeld, and Lampe or an organization - and a simple desire (2007) found that Facebook utilization to communicate across physical bound- was positively related to the amount of aries with other interested people” social resources (“social capital”) en- (Carter, Foulger, & Ewbank, 2008, p. joyed by undergraduate students. This 682). The most popular of these are Face- effect was exaggerated in students who book and MySpace, although others, reported lower levels of life satisfaction such as LinkedIn and Friendster, also and self-esteem, suggesting the particu- have followings, albeit to a lesser extent lar usefulness of SNS usage for individ- (Salaway & Caruso, 2008). uals with social struggles offline.

As part of their online networking prac- Patterns of Social Networking Site Use tice, users typically post personal infor- An extensive survey conducted by the mation about themselves that may Educause Center for Applied Research include educational, occupational, and (Salaway & Caruso, 2008) yields statis- contact information, as well as descrip- tics on SNS usage that make the phe- tions of their interests and activities. nomenon impossible for psychologists Many users also post photographs of to ignore. The findings indicate that the themselves alone and/or in groups. vast majority (85.2%) of all undergradu- Users may communicate with each ate students frequent at least one SNS, other by leaving messages on one an- with membership comprised of a other’s pages or merely learn more greater proportion of younger students about other users via viewing their per- than older students (i.e., fully 95.1% of sonal profiles. While these sites are typ- 18-19 year old students report SNS ically used for general networking usage, compared with only 37% of un- purposes, some appeal to particular in- dergraduates aged 30 years or more). terests (e.g., LinkedIn’s primary aim is Furthermore, 56.8% of respondents career networking) or populations (e.g., make SNS usage a part of their everyday Facebook initially limited its member- activities, up from 32.8% in 2006, which ship to undergraduates, who continue to demonstrates the recent and consider- comprise the bulk of its members; Sal- able rise in the integration of SNSs in away & Caruso, 2008). users’ daily functioning. The most fre- quently reported purpose of SNSs is to The sharing of personal information maintain connections with existing across as public a medium as the Inter- friends and acquaintances (96.8%); just net brings with it a number of risks, and 16.8% make use of these sites to foster users are wise to recognize that abuse or entirely novel friendships. In addition, simply negligent use of these sites may more than half of respondents use these have deleterious effects. For example, re- sites to gather more information about vealing excessive personal information people they may or may not have met without implementing sufficient privacy (51.6%) and to share photographs, controls has led to fear of identity theft videos, and other media (67.7%). and Internet stalking. Additionally, the prominent case of Megan Meier, the 13- Yet, SNS use is not limited to undergrad- year-old girl who committed suicide in uate students. Facebook presently has 2006 after receiving harassing messages more than 175 million registered users on MySpace from a user who had cre- continued on page 17 16 worldwide. More than 3 billion minutes propriately. While it seems as though the are spent on Facebook each day and simple solution to this dilemma is to ei- more than 18 million users update their ther limit search options or refrain from page each day (Facebook, 2009). My- using SNSs altogether, even these precau- Space presently has more than 185 mil- tions may not eradicate the issue: current lion registered users worldwide. or former psychotherapy clients may Approximately 25% of all Americans are send electronic membership invitations active MySpace users. Almost 350,000 to clinicians who do not already have a individuals sign up as new users of My- SNS listing (as illustrated in Scenario 1 Space each day and it has achieved more above). For those who have a SNS the use than 4.5 billion page views in a single of different levels of security settings may day. Over 1.5 billion images are shared prevent clients from having free access to via MySpace each day. Fifty million the psychotherapist’s online materials, mails are sent each day through My- but the existence of the online profile is Space and there are over 10 billion active usually not hidden and clients may still friend relationships at present (Social request being accepted as a friend. Fur- Network Stats, 2008). The ubiquitous ther, some clients who are very computer nature of SNSs in the lives of so many is savvy may be able to circumvent security quite evident from the above data. settings and obtain access to information intended only for personal use. Ethical Challenges and Dilemmas The use of SNSs by psychotherapists and In some ways, friend requests and mem- their clients raises a number of bership invitations may be viewed as ethical challenges in areas that include auspicious, as they may indicate that the informed consent, boundaries, self- dis- client considers the therapeutic relation- closure, and multiple relationships. ship to be a strong one. They may also in- Boundary violations and multiple rela- dicate a client’s desire to share personal tionships are inherent concerns when information with the clinician that is rel- considering SNSs for psychotherapists. evant to the psychotherapy and this may Practitioners who utilize these sites may be a valuable contribution to the psy- receive online requests from their clients chotherapy process (Lehavot, 2009). In to become “friends” on these sites, and such cases, it may be possible to view the accepting these requests necessarily client’s online materials together and blurs the lines of the therapeutic relation- process them as part of the ongoing ther- ship. Although it is generally accepted apeutic process. Alternatively, friend re- that “friends” on SNSs are often mere ac- quests may indicate a client’s suspicion quaintances, the title may still complicate of the clinician or simply a boundary expectations of the relationship and the crossing to obtain more information role of the psychotherapist in the client’s about the psychotherapist’s personal life life. Although befriending a client online to quell curiosity. Regardless, such an does not necessarily constitute an ex- event should be addressed in psy- ploitative multiple relationship (See Stan- chotherapy in order to determine the im- dard 3.05 of the APA Ethics Code), it may petus for the request and the client’s be the first step in a series of increasingly reaction if the psychotherapist chooses to inappropriate communications or disclo- decline the invitation. As Lehavot (2009) sures that are not consistent with antici- states: “By paying thoughtful attention to pated professional roles. the function of the client obtaining infor- mation about the clinician online, the Declining the client’s ‘friend’ request may psychotherapist can examine this behav- be a clinical challenge and may have ior as an opportunity to enhance the some impact on the psychotherapy rela- client’s treatment” (p. 28). tionship and process if not addressed ap- continued on page 18 17 It should be pointed out that sharing in- that the clinician’s theoretical orienta- formation with a client in itself is not tion may impact views of the appropri- necessarily unethical. Psychotherapists ateness and use of psychotherapist have the right to decide how much per- self-disclosure. Humanistic psychother- sonal information they are comfortable apists may be more open to the use of sharing with clients. But, psychothera- self-disclosure to make themselves ap- pists should also consider the impact of pear more genuine and to narrow the such online relationships on the psy- power differential between clinician and chotherapy relationship and process. client. In contrast, psychoanalysts and Considering these issues and their po- psychodynamic psychotherapists may tential consequences before they become prefer less transparency with their an issue with a particular client is rec- clients to promote the transference rela- ommended. tionship and thus may utilize self-disclo- sure much more sparingly. Williams Issues of informed consent arise when importantly portends the possibility of clinicians decide to conduct online ethically incorporating SNS usage into searches for their clients without their clinical practice in his suggestions for a knowledge or prior approval. While one thoughtful and flexible approach to may argue that viewing a client’s profile boundaries and self-disclosure. Still, if can be useful clinically insofar as it may clinicians decide to use SNSs profession- provide clinicians with additional or ally, they are encouraged to do so only corroborating data to enhance under- after carefully weighing costs and bene- standing of various aspects of the fits and proceeding with appropriate client’s life, doing so clandestinely may caution so that the standards of the APA have substantial negative implications Ethics Code may be upheld and clients’ for rapport. For example, if a psy- best interests are addressed. chotherapist learns of a client’s experi- mentation with illicit substances online It is, however, important to keep in and the client has not disclosed this in mind that in the Internet age, many treatment, what does the psychothera- clients are likely to search for informa- pist do with this information? Should tion about their psychotherapist. This one disclose their search and what they will likely be true regardless of one’s de- have learned, accepting any negative cision to participate in SNSs given that impact on the therapeutic relationship, individuals have been encouraged in re- or should one withhold the information cent years to become more informed and not address in treatment a poten- consumers of services and to be more ac- tially significant clinical issue? Similar tively involved in their care, and that issues are relevant for supervisors who use of the Internet for such purposes is search for information about their su- prevalent. Psychotherapists should an- pervisees online (as depicted in Scenario ticipate this occurring. In fact, one recent 2 above). Psychotherapists and supervi- survey of consumers found that 80% of sors should consider issues of trust as all Internet users have searched for well as professional role modeling when health care information online to include considering these decisions. information about specific health care professionals (Fox, 2005). It should be noted that psychotherapists vary in their perceptions of the clinical Cohort Effects impact of self-disclosure, multiple rela- Seasoned Professionals tionships, and boundary crossings and While some senior psychotherapists will vary in their comfort level with the may be active online, many may feel un- intersection of SNSs and their clinical affected by the SNS trend in terms of its practice. Williams (1997) has pointed out continued on page 19 18 influence on their ethical practice by Trainees should very carefully monitor virtue of the fact that relatively few of and consider the information they in- them participate in online social net- clude in their online profiles. While it is working. Many, although clearly not all, necessary for all practitioners to be cog- may also be unaware of the pervasive ef- nizant of the information they share on- fects of the SNS trend, given that they line, many trainees will have developed came of age in a different time. How- a profile prior to their involvement in ever, the issue remains an important one the field of psychology. For that reason, to consider, especially when treating it is recommended that trainees review clients who are active on the Internet. all material on their profiles in order to For seasoned professionals, limited fa- determine its appropriateness and make miliarity with SNSs may restrict their alterations as needed. For example, on- ability to comprehend the social sub- line videos, photos, and writings that strate in which many of their clients seemed very appropriate for an audi- function, particularly those in the net ence of peers when a college sophomore generation. These clients are so-called may not be viewed in the same manner “digital natives” (Prensky, 2001) in that by graduate school admissions commit- they have been raised in an electronic tee members or even by undergraduate culture, speaking a digital language that faculty who are asked to write letters of is foreign to many “digital immigrant” recommendation. Then, when in gradu- seasoned professionals. Given the wide- ate school, one’s online presence may spread use of SNSs, it is prudent to ob- impact externship and internship deci- tain at least a general awareness of the sions. Graduate student psychothera- purpose, features, and potential risks pists-in-training must also consider the and benefits of these sites so that we are potential impact of their online presence able to converse with clients and under- on their clients. stand the world in which they function. Recommendations Students and Trainees Psychotherapists should consider all on- The psychology graduate student co- line posts they make and profiles they hort is arguably the one within our pro- keep to be self-disclosures, even if pre- fession most associated with the SNS cautions are taken by setting privacy trend. They are in a unique position as controls on SNSs. Clinicians are encour- budding professionals in the field in aged to remain cognizant of the fact that that SNSs are already largely a part of even if a given disclosure is not unethi- their social lives; that is, many trainees cal per se, it still may have an impact were undergraduates when the social clinically; that is, anything that is put on networking craze began and initially the Internet may influence our profes- thrived on college campuses (e.g., Face- sional roles and relationships. Further- book was launched in 2004). As such, more, although the Ethics Code only the next generation of psychologists has technically pertains to professional en- been largely immersed in the culture of deavors, materials placed on the Inter- online social networking and likely net for personal relationships cannot be hadn’t considered issues of profession- kept completely separate from our pro- alism in social networking prior to en- fessional roles. Additionally, informa- tering graduate school. The recent tion accessed about psychotherapists in concern about psychology graduate stu- our personal lives may impact the pub- dents’ lives on the Internet has been lic’s view of us professionally as well. mirrored by similar concerns in the medical (Thompson et al., 2008) and It is recommended that psychotherapists teaching (Carter, Foulger, & Ewbank, maintain professional websites so that 2008) professions. continued on page 20 19 clients who search for us via the Internet SNS use to clients to address certain will access the information shared there challenges they may have, either as a that is of relevance to our professional primary intervention or as a supplement roles and activities. Information shared to other, more traditional strategies. may include credentials, training For example, a client who is struggling experiences, areas of specialization and to find a worthwhile career path may populations worked with, and related engage in standard career counseling professional information (Barnett & as well as become involved in Hillard, 1999). Always consider the mean- LinkedIn.com, which is largely devoted ing of “friend” requests from clients in the to professional development. context of their psychotherapy. When ap- propriate, use joint review of the SNSs as Teaching professionals should include a therapeutic activity. That is, if a client their policy statement on online searches has invited a psychotherapist to be their of applicants and students in their pro- “friend” online in order to share personal gram materials. Additionally, expecta- information, photos, or other media, sug- tions for student professionalism with gest the option of having the client log on regard to their online presence and ac- to their profile during session so that the tivities should be included in student profile viewing may be done together. handbooks and be reviewed beginning This may help ensure a minimal likeli- at orientation and reviewed throughout hood of boundary violations or threats their training. Assisting trainees to make to trust and guarantees that the online the digital transition from the purely content may be jointly explored and personal to the professional is an impor- processed in session. tant role for supervisors and faculty.

Consider the option of prescribing (References available on-line.)

H N O F PSYCHOT E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C

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20 EDUCATION & TRAINING Prioritizing Case Formulation in Psychotherapy Training Eugene W. Farber, Ph.D., Emory University, Atlanta

Increasing emphasis Case Formulation: Definition and Rele- recently has been vance to Psychotherapy Training placed on identifying Psychotherapy case formulation may be de- foundational and func- fined as “…a hypothesis about the causes, tional competencies precipitants, and maintaining influences of a for professional psy- person’s psychological, interpersonal, and be- chology practice (for havioral problems…” (Kendjelic & Eells, review, see Rodolfa et 2007, p. 66). Teaching systematic case formu- al., 2005). A key purpose for elaborating lation strategies affords trainees the opportu- these competencies is to inform the develop- nity to organize their thinking about clinical ment of competency-based models for pro- material into a coherent plan for psychother- fessional training in psychology (Kaslow, apy intervention. The formulation provides a 2004). In contributing to the professional di- conceptual framework for understanding the alogue on this issue, Spruill et al. (2004) client, including clinical symptoms, prob- identified case formulation among a set of lems, and psychological themes expressed in important clinical competencies in interven- psychotherapy. It also informs psychotherapy tion planning. They characterized compe- planning, including the identification of tency in case formulation as requiring skills themes that comprise the focus of treatment, in integrating information gleaned from the the setting of treatment goals, the selection of clinical assessment into a conceptual model psychotherapy techniques and intervention of both the clinical problem and pathways strategies, and the management of the psy- for addressing the problem. In their discus- chotherapy relationship. Finally, case formu- sion of this issue, Spruill et al. also cited the lation can be invaluable in making sense of role of clinical supervision in helping psy- unanticipated and/or clinically complex chotherapists in training to develop compe- events, crises, or problems that arise in the tency in case formulation. Concerns recently course of psychotherapy. The psychotherapist have been raised, however, about a relative typically must improvise in responding to lack of explicit concentration on the devel- these unpredictable clinical situations (e.g., opment of case formulation competencies in Binder, 2004), and having a clearly defined psychotherapy training (Ivey, 2006). An conceptual roadmap can provide a helpful ref- electronic search of the psychology literature erence point that anchors the psychotherapist using the keywords “case formulation and in this process. This is particularly valuable psychotherapy training” yields only 6 arti- for trainees, where continual and systematic cles on this topic. This points to the paucity use of the case formulation as a basis for psy- of professional dialogue on case formulation chotherapeutic decision-making provides the training. As such, there appears to be a need clarity needed to organize a well thought-out to raise the level of professional discussion response to challenging and ambiguous situ- on the issue of training in psychotherapy ations arising in the psychotherapy process. case formulation as part of the overall Although research on this topic is limited, process of psychotherapy training in general. there are empirical findings supporting the This includes the articulation of training usefulness of formulation-based psychother- strategies that support development of key apy practice, including the benefits of using case formulation competencies in psy- case formulation in psychotherapy with chotherapy trainees. clinically complex cases (for review, see Kendjelic & Eells, 2007). continued on page 22 21 Competencies and Case ity functioning and psychotherapy process Formulation Training (Binder, 2004). When training psychothera- A competencies-based approach can help to pists in case formulation, it is critical that the inform thinking about the issue of training in trainee learn how to work within a conceptual psychotherapy case formulation. In reporting model of psychological functioning and psy- a study showing that expert psychotherapists chotherapy process to develop a theoretically demonstrated superior case formulations informed case formulation of a given clinical when compared with novice and experienced case. Often trainees experience a discrepancy psychotherapists (Eells, Lombart, Kendjelic, between their theoretical knowledge and their Turner, & Lucas, 2005), the study authors of- capacity to apply this knowledge in develop- fered interpretations in explaining their find- ing a clinically useful case formulation, and ings that may point to some clues regarding good case formulation training should pro- competencies in case formulation. For exam- vide opportunities for trainees to practice in- ple, they suggested that experts in their study tegrating their theoretical knowledge with might have a particularly well developed ca- their clinical knowledge and skills (Ivey, pacity to glean a range of patterns from clin- 2006). A second competency outlined by ical data and use this capacity to develop Binder (2004) involves skill in developing the complex and nuanced formulations. Addi- case formulation itself. To develop this com- tionally, the experts appeared to utilize a con- petency, the trainee must learn to make effec- sistent and systematic formulation approach tive use of the assessment process and to that may facilitate a deep level of understand- organize clinical material obtained through ing of clinical material. The study authors the assessment process into a theoretically in- also surmised that well developed self-mon- formed and coherent formulation of the prob- itoring skills also may be of benefit in the lem. This formulation comprises a “story” of case formulation process. the problem and the factors sustaining the problem and suggests a clinical focus that In describing a specific method for psycho- guides treatment, including pathways to ad- dynamically focused case formulation dressing the problem (Binder, 2004). A third training, Ivey (2006) identified several com- competency articulated by Binder (2004) in- petencies required for developing good for- volves the capacity of the psychotherapist to mulations. These include skills in observing utilize the case formulation in the moment-to- and describing both verbal and nonverbal moment unfolding of the psychotherapy behavior, the ability to elicit a detailed de- process. As such, training also needs to focus scription of the patient’s experience that can on developing skills in tracking the treatment be elaborated into an experiential account of focus specified by the case formulation over the patient’s problems, the capacity to track the course of treatment and to adjust the for- the patient’s perceptions of and relationships mulation where needed to accommodate new to self and others, awareness of the patient’s clinical findings over time. reactions to the psychotherapist, and a suffi- cient grasp of theory, including the capacity Examples of Case Formulation to apply it to the case formulation process. Training Approaches Despite the paucity of written accounts of Although not focusing on psychotherapy case systematic approaches to psychotherapy formulation competencies per se, Binder case formulation training, Ivey (2006) offers (2004), in a discussion of psychotherapy com- a structured model for case formulation petency as applied to the clinical practice of training for psychology trainees. Although brief dynamic psychotherapy, has described psychodynamic in focus, the general struc- several broad psychotherapy competencies ture of this approach could be applied to the that are instructive in thinking about psy- process of case formulation training across chotherapy case formulation training. One the spectrum of theoretical perspectives. The such competency pertains to having a theo- training is conducted in a module that in- retical framework for understanding personal- continued on page 23 22 cludes weekly sessions held over a 3 month in the theoretical underpinnings of TLDP and period concurrent with modules on psy- its theoretically grounded template for devel- chopathology, psychotherapy, and psycho- oping a psychotherapy case formulation. This logical assessment. Case formulation template is comprised of model-specific cate- training occurs using an 8-step process. The gories of clinical data that can be organized first step focuses on definitions of case for- and synthesized into a narrative conceptual- mulation and the clinical information do- ization of the case. Trainees also are explicitly mains that are relevant to conducting case invited to explore their own feelings and reac- formulation. In the second step, trainees are tions to their clients and to incorporate these provided with written case material for prac- experiences into their case formulations. tice in constructing a case formulation Trainees develop written case formulations of guided by specific instructions for doing so. their psychotherapy patients using the TLDP Trainees use their practice case formulation template and utilize these formulations to in- in step 3 as a starting point for learning the form the development of treatment goals. The specific criteria for what a good case formu- case formulation and goals are routinely dis- lation looks like. Trainees then are asked to cussed in group supervision as part of each evaluate their practice formulations in accor- trainee’s presentation of videotaped psy- dance with these criteria. In step 4, having chotherapy sessions, providing opportunities already covered general concepts of case for- for input from both the supervisor and trainee mulation, the characteristics that make a for- peers. Trainees are specifically encouraged to mulation narrative explicitly psychodynamic reflect on how the case formulation informs are outlined. In step 5, the structure of the psychotherapeutic decision- making and how case formulation is explained, including the the case formulation may evolve or change as conceptual elements of the formulation and new clinical information emerges. how they are synthesized to provide a coher- ent clinical narrative for understanding the Kendjelic & Eells (2007) conducted a study problems and concerns of the client. The examining the effects of clinician training in sixth step involves practice in small training use of a so-called generic components ap- groups, utilizing the structure outlined in the proach to case formulation. The 4 compo- previous step to develop case formulations nents of their case formulation approach drawn from written case material. These for- included symptoms and problems, precipi- mulations are discussed and critiqued by the tating stressors, predisposing events and trainee group. Videotaped clinical material conditions, and an inferred mechanism for is provided in step 7 as the basis for further conveying the psychotherapist’s explanation case formulation practice. This allows of patient’s problems. In this study, the trainees to expand their repertoire of case TLDP case formulation approach was used formulation skills by learning to incorporate as an example of an inferred mechanism. observations of the client’s nonverbal behav- Clinicians in the training group received a 2 ior and patterns of response to the clinician. hour group presentation on case formulation. In the final step, trainees are asked to inte- The training included discussion of why case grate their subjective emotional reactions to formulation is important, and introduced the the client observed in videotaped samples 4 generic components comprising the case into their case formulations. formulation approach. Factors contributing to the quality of a case formulation also were Levenson (1995, 2003) has described an ap- discussed, and participants had an opportu- proach to psychotherapy case formulation nity to practice the case formulation method training integrated within a 6-month program using a sample vignette. Study results of training in time-limited dynamic psy- showed that even with as little as 2 hours of chotherapy (TLDP; Strupp & Binder, 1984). training, clinicians in the training group pro- Levenson’s (1995, 2003) approach includes a duced higher quality case formulations than weekly didactic seminar and a psychotherapy clinicians in the control group. supervision group. Trainees receive instruction continued on page 24 23 Conclusions: Toward Increasing Dialogue proach training in psychotherapy case for- on Case Formulation Training mulation warrants further discussion. This The value of case formulation for psycho- discussion should include consideration of the therapy planning and intervention is widely key competencies to be included in case for- acknowledged across a spectrum of mulation training and elaboration of methods psychotherapy orientations (Eells, 2007). to systematically develop these competencies. Recent empirical research underlines the Approaches to evaluating the effectiveness usefulness of systematic training in methods of training methods in psychotherapy case for- of psychotherapy case formulation (Kend- mulation also should be considered. jelic & Eells, 2007). Given the importance of good case formulation skills to psycho- (References available on-line.) therapy practice, the issue of how best to ap-

CONGRATULATIONS TO OUR AWARD WINNERS! Distinguished Psychologist Award for Contri- butions to Psychology and Psychotherapy: The Distinguished Psychologist Award is based on significance of contributions to the practice, research, and/or training in psychotherapy. The 2009 award is presented jointly to Norine Johnson, Ph.D and Jon Carlson Ed.D., in recog- nition of their outstanding accomplishments and significant lifetime contributions to the field of psychotherapy

American Psychological Foundation Division of Psychotherapy Early Career Award is presented to Katherine Muller, Psy.D. for distinguished early career contributions to the field of psychotherapy and the Division of Psychotherapy.

The Division of Psychotherapy Award for Best Empirical Research Article in 2008 is presented to: Michelle Newman, Louis Castonguay, Thomas D. Borkovec, Aaron J. Fisher, & Samuel S. Nordberg. (2008). An open trial of integrative therapy for generalized anxiety disorder. Psychotherapy: Theory, Research, Practice, Training, 45, 135-147

The Division of Psychotherapy Award for Distinguished Contributions to Teaching and Mentoring, which is presented in its inaugural year to Marvin Goldfried, Ph.D. in recognition of his significant contributions to the field of psychotherapy through his impact on the lives of developing psychologists in their careers as psychotherapists

The Division is also pleased to announce the following student paper ward winner: Mathilda B. Canter Education and Training Student Award presented to Sarah M. Gates 24 PERSPECTIVES ON PSYCHOTHERAPY INTEGRATION Making Evidence-Based Practice Work: The Future of Psychotherapy Integration Marvin R. Goldfried, Ph.D., Stony Brook University

Within the past several suggested that, in the final analysis, it decades, there has been was the empirical approach to integra- an increasing interest in tion that was most important (see Nor- psychotherapy integra- cross & Goldfried, 2005). As early as the tion, with several arti- 1950s, Frederich Thorne, a psychiatrist, cles on this topic commented that the practice of psy- having recently ap- chotherapy was very different from peared in this newsletter. In writing still what he learned in medical school, another article on psychotherapy inte- which emphasized empirically based gration, my goal here is to provide a pre- principles of bodily functioning as the diction about where it may be heading guide to clinical practice, not theoretical in the future. Although it is very risky to orientation. Several other therapists and predict the future, I am taking that risk researchers over the years similarly ar- because of a number of converging gued that psychotherapy integration forces within the field that point to a should be based on empiricism, such as likely direction. the contributions of Beutler, Garfield and Lazarus. Most recently, Castonguay A Bit of History and Beutler (2006) edited an important When the Society for the Exploration of volume that specified empirically based Psychotherapy Integration (SEPI) was principles of change that were relevant founded in 1983, the goals were twofold: for dealing with various clinical prob- (1) the integration of the different ap- lems—regardless of one’s theoretical ori- proaches to therapy, analyzing the entation. points of similarity and differences among them, and (2) the integration of The Strained Alliance between research and practice. Since that time, Clinician and Researcher the vast majority of work has dealt with As is well known to readers of this the first goal, which no doubt resulted in newsletter, there has been a long-stand- creating a zeitgeist that is now more fa- ing strain in the alliance between clini- vorable to the concept of psychotherapy cians and researchers. Living in two integration than it was over two decades different professional worlds, members ago. However, relatively little attention of each group have tended to favor their has been devoted to the second goal: the own approach to understanding human integration of practice and research. I behavior and the therapeutic change would suggest that the future of psy- process—often going so far as to deni- chotherapy integration lies with the suc- grate the contribution of the other. Re- cessful pursuit of this goal. searchers have complained that clinicians do not read the literature, Although most of the work on integra- while clinicians have argued that the lit- tion has involved a focus on considering erature has little to say about their clini- the similarities and differences among cal practice. As recently noted by Kazdin various theoretical orientations and their (2008): procedures, there nonetheless have been a number of workers in the field who continued on page 26 25 A frequently voiced and enduring clinical expertise plays in implementing concern is that key conditions and specific intervention procedures or prin- characteristics of treatment research ciples of change. Thus what has been (e.g., therapists, patients, treatments, openly acknowledged is what we all and contexts) depart markedly from have known to be true, namely that those in clinical practice and bring into when it comes to doing effective ther- question how and whether to generalize apy, a competent clinician is also the results to practice (p. 147). needed. Indeed, whether we are re- searchers or clinicians, when we need to Together with Barry Wolfe—who spent select a physician to perform a compli- 22 years of his career funding psy- cated medical procedure, we are careful chotherapy and research as a staff mem- to select someone who not only is aware ber of the NIMH—I have argued that of the state of the art, but also who is ex- although randomized clinical trials can perienced and competent. provide us with important evidence about the efficacy of different therapy To stay with the medical analogy a bit procedures, many of the methodological longer, consider the interplay between constraints associated with the research research and practice in medicine. Cer- often undermine the clinical validity of tainly in the area of pharmacology, even the findings (Goldfried & Wolfe, 1996). when a drug has been approved by the Thus, unlike what occurs in controlled FDA after a careful analysis of research clinical trials, the practice of therapy findings, it nonetheless is subjected to often involves more complex clinical clinical scrutiny. Physicians routinely file cases, and is not constrained by a treat- incident reports, indicating some of the ment manual. adverse effects of the drug that were not detected during the research trials. This As a result of the lively controversy over also occurs in other aspects of medicine, empirically support treatments in the lit- such as recent clinical findings by ortho- erature, we happily seem to have moved pedic surgeons that certain approved in the direction of recognizing that both hip replacement parts have resulted in researchers and clinicians have some- problematic clinical findings. Thus, de- thing to offer. Acknowledging the limi- spite the tension that also exists between tations of simply identifying empirically medical researchers and practitioners, supported treatments, the APA Presi- there nonetheless exists a two-way dential Task Force on Evidence-Based bridge, whereby each may inform the Practice (American Psychological Asso- other. ciation, 2006) made it clear that random- ized clinical trials represent only one Building a Two-Way Bridge Between approach for providing empirical evi- Psychotherapy Practice and Research dence that can inform clinical practice. In considering the relationship between Findings from other forms of research, psychotherapy practice and research, it such as basic research on the variables is possible to view clinical work as pro- associated with various clinical disor- viding us with the context of discovery. ders, as well as the findings on the Working with clients directly and dis- process of change, are all most relevant. cussing clinical cases with supervisees Moreover, the task force has under- and colleagues presents the practitioner scored the very important role of the cli- with the challenge of translating general nician, defining evidence-based practice research findings and clinical experience much more broadly than simply the so that they can be applied to the indi- presence of research findings. What they have emphasized is the central role that continued on page 27 26 vidual case at hand. It also affords the ing to close the gap between practition- clinician with the opportunity of wit- ers and researchers, such as Cas- nessing firsthand the ever-varying pa- tonguay’s role as Co-Chair of the rameters of human behavior and the National Research Practice Network; psychotherapy change process. In our Goldfried’s founding of the journal In roles as clinicians, we can generate clini- Session, which includes research reviews cal hypotheses that may be studied written for the practicing clinician; Mag- under better-controlled research condi- navita and Newman serving as Guest tions, designed to verify what had been Editors for this journal; Sobell’s collabo- observed clinically. The findings from ration with therapists in designing a such research—the context of verifica- therapy manual and research protocol tion—can then, in turn, readily be fed for the treatment of substance abuse (So- back to the clinical community. bell, 1996); and Wolf’s professional ded- ication to fulfilling the model of the As of January 2010, I will assume the scientist-practitioner. role of President of Division 12—the Society of Clinical Psychology. The pres- Our objective is to set up a mechanism idential initiative that I will be undertak- for providing feedback to researchers, ing consists of a life-long desire to build piloting this mechanism with one clini- a two-way bridge between practice and cal problem for which an empirically research. Taking the lead from medicine, supported treatment has been identi- which has such a bridge, my goal is to fied. We decided that a clinical problem establish a mechanism whereby thera- that has received favorable research ev- pists can provide feedback to re- idence, and one that occurs frequently in searchers about the successes and clinical practice, would be panic disorder. failures in their attempts to apply empir- Despite the fact that there has been ex- ically supported treatments in clinical tensive research on the treatment of practice. Exactly how this will be done, panic, we believe that there is still much and what the mechanism will look like, that can be learned from the clinicians is still in the developmental stage. For- treating such patients. Although all ther- tunately, I have a group of experienced, apists who have experience with this motivated and enthusiastic researchers clinical problem would have much to and practitioners who similarly have offer, we decided to focus on the use of had an ongoing dedication to closing the an intervention that has received empiri- gap between practice and research. This cal support—cognitive-behavior therapy. is a standing committee of Division 12, There is a promising psychodynamic and includes Louis G. Castonguay (Pres- treatment for panic currently under in- ident-Elect of the Society for Psychother- vestigation, but it has yet to have apy Research); Marvin R. Goldfried achieved empirically supported status (Past-President of the Society for Psy- (Milrod, et al., 2007). Starting with infor- chotherapy Research and President- mal interviews with practicing clinicians Elect of Division 12 as of 2009); Jeffrey J. that make use of such cognitive-behav- Magnavita (President-Elect of Division ioral interventions with this population, 29 as of 2009); Michelle G. Newman we hope to be able to identify those pa- (psychotherapy researcher with expert- tient, therapist, treatment, and contex- ise in anxiety disorders); Linda Sobell tual variables that are likely to influence (Past-President of Division 12); and the clinical effectiveness of the empiri- Abraham W. Wolf (Past-President of Di- cally supported treatment in actual prac- vision 29). In addition to their motiva- tice. With this information on hand, we tion and interest, members of this group will then move on to apply this feedback have had ongoing experience in work- continued on page 28 27 procedure on a broader scale. close links between clinician and re- searcher, we face the danger of our the- We believe that this initiative can pro- ory and research becoming too far vide an approach where everyone bene- removed from the clinical foundations fits—the clinician, the researcher, and of our generalizations (Goldfried & certainly the client. It is our hope that Padawer, 1982, p. 41). this will afford the clinician with an op- portunity to provide invaluable infor- With psychotherapy in general respond- mation for future research. For the ing to pressures for accountability, evi- researcher, it provides them with re- dence-based practice is likely to be the searchable—and hopefully fundable— driving force for how therapy is con- hypotheses for research that is born out ducted in the future. For it to be imple- of clinical practice. mented in an empirically and clinically sophisticated way, the collaborative ef- How does this all tie in to psychother- forts of researcher and practitioner are apy integration? A friend who is a physi- essential. More than ever before, this col- cian once characterized psychotherapy laboration needs to become the organiz- as “an infant science,” where what we ing theme for integration. It is for this do is based more on theory than evi- reason that I would suggest that empir- dence. In order for our field to mature, ical pragmatism—based on the converg- we need to move beyond theoretical ing evidence obtained from research and schools of thought and base what we do practice—not theory, will be the integra- clinically on available and research find- tive theme of the 21st century. ings that also have been shown to work in clinical practice. As I have suggested Author Note in the past: Correspondence regarding this article can be addressed to Marvin R. Gold- Although varying theoretical orienta- fried, Department of Psychology, Stony tions have clearly been useful in helping Brook University, Stony Brook, NY, us to develop a wide variety of thera- 11794-2500. Electronic mail can be sent peutic procedures, we see a need to to: [email protected] make greater use of what actually goes on clinically as a way of generating fruit- (References available on-line.) ful research hypotheses. Without such

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

NOTICE TO READERS

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

28 DIVISION 29 ~ 2009 APA PROGRAM THURSDAY, AUGUST 6th Existential Humanistic Therapy Comes of Age (Symposium) 8:00 AM – 9:50 AM • Metro Toronto Convention Centre – Meeting Room 202C Chair: Kirk J. Schneider, PhD Participant/1st Author Alexander Bacher, MA Pernilla Nathan, MA Stacie L. Cooper, MA Orah T. Krug, PhD Dave Fischer, MA Kirk J. Schneider, PhD

Two Viewpoints on Future Directions for Alliance Theory (Symposium) 10:00 AM – 10:50 AM • Metro Toronto Convention Centre – Meeting Room 203A Chair: Robert L. Hatcher, PhD Participant/1stAuthor Robert L. Hatcher, PhD Adam O. Horvath, EdD

Process and Outcome in CBT: The Importance of Cognitive Errors and Coping (Symposium) 10:00 AM – 11:50 AM • Metro Toronto Convention Centre – Meeting Room 206A Chair: Martin Drapeau, PhD, MA Participant/1stAuthor Deborah Schwartzman, BA Jesse Renaud, MA Martin Drapeau, PhD, MA Debora D’Iuso, MA

Getting Real in Psychotherapy Explorations of the Real Relationship (Symposium) 12:00 PM – 12:50 PM • Metro Toronto Convention Centre – Meeting Room 205A Chair: Charles J. Gelso, PhD Participant/1stAuthor Charles J. Gelso, PhD Cheri L. Marmarosh, PhD Discussant: Jeanne Watson, PhD

What We Wish We Had Known: Tips for Future Psychotherapists (Symposium) 1:00 PM – 2:50 PM • Metro Toronto Convention Centre – Meeting Room 103A Chair: Elizabeth Nutt Williams, PhD Participant/1stAuthor Ali M. Mattu, MA Norine G. Johnson, PhD Jeffrey Zimmerman, PhD Jean A. Carter, PhD

Using a Training Center Database to Promote Science and Practice (Symposium) 3:00 PM – 3:50 PM • Metro Toronto Convention Centre – Meeting Room 714A Chair: Cynthia E. GliddenTracey, PhD Participant/1stAuthor Brian Garbarini, MEd Charles C. Claiborn, PhD Jessica E. Rohlfing, MA 29 FRIDAY AUGUST 7th The Art and Science of Impact: What Psychotherapists Can Learn From Filmmakers and Social Psychologists (Symposium) 8:00 AM – 9:50 AM • Metro Toronto Convention Centre – Meeting Room 713A Chair: Jeffrey K. Zeig, PhD Participant/1stAuthor Jeffrey K. Zeig, PhD Patricia Rozema Discussant: Lee D. Ross, PhD

Poster Session: Research in Psychotherapy 12:00 PM – 12:50 PM • Metro Toronto Convention Centre – Exhibit Halls D & E Participant/1st Author ____ Kathleen R. Bhogal, MA Faye Mishna, PhD Robert J. Reese, PhD Michael Basseches, PhD Rebecca E. Sachs, MA Daniel L. Hoffman, MA Toni J. Welsh, MA Geneviève Bourdeau, BS Zita Sousa, MA James M. Yokley, PhD Jennifer R. Henretty, MS Carey A. Heller, BA Patricia A. Rupert, PhD Jennifer Grote, MA Stephanie A. Wiebe, BA Julie R. Ancis, PhD, MS Jessica E. Lambert, PhD Joana Coutinho, PsyD Sally M. Hage, PhD, MTS Nathaniel Thorn, BA Ennio Ammendola, MA Shawn J. Harrington, BA Denise H. Bike, MS Allen K. Hess, PhD Erin Olufs, BS Mari Yoshikawa, EdD Adam O. Horvath, EdD Grazyna T. Kusmierska, MA Arlene J. Simpson, BA Rebecca S. Klinger, MS KC L. Collins, BA Saunia S. Ahmad, MA Nancy L. Murdock, PhD

Symposium (S): Eminent Psychotherapists Revealed Audiovisual Presentation of Principles of Psychotherapy 2:00 PM – 3:50 PM • Metro Toronto Convention Centre – Meeting Room 801A Chair: Jeffrey J. Magnavita, PhD Participant/1stAuthor ____ Jeffrey J. Magnavita, PhD Hanna Levenson, PhD Jay Lebow, PhD Judith S. Beck, PhD Discussant: Nadine J. Kaslow, PhD

Business Meeting 5:00 PM – 5:50 PM Fairmont Royal York Hotel – Territories Room

Social Hour 6:00 PM – 6:50 PM Fairmont Royal York Hotel – Salon B 30 SATURDAY AUGUST 8th Psychotherapist Expertise Developing Wisdom to Guide Theory, Research, and Practice (Symposium) 9:00 AM – 9:50 AM • Metro Toronto Convention Centre – Meeting Room 802B Chair : Allen K. Hess, PhD Participant/1stAuthor Robert M. Leve, PhD Leonard Greenberg, PhD Barbara Schwartz, PhD C. Alexander Simpkins, PhD Tanya H. Hess, PhD Discussant Carol Falender, PhD Edward P. Shafranske, PhD

Conversation Hour: Lunch With the Masters for Graduate Students and Early Career Psychologists 12:00 PM – 1:50 PM Fairmont Royal York Hotel Quebec Room

Mistakes in Psychotherapy Yielding Power, Constraining Dialogue, and Nurturing Envy (Symposium) 2:00 PM – 2:50 PM Fairmont Royal York Hotel British Columbia Room Chair: Randolph Pipes, PhD Participant/1stAuthor Randolph Pipes, PhD Annette S. Kluck, PhD Caroline Burke, PhD Discussant: John Dagley, PhD

CWC/Evidence-Based Practice Using Evidence-Based Principles to Optimize Clinical Process and Outcome With Personality Disorders (Symposium) 3:00 PM – 4:50 PM Metro Toronto Convention Centre Meeting Room 714A Participant/1stAuthor Jeffrey J. Magnavita, PhD Kenneth L. Critchfield, PhD

31 SUNDAY, AUGUST 9th Schema Therapy for BPD Breakthrough: Treatment for Improving Life Functioning (Symposium) 9:00 AM – 10:50 AM Metro Toronto Convention Centre Meeting Room 712 Chair: Joan M. Farrell, PhD Participant/1stAuthor Arnoud Arntz, PhD George Lockwood, PhD Ida A. Shaw, MA Michael Webber, MD Discussant Jeffrey Young, PhD

Affect Phobia Treatment Approach: Two New Pathways to Change (Symposium) 11:00 AM – 11:50 AM Metro Toronto Convention Centre Meeting Room 706 Chair: Stuart Andrews, PhD Participant/1stAuthor Stuart Andrews, PhD Kristin A.R. Osborn, MA Maneet Bhatia, MA Discussant Allen Kalpin, MD

Culturally Informed Interventions With Ethnically Diverse Populations (Symposium) 12:00 PM – 1:50 PM Metro Toronto Convention Centre Meeting Room 202A Chair: Chaundrissa Oyeshiku Smith, PhD Participant/1stAuthor Guillermo Bernal, PhD Asha Z. Ivey, PhD Frederick T.L. Leong, PhD Kafi S. Bethea, BA Joseph E. Trimble, PhD Discussant Nadine J. Kaslow, PhD H N OF PSYCHOT E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C 32 EARLY CAREER Building a Private Practice by Being Public: From Social Networking Circles to Psychotherapy Groups Renee Hoekstra, Psy.D., Private Practice, Boston, MA

It Starts with was in this situation? Was anyone start- Your Strengths ing his or her own practice? Who else What now? My post- wanted their own practice, but felt as if doc had ended, I had they had no idea where to go? And who no job, and I had lived else has been successful in starting a in four different states practice and would be willing to let me in order to complete pick their brain? a master’s degree, a doctorate degree, a pre-doctoral intern- Inspiration from Revolve Nation’s ship, and a post-doctoral fellowship. To Boston Entrepreneur Group this end I found myself living in Boston Two weeks after I passed the Examina- with a determination to get licensed and tion for Professional Practice in Psychol- to stop moving across the universe. I ogy (EPPP), I went to a meetup group wasn’t looking for the 9-5 grind, I for entrepreneurs. It was the business- wanted autonomy and creativity in my networking world that I knew nothing clinical work, and I wanted to earn rea- about, and I went not only for the social- sonable money. I had heard enough peo- izing, but also because I was thinking ple complain about poor starting about selling my watercolor artwork. I salaries in hospital positions. I was not was gently encouraged to come back. I interested in the responsibilities in- started to think about the possibility of volved in administration or supervision, business networking, which led to more and I wanted the majority of my work ideas about starting my practice, which to be direct clinical services. The one led to ideas about networking with thing that I wanted to do for sure was to healthcare providers, which led to lead psychotherapy groups. the current brainstorms and flurry of activity that followed over the last year. Shortly after obtaining my license, I took I started joining list-serves and looking out a calculator and figured that I could for books and articles about starting a make more than my post-doc salary if I practice. I dug up my psychology of busi- conducted two psychotherapy groups a ness class material and started poring week. The question was: Given that I through it. I tentatively proposed a study knew nothing about running my own group on various list-serves, which led to practice or being in business for myself, meeting other psychologists. I selected a how exactly was this going to happen? book: Financial Success in Mental Health Practice (Walfish & Barnett, 2009) and Despite being here for one post-doctor- proposed to the online community a ate year, I still barely knew anyone in study group with weekly meetings to Boston; let alone how to get from Ja- read, discuss, and plan assignments that maica Plain to Somerville without a moved people in the direction of their GPS! I needed a job, a professional com- own practice. I established a mission for munity, and an opportunity to connect the study group: and establish myself as a professional. Boston was a huge city with many re- • To help early career psychologists cent transplants. I wondered: Who else continued on page 34 33 build and establish their own private I continued to attend the weekly meet- practices up groups hosted by the entrepreneurial • To learn together the relevant aspects law firm—the first to not bill by the of the business of psychology hour. They served wine and cheese and • To decrease our vulnerability to pub- were attended by a range of business lic and private organizations inter- professionals ranging from CEO’s to in- ested in hiring psychologists terested college students. People there provided a sense of business-minded • To decrease our vulnerability to poor mentorship and had a plethora of re- pay sources I wouldn’t have known where • To establish and generate goals and to find elsewhere. I met someone who strengths, and to be able to utilize agreed to help me with a business plan. these in a marketable way I started to think seriously about my el- • To develop peer consultation, net- evator speech and the audience of non- working groups, and the support and mental health professionals. I started to resources of other early career psy- listen to advice and feedback about mar- chologists keting and business. • To locate available resources when we lack answers or have further I also decided to host an EPPP forum for questions post-docs. I rounded up recently li- censed psychologists to talk about the li- I posted my mission on various list-serves censure application process, studying and started to establish a following. for the EPPP, and the jurisprudence The authors of Financial Success in Men- exam. My state association offered office tal Health Practice contacted me and of- space, and the rest was a matter of tap- fered to answer questions via e-mail ping the relevant list-serves. I e-mailed between our study groups. I began cre- all of the post-doctoral training directors ating assignments, such as developing listed on my state association website, as mission statements for our practices, well as the EPPP and early career list- working on website and marketing serves. This was popular. I felt as if I had plans, and generating and finding re- found an unmet need in the community sources for ourselves. and had been able to reach that need. I started to think about this as an experi- Fits and Starts mental step in marketing, and I felt like Despite my involvement with the it was an additional way of being con- worthwhile early career activities above, nected to early career psychologists. I still did not have a job. I had been inter- viewing intermittently while studying My business of psychology class profes- for licensure, but nothing yet had come sor had done something clever that I at- to fruition. However, accessing re- tempted to replicate: she brought in sources, talking to psychologists, and business-related persons to our class. reading the list-serves provided me with This not only allowed them to market important insight during my job search. their services, but also allowed her to For example, I had a firm grasp on the maintain her relationships with the busi- pros and cons of joining group practices. ness community. I started to think about One narrative stood out to me- psychol- the various business-related persons ogists in group practices were losing who might be interested in fulfilling a money that they could be retaining if on need for early career psychologists, and their own. Thus, I started calculating the I started to put together workshops for costs of starting out on my own and the possible means to achieve this end. continued on page 35 34 early career and private practice-inter- both formal and informal. I met people ested psychologists. Early in my en- who were a few years down the road deavors, I was contacted by another from me and found out what they were early career psychologist and encour- doing and how they were doing it. Peo- aged to apply for the early career schol- ple started asking me about taking on arship to attend the American different leadership roles. People started Psychological Association (APA) Lead- to e-mail me and ask about job leads and ership Convention. My state association other resources. I reflect back on the ad- nominated me to the Early Career Psy- vice of a psychologist I met in graduate chologist Committee and I was granted school, who stated that she made the ef- the scholarship. fort to meet someone connected to the field of psychology for lunch at least Connecting and Including once a week. Community I wanted to continue to give people a I was licensed in October of last year. I chance to socialize and network, and I had a few false starts with jobs, but continued to have an interest in connect- found office space to sublet and got my ing recent post-doctoral transplants who website up by April of this year. I was had similar confusion about driving offered a job in a group practice in a dif- around the Boston-cow-paths-turned- ferent geographical area than my own into-roads. My many transitions to get practice. The offer came from someone through graduate school had left with who was clearly impressed with my me several family-less holidays, and I early career endeavors and receptive to often thought about hosting Thanksgiv- the idea of starting on my own at the ing dinner for all the family-less post- same time. docs and interns. Practical Aspects I started to host social hours, which pro- I found someone to develop my website vided the opportunity for psychologists for a very reasonable rate. I found out who were not interested in clinical work how easy it was to sublet office space for or private practice to connect and join. a few hours a week. I found a business Through my social networking I found planner who got me started with finan- someone with a space big enough to cial bookkeeping software and devel- host potlucks. I was also contacted by oped my own personal profit and loss senior psychologists, people interested statement. I solicited feedback about my in hiring psychologists, and persons in- website from various parties before terested in mentorship. I was offered a going live, and I created my own art- job shortly after hosting a social hour. I work to communicate my interest in also offered to cross post job offers to dif- psychotherapy groups. I distributed var- ferent list-serves and connect job-seekers ious mailings and found ways in which with job-finders. people advertise services in the Boston area. I tried to meet people for lunch Through all my efforts, I have been im- whenever possible. I contacted people mensely rewarded and enriched in a va- providing Dialectical Behavioral Ther- riety of ways that I never anticipated at apy (DBT), as well as group psychother- the outset. The more I offered to host ac- apy, and I joined the Northeast Society tivities and spread the word, the more I Group Psychotherapy and presented at was put into contact with persons who their conference. I signed up to teach a could help me build my practice. People class through the Boston community became interested in me and my pur- suits. I found a diverse array of mentors, continued on page 36 35 college for adult education. not going to stop the social networking anytime soon. I’m getting around A Lot of Work Boston and I’m meeting people, and I Like starting groups in private practice, feel more connected than I did before. I starting the early career efforts wasn’t al- know people who work with autistic ways easy. Some things were not always spectrum disorders, provide group ther- well attended, but I continue to commit apy for substance abuse, work with deaf to doing them and meet new people children, and specialize in medical hyp- every time I host an event. I get what I nosis and sexual pain disorders. And the can out of what I do and continue to go best part is that I could probably find a from there. referral for a specific concern if I did a little searching. The client referrals are starting to trickle in. My business planner tells me that 4- I’m having fun being the center of all the 5 phone calls a week is good news for attention. The good news is that there is someone just starting out. I get impa- always room for entrepreneurship and tient, but people say that all my work creativity, and if people are willing to in- will pay off shortly. Someone recently vest the energy they can create their own was incredulous that I actually thought early career networking circles. I did. I’m I might not get referrals. I panic some- making this up as I go along, and this is times at the thought of getting flooded, my story of what’s happened as a result. and people say that private practice has And I’m certainly receptive to a helping its ebbs and flows. I’ve almost got hand if a helping hand shows up. enough people to start a DBT group, and I’m starting to get inquiries about indi- I believe that if nothing else, Boston vidual clients. I’ve got a mixed bag with early career psychologists should have the insurance: I’m not able to take it be- the opportunity to socialize and net- cause most insurance companies dis- work from time to time. I’m currently criminate against recently licensed working on establishing a “Welcome to psychologists. Although there is some Boston” social hour for incoming psy- room for negotiation, I’ve gotten a wide chology interns and post-docs in Sep- range of feedback and perspectives from tember of 2009. If you’ve never been private practice individuals who both here, I’ll teach you how to say things like endorse and hate insurance companies. “pahk” and “nor’easter” and tell you It’s a lot to think about. But I’ve worked about the pros and cons of buying a very hard to get to where I am today and GPS. If interested in this or any of my am determined to generate revenue that other endeavors, you can check out my reflects that. website at www.bostondbtgroups.com A Ways to Go or get in touch with me at Renee_Hoek- While I haven’t yet climbed the ladder [email protected]. to financial freedom (although I’ve cer- tainly met my share of financial plan- (References available on-line.) ners!), the groundwork is being laid. I’m

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

36 FEATURE 2009 Presidential Summit on the Future of Psychology Practice: Collaborating for Change James H. Bray, APA President, Department of Family & Community Medicine Baylor College of Medicine Carol Goodheart, APA President- Elect, Independent Practice, Princeton, New Jersey Margaret Heldring, Independent Practice, Seattle, Washington

When you bring 150 Summit was supported by a financial leaders from psy- contribution from the division. chology, business, consumer groups, Jeffrey Magnavita summed up his economics, insurance, experience this way: “It was awesome, medicine, and politics inspiring, frustrating, challenging, gen- together to transform erative and hopeful.” The recommenda- the practice of psy- tions from the Summit need to be chology, what do you implemented to make a real difference. get? The Presidential The Summit is part of the 2009 Presiden- Summit on the Future tial Initiative on the Future of Psychology of Psychology Practice, Practice. The Task Force (working since held May 14-17, in San 2008) and Summit are collaborative ef- Antonio, Texas, was a forts and opportunities for strategic transforming event to thinking about our future. James H. Bray, move the practice of APA President, Carol Goodheart, APA psychology forward in President-elect and Margaret Heldring the 21st century. With chair the Task Force that also includes advances in neuro- Robert Gresen, Gary Hawley, Tammy science, genetics, col- Hughes, Jennifer Kelly, Jana Martin, laborative health care Susan McDaniel, Thomas McNeese, and and international busi- Emil Rodolfa; Sandra Shullman, Joan ness opportunities, psychology is more Brannick, and William Strickland are relevant than ever and the summit illu- consultants to the Task Force on organi- minated many new possibilities for psy- zational psychology issues. chology practice. The Task Force is staffed by Katherine Division 29 was well represented at the Nordal, Randy Phelps, Joan Freund, and Summit with two division delegates Beth Nichols-Howarth of the Practice (Nadine Kaslow and Jeff Magnitva) and Directorate. Cynthia Belar, executive di- a number of invited psychologists (Jean rector of the Education Directorate, also Carter, Armand Cerbone, Pat DeLeon, contributed to the Task Force. Jennifer Kelly, Michael Murphy). The continued on page 38 37 The Summit’s goal was to engage the Day 2 included a talk by health econo- broader practice community in an mist Richard Frank, on the changes in agenda- and priority-setting meeting to funding for health and mental health inform the work of the APA Practice Di- care. He pointed out that while health rectorate and the APA Practice Organi- care costs as a percentage of the GNP zation. We assembled leaders in the have increased over the past 20 years, practice of psychology and related pro- mental health care costs have stayed sta- fessionals from other practice associa- ble as a percentage of the GNP. In addi- tions, government entities, training tion, there has been an increase in the organizations, consumers, insurers, and use of psychotropic medications, by businesses to identify: both psychiatrists and other physicians, • Opportunities for future practice to while payments for psychotherapy have meet the needs of a diverse public. declined. This is a strong reason for psy- • Priorities for psychologist practition- chology to continue to fight for prescrip- ers in private and public settings. tive authority. • Resources needed to address the pri- Physician Tillman Farley spoke about his orities effectively. model of integrated community health • Partnerships and roles to implement care that places behavioral health the priorities. squarely in the primary care model. Janet Reingold, media and marketing expert, The Summit was a vehicle for considera- discussed how to brand the profession tion of new forms, settings and partner- and distinguish psychology from other ships for psychological practice; disciplines. On Day 3 Elizabeth Gibson, a expanded thinking about practice trends; consulting psychologist, described how and conceptualizations of practice that she helped transform Best Buy from a cross traditional lines. The Task Force will bankrupt company to a leading retailer use the findings from the Summit to de- in America. The principles she described velop clear recommendations for our di- are applicable to transforming the profes- verse practice community. sion of psychology.

There were a number of outstanding The real work of the Summit occurred in keynote addresses. Day 1 included a small work groups. The work groups thought provoking talk by Dr. Ian Mor- were urged to think big and outside the rison, a futurist, who discussed how box. Work groups addressed questions businesses change. Morrison stated that such as: in every business there are two curves: • What are priorities for our con- in the first, you already do well and feel stituents? comfortable, but the second is a new • What are the pathways to get there? way of doing things that is dramatically different from the first. To succeed, you • What partners should we develop? have to manage both curves—keep • What are the economic challenges doing what works while developing that present future opportunities? new opportunities. Dr. Norman Ander- • What will be the impact of cross-cut- son addressed health disparities and the ting changes in the future of psychol- importance of overcoming them in our ogy practice in regards to diversity, future work. We had a wonderful talk science & technology developments, after dinner by Ann McDaniel, vice- and partnerships? president of the Washington Post Com- panies, who gave an update on the Here are some of the issues that Obama administration and plans for emerged at the summit, especially in health care reform. continued on page 39 38 light of national health care reform: ices. We have long resisted developing these guidelines, but the time has come Practitioners are still being trained for to define psychological treatment prac- the “first curve” — traditional practice . tices, or others will do it for us. To thrive in the future, psychologists will need to redefine training and take Health promotion and prevention. The advantages of new practice opportuni- focus on primary care also opens oppor- ties outside of traditional psychotherapy tunities for prevention of health prob- practice. That doesn’t mean foregoing lems and enhancing the health of our all the wonderful ways psychologists population. Many chronic health prob- are currently trained, but it does mean lems, such as diabetes, hypertension, adding new elements, skills, embracing obesity, are caused by psychosocial and best practices and getting interdiscipli- life-style problems. Psychologists have nary training. much to offer to prevent these problems and help people better manage their The need to collaborate in primary chronic health problems. care. As Summit speaker Frank DeGruy said, “Mental health care cannot be di- Creating and nurturing partners for vorced from primary medical care, and change. One of the innovations of the all attempts to do so are doomed to fail- Summit was to have a significant num- ure.” It is becoming increasingly clear ber of invited guests who represented that health-care reform will include a other organizations, businesses and con- greater emphasis on primary care and sumers of psychological services. They prevention of chronic disease. These are are open and interested in partnering both areas that psychologists can make with the APA in our advocacy efforts. major contributions. This will require These relationships need to be nurtured that we partner and practice with pri- and strengthened in our future. There mary-care physicians and nurse practi- was much discussion at the summit tioners. Most practicing psychologists about who is the mental health cham- have not been trained to work in these pion in the Obama administration—no settings and in the busy style of pri- one was clearly identified. We need to mary-care medicine. It is one of our fu- develop our champion. The Campaign ture practice opportunities. for Mental Health Reform is a collabora- tive effort of 18 mental health organiza- The need to be accountable. Whether tions; APA is a participating member of we like it or not, there are changes in this coalition group. William Emmet, the health care payments and reimburse- director for Campaign for Mental ments that require practitioners to Health Reform, was the only mental demonstrate accountability for their health person invited to President work. This was a clear message from the Obama’s White House health care re- insurance, business and legislative del- form meeting. He was a delegate to the egates at the summit. We have the op- summit and he provided important in- portunity to define how we should be sights about the role of mental health in evaluated by developing our own psy- national reforms. chology treatment guidelines and meth- ods to assess our work. Psychiatry has Future Plans done this. Their guidelines are used by The Task Force on the Future of Psychol- the insurance industry to determine ogy Practice will synthesize the ideas treatment and reimbursements. Accord- and recommendations from the summit. ing to the summit’s insurance and leg- The Task Force will recommend them to islative delegates, there are not any for the Committee for the Advancement of psychotherapy and psychological serv- continued on page 40 39 Professional Practice and into the APA tential of bringing a sea change to the strategic planning process and policy practice of psychology. The ideas and changes for the association. You can recommendations from the summit watch portions of the summit on the APA need to be implemented at all levels of webpage, www.apa.org. You can also our profession to make a real difference. learn more about the summit during a 2- As stated at the summit, “¡Lo que ocur- hour session at the APA Convention, Fri- rió en San Antonio, no puede per- day, August 7 from 10 AM – 12 noon. manecer en San Antonio! What happened in San Antonio cannot stay in The impact of this summit has the po- San Antonio!”

H N O F PSYCHOT E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C

ATTENTION GRADUATE STUDENTS AND EARLY CAREER PROFESSIONALS

You are invited to “Lunch with the Masters – For Graduate Students and Early Career Psychologists”

Saturday, August 8th 12:00 Noon – 1:50 pm Fairmont Royal York Hotel, Quebec Room Hosted by Division 29 (Psychotherapy) at the 2009 APA Convention.

Come join Drs. Lynne Angus, Judith Beck, Beverly Greene, Leslie Greenberg, Nadine Kaslow, Arthur Nezu, and others for lunch and conversation. We will also host a book raffle and early career focus group to determine the needs of our early career constituents.

No RSVP needed, but please feel free to contact Dr. Michael J. Constantino ([email protected]) for additional information.

Come find out more about Division 29 and invite others to join!

You do not need to be a member of Division 29 to attend, but we will have membership information available on site for those who are in- terested in joining.

40 FEATURE Ethics and the Interrogation of Prisoners Norman Abeles, Ph.D., Michigan State University

Recently, I was asked pist to manipulate or control the client to co-author a book by force or threat. chapter on the history of ethics. Having More recent concerns have focused on taught a course on the possible role of therapists in dealing professional and sci- with alleged terrorist detainees held by entific ethics to gradu- military authorities. In general, a psy- ate students for over chotherapist cannot ethically coerce a 30 years, I readily agreed to do so. I client into treatment or force certain thought our readers would be interested goals or outcomes against the client’s in reading about one of the topics I was wishes. Some special problem situations unable to include in the chapter due to exist along these lines including clients lack of space: coerced therapy and the in the military or involuntarily confined interrogation of prisoners. This topic is in institutions such as prisons. The more known to most of our readers, though subtle aspects of coercion require partic- they may not know the significant de- ular sensitivity. This might include the tails which I discuss here. use of group pressure, guilt induction, creating cognitive dissonance, attempts Coerced or mandated psychotherapy at total environmental control, and the and interrogation of prisoners establishment of a trusting relationship Some commentators have described in order to effect change in another psychotherapy as a means of social con- person (Dolliver, 1971). Therapists must trol (Hurvitz, 1973) and compared it in attempt to remain aware of potentially some ways to brainwashing (Dolliver, coercive influences and avoid any that 1971; Gaylin, 1974). Others have dis- do not offer full participation, discus- cussed the use of coercive persuasion, sion, and choice by the client. The deprogramming, and hypnotic sugges- constant critical re-examination of the tion techniques from the viewpoint of strategies and goals of treatment involv- client manipulation (Fromm, 1980; ing both client and therapist affords the Kline, 1976). Many other types of coer- best means to this end. cive practices have become central to some psychotherapeutic approaches Some of my colleagues tell me that they with strong public approval. These in- would never accept a referral for court clude court ordered therapy for a range mandated therapy, nor would they ever of conditions (e.g. anger management, treat a client who is coerced into therapy. driving while intoxicated, sexual acting I respond by asking whether or not they out). Other therapeutic-like techniques have ever seen children and adolescents include restrictions placed on non-incar- for treatment. They often respond by cerated sex offenders (Schopp, Winick, saying that in those cases the parent is & La Fond, 2003), restrictions in educa- the client. Then I ask them if they have tional settings (Sidman, 1999) and coer- ever seen a client who is contemplating cive restraint or forced holding therapies divorce; usually they answer by saying for children (Mercer, 9003). This raises yes. Then I ask them if they would ter- questions about the extent to which psy- minate a client who told them during chological techniques permit the thera- continued on page 42 41 the 5th session that the main reason they gists at risk and would harm vulnerable came for therapy is that they were given populations by restricting the practice of an ultimatum by their spouse or partner psychologists who work in a variety of to seek therapy or ace divorce or separa- settings such as psychiatric hospitals, tion. The point I am making is that co- correctional facilities and places where erced therapy is somewhat of a slippery authorities detain individuals for their slope and yet many of us may have own or the public’s safety. Constitu- treated individuals who at least believed tional challenges may arise in a range of they were not coming of their own free settings which could result in conflicts will. with international standards. The state- ment also noted that the petition pro- Psychologists’ Involvement in vided two exemptions for psychologists: Detention of Alleged Terrorists one for those who work directly for the (a.k.a. Violent Extremists)* person held in detention and the other In 2008, for the first time in the organiza- for those who work for an independent tion’s history, a petition signed by over third party involved in protecting 1% APA members invoked a referen- human rights. The statement also noted dum provision of the by-laws calling for that APA had already prohibited as un- a vote on whether psychologists can ethical any participation in torture in- continue to work in detention settings cluding knowingly planning, designing that exist in violation of international participating or assisting in torture. Fi- law or the U.S. Constitution nally, the opponents expressed concern (http://www/apa.org/governance/res about the precedent of defining settings olutions/work-settings.html). The final in which psychologists may work. vote tally was 8792 voting in favor of the resolution and 6157 voting against the Understanding some of the history of resolution. Note that this resolution it- this debate provides a useful backdrop self did not deal with the APA Ethics to ethics in psychotherapy, particularly Code but rather where psychologists when coercion applies (e.g. mandated or could work. court-ordered treatment, involuntary *In his June 2009 speech in Cairo, Presi- hospitalization, or treatment while in- dent Obama used the term violent carcerated). Almost 15 years ago, John- extremists rather than terrorists. son (1995) warned of ethical quandaries in the military and talked about collabo- In statements accompanying the ballots, ration between APA and the Depart- advocates of the petition argued that our ment of Defense. Such efforts can first ethicalprinciple is to do no harm, include the determination of personal yet alleged that psychologists have par- qualifications, screening leadership ticipated in the design and actual inter- qualities, and examining organizational rogations which equate to torture. The productivity. As Carter and Abeles statement asserted that by participating (2009) point out, terrorist activities have in the design of interrogations, psychol- provided the impetus for prisoner inter- ogists have helped to legitimize abusive rogations in a range of settings and lo- treatments at such sites. They also as- cales; thus there was continuing need for serted that the referendum does not pre- further consultation with experts. Psy- vent psychologists from working in chologists have served on Behavioral settings which uphold international law Science Consultation teams (BSCT’s) and human rights, such as the U.S. crim- where they observe interrogations and inal justice system. The statement in op- provide interrogators with feedback position to the petition argued that information. Okie (2005) underscores passage would place ethical psycholo- continued on page 43 42 that these team members may not pro- tions. APA explicitly stated that it is eth- vide confidential information about ical for psychologists to be involved in prisoners, nor may they advise military interrogations. The editorial continues interrogators to take advantage of psy- by noting that “interrogation is neces- chological vulnerabilities. Carter and sary to prevent loss of life from terror- Abeles (2009) note that BSCT psycholo- ism and that some professionals feel it is gists have been accused of using their their duty to ensure that activity is con- training to develop interrogation pro- ducted responsibly” (p. 300). Even the grams used at Guantanamo Bay. In par- New York Times notes that harsh inter- ticular there is reference to the Survival rogation tactics were considered legal Evasion Resistance and Escape (SERE) (Shane & Johnston, 2009), though legal- program; the allegations suggest that ity does not necessarily equal ethical be- some psychologists reversed this train- havior. Pope and Gutheil (2009) ing in order to aid prisoner interroga- recommend that professional organiza- tion, Two psychologists (not members of tions should include specific and en- APA) have been associated with this ef- forceable ethics standards when fort. Evidence indicates that Michael working with particular at-risk groups. Gelles, a psychologist at Guantanamo Further, professional organizations acted as a whistleblower and called at- should make more effort to acquaint all tention to abuses (Soldz, 2007). their members about their ethical re- sponsibilities. Finally, they recommend In part because of considerable outcry that there may be complex ethical ques- concerning the participation of psychol- tions that arise in custodial settings ogists in these interrogation of where governmental authority may be prisoners, APA formed a Task Force in contrast to ethical responsibilities by (PENS) whose job it was to review the professionals. APA Ethics Code to see if the ethical as- pects of prisoner interrogation were ad- We turn again to the PENS report. To equately addressed. The report of this guide its thinking, the Task Force cited task force was published (APA, 2005) the Preamble to the Ethics code (APA, and notes that their charge did not in- 2002) which states that psychologists re- clude an investigative or adjudicatory spect and protect civil and human role. The PENS Task Force pointed out rights. They also cited Principle A that psychologists may serves in consul- (Beneficence and Nonmaleficence) tative roles to interrogation and infor- which asks psychologists to safeguard mation gathering processes, and the welfare and rights of those with acknowledged a long standing tradition whom they interact professionally. Ad- for doing so in other law enforcement ditionally, Principle D (Justice) and Prin- contexts. A recent editorial in Nature ciple E (Respect for people’s Rights and (2009) noted that six of the members of Dignity) were cited. The PENS Task the PENS Task Force were on the Penta- Force concluded that the Ethics Code is gon’s payroll (p. 300) and states that the sound in addressing ethical dilemmas allegation that the Pentagon was dictat- that occurred in the context of national ing policy to APA is not obvious in the security related work. Several state- 12 principles. Additionally, the editorial ments were prepared with regard to this points out that other professional soci- overall issue. These noted that psychol- ogists do not engage in, direct, support, eties including the American Medical facilitate, or offer training in torture or Association, the American Psychiatric other cruel, inhuman or degrading treat- Association, and the World Medical As- ment, and noted that psychologists have sociation have come out against having their members participate in interroga- continued on page 44 43 an ethical responsibility to report such It should be noted also that in 2002, Pres- acts to appropriate authorities. This also ident Bush ordered an executive decla- included reference to not using health ration indicating that the 1949 Geneva care related information to the detriment Convention did not protect al-Quaeda of the individual’s safety and well being. captives at Guantanamo Bay because It was pointed out that psychologists they were enemy combatants. That need to consult when facing ethical meant they could not be considered dilemmas. They must be alert to acts of prisoners of war which would have en- torture and do not engage in behaviors titled them to the right to refuse ques- that violate the laws of the United States tioning (Carter and Abeles, 2009). Of though they may refuse for ethical rea- course that does not mean that they sons to follow laws or orders that are un- could be tortured. just or that violate basic principles of human rights. The report also reiterated Concerning the reaffirmation against that psychologists may serve in various torture, there was an amendment pub- national security related roles but must lished that included techniques listed by remain mindful of factors unique to the World Medical Association Declara- roles and contexts that require special tion of Tokyo and the principles of med- ethical considerations. ical ethics in the protection of prisoners and detainees against torture (APA, The task force members did not reach 2008). A critique of this resolution by consensus on all issues. They differed psychologist Arrigo and retired counter- with regard to the role of human rights intelligence operative De Batto argues and international standards; some ar- that effective ethical oversight by APA or gued that international standards any other outside organization is not should be built into the Ethics Code. possible (Arrigo & De Batto, 2008). They There was also disagreement on the ex- believe that the resolution is symbolic tent to which psychologists may ethi- only and has no effect on operations; cally disguise the purpose of their work, there are a number of institutional fac- though they did agree that full disclo- tors that defeat this resolution. They sure of the nature and purpose suggest that in intelligence operations, of the work is not ethically required in information is given on a “need to know all instances. Finally, there was no con- basis.” Further, the role of interrogation sensus on whether the discussions of the consultant is one of several roles where Task Force should have been made pub- psychologists can facilitate abusive in- lically available. They voted to limit terrogations. Since psychologists are what information should be discussed staff officers, they must obey field com- concerning the deliberations by the Task manders of whatever rank. Most psy- Force. In later developments, APA chologists in contact with detainees are passed a resolution on the reaffirmation junior officers who owe service in ex- of the position against torture and other change for educational scholarships. cruel, inhuman, or degrading treatments While all this may be true, the enforce- or punishment, and its applications to ment of the APA Ethics Code depends individuals defined by the United States on information presented as complaints as “enemy combatants.” The resolution filed by individuals with the APA Ethics provided condemnation and absolute Committee. prohibitions against direct indirect par- ticipation in interrogations related to We should note that allegations that APA mock executions, water boarding or supported participation of psychologists other simulated drowning, as well as ad- ditional humiliating practices. continued on page 45 44 in interrogations suggest that APA did psychologists can not work in detention not want to alienate key decision makers settings that exist in violation of interna- in the Bush Administration (Carter & tional law or the U.S. constitution. Abeles, 2009). Former APA President Summary Koocher noted in rebuttal that APA This paper reports on the issue of co- voted in favor of the McCain anti-torture erced or mandated psychotherapy and resolution and past APA president the interrogation of prisoners. It begins Sharon Brehm argued that having psy- by raising the question as to whether or chologists consult with interrogation not psychotherapy can be viewed as one teams assists in keeping interrogations means of social control and moves on to safe and ethical. APA also opposed the the possible role of psychotherapists in Military Commission Act (2006) since, dealing with alleged terrorist (violent unfortunately, this law created ambigu- extremists) detainees held by military ity concerning the types of interrogations authorities. It notes the recent APA ref- which are permitted. The reader can erendum forbidding psychologists to come to his or her own conclusions on work in detention settings that exist in this difficult ethical issue. It is clear that violation of international law or the U.S. more work needs to be done to resolve Constitution. It provides background on all the dilemmmas created by this com- this topic and raises the question as to plex, confusing topic. There will con- whether or not the APA Ethics Code tinue to be debate about whether or not should include specific prohibitions con- the APA Ethics Code should include spe- cerning the interrogation of detainee cific and enforceable provisions concern- prisoners. ing the ethics of interrogation tactics now that a referendum has determined that (References available on-line.)

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

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45 46 STUDENT FEATURE Journey to Adulthood in the 21st Century Pekti Miles, M.A., Pacifica Graduate Institute

Adolescence is proba- Today a large part of the adult percep- bly the most infamous tion of adolescence emerges from por- of all the developmen- trayals tinted with the stereotypes of a tal stages. The “know- previous century. A nationwide poll of it-all” affect, rebellion, adult’s attitudes about teenagers, spon- and mood swings as- sored by Public Agenda in 1999, found sociated with this pe- that 71 percent of adults had a negative riod of psychosocial opinion about youth; yet in a major transition from child to study on the self image of adolescents in adult in a human lifetime has received a ten countries, 73 percent of the partici- great deal of attention in the field of de- pants reported a healthy self image velopmental psychology (Spruijy, 1999, (Offer, Howard, & Atkinson, 1988). This pp. xi-xii). This paper will explore one discrepancy between the way in which way that research on adolescent brain adults perceive teens, and the way that maturity might support the rapidly adolescents view themselves, may be ex- changing paradigm of adolescent devel- plained by the fact that teenagers spend opment which aids understanding of close to one third of their time talking multilevel systemic change and seeks to with peers as opposed to 8% with provide an agenda for promoting posi- adults. (Spear, 2000, p.120). tive life experience (Lerner, 2004). Fi- Adolescence and Society nally, the implication of self-regulation John Santrock (2005), author of a recent training on adolescent educational book also titled Adolescence, proposed achievement is considered. that conflicting perceptions about ado- How Adolescence Is Viewed lescence are increasingly a problem for Granville Stanley Hall is considered the society. “Although the majority of ado- founder of adolescent psychology. In the lescents experience the transition from book Adolescence (1908) Hall suggested childhood to adulthood more positively that adolescence is a developmental stage than is portrayed by many adults and of “Sturm und Drang” (storm and stress): the media, too many adolescents today are not provided with adequate oppor- Every step of the upward way is tunities and support to become compe- strewn with wreckage of body, mind, tent adults” (p.500). The gap between and morals. There is not only arrest, adult and adolescent perceptions is a but pervasion at every stage, and broken link which threatens the sustain- hoodlumism, juvenile crime, and se- ability of our society. In the book Child- cret vice… (2005, p. XIV). … normal hood and Society (1950) Erik Erikson children often pass through stages of stated: passionate cruelty, laziness, lying and thievery (p.334). …the human personality develops according to steps predetermined in More than a century after this work was the growing person’s readiness to be conceived, Hall’s take on adolescent per- driven toward, to be aware of, and sonality continues to influence the way to interact with a widening social adults view this important juncture in radius; and… that society, in principal, human development. continued on page 48 47 tends to safeguard and to encourage even imagine. As they progress from one the proper rate and the proper se- stage to the next, adolescents have not al- quences of their unfolding. This is the ways been able to depend on the preced- ‘maintenance of the human world’ ing generation to provide psychosocial (p.270). instruction. The fact is that even if the older generation provides informed Since each stage is interdependent, Erik- boundaries, they will likely be rejected son’s theory makes room for what he because adolescents are sometimes mor- described as the variations in “tempo bidly, often curiously, preoccupied with and intensity” (1950, p.71) presented by what they appear to be in the eyes of oth- culture. It also facilitates bits and pieces ers as compared with what they feel they of the founding developmental theoret- are and with the question of how to con- ical contributions as well as the biologi- nect to earlier cultivated roles and skills cal information that is being amassed with the ideal prototypes of the day from current brain research. For this rea- (Erikson, 1959, p.89). son attention to the stages provided by Erikson’s Epigenetic Chart (1950 pp.272- Implications are clear that a large part of 273) can be very helpful in our quest for adolescent success in the current milieu a stable society. is based on the development of an inter- nal locus of control. Adults are pressed According to Erikson’s system of stages, to discover ways to help adolescents im- adults in our society are responsible for prove the input phase of processing. providing the skills and tools necessary for young people to move into adult- Recently adults in our culture have hood. Nonetheless, it is important to note taken a liking to deep breathing, medita- that the advent of the Internet has com- tion and yoga to help manage the stress pletely revolutionized our daily lives. of our new world (Barnes, 2008). Medi- The way that children absorb informa- tation research proves to be helpful in tion has changed drastically in the last the navigation of our increasingly com- decade. In Erikson’s view, during periods plex environment. The information af- of rapid social change such as the one we forded by new technology has the are experiencing now, the older genera- potential to assist in developing inner tion can no longer provide adequate role awareness skills that would augment an models (1950, p.280). How then can we internal locus of control. Neuroimaging assist our children in making the transi- researchers have described meditation tion to a culture that we have yet learned as a set of “…practices that self-regulate to navigate, much less master? the body and mind, thereby affecting

st mental events by engaging a specific at- 21 Century Technology tentional set” (Cahn & Polich, 2006 Many adults in this culture are dubious p.180). In the same way that physical fit- about the magnitude of unsupervised ness can be enhanced through a regular external stimulation that dominates the exercise routine, research suggests that psychic space of our youth. What possi- the mind can also be trained and im- ble training can help to reduce the dan- proved through methodical practice. gers associated with being an adolescent in a changing society? Like teenagers The Adolescent Brain and Meditation from every generation, these kids are There are brain changes related to each doing their job of pushing human devel- stage of human development that opment in new directions. contribute to responsible for sexual maturation, physical growth, emotional Thus, this generation’s children are pro- cessing information at a rate we cannot continued on page 49 48 expansion, cognitive development, self [UNFPA] has determined that for the regulation, and maturation of judg- first time in history more than half of the ment. “Prominent developmental trans- world’s population will be living in formations are seen in prefrontal cortex urban areas and subjected to the and limbic brain regions of adolescents plethora of pressures unique to that across a variety of species…. Develop- lifestyle (UNFPA 2007 p.1). “Today’s mental changes in these stressor-sensi- generation of young people is the largest tive regions…likely contribute to the in history. Nearly half of the world’s unique characteristics of adolescence” population (almost 3 billion people) is (Spear, 2000 p.418). Behaviors associ- under the age of 25” (UNFPA, 2005 ated with adolescence such as risk tak- p.45). The potential impact of today’s ing, impulsiveness, poor self regulation young people on the future is stagger- and identity crisis might be soothed by ing. If these adolescents, who hold the the trait changes afforded by medita- power to shape humanity, are to realize tion, as brain imaging has shown the their collective potential, new solutions same areas of the brain most changed must be found for the many stressors during adolescence are activated also they have inherited. Without an under- during meditation. standing of the complexities of the ado- lescent brain, we will have little to offer It is important to note that adolescents their succession. An investigation of the have more pronounced brain activity in effect of meditative traditions on adoles- the amygdala than in the frontal cent development may expose far-reach- lobe (Baird,et al.1999). The amygdala ing benefits for our global predicament. processes emotions while the frontal lobe is involved with reasoning and thinking. Conclusion Neuroimaging studies of meditation In this essay I presented the argument show increased frontal-parietal and that mindfulness works the mental mus- frontal-occipital activation and decreased cle, where the mind is trained to focus posterior-anterior activation (Herzog, et even when bombarded with a web of in- al., 1990). “Trait changes from long-term formation. Adolescents are required to meditation include a deepened sense of synthesize more technology than the calmness, increased sense of comfort, previous generation; therefore statistics heightened awareness of the sensory nudge us toward a new pedagogy field, and a shift in the relationship to which includes intentional self-regula- thoughts, feelings, and experience of self tion of attention for self-inquiry. Can “(Cahn & Polich, 2006 p.181). Therefore, meditation (e.g., in the school system, it will be advantageous to explore the na- where our children spend the majority ture and consequence of meditation on of their day), be helpful? Research sug- the developing adolescent brain; a morn- gests that all of us, and particularly ado- ing meditation in high school may prove lescents, need to stop a moment, sit to be as effective as a midday nap in silently and take a long deep breath. kindergarten. Today’s Adolescent (References available on-line.) The United Nations Population Fund

H N OF PSYCHOT E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C 49 FEATURE Psychotherapeutic Treatment Implications for Obese Adolescents Dena F. Miller, M.A., University of Denver, Graduate School of Professional Psychology

Headlines regularly mental consequences for youths. Ado- highlight the dramatic lescence is an often anxiety-producing rise in the rate of developmental stage where peer pres- childhood obesity. sure and psychosocial stressors abound. Photographs of 300 Teens who are overweight are at addi- pound teenagers ac- tional risk for weight-related teasing, company headlines body dissatisfaction, low self-esteem, like, “Into the Mouths depression, anxiety, and suicidal of Babes: Childhood Obesity” in the New ideation (Fulkerson, Strauss, Neumark- York Times (Zeller, 2007), “Dear Parents: Sztainer, Story, & Boutelle, 2007). Your Child Is Fat” in Time Magazine (Losh, 2008), and, “It’s not baby fat: There is a clear need for effective psy- Among 4-year-olds, nearly 1 in 5 is chotherapeutic treatments for childhood obese” on CNN (Park, 2009). These and adolescent obesity. Numerous med- catchy headlines point to the perceived ical treatments including drug therapy severity and prevalence of childhood and surgical interventions exist to treat obesity in the United States. obesity, yet “successful [psychothera- peutic] treatments for obesity have been Obesity is diagnosed when a child’s elusive” (Stice, Shaw, & Marti, 2006, p. Body Mass Index (BMI) is at or above the 667). This article outlines psychotherapy 85th percentile for their age. According to interventions to address the treatment of the American Heart Association (AHA; obese adolescents. Family-based inter- 2009), 23.4 million children between the ventions, cognitive behavioral therapy, ages two to nineteen are overweight and and motivational interviewing modali- obese. Approximately 8-13% of ties will be discussed. preschoolers and between 13% and 22% There are numerous obstacles to treating of children and adolescents are now con- adolescents who are obese. Weight gain sidered overweight, and an additional is common and difficulty can be disap- 31% are at risk for becoming obese pointing for counselors and therapists. (AHA, 2009; Powell, Calvin, & Calvin, Mental health providers often assume 2007). The consequences for children and that obesity can only be treated med- adolescents who are obese can be signif- ically, rather than behaviorally. Other cli- icant and lasting, including an increased nicians too readily accept that genetic risk for numerous health problems such blueprints for obesity preclude effective as coronary heart disease, type II dia- nutritional and behavioral treatments betes, cancer, and hypertension (Stice, (Panzer, 2006). Despite these challenges, Prensell, Shaw, & Rohde, 2005). it is the responsibility of mental health providers to learn and develop interven- Increasingly described as a global epi- tions to help obese teenagers who are demic (Powell et al., 2007), obesity can clearly at risk and in need of services. result not only in severe physical health problems, but has significant negative Because obesity tends to run in families, psychosocial, emotional, and develop- continued on page 51 50 researchers have developed family- should focus on both behavior change based interventions, targeting eating be- and parental and teen skill develop- havior and activity change in the ment, as well as increasing healthy eat- children and their parents (Epstein, ing behavior with an emphasis on Paluch, Roemmich, & Beecher, 2007). mealtime strategies and incorporating This model includes teaching parents be- positive family support. havioral skills to facilitate change in their teenagers. The therapy focus is on be- Cognitive behavior therapy (CBT) is an havioral interventions including ad- evidence-based treatment modality de- dressing poor parental modeling and signed to address the negative psycho- support for overeating and under exer- logical effects of obesity. One study cising. A primary goal of family-based outlines a CBT model that incorporates interventions is to mobilize family re- psychoeducation, diet change, and in- sources to support the teen’s healthy eat- creasing physical activity into therapy ing as well as increased physical activity (Panzer, 2006). The treatment protocol level. At least one parent is asked to take states that, “Sessions should include an active role in the intervention. Treat- weighing the child…reviewing food and ment typically lasts 16 weeks to 8 activity charts… providing positive re- months and includes follow-up periods inforcement, exploring and addressing of at least one year with “booster” ses- various forms of nonadherence or resist- sions to help children maintain both ance, assigning cogent homework tasks, healthy eating behavior and physical ac- summarizing the interview, and plan- tivity (Epstein et al., 2007). The length of ning for the next visit (Panzer, 2006, p. treatment varies based on the family, and 540).” the level of severity of the adolescent’s CBT uses behavior modification to help obesity. Some studies have taken into adolescents achieve diet and exercise consideration different levels or severity goals in treatment. Sessions begin with of obesity (Panzer, 2006; White, 1986) introducing and refining specific strate- given that White (1986) found, “the more gies and using psychoeducation to teach obese the child, the greater the psycho- adolescents about obesity. Identifying logical consequences” (p. 263). and recognizing cognitive patterns In addition to behavioral interventions, within the family is important, along other family-based treatment models with identifying negativistic and dichoto- focus on the family environment and ac- mous thinking and overgeneralizations. tivities, such as mealtimes. Fulkerson et Other cognitive techniques such as re- al. (2007) found that making family framing can be useful for teaching ado- meals a priority and having a positive lescents coping skills to manage feelings mealtime environment were positively of hunger and body image concerns. CBT associated with psychological well is a structured psychotherapy model de- being and inversely associated with de- signed to help teenagers change un- pressive symptoms and unhealthy healthy eating behavior through weight-control behaviors in adolescents. identifying and challenging their dys- Indicators of poor psychological health functional thoughts and behaviors. Help- included family members teasing teens ing teens identify and then change their about their weight and parental encour- dysfunctional thoughts about eating, and agement to diet; such teasing was negative thoughts about themselves can strongly correlated with negative psy- significantly increase self-esteem, as well chosocial outcomes (Fulkerson et al., as create positive and lasting healthy 2007). These findings indicate that fam- lifestyle changes. ily-based psychotherapy interventions continued on page 52 51 Motivational interviewing (MI) is an- associated with less body dissatisfaction other therapeutic technique that has been for certain ethnic minority groups (Stice used to treat obesity (Carels et al., 2007). et al., 2006). In addition to race and eth- MI was designed to enhance motivation nicity, age and development may impact and decrease ambivalence toward behav- psychotherapeutic outcomes for obese ior change (Miller & Rollnick, 2002). Al- teenagers. For example, an insightful though MI was originally developed to and mature 17-year-old may be more treat addictions, it is increasingly being successful using a CBT perspective, used in psychotherapy to motivate ado- while a younger child may benefit from lescents who are resistant to treatment more parental guidance and support and to enhance health behaviors. Arecent using a family-based approach. study integrated MI into a behavioral weight loss intervention (Carels et al., Socioeconomic status and gender also ef- 2007). When poor progress toward fect treatment outcomes. Children who weight loss goals was detected, MI was live in single-parent homes, for example, used to enhance motivation. Findings may not have a parent who can commit showed that participants lost more to an intensive family-based intervention. weight and engaged in greater weekly Psychotherapists should be sensitive to exercise when MI was used. Using MI these important potential barriers to chil- alone, or in conjunction with other psy- dren’s success in therapy. Gender is an- chotherapy techniques may help moti- other important consideration for the vate teens to decrease sedentary behavior treatment of obesity. One study found and increase both healthy eating and ex- that, “sex differences may exist in vulner- ercise and physical activity. ability to weight stigma in youths” (Puhl & Latner, 2007). For example girls tend to In addition to outlining effective psy- engage in relational aggression more fre- chotherapeutic treatment interventions quently than boys (Simmons, 2002), and for obese teenagers, previous research may be at higher risk for being teased emphasizes the importance of consider- and becoming depressed. ing adolescents’ demographic character- istics in treatment. Race/ethnicity, age, The medical and mental health risks for gender, and socioeconomic status, all ef- teenagers who are obese are great. Not fect adolescents’ presentation in therapy, only does obesity increase the probabil- and are especially important when treat- ity that these teens will face future med- ing obese teenagers. Latino and Black ical complications and chronic health adolescents are more likely to be obese conditions, but the psychological, social, (Stice, Shaw, & Marti, 2006), and over and developmental repercussions of one third of Latino and Black children obesity cannot be ignored. Mental health ages 2-19 are considered obese (AHA, providers can make a difference in the 2009). This suggests that interventions childhood obesity epidemic by helping targeting these high-risk youths may be adolescents develop new behaviors and more effective because there is a greater skills and ultimately lead healthier lives. opportunity to show a prevention effect. However, obesity is less stigmatized and (References available on-line.)

H N OF PSYCHOT E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C 52 CONGRATULATIONS TO DIVISION 29 IMMEDIATE PAST PRESIDENT JEFFREY E. BARNETT, PSY.D., ABPP APA Award for Distinguished Professional Contributions to Independent Practice The Complete Practitioner: Still a Work in Progress Friday, August 7, 2009 from 11:00 am – 11:50 am, at the Convention Center, South Building, Meeting Room 703 The APA/APF Award Ceremony Friday from 4:00 pm – 5:50 pm in the Fairmont Royal York Hotel (room to be announced)

AWARD CITATION— “For outstanding, distinguished and meritorious service in several areas of professional practice, especially in the areas of professional ethics and psychotherapy treatment. Dr. Jeffrey E. Barnett has produced hundreds of high quality publications, workshops and symposia that have had widespread impact. He has provided visionary leadership service and outstanding legislative advocacy. He is well known for his quality mentoring of students, early career professionals and members of diverse groups. He tackles projects, causes and support of people with a spirit of enthusiasm, passion, and care that is quite unique. He is acknowledged, respected, and honored by all who know him.”

BRIEF BIO— Jeffrey E. Barnett, Psy.D., ABPP received his doctorate from the Ferkauf Graduate School of Yeshiva University in 1984. He is a licensed psychol- ogist in independent practice in Arnold, Maryland where he provides psychother- apy and comprehensive psychological evaluations, primarily for children and adolescents. He is Professor on the faculty of Loyola College of Maryland. He is a Diplomate of the American Board of Professional Psychology in Clinical Psy- chology and in Clinical Child and Adolescent Psychology and a Distinguished Practitioner of the National Academies of Practice. He is a Fellow in seven APA Divisions.

Dr. Barnett has served in numerous leadership roles including as President of the Maryland Psychological Association (MPA); in APA he served as President Divisions 29, 31, and 42. He served on APA’s Council of Representatives for six years and is a trustee of the Association for the Advancement of Psychology. Dr. Barnett served as chair of APA’s Board of Convention Affairs and is presently Chair of APA’s Ethics Committee. He is Associate Editor of the APA journal Pro- fessional Psychology: Research and Practice.

Professional interests reflected in his numerous publications and presentations in- clude ethics, legal, and professional practice issues in psychology; mentoring stu- dents and early career psychologists; working to advance diversity in our profession; and advocacy. Dr. Barnett lives with his wife of 23 years, Stephanie, and his two children, Stuart and Madeline. He is an avid runner, swimmer, and cyclist, and continually endeavors to practice effective self-care and to strike a balance among his many interests.

53 CALL FOR FELLOWSHIP APPLICATIONS DIVISION 29—PSYCHOTHERAPY Jeff Hayes, Chair, Fellows Committee

The Division of Psychotherapy is now APA Council of Representatives. The accepting applications from those who following are the requirements for initial would like to nominate themselves or fellow applicants: recommend a deserving colleague for • Completion of the Uniform Fellow Fellow status with the Division of Blank; Psychotherapy. Fellow status in APA is awarded to psychologists in recognition • A detailed curriculum vita (please of outstanding contributions to psychol- submit 3 copies); ogy. Division 29 is eager to honor those • A self-nominating letter (self-nomi- members of our division who have dis- nating letter should also be sent to tinguished themselves by exceptional endorsers); contributions to psychotherapy in a • Three (or more) letters of endorsement variety of ways such as through of your work by APA Fellows, at research, practice, and teaching. least two of whom must be Division 29 Fellows who can attest to the fact The minimum standards for Fellowship that your “recognition” has been be- under APA Bylaws are: yond the local level of psychology; • The receipt of a doctoral degree • A cover letter, together with your c.v. based in part upon a psychological and self-nominating letter, to each dissertation, or from a program endorser. primarily psychological in nature; • Prior membership as an APA Member Those members who have already at- for at least one year and a Member tained Fellow status through another di- of the division through which the vision may pursue a direct application nomination is made; for Division 29 Fellow by sending a cur- • Active engagement at the time of riculum vita and a letter to the Division nomination in the advancement of 29 Fellows Committee, indicating in psychology in any of its aspects; your letter how you meet the Division 29 criteria. • Five years of acceptable professional experience subsequent to the grant- ing of the doctoral degree; Initial Fellow Applications can be attained from the central office or • Evidence of unusual and outstand- online at APA: ing contribution or performance in the field of psychology; and Tracey Martin • Nomination by one of the divisions Division of Psychotherapy which member status is held. 6557 E. Riverdale St. Mesa, AZ 85215 There are two paths to fellowship. For Phone: 602-363-9211 those who are not currently Fellows of Fax: 480 854-8966 APA, you must apply for Initial Fellow- Email: [email protected] ship through the Division, which then sends applications for approval to the APA Membership Committee and the continued on page 55 54 DEADLINE FOR SUBMISSION Completed Applications should be forwarded to: The deadline for submission to be con- sidered for 2010 is December 15, 2009. Jeff Hayes The initial nominee must enclose a Chair, Division 29 Fellows Committee Uniform Fellow Application, self-nominat- 307 Cedar Building ing letter, three or more letters of en- Penn State University dorsement, updated CV, along with a University Park, PA 16802 cover letter, and three copies of all the Email: [email protected] original materials. Incomplete submis- Phone: 814-863-3799 sion packets after the deadline will not Please feel free to contact me or other be considered for this year. Those who Fellows of Division 29 if you think you are current Fellows of APA who want to might qualify and you are interested become a Fellow of Division 29 need to in discussing your qualifications or the send a letter attesting to your qualifica- Fellow process. Also, Fellows of our tions and a current CV. Division who want to recommend a deserving colleague should contact me with their name.

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

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O F PSYCHOTH N E HE IVISION OF SYCHOTHERAPY R T D P O I A S I P V

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Name ______Degree ______Address ______City ______State ______ZIP______Phone ______FAX ______Email ______If APA member, please Member Type: ! Regular ! Fellow ! Associate provide membership # ! Non-APA Psychologist Affiliate ! Student ($29) ! Check ! Visa ! MasterCard Card # ______Exp Date _____/_____ Signature ______Please return the completed application along with payment of $40 by credit card or check to: Division 29 Central Office, 6557 E. Riverdale St., Mesa, AZ 85215 You can also join the Division online at: www.divisionofpsychotherapy.org 56 OF PSYCHOTH N E O R I A S I P V Y I D 29 . A N M S E S R A I C L A A N PSYCHOLOGI C DIVISION OF PSYCHOTHERAPY American Psychological Association 6557 E. Riverdale Mesa, AZ 85215

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