APPIC-June 2000 12/16/03 3:48 PM Page 1

Association of Psychology Postdoctoral and Internship Centers

PPIC APPIC A F o 8 NEWSLETTER u 9 6 n d e d 1 Volume XXV, Number 1 JULY 2000

Special Section: Chair’s Column ♦ ♦ The Journal of Training BY NADINE J. KASLOW, PH.D., SEE PAGES ...... 6-13 ABPP

APPIC Postdoctoral Membership and Review Since writing my Committee Completes Term of Office last APPIC News- letter column, the BY KATHLEEN R. BOGGS, PH.D APPIC Board, APPIC Central Office Administrative The Postdoctoral Membership and Review Committee Director (Connie Hercey), Public with Chair Philinda Smith Hutchings, Ph.D., ABPP, and Members Member Designate (Mona Mitnick, James E. Dobbins, Ph.D., ABPP, and George Vesprani, Ph.D. held J.D.), Committee Chairs, and liaisons their first meeting in Cincinnati, Fall 1997. In 3 years, they recom- from other training and professional psy- mended 18 postdoctoral programs for APPIC Membership and re- chology organizations had a very pro- viewed for continued membership all APPIC Member ductive meeting in St. Pete, Florida. The Postdoctoral Programs which were not APA accredited. In addi- committee chairs in attendance were tion, they strengthened the Postdoctoral Membership Criteria Michael Carey, Ph.D. (Doctoral through suggested changes approved by the APPIC Membership. Membership Committee), Karen They wrote the Postdoctoral Membership Clarification Document Schmaling, Ph.D. (Doctoral Review published in the APPIC Directory, developed a standard report format for the Committee), Steve Holliday, Ph.D. Committee, revised the Postdoctoral Membership Application Form, and revised the (Postdoctoral Membership and Review procedures for program application and review in the APPIC Policy and Procedures Committee), Robert Hall, Ph.D. and Manual. They sent over 600 invitations to join APPIC to agencies advertising postdoc- Jeanette Hsu, Ph.D. (Directory Co- toral positions and designed a survey to assess needs of APPIC Member Postdoctoral Editors), Gordon Williams, Ph.D. Programs. This Committee held their last meeting April 19-20, 2000. The APPIC Board (Website Coordinator), and Carl Zimet, expresses appreciation for their excellent service in not only reviewing programs for Ph.D. (APPIC Standards and Review membership but also in refining and enhancing the criteria, documents, and policies Committee). These individuals all work and procedures for program review. They will be recognized for their contributions at extremely hard for APPIC and they do the APPIC Membership so in a very conscientious, responsible, Meeting at APA in and thoughtful manner. Without their August. To provide transi- dedication and the help of the members tion, Dr. Hutchings has of their committees, much of the “busi- been working with Dr. ness of APPIC” would not be accom- Stephen Holliday, ABPP, plished in such a timely and effective Chair of the incoming way. These people are some of the un- Postdoctoral Membership sung heroes and heroines of APPIC, and and Review Committee thus on behalf of the APPIC Board and which will hold their first Membership, I want to say THANK meeting in October. Dr. YOU! Kathleen Boggs has As all of you know, the training of pre- worked closely with the doctoral interns and postdoctoral resi- Committee as the APPIC dents occurs in a larger context of grad- Board Contact. Drs. Vesprani, Hutchings, & Dobbins uate training, licensure, certification, continued on page 3 continued on page 4

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ASSOCIATION OF ASSOCIATION OF PSYCHOLOGY POSTDOCTORAL AND INTERNSHIP CENTERS PSYCHOLOGY (APPIC) POSTDOCTORAL AND INTERNSHIP CENTERS The Association of Psychology Post- Board of Directors Associate Editors doctoral and Internship Centers (APPIC) (Terms expire as noted by year ADULT GENERAL PSYCHOLOGY was formed in 1968 to foster the sharing of after name) David E. Aronson, Ph.D., ABPP information about mutual concerns and to CHAIR Massillon Psychiatric Center PO Box 540 provide a uniform voice with respect to Nadine Kaslow, Ph.D., ABPP (2002) pre- and postdoctoral internship training Department of Psychiatry Massillon, OH 44648 Emory University School of Medicine CHILD CLINICAL PSYCHOLOGY interests within psychology. 80 Butler Street SE Jon V. Thomas, Ph.D. We publish a newsletter three times per Atlanta, GA 30324 Child and Adolescent Service Center year for our members. We are recognized 404/616-4757 1226 Market Avenue, North by APA as the primary organization to con- Canton, OH 44714-2658 CO-VICE CHAIR sult about internship training. Since our in- Nancy Garfield, Ph.D. (2000) FORENSIC PSYCHOLOGY ception, we have maintained a formal liai- Colmery-O’Neil VA Medical Center Randy K. Otto, Ph.D., ABPP son with APA’s Education Directorate. 2200 Gage Blvd. Florida Mental Health Institute Topeka, KS 66622 University of South Florida We publish an annual Directory of 913/350-3111 13301 Bruce B. Downs Boulevard Internship and Postdoctoral Programs in Tampa, FL 33612-3899 CO-VICE CHAIR Professional Psychology, which is intended DOCTORAL REVIEW COMMITTEE GEROPSYCHOLOGY in part as a service to students. BOARD CONTACT Victor A. Molinari, Ph.D. Approximately 1,500 copies of the Emil R. Rodolfa, Ph.D. (2001) Psychology Service (116B) Directory are now distributed each year. Counseling Center VA Medical Center University of California, Davis Houston, TX 77030 The Directory is updated every year in late 219 North Hall summer, and is free to APPIC members. Davis, CA 95616 HEALTH PSYCHOLOGY We also are responsible for establishing (Vacant) 530/752-0871 with our members a standardized proce- INTERNATIONAL ISSUES SECRETARY dure and a uniform date and time span for Janice S. Cohen, Ph.D. NEWSLETTER EDITOR Children’s Hospital of Eastern Ontario matching internship applicants and intern- Robert W. Goldberg, Ph.D., ABPP (2001) 401 Smyth Road ship programs. The procedural guidelines Mental Health Service, 116B (W) Ottawa, ON K1H8L1 Louis Stokes Cleveland DVA Medical Center are published annually in both the 10701 East Boulevard ISSUES CONCERNING PERSONS Newsletter and the APPIC Directory. Cleveland, OH 44106 WITH SERIOUS MENTAL ILLNESS Additionally APPIC operates a 216/791-3800 x4970 Sandra E. Tars, Ph.D., Clearinghouse to facilitate the placement Hutchings Psychiratic Center TREASURER 620 Madison Street of unmatched predoctoral internship appli- DOCTORAL MEMBERSHIP Syracuse, NY 13210 cants with unfilled positions at APPIC COMMITTEE BOARD CONTACT member programs. The Clearinghouse Gerald Leventhal, Ph.D. (2000) ISSUES GERMANE TO UNIVERSITY University of Medicine and COUNSELING CENTERS starts its operation after the Uniform Dentistry New Jersey Anna Beth Payne, Ph.D. Notification date for predoctoral matching. 215 South Orange Avenue Counseling & Student Development Center Please see the current APPIC Directory Newark, NJ 07103 Northern Illinois University for detailed information on the 973/972-4869 DeKalb, IL 60115 Clearinghouse. POSTDOC MEMBERSHIP COMMITTEE LITERATURE REVIEW APPIC Membership is by institution James M. Stedman, Ph.D. BOARD CONTACT rather than by individual. In order to be a Kathleen Boggs, Ph.D. (2000) University of Texas Health Science Center University of Missouri Counseling Center 7703 Floyd Curl Drive member of APPIC, an internship program Columbia, MO 65211 San Antonio, TX 78284-7792 must be one year full-time or two years half 573/882-6601 NEUROPSYCHOLOGY time, accept only applicants enrolled in a MATCH COORDINATOR Dean R. Skadeland, Psy. D. regionally accredited doctoral degree Greg Keilin, Ph.D (2002) Neuropsychology Clinic (116B) granting program in professional psychol- Counseling and Mental Health Center VA Medical Center ogy, be directed by a licensed professional 4801 Linwood Boulevard The University of Texas at Austin psychologist, meet other relevant member- 100-A West 26th Street Kansas City, MO 64128 ship criteria, and provide annual updates of Austin, TX 78712 SETTING-RELATED ISSUES 512/475-6949 Robert H. Goldstein, Ph.D. descriptions of its program for the APPIC Directory. PUBLIC MEMBER 919 Westfell Rd., Ste, B-240 ASARC BOARD CONTACT Rochester, NY 14618 Membership dues are $400 for pre-doc- Patricia A. Hollander, Esq. (2000) ***** toral internship programs, $400 for free- 330 E. 39th Street WEBSITE COORDINATOR standing post-doctoral training programs, Apt. 19L J. Gordon Williams, Ph.D. and $650 for pre-doctoral and post-doctoral New York, NY 10016 Counseling Center 212/370-4361 207 Student Services programs at the same agency/institution. Michigan State University Application fees are $250 per application. PAST CHAIR East Lansing, MI 48824-1113 Peggy J. Cantrell, Ph.D. (1999) Non-APA-accredited internship programs, 517/355-8270 VA Medical Center and post-doctoral training programs are re- Fax: 517/353-5582 Psychology Service 116B viewed in order to determine whether they 4801 Linwood Boulevard meet APPIC membership criteria. For fur- Kansas City, MO 64128 816/861-4700 x2681 ther information write to APPIC, c/o Ms. Connie Hercey, MPA, 733 15th Street, NW, Suite 719, Washington, D.C., 20005, or call 202/347-0022.

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Remarks From In This Issue the Editor: CHAIR’S COLUMN ...... NADINE J. KASLOW 1 APPIC POSTDOCTORAL MEMBERSHIP & REVIEW Comings and COMMITTEE COMPLETES TERM OF OFFICE ...... KATHLEEN R. BOGGS 1 Goings REMARKS FROM THE EDITOR ...... ROBERT W. G OLDBERG 3 SPECIAL SECTION: BY ROBERT W. G OLDBERG, PH.D., ♦ ♦ ABPP THE JOURNAL OF TRAINING AVAILABILITY OF TRAINING IN PSYCHOLOGICAL TESTING AND THE Reviewing the material in preparation PSYCHOTHERAPIES DURING THE PREDOCTURAL for this issue, I was struck with the num- INTERNSHIP ...... JAMES M. STEDMAN, ber of “Comings” and “Goings” that will JOHN P. H ATCH, & LAWRENCE S. SCHOENFELD 6 be evident to the careful reader: ADDICTIONS TREATMENT: THE MISSING COMPONENT IN PSYCHOLOGY Coming: Actually, it is here: the sec- ond ‘Journal of Training’ issue, with some TRAINING ...... JERRY A. MORRIS, JR.7 excellent and thoughtful contributions to the corpus of internship training liter- INTEGRATING GROUP THERAPY TRAINING ON ature. INTERNSHIP ...... HOWARD E. MARKUS Going: The ‘Journal of Training’ issue & DEBORAH A. KING 8 concept. While submissions have been WATCH WHERE YOU WALK: AN APPEAL FOR HUMANE INTERNSHIP of high quality, they have not been of sufficient number to sustain this concept INTERVIEWING AND OTHER APPLICATION PROCESSES . . .KAREN E. JOSEPH, in this form. We will instead be focusing KEVIN E. VOWLES, & DANIEL W. M CNEIL 9 on special theme issues or special sec- REPORT ON EDUCATION AND TRAINING IN BEHAVIORAL EMERGENCIES tions within issues. Please see the CALL (ABRIDGED) ...... PHILLIP M. KLEESPIES, FOR PAPERS on Family Therapy ALAN L. BERMAN, THOMAS E. ELLIS, Training and Psychology Training in Primary Care. RICHARD MCKEON, DALE E. MCNIEL, Coming: Janice S. Cohen, the new MATTHEW NOCK, HEIDI RESNICK, JOE SCROPPO, Associate Editor for International EDWIN S. SHNEIDMAN, JASON S. SPIEGELMAN, Issues. Dr. Cohen is the Canadian ANTHONY SPIRITO, AND ROBERT I. YUFIT 10 Council of Professional Psychology PUT IT IN THE BANK ...... STEPHEN T. D EMERS 11 Programs’ liaison to the APPIC Board and psychologist at the Children’s NOT FOR STUDENTS ONLY—THE NATIONAL PSYCHOLOGIST TRAINEE Hospital of Eastern Ontario. REGISTER ...... JUDY HALL 12 Going: Kathleen Boggs, whose term TRACKING PRACTICUM HOURS DURING GRADUATE of office on the APPIC Board expires TRAINING ...... AMY D. HERSCHELL shortly, and whose news contributions & DANIEL W. M CNEIL 13 regarding the Bi-Annual Membership Conferences, Postdoctoral Membership ALSO IN THIS ISSUE: and Review Committee, and Tips for Trainers columns will be missed. APAGS GUEST COLUMN ...... TAMARA DUCKWORTH 14 Coming: Tamara Duckworth, new INTERNSHIPS AND THE LAW ...... PATRICIA A. HOLLANDER 15 APAGS liaison to the APPIC Board, who ASSOCIATE EDITORS ...... JON V. THOMAS, VICTOR MOLINARI, will now solely author the APAGS Guest JANICE S. COHEN, SANDRA E. TARS, ANNA BETH PAYNE, Column. Ms. Duckworth is a graduate student at the University of Florida. JAMES M. STEDMAN, & ROBERT H. GOLDSTEIN 16 Going: Anna Beth Payne as Associate MINUTES ...... ROBERT W. G OLDBERG 20 Editor for Issues Germane to Counseling Centers, who always an- swered the bell with lively content and special articles. CALL FOR PAPERS: Coming: A new Associate Editor for Health Psychology . . . . eventually! FAMILY THERAPY TRAINING Going: Pat Hollander, whose long PSYCHOLOGY TRAINING IN PRIMARY CARE term of service as Public Member on the APPIC Board will shortly end. Pat Upcoming Special Sections in the APPIC Newsletter will feature articles on FAM- was unfailingly the first regular contrib- ILY THERAPY TRAINING and in PSYCHOLOGY TRAINING IN PRIMARY CARE utor to send me her column for each and and submissions are invited for any aspect of these areas of internship training. every issue; in fact, some submissions Deadline for submissions is September 15; please send them to APPIC Central preceded my official call and reminded Office. Prospective contributors wishing to communicate with the Editor Dr. me of an impending deadline. Her co- Goldberg about suitability of a topic or concept can do so by e-mail at gent discussion of case law relevant to [email protected] or telephone at (216) 791-3800, x4970. internship training always made sense and will be sorely missed. APPIC NEWSLETTER JULY 2000 3 APPIC-June 2000 12/16/03 3:48 PM Page 4

Chair’s Column from all relevant constituency groups. I and at times illegal questions by some continued from page 1 strongly encourage graduate programs internship and postdoctoral trainers and to consider devising creative strategies current interns and postdoctoral resi- to defray part or all of these costs for dents. Guidance on this matter is of- and the job market. Thus, when dis- their students. fered in this Newsletter and later cussing many issues pertinent to intern- There was extensive discussion re- Newsletters and ultimately will be avail- ship and postdoctoral training, it is es- garding the timing of the APPIC Match, able on our website (www.appic.org). sential that we dialogue with our with a strong indication from represen- Please remember the importance of not colleagues associated with other aspects tatives of the training councils that it asking inappropriate or illegal questions of the development of professional psy- would be preferable to move the applica- (e.g., which of the sites at our consor- chologists. Therefore, we are grateful tion process later and APPIC Match Day tium do you rank first, how will you and that our cadre of liaisons from other or- to mid April. This may reduce the your husband manage living apart or are ganizations is growing. This year, some amount of time students spend on the in- you planning to have him move with familiar faces were at our Board ternship application process, and would you, do you think with your disability Meeting, including Frank Collins, Ph.D. likely decrease the disruption to stu- that you will be able to handle the rigors (Council of University Directors of dents’ academic training. Therefore, we of our training program). Please educate Clinical Psychology - CUDCP), Janice are considering moving the 2002 (not your staff/faculty and trainees about Cohen, Ph.D. (Canadian Council of 2001) Match later, but will survey our what questions are appropriate and what Professional Psychology Programs - members prior to making a final deci- questions are not appropriate. CCPPP), and Nancy Elman, Ph.D. sion. In reflecting on our activities and pri- (Council of Counseling Psychology Regardless of the timing of future orities over the past few years, it became Training Programs - CCPTP). We are APPIC Matches, for the upcoming clear to the APPIC Board that we have pleased to have new liaisons from the Match, we strongly encourage all pro- not devoted as much attention to post- National Council of Schools and grams to VOLUNTARILY COMPLY doctoral training as we had planned. Programs in Professional Psychology with the following recommendation: AP- Therefore, we have decided to under- (NCSPP) (Leonardo Marmol, Ph.D.) PLICATION MATERIALS DUE NO- take a number of activities to enhance and the APA Graduate Student VEMBER 15, 2000, INTERVIEW NOTI- our focus on postdoctoral training. This Association (APAGS) (Tamara FICATION NO LATER THAN year, we will be sending out separate Duckworth). And, for the first time, we DECEMBER 15, AND A SUFFICIENT surveys to internship and postdoctoral had representatives from the NUMBER OF INTERVIEW DATES trainers, and the survey for postdoctoral Association of State and Provincial SHOULD BE AVAILABLE MORE trainers will be focused specifically on Psychology Boards (ASPPB) (Mary THAN 21 DAYS FOLLOWING NOTIFI- key issues most pertinent to their work, Willmuth, Ph.D.) and the National CATION. This recommendation is par- such as uniform application, uniform no- Register (NR) (Judy Hall, Ph.D.). ticularly geared toward those sites that tification date, and funding concerns. In The diverse nature of the group com- have on-site interviews, as such an ap- addition, we will place Self-Study materi- bined with the value each participant proach will enable students to obtain the als for APA accredited postdoctoral places on high quality education and lowest possible airfares and to coordi- training programs on our website. More training, career development of individu- nate their travel plans with multiple time at the APPIC Membership als in the “pipeline”, and forging collabo- sites. Again, for both internship and Conference will be devoted to postdoc- rations to address the complex and chal- postdoctoral applicants, we urge you to toral training. Please email me if you lenging issues facing professional consider a broad array of options that have additional suggestions for the role psychology today led to a very lively, will help applicants reduce their costs APPIC can play in supporting and advo- fruitful, and collegial interchanges. (e.g., multiple interview dates, phone in- cating for formalized postdoctoral train- Therefore, I want to highlight some of terviews for those who can not afford to ing programs. the major topics that we discussed. come in person, use of video conferenc- One of the professional activities that Much time and attention was focused ing, providing housing with people in I have personally found to be the most on the APPIC Directory-On-Line (DoL). the area). Of course, one of the most ef- rewarding and stimulating during the It was exciting to see Drs. Hall and Hsu fective ways for applicants to reduce past few months is participating in the demonstrate the use of the DoL. We their costs is to only apply to sites for Primary Care Public Policy Fellowship were able to update our databases and which they are a good fit. For applicants under the auspices of the Department of conduct searches. We decided, based on to ascertain their goodness of fit with a Health and Human Services. This fel- feedback that we received from our li- particular site, it is helpful for the site to lowship has afforded me the opportunity aisons, that individuals will have access provide as accurate and thorough a per- to focus more of my energies on training to unlimited searches. The complicated spective on the site as possible in all of in primary care settings for psychology issue of DoL pricing was examined in their written communications (e.g., interns and postdoctoral residents. To detail, with an eye toward balancing the brochures, web postings, Directory-On- highlight this issue for our members, we need to keep student costs at a mini- Line, mailings). See our ongoing Tips are organizing a series of articles on in- mum while simultaneously covering the for Trainers Section for more guidance novative training models in primary care actual costs of creating and maintaining and ideas. settings. These articles will be pub- an electronic Directory. We agreed to re- Another topic that has received con- lished in a Special Section of a subse- quire a $20 DoL fee per student entering siderable attention on the student list- quent Newsletter. Any of you with in- the APPIC Match for unlimited servs, as well as the listservs of acade- ternship or postdoctoral programs that searches. This fee has been set for a one mic Directors of Training, relates to the emphasize work in primary care set- year time period and will be re-evaluated documented and often justified con- tings or who have staff/faculty or former following the 2001 Match with input cerns regarding the use of inappropriate trainees based in primary care settings

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are encouraged to submit descriptions place from 11am - 2pm on the West to our wonderful APPIC Newsletter Steps of the U.S. Capitol. Finally, the Editor, Robert Goldberg, Ph.D., ABPP. date for our 2001 Membership Finally, in closing, I want to encour- Conference is March 29-March 31, 2001. age all of our readers, both members Jerry Leventhal, Ph.D. is planning a fab- PPIC and subscribers, to plan to attend the fol- ulous conference for us in New Orleans. lowing activities. The annual APPIC I hope to see as many of you as possible A Membership Meeting will be held at the at each of these events. I have appreci- annual convention of the APA in ated the opportunity to dialogue with Washington D.C. on Friday August 4, many of you via email over the past 2000 from 8-10:50am at the Grand Hyatt two years, and look forward to con- in Constitution C. A continental break- tinuing to do so in the future F fast will be served. Following the meet- ([email protected]). Please feel free o 8 ing, we hope that all of our members will to contact me regarding the myriad chal- u 6 join us for the National Psychology lenges we face as trainers. n 1 9 Graduate Student Rally that will take d e d

Association of Psychology Postdoctoral and Internship Centers Announces Two APPIC Pre-Convention Workshops American Psychological Association Convention Washington, DC - August 3, 2000

APPIC will offer two half-day pre-convention workshops at the August 2000 meeting of the American Psychological Association. The workshops will be held Thursday, August 3, the day before the convention. The workshops provide information and insights that will enhance your psychology internship or postdoctoral training program.

1. Workshop for New Training Directors Date, Time, Place: Presenters: Thursday, August 3, 2000; 1:00 p.m.-5 p.m.; Hotel Washington, Jerry Leventhal, Ph.D., Treasurer, APPIC Board of Directors, The Federal Room - 515 - 15th Street, NW Chief Psychologist and Training Director, University of Cost: $60.00 Medicine and Dentistry of New Jersey Workshop Focus and Goals: Emil Rodolfa, Ph.D., Vice-Chair, APPIC Board of Directors, An overview of multicultural competencies for professional Associate Director and Director of Training, Universe of psychology training and practice will be presented. Current California, Davis Counseling Center models and innovative resources to address the issues involved Date, Time, Place: will be demonstrated. The goal is to provide internship and Thursday, August 3, 2000, 8:00 p.m.-noon; Hotel Washington, postdoctoral trainers with approaches to integrating multicul- The Federal Room - 515 - 15th Street, NW tural training into their training program, as well as strategies Cost: $60.00 for enhancing the practice of culturally competent assessments Workshop Focus and Goals: and interventions. An overview of essential components of internship training in- cluding curriculum, supervision, funding, intern selection, Special Rate: Participants who attend both workshops pay APPIC Match policies, evaluation, intern impairment, due only $110.00 for the day. process, communication with academic programs, dual rela- tions, and more. Sign-up Information: Contact APPIC Central Office (202-347- 0022) for further information. We look forward to seeing you in 2. Training in Multicultural Competencies for Internship Washington, DC. Please view our website for announcements and Postdoctoral Residents concerning APPIC and the training community. www.appic.org Presenters: Madonna Constantine, Ph.D., Professor, Teacher’s College, Continuing Education Credits: Participants receive 4 CE Columbia University credits for each workshop. APPIC is approved by the American Nadine Kaslow, Ph.D., Chair, APPIC Board of Directors, Chief Psychological Association to offer continuing education credits Psychologist, Emory University School of Medicine, Atlanta, GA for psychologists and the MCEP to offer continuing education Greg Keilin, Ph.D., Member, APPIC Board of Directors, Staff credits for California psychologists. APPIC maintains responsi- Psychologist, The University of Texas at Austin. bility for this program.

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♦ Journal of Training ♦ Availability of Training in Psychological Testing and the Psychotherapies during the Pre-Doctoral Internship

BY JAMES M. STEDMAN, JOHN P. H ATCH, AND LAWRENCE S. SCHOENFELD THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO

Abstract ered only the “empirically validated” cording to the settings in which training What categories of psychological testing therapies. occurs. The relative percent representa- and psychotherapy are currently being Though the studies cited above offer tion of each type in our sample closely taught in the internship programs? The pre- some insight into the availability of train- matched the representation of each type sent investigation sought to answer this ques- ing in psychological assessment and the in the population of APPIC-member pro- tion by developing a comprehensive profile of psychotherapies during internship, they grams as reported in the APPIC internship training in the major categories of are for the most part narrowly focused Directory (Hall, Cantrell, & Boggs, psychological testing and psychotherapy, as and most are quite dated. In the present 1997). Thus our sample closely approxi- reported by the internship directors of the study, we sought to document more mates the APPIC membership and in- Association of Psychology Postdoctoral and comprehensively the availability of pre- cluded respondents from all US states Internship Centers (APPIC). Results indi- doctoral internship training in the more and all Canadian provinces. cated broad training in intelligence, objective important categories of psychological personality and projective personality testing testing and the psychotherapies. Analysis and similar broad training in the therapy The goals of this investigation were modalities; however, three modalities, cogni- The Project to develop availability profits for pre- tive-behavioral, short-term psychodynamic, doctoral internship training in psycho- and group, are offered most frequently. The Questionnaire logical testing and psychotherapy. implications of these patterns of availability The questionnaire was designed to Hence, results are presented in a de- are discussed with regard to the internships obtain information regarding the avail- scriptive format. themselves and with regard to prospective in- ability of psychological testing and psy- Table 1 (see page 26) presents find- terns. chotherapy experiences as training ings regarding training in test-based as- events during internship. Directors indi- sessment. Displayed are the percent- Substantial training in psychological cated whether or not interns conducted ages of programs in which interns assessment and the psychotherapies oc- five categories of psychological testing, administer the five categories of tests. curs during graduate/professional including the following categories: intel- Directors in all types of programs re- school education, and the pre-doctoral lectual, achievement, objective personal- ported high levels of access to training internship continues, enhances, and ity, projective personality, and neuropsy- in objective personality testing (avail- often broadens those efforts. Hence, it is chological. Particular tests were not able in 88 to 100% of programs within all important that our knowledge regarding specified beyond these categories. settings). All program types, except the availability of internship training in Directors also indicated whether or not University Counseling Centers, re- test-based assessment and psychother- interns conducted eight categories of ported high levels of access to intellec- apy be current and adequate. Surveys psychotherapy, including the following tual test training (96 to 100%); only 55% related to testing have inquired about modalities: long-term psychodynamic, of University Counseling Centers pro- training with specific tests, e.g., the short-term psychodynamic, cognitive- vide this training. Access to projective MMPI (Dahlstrom & Moreland, 1983), behavioral/behavioral, group, marital, personality training lagged somewhat projective tests (Piatrowski, 1984), and family, interpersonal, and play. but was reported at relatively high lev- instruction in neuropsychological as- els (72 to 100%), again with University sessment (Cripe, 1995; McCafferty, Participants Counseling Centers being the exception Malloy, and Brief, 1985). Older surveys Questionnaires were mailed to the in- (53%). Training in achievement testing of training in the psychotherapies exam- ternship directors of 524 of the 542 was more variable but is available at ined instruction in specific techniques, members of the Association of high rates in nine of the program types e.g., hypnosis (Rodolfa, Kraft, Kelly & Postdoctoral and Internship Centers (70 to 86%). Access to training in neu- Blackmore, 1983), group therapy (APPIC) in the United States and ropsychological testing was also avail- (Carmody & Zohn, 1980), alcohol treat- Canada. Eighteen programs were ex- able at high levels across nine types of ment (Bacorn & Conners, 1989). More cluded because they have only part time programs (70 to 96%) but at lower rates recently, Crits-Christoph, Chambless, positions or are having membership dif- in University Counseling Centers (10%), Brody, and Karp (1995) conducted a ficulties at present. Two mailings pro- Child Facilities (58%), and Correctional more comprehensive investigation of duced usable responses from 324 pro- Institutions (62%). the types of psychotherapy training oc- grams for a 62% return. APPIC-member curring during internship but consid- programs are classified into 12 types ac- continued on page 26

6 APPIC NEWSLETTER JULY 2000 ♦ Journal of Training ♦ APPIC-June 2000 12/16/03 3:48 PM Page 7

Addictions Treatment: The Missing Component in Psychology Training

BY JERRY A. MORRIS, JR., PSY.D. COMMUNITY MENTAL HEALTH CONSULTANTS, INC.

Abstract qualify for psychological intervention in Cost-Effectiveness of Psychological their lifetime (Regier, et al., 1984). Many Interventions Substance abuse and addition are serious of these individuals will suffer serious The high prevalence of substance health problems which will affect one in four and persistent mental illness and/or abuse and mental illness indicates that to one in seven patients seen by psychologists. chronic addiction and will be unable to between one in seven to one in four indi- Psychologists have amassed considerable re- work (Barker, et al., 1989; Higgins & viduals entering a primary healthcare search, theory, and techniques that have Silverman, 1999, p. 4). Many individuals system will have a diagnosable sub- demonstrated utility in dealing with the sub- screened in hospital emergency rooms stance abuse and/or mental health prob- stance use spectrum disorders. However, suffer from conditions directly or indi- lem (Morris & Wise, 1992). Data cover- very few psychology training systems have a rectly attributable to substance abuse ing the employed population in the substantial substance abuse treatment train- (Morris, 1997). These figures worry the United States (ages 18 and up) indicate government and managed care compa- that 10.3% of men and 4.1% of women are ing component. Because the economic and nies, and have resulted in various forms alcohol dependent (Parker & Harford, healthcare costs of substance abuse and ad- of contrived rationing of services as the 1992). Further, these authors note that diction are substantial, practitioners with primary approach to spiraling health 3.9% of men and 1.0% of women are se- skills in treating these disorders will be valu- care costs in the U.S. (Morris, 1994). verely chemically dependent. Many oth- able to facilities and the health care system. There are approximately 46 million ers will have a physical illness which is The American Psychological Association has smokers in the U.S. and many of them maintained by their behavior or related recognized the importance of this area of are addicted. Smoking is the most phys- to lifestyle. practice by developing the Office of Substance ically dangerous drug addiction killing It has been noted that the top risks to Abuse in the Practice Directorate and the nearly half of long term heavy users and good health in the United States (smok- Certificate of Proficiency in the Treatment of more people than all other drugs abused ing, diet, alcohol, unintentional injuries, Alcohol and Other Psychoactive Substance in combination (Slade, 1999). When we suicide, violence, and unsafe sex) are be- Abuse in the National College of Psychology. add smokers with complications to the havioral problems. Some of these behav- It is suggested that training directors de- figures just discussed, the numbers are ioral problems give rise to addictive pat- velop faculty with expertise and skills in the staggering. Of course, many who are ad- terns. Psychological and addictions treatment of alcohol and psychoactive sub- dicted to nicotine are also addicted to interventions are more appropriate than stance abuse. Training programs are encour- other substances. The reasons for inclu- medical services for these patients aged to focus program resources on provid- sion of nicotine when treating other ad- (VandenBos, 1993). ing students with background and skills dictions were explored by Hoffman and The total economic costs of alcohol which will prepare them to deal with patients Slade (1992). They conclude that smok- abuse and dependence for 1990 are esti- with psychoactive substance abuse disorders. ing is one of the most preventable major mated to be $98.6 billion with medical causes of death, negative effect on other care costs estimated at $10.5 billion. In this manner, psychology can address a drug addictions, presents significant Psychological and addictive behaviors glaring weakness in the training of psycholo- danger of secondary smoke related resulting in medical care, or failure to gists in the United States of America. health problems, and smoking is often a treat the behavioral aspects of medical Substance abuse and dependence is cue for relapse. care, add additional costs (Rice, 1993; one of the most serious behavioral Psychologists and addictions special- Hartman-Stein & Reuter, 1993). health problems in America. 24 million ists are reminded that smoking is the Targeting mental health interven- members of U.S. households age 12 most addictive and pathological drug, tions to Medicaid patients with sub- years and older report illicit drug use in killing nearly half of those addicted to stance abuse disorders reduced medical the past year and nearly 14 million re- nicotine (McCrady & Epstein, 1999, p. care costs as much as $514 per person port use in the past month (Substance 3). Cigarette smoking remains the lead- (15%) per year. Medical costs for Abuse and Mental health Services ing cause of preventable mortality in the Medicaid patients who had substance Administration [SAMHSA], 1998a; U.S. with 20% of all deaths directly re- abuse disorders but who did not receive 1998b). From 1993 to 1997, the number lated to smoking (Shoptaw et al., 1999). mental health treatment increased 91% of individuals who reported using People addicted to other drugs are (Cummings, Dorken, Pallak, & Henke, heroin in the past month increased from about three times more likely to smoke 1990). Counseling and mental health 68,000 to 325,000, and the number of 12- cigarettes with a 60-80% prevalence rate components are necessary to treat com- 17 year olds who reported using illicit (Hurt, Eberman, Slade, & Karan, 1993). pulsive, addictive processes such as eat- drugs in the past month almost doubled While there has been some leveling off ing disorders, smoking, and reckless, from approximately 1.4 million to 2.6 of rates of smoking in adults, among thrill seeking behaviors which nega- million (SAMHSA, 1995; 1998a; 1998b). youth there has been little, if any, de- tively affect long-term physical health. Approximately 10 individuals per 100 cline in rates with some estimates indi- Depression, another major behavioral suffer from mental disorder (Kaplan & cating that as much as 30% of high health problem, is clearly and frequently Sadock, 1985; Regier, et al., 1984), and school seniors smoke (Hymowitz, 1998). associated with substance abuse and de- another 20 patients per 100 population This bodes poorly for the future, and pendence. Research indicates that the from substance abuse or dependence smoking is likely to re-emerge as an in- psychologist treating depression in a be- (Regier, et al., 1984; Regier, et al., 1990). creasing problem in the next generation Over half of all United States citizens will of adults. continued on page 28

♦ Journal of Training ♦ APPIC NEWSLETTER JULY 2000 7 APPIC-June 2000 12/16/03 3:48 PM Page 8

Integrating Group Therapy Training on Internship

BY HOWARD E. MARKUS, PH.D., C.G.P. DEBORAH A. KING, PH.D., ASSISTANT TRAINING DIRECTOR (PSYCHOLOGY) AND TRAINING DIRECTOR (PSYCHOLOGY)

DEPARTMENT OF PSYCHIATRY UNIVERSITY OF ROCHESTER SCHOOL OF MEDICINE AND DENTISTRY

Abstract Didactic Instruction: We are commit- Supervision: Clinical supervision ted to the belief that clinicians must be takes place in two formats—live individ- In light of the documented efficacy and well-grounded in psychological theory ual supervision and group supervision growing utilization of group psychotherapy as and conceptualization. While knowledge of group therapy (“group supervision of a principal treatment modality, group therapy of individual psychological theory and group”). In at least one of the groups skills will become increasingly essential for skills in individual treatment approaches they lead, interns are paired with a co- psychologists. This article describes the are essential for group clinicians, they therapist who is a senior clinician with group therapy training program that exists as are insufficient to ensure adequate demonstrated expertise in group ther- part of the required predoctoral internship group therapy skills. There is a distinct apy. Typically, the intern and his or her curriculum at the University of Rochester theoretical base and intervention strat- co-therapist also meet outside of group Medical Center. In this paper, we address the egy for group treatment. At our training for 30-60 minutes per week to discuss essential elements of such a program as well site, we offer a 12-hour didactic seminar conceptualization and treatment strat- as the various challenges that must be con- on the principles of group psychother- egy. Evaluation of the supervisory dyad fronted in order to maximize the likelihood apy. Historical perspectives and an is bi-directional; both intern and super- that such a training program will be imple- overview of the major schools of group visor offer verbal and written feedback mented successfully. therapy approaches (i.e., psychody- at two points during the year. The pair- namic, cognitive-behavioral, interper- ing of trainee and supervisor as a co- In order to address this deficit in sonal, and system-centered) are pro- therapy dyad creates a possible power training and with hopes of fostering vided. The role of the group therapist is differential between group leaders more positive beliefs and attitudes to- addressed, with special emphasis on which may stifle the trainee’s spontane- ward group therapy, we have estab- sources of therapist affect, therapeutic ity and impact on group process. lished a comprehensive group therapy tasks, and treatment strategy. The semi- Feelings of vulnerability and exposure training component within our predoc- nar focuses on how group psychother- for both the supervisor and supervisee toral internship program. It is not our in- apy can be used to improve patients’ may increase the anxiety and stress dur- tent to make all interns into practicing level of psychosocial functioning and ing the early stages of their work to- group psychotherapists. Some interns how to assess which persons are appro- gether. This necessitates the creation of become excited and invested in learning priate for which type of group (or no a safe, open supervisory relationship in and conducting therapy groups. Others group at all). Lectures and discussions which the participants can discuss their discover that their interests and talents are supplemented by an extensive read- feelings and reactions to working to- are best served through an individual ing list and a take home “final exam”. gether as well as its impact on group treatment approach. Our goal is to pro- Group leadership experience: All in- process. Supervisors and interns alike vide sufficient experience, both didactic terns are given the opportunity to lead report that this training format is both and experiential, so that the interns or co-lead a treatment group. In the out- enriching and educational. leave our program with greater aware- patient ambulatory program of the med- The second supervision format is ness of the practice and utility of group ical center, we have the luxury of over 20 group supervision of group therapy. therapy. The design of our group ther- therapy groups running at any given Two times per month, interns meet to- apy rotation is based on the guidelines time. These groups range from time-lim- gether with the director of group ther- set forth by the American Group ited psychoeducational formats to ongo- apy training in psychology (first author) Psychotherapy Association (AGPA) and ing interpersonal process modalities. In during their lunch hour. This forum is the National Registry of Certified Group addition, myriad homogeneous “topic” used as an opportunity for trainees to Psychotherapists. For those trainees groups such as Eating Disorders, discuss their experiences leading who wish to conduct therapy groups in Anxiety Management, and Parenting groups, including their fears, anxiety, their professional practice, our training Skills exist. To whatever extent possible, missteps, and successes. It allows program offers an additional benefit in we endeavor to assign trainees to groups trainees to experience the powerful im- that it fulfills some of the requirements that are of particular clinical interest pact of universality, cohesion, and en- for certification with the National (e.g., an intern whose professional aspi- couragement from peers that is possible Registry of Certified Group rations include working with the deaf within a group setting. Group supervi- Psychotherapists. population was linked with an interper- sion has a number of additional advan- Our training consists of four central sonal process group for deaf adults). tages. Trainees’ beliefs and attitudes to- components: didactic instruction, group Interns also have the opportunity to lead ward group therapy are explored and leadership experience, supervision, and treatment groups at the state psychiatric verbalized—including misgivings and an experiential process group. Each ele- hospital where they do approximately criticisms of the treatment approach. ment will be described in turn and then 25% of their training. Throughout the Group supervision of group also pro- we will discuss some of the larger sys- training year, our interns can accumu- vides a venue in which interns can dis- tems issues of implementing such a pro- late approximately 75-100 hours of gram. group therapy leadership experience. continued on page 30

8 APPIC NEWSLETTER JULY 2000 ♦ Journal of Training ♦ APPIC-June 2000 12/16/03 3:48 PM Page 9

Watch Where You Walk: An Appeal for Humane Internship Interviewing and Other Application Processes

BY KAREN E. JOSEPH, KEVIN E. VOWLES, AND DANIEL W. M CNEIL WEST VIRGINIA UNIVERSITY

Abstract process, and offer suggestions to make that focused on describing their site The process of applying for a psychology the process even better. We interviewed honestly to students versus solely internship is inherently stressful generally, 15 individuals trained at doctoral gradu- drilling them with questions. including interviewing as a significant spe- ate programs in psychology who cur- Interviewing with faculty and interns cific stressor. APPIC has made great strides rently were applying for or were on in- was described as good preparation for toward making the application process fair ternship. We asked all interviewees, via applying for postdoctoral fellowships and limiting applicant stress. Positive aspects a series of open-ended questions, to list and jobs. of current procedures are noted, along with the positive and negative aspects of the present problems. Ten suggestions for en- internship application process and to Grievances with the Internship hancement are offered, at both the systems offer their suggestions for improvement. Application Process and individual site level. Also reflected in this article are com- ments from some students who have re- Poor Access to Current Information Looking across an office at an eager, cently completed their internship, some about Internship Sites spit-and-polished, professionally-attired doctoral training program directors, and Applicants indicated that a negative interviewee, it may be difficult to com- some internship training directors, as aspect of the internship application prehend that this individual is truly des- well as some ideas of our own. process was receiving outdated applica- perate. Unless the person “loses it” by tions or program information from web addressing your staff, or even you, Positive Aspects of the Internship sites which had not been updated. This snidely or sarcastically after just one too Application Process resulted in many individuals having in- many frustrations, you may not realize As noted by Boggs (1999), the accurate program information, submit- the extreme stress that some or many Association of Psychology Postdoctoral ting applications incorrectly, or repeat- applicants experience during the intern- and Internship Centers (APPIC) has ex- ing steps upon learning that the ship application process, particularly ercised judicious and forward-looking information was outdated. The extra during interviewing. leadership in changing and then “tweak- telephone calls that students felt com- It is inherently stressful to apply for ing” the internship application process pelled to make to internship programs internship when one considers the in- over the past five years. The APPIC upon noticing obsolete information were vestment that applicants have made in board has been courageous in institut- described as time consuming, frustrat- terns of time and money, as well as the ing essential improvements in the ing, and costly. Lack of access to down- countless personal sacrifices, to get to process. The students that we inter- loadable applications for many sites also that career stage. The fact that intern- viewed noted many examples of im- was rated negatively. Additionally, stu- ship directors and faculty have a tremen- provements. For instance, the computer dents were frustrated by lack of infor- dous amount of power, whereas student match reduces stress levels and time mation about research opportunities for applicants have relatively little, only spent strategizing under the old system. interns and post-internship possibilities. compounds the stress and lack of con- The APPIC Application for Psychology trol that students can feel. We realize Internship (AAPI) also saves time and An Unnecessarily Time-Consuming, that most internship directors and fac- provides crucial standardization at a Complex, and Unclear Process ulty probably never wanted and may not time when applicants increasingly find it Many respondents indicated that enjoy the power they hold. Nonetheless, necessary to apply to a large number of being asked by internship sites to an- they do have a remarkable amount of sites. swer multiple questions in addition to power and need to act judiciously and Students indicated that some intern- those required by the AAPI, especially flexibly. Just as a large, benevolent, ele- ship programs have made advances to those that were redundant, was a nega- phant meandering down a path cannot facilitate the internship application tive aspect of the process. Students also see where it steps, and may inadver- process. Updated information about in- expressed discontent over internship tently kick, crush, or maim other crea- ternship programs available on the web sites requiring different application tures, even without intent to do so, or has enabled convenient access to impor- steps. For example, sites had different knowledge of the deed, internship direc- tant facts. Downloadable application application deadlines, requirements for tors and faculty also may not see where forms on the web were rated as more the number of transcripts and letters of they step. If they do not place their convenient, time- and cost-efficient, and recommendation to send, and policies weight carefully and plan their path, easier to use than paper applications. for how to submit materials. Applicants they may inadvertently harm others Internship programs that required the conveyed that applying to numerous who are less powerful than they. AAPI alone for their application de- sites, each with its own specifications, This article is intended to increase creased redundancy and saved students made the process unnecessarily confus- the attention of internship staff to the time. Time to interact with faculty and impact their power has on applicants, interns during interviews was reported highlight reported student grievances as a positive aspect of the process. continued on page 31 regarding the internship application Applicants appreciated internship sites

♦ Journal of Training ♦ APPIC NEWSLETTER JULY 2000 9 APPIC-June 2000 12/16/03 3:48 PM Page 10

Report on Education and Training in Behavoral Emergencies: Abridged Version1

BY THE TASK FORCE ON EDUCATION AND TRAINING OF THE SECTION ON CLINICAL EMERGENCIES AND CRISES (SECTION VII), SOCIETY OF CLINICAL PSYCHOLOGY (DIVISION 12), AMERICAN PSYCHOLOGICAL ASSOCIATION PHILLIP M. KLEESPIES2, ALAN L. BERMAN, THOMAS E. ELLIS, RICHARD MCKEON, DALE E. MCNIEL, MATTHEW NOCK, HEIDI RESNICK, JOE SCROPPO, EDWIN S. SHNEIDMAN, JASON S. SPIEGELMAN, ANTHONY SPIRITO, AND ROBERT I. YUFIT

Statement of Purpose immediate response to avoid serious Patient Suicidal Behavior The purpose of this report is to docu- and irreversible harm. Fortunately, Those who have studied the inci- ment the critical need for improved clin- there are relatively few situations in psy- dence of actual patient suicide have re- ical education and training in the evalua- chological practice that qualify as behav- ferred to it as “an important occupa- tion and management of psychological ioral emergencies. They include (1) se- tional hazard for psychotherapists” or behavioral emergencies. The report rious suicidal states, (2) potential (Chemtob, Bauer, Hamada, Pelowski, presents evidence on the incidence of violence, (3) states of very impaired and Muraoka, 1989; p. 294). In a national behavioral emergencies in clinical prac- judgment in which the individual is en- survey of psychologists, 97% of the re- tice; the impact of dealing with behav- dangered, and (4) situations of grave spondents reported being afraid of los- ioral emergencies on practitioners (par- risk to a relatively defenseless victim ing a patient to suicide (Pope and ticularly those in training); the status of (e.g., an abused child or elder). Tabachnick, 1993). current psychological training in evalu- A behavioral crisis, on the other hand, Several studies have been conducted ating and managing emergencies; and is said to occur when a patient or client in recent years that have helped to doc- recommendations for how the profes- is faced with a set of circumstances for ument the incidence of patient/client sion might improve its education and which is or her resources for coping are suicidal behavior in clinical practice, al- training in this regard. insufficient and overwhelmed. A though much of the research has been marked increase in anxiety or tension limited to the incidence of completed Definitions usually occurs, and the person searches suicide. Thus Chemtob and his col- The term “emergency” can have dif- for alternative methods of coping. If leagues surveyed both psychologists ferent meanings. In a general sense, it these other methods also fail, the indi- and psychiatrists concerning the inci- may mean an unforeseen circumstance vidual enters a state of crisis. A state of dence of patient suicide in their practice. that calls for immediate action. In regard crisis, however, does not necessarily Chemtob, Hamada, Bauer, Kinney, and to mental health emergencies, however, imply that the patient or client will en- Torigoe (1988) found that 259 psychia- Callahan (1994; 1998) has argued for a gage in life threatening behavior, and trist respondents (46% response rate), more specific use of the term, a use that consequently it does not require as im- 51% reported having had a patient com- implies risk of serious harm or death to mediate a response to avoid serious mit suicide. In a parallel study with psy- self or others unless there is some im- physical harm. As Kleespies, Deleppo, chologists, Chemtob, Hamada, Bauer, mediate intervention; and he distin- Gallagher, and Niles (1999) have Torigoe, and Kinney (1988) found that of guishes it from the term “crisis.” His pointed out, a crisis often precipitates an the 365 respondents (68% response point is that, in clinical practice, the def- emergency, but it is never sufficient to rate), 22% reported having had a patient inition of these terms can guide our explain it. Behavioral emergencies are commit suicide. Also surveying psychol- thinking, our decision making, and our determined by many factors including ogists, Pope and Tabachnick (1993) interventions. For the purposes of this predisposing or distal factors, acute or found that 28.8% of the clinicians in their report, therefore, a behavioral emer- proximal factors, and a relative lack of study experienced the completed sui- gency will be said to occur when a pa- protective factors (Rudd and Joiner, cide of a patient. Based on these studies, tient or client has reached a state of 1998; Moscicki, 1995). it appears that approximately 1-in-2 psy- mind in which there is an imminent risk In clinical practice, the practitioner is chiatrists and 1-in-4 psychologists are that he or she will behave in such a way asked to assess a variety of behavioral or likely to have a patient commit suicide at as to bring about serious harm or death psychological crises, and an important some time during their professional ca- to self or others unless there is some in- part of the work is attempting to distin- reers. tervention. The behavior is potentially guish between crises that may progress Kleespies, Penk, and Forsyth (1993) life threatening, appears to be imminent to emergencies and those that will not. examined not only the incidence of pa- (i.e., likely to occur in the next few min- tient suicide, but also a broader spec- utes, hours, or days), and requires an The Incidence of Patient trum of patient suicidal behavior during Emergencies in Clinical Practice the pre-doctoral training years of psy- Although some might say that patient chologists. They contacted 292 of a pos- emergencies are primarily in the sible 307 recent graduates from 11 dif- province of the emergency room or cri- ferent internship programs. Of those sis team clinician (Dubin and Weiss, contacted, 100% participated in the sur- 1A copy of the complete version of this 1991), this is clearly not the case. A pa- vey. It was found that 97% of the respon- Task Force Report can be obtained by writing tient emergency can arise in the course dents had had at least one patient with to: Phillip M. Kleespies, Ph.D., Psychology of any clinician’s routine practice. In the some form of suicidal behavior or Service (116B), VA Medical Center, 150 section ahead, the evidence supporting ideation during their training years (i.e., South Huntington Ave., Boston, MA 02130. 2Phillip M. Kleespies is the Chairperson of this position is presented for patient sui- up to and including the internship year). cidal behavior, patient violent behavior, the Task Force. Following Dr. Kleespies, the continued on page 33 order of authors is strictly alphabetical. and patient victimization.

10 APPIC NEWSLETTER JULY 2000 ♦ Journal of Training ♦ APPIC-June 2000 12/16/03 3:48 PM Page 11

Put It In The Bank

BY STEPHEN T. D EMERS, ED.D., DIRECTOR, ASPPB CERTIFICATION AND CREDENTIALS BANK PROGRAM

Obtaining one’s license to practice licensure standards over time, many both individual psychologists and psy- psychology is a complicated and time psychologists experience difficulty ob- chology licensing boards throughout consuming process. Often, the evidence taining licensure in another jurisdiction. the U.S. and Canada. We have received needed to document one’s qualifications Students, interns and residents who thousands of requests for applications for licensure is acquired over many open a credentials record will not only from individuals interested in acquiring years and across multiple settings (uni- be well positioned to document their the CPQ or opening a credentials versity, internship site, postdoctoral ex- training and experience to obtain their record. In February 2000, the APA perience, etc.). Once licensed, psycholo- initial license, but also well on their way Council of Representatives passed a res- gists frequently experience great to acquiring the ASPPB Certificate of olution affirming that “the attainment of difficulty obtaining a license in a new Professional Qualification in Psychology reciprocity of licensure and other mech- state or province if they decide to move, (CPQ), a mobility credential that makes anisms for professional mobility are ur- practice across state or provincial bor- relicensure in another state or province gently needed.” The resolution directed ders, or retire to a new location but con- simpler. Information archived in the two major APA committees to develop a tinue to practice. Most psychology li- Credentials Bank is thus available to plan in collaboration with ASPPB to censing boards require original qualify someone for the CPQ if they achieve this goal. The April 2000 APA documentation of meeting licensure re- meet eligibility requirements. Monitor carries a message from APA quirements, even if this experience or Information that may be easy for indi- President Pat DeLeon that focuses on requirement was satisfied years earlier viduals to acquire as they complete li- the need for psychology to address the and already documented to a previous li- censure requirements can be stored and problems of professional mobility and censing board. Given the likelihood of retrieved in the years ahead, perhaps practice across state boundaries and relocating during one’s career and the long after the last contact with intern- cites the CPQ as an important step for- growing interest in practice across state ship or postdoctoral supervisors, or long ward in addressing these concerns. and provincial boundaries through after other crucial licensure-related in- ASPPB is working with all its member telecommunications and other innova- formation is readily accessible. Such boards to encourage acceptance of the tive practice arrangements, the prob- archived documentation can be ex- CPQ for relicensure. ASPPB member li- lems associated with professional mobil- tremely helpful in maintaining one’s li- censing boards that accept the CPQ ity for licensed psychologists including censure eligibility since they can be ac- agree to accept the education, training, documenting qualifications for licensure cessed and submitted to any licensing supervised experience and examination and relicensure must be addressed. board, thereby avoiding many of the typ- performance of all CPQ holders without Doctoral students, interns and post- ical difficulties of documenting compli- further review. A jurisdiction may re- doctoral residents who plan to someday ance with licensure criteria. The fees to quire a CPQ holder to pass any local re- be licensed as a psychologist should open and maintain a credentials record quirement such as a jurisprudence consider taking advantage of the are reduced for students and interns so exam (e.g. on local mental health law), Credentials Bank program offered by that these individuals can take advan- training on abuse reporting, or a per- the Association of State and Provincial tage of this service while beginning sonal interview. Twelve states and Psychology Boards (ASPPB). The their professional careers. For students provinces now accept the CPQ including Credentials Bank is an electronically who are completing requirements for a Alberta, California, District of Columbia, stored record of university transcripts, doctoral degree (e.g. internship), and Kentucky, Mississippi, Nevada, Ohio, supervised experience, work experi- for individuals completing the postdoc- Oklahoma, Ontario, Pennsylvania, ence, and examination performance that toral experience required for initial li- Vermont and Wisconsin. Eight other can be reproduced and transmitted to a censure, fees are $50 U.S. to open a cre- states and provinces (Alabama, licensing board where one is seeking li- dentials record (which includes the first Connecticut, Manitoba, Michigan, censure. ASPPB is the association of 61 year of banking), $50 U.S. for the second Missouri, new Mexico, Nova Scotia and psychology licensing boards in the U.S. year, and $75 U.S. for the third year. A Rhode Island) have decided to accept and Canada. It creates the written li- maintenance fee of $75 U.S. is required the CPQ and are working to amend their censing examination used by those every two years beginning after the rules or procedures to allow full imple- boards, the Examination for third year of credentials banking. The mentation in the near future. The Professional Practice in Psychology regular fee to open a credentials record ASPPB website (http://www.asppb.org) (EPPP), and operates several programs is $175 U.S. for individuals who are al- includes an up-to-date list of all states designed to facilitate professional mobil- ready licensed, with a $75 U.S. mainte- and provinces that recognize the CPQ. ity for psychologists, including the nance fee every two years. As more and more jurisdictions move to Certificate of Professional Qualification The CPQ and Credentials Bank pro- accept the CPQ, its value in facilitating in Psychology, or CPQ. grams are modeled after successful sys- mobility will increase. And, even if one The Credentials Bank program is part tems of professional mobility developed seeks to relocate in a jurisdiction that of ASPPB’s efforts to facilitate profes- in other professions such as architec- has not adopted the CPQ, establishment sional mobility for licensed psycholo- ture and pharmacy. The CPQ and of the credentials record with ASPPB gists. Because of variations in specific Credentials Bank programs have been requirements for licensure across states in operation for approximately 18 and provinces and because of changes in months and have been well-received by continued on page 38

♦ Journal of Training ♦ APPIC NEWSLETTER JULY 2000 11 APPIC-June 2000 12/16/03 3:48 PM Page 12

Not For Students Only—The National Psychologist Trainee Register

BY JUDY HALL, PH.D.

At the APPIC Board of Directors Application membership or hospital privileges. meeting in April 2000, Dr. Judy Hall, What are the benefits to students par- Organizations need only subscribe to Executive Officer of the National ticipating in the NPTR? the National Register OSD to identify Register of Health Service providers in Having the National Register review which psychologists have been creden- Psychology, presented information and approve students’ education and tialed and thus have on file at the related to the newly established training credentials will increase their National Register primary source verifi- National Psychologist Trainee Register national visibility because they will be in- cation of their approved internship, doc- (NPTR). So that internship directors, cluded in a special section of the Online toral degree and postdoctoral year of ex- faculty and students are informed about Searchable Database (OSD). This sec- perience. Subscribing organizations the NPTR, this article summarizes the tion for Trainee Registrants highlights include private, state, and federal ser- purpose, process and the benefits of the training component(s) approved by vice delivery systems (e.g., Blue participating in the NPTR and later the National Register and provides spe- Cross/Blue Shield, Medicare, medicaid, being credentialed by the National cific information on that credential. CHAMPUS, Magellan) and numerous Register. Verification of each approved element to hospitals. potential employers or licensing boards To assist training directors who are Purpose of the NPTR is then available for no charge. Once a applying for or renewing APA program The National Psychologist Trainee NPTR participant, the student receives accreditation, the National Register pro- Register (NPTR) allows the upcoming the Psychologist’s Legal Handbook and a vides the names of internship graduates generation of psychologists to apply on- subscription to the Register Report again later credentialed by the National line, bank their credentials with the at no charge. These publications offer Register for the programs to use as an National Register of Health Service extensive legal information/documenta- outcome measure. The same will be true Providers in Psychology (now in its 25th tion, scholarly insights, current events for Trainee Registrants. Internship di- year) and have each credential evalu- and other articles relevant to graduate rectors need only send an email to ated at the time of completion for its ad- students. Once licensed, these Trainee [email protected] requesting herence to national standards. The Registrants then become National the information needed. NPTR Registrants almost automatically, no ap- The OSD and optional personalized • saves the student money by freez- plication process, by just submitting web pages for National Registrants also ing the fees for the application proof of a license and a fee for the first help promote psychology as an indepen- (credential review), and the initial year of credentialing. Once credentialed dent healthcare profession and assist year of credentialing after the stu- by the National Register, Registrants the public in obtaining necessary infor- dent is licensed, have met the foundation requirements mation on the 14,000 qualified psycholo- • does not require a yearly or bian- for several other credentials. gists across the United States and nual fee to “maintain” the creden- What are some of the benefits to Canada who have qualified for the data- tials, those credentialed by the National base. Additionally, retirement and sup- • acts as a foundation for later cre- Register? plemental retirement plans for psycholo- dentialing by the National The newest benefit relates to the gists and trainee psychologists, their Register and other organizations, National Register securing “deemed sta- families and employees are available and tus” with the healthcare organiza- through the National Register, and read- • gives the student seven years in tions/plans seeking accreditation by the ing the substantive articles in the which to complete all three steps National Committee on Quality Register Report offers a way to earn free and licensure. Assurance (NCQA). This stems from continuing education credits. You may the decision to purposely rewrite the check this out at the web site at www.na- Application & Review Process NCQA new accreditation standards (Cr. tionalregister.org. The Credential Review process is di- 3.3 and 3.4) to specifically “include orga- To obtain more information on the vided into three steps/payments, nizations such as the National Register” National Psychologist Trainee Register 1. $50 fee for Part I. Complete Internet in response to the continued inquiry by (NPTR). NPTR application, submit internship the National Register over the past four confirmation form for evaluation years. This designation will allow health- • review the information at www.na- 2. $50 fee for Part II. Submit transcript care plans and hospitals to use the tionalregister.org/NPTR.html and have doctoral program evaluated National Register as the primary source • apply online at www.nationalregis- 3. $50 fee for Part III. Submit postdoc- for verifying education, training and ter.org/trainee/index.html toral experience/training confirmation board certification of psychologists. • contact form(s) for evaluation This means that those psychologists [email protected] if the = $150 Total Credential Review Fee = should not have to submit their creden- information provided does not an- Completed NPTR tials anew when they apply for panel swer your questions

12 APPIC NEWSLETTER JULY 2000 ♦ Journal of Training ♦ APPIC-June 2000 12/16/03 3:48 PM Page 13

Tracking Practicum Hours During Graduate Training

BY AMY D. HERSHELL & DANIEL W. M CNEIL WEST VIRGINIA UNIVERSITY

Soon, many students will be prepar- copy of a Hours Log. On this Hours Log, Hayes, S. C., Barlow, D. H., & Nelson- ing their application materials for sub- in a Time Interval column, the trainee Gray, R. O. (1999). The scientist practi- mission to internship sites. This prepa- would record the time the session began tioner: Research and accountability in ration will require them to report as well as the time the session ended. In the age of managed care, second edi- numerous details about their practicum an Hours column, the trainee would in- tion. Boston: Allyn and Bacon. hours (Lopez & Draper, 1997; Mellott, dicate the number of hours that session Lopez, S. J., & Draper, K. (1997). Recent Arden, & Cho, 1997). While some stu- took, and under a Details column, the developments and more internship dents will have kept detailed records of trainee would record specific session in- sites: A comment on Mellot, Arden, hours spent in clinically relevant experi- formation. On the Client Log, an anony- and Cho (1997). Professional ences, many other students will have mous code number would be specified Psychology: Research and Practice, 28, not. For those who did not record their for the client, along with demographic 496-498. clinical experience as the hours were ac- and diagnostic information. Lopez, S. L., Oehlert, M. E., & Moberly, crued, the application process can be The paper version of this system can R. L. (1996). Selection criteria for time-consuming, frustrating, and even be used alone or in conjunction with a American Psychological Association- somewhat painful. To make matters computerized database, developed in accredited internship programs: A worse, the end result even may be inac- Microsoft Access, a member of the survey of training directors. curate. Retrospective self-report has Microsoft Office software. Using this Professional Psychology: Research and been widely criticized and debated (e.g., system, the trainee is provided with a Practice, 27, 518-520. Hayes, Barlow, & Nelson-Gray, 1999; user-friendly form complete with pull Mellott, R. N., Arden, I. A., & Cho, M. E. Rogler, Malgady, & Tryon, 1992) be- down menus for selecting standardized (1997). Preparing for internship: Tips cause of concerns of accuracy (e.g., activity descriptors on which to enter in- for the prospective applicant. Bradburn, Rips, & Shevell, 1987). formation. That information is then Professional Psychology: Research and Considering that internship program stored in a spreadsheet, manipulated in Practice, 28, 190-196. training directors report clinical experi- queries, and summarized in easy-to-read Rogler, L. H., Malgady, R. G., & Tryon, ence to be the most commonly used cri- reports. Examples of reports that can be W. W. (1992). Evaluation of mental teria in selection for APA accredited pre- obtained by clicking specific pro- health: Issues of memory in the doctoral internships (Lopez, Oehlert, & grammed icons include number of di- Diagnostic Interview Schedule. Moberly, 1996), it is critical that report- rect clinical hours completed, types of Journal of Nervous and Mental ing of practicum hours is accurate. In therapies completed, and number and Disease, 180, 215-226. the hopes of decreasing some of the type of assessment experiences. Zvolensky, M. J., Herschell, A. D., & stress associated with gathering applica- The computerized version of this sys- McNeil, D. W. (2000). Learning to ad- tion materials and improving students’ tem offers several advantages such as ministrate, administrating to learn. reporting accuracy, an ongoing, system- the convenience of reports being calcu- Professional Psychology: Research and atic method for recording practicum lated automatically, and if updated regu- Practice. hours was developed when the first au- larly, the trainee is able to easily obtain thor was beginning graduate school and progress reports at any time. Not only the second author was Director of can this type of timely information be Clinical Training (Zvolensky, Herschell, useful to the trainee, it also may be use- & McNeil, 2000). ful to a program director who is inter- This experience tracking method can ested in determining what type of expe- be either paper or computer-based (or riences students are obtaining. Copies of both). The paper forms include a pri- this recording system, both paper- and mary form (Hours Log) and a sec- computer-based, are available at the fol- ondary form (Client Log) for the record- lowing web site at no cost P ing of information. There is a (http://www.as.wvu.edu/psyc). It is pro- P IC supplemental Code Form that provides vided as a service to our colleagues in A classification categories for demograph- training with the hope of easing the ics (e.g., ethnicity) and various profes- stress associated with the internship ap- sional activities (e.g., type of supervision plication process and increasing the ac- F received). The paper forms are de- curacy of practicum-hour reports. o 8 u 9 6 signed so that trainees can keep a copy n d e d 1 with them and record information References throughout the day. For example, sup- Bradburn, N. M., Rips, L. J., & Shevell, pose while at an off-campus practicum S. K. (1987). Answering autobiograph- or internship site, a trainee completed ical questions: The impact of memory two hours of assessment. Using this and interference on surveys. Science, recording method, the trainee would 236, 157-161. record relevant information on a paper

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Directorate. Following three days of marital status, and child/family obliga- APAGS Guest workshops, APAGS’ committee mem- tions. Unfortunately, the AAPI does not bers, along with leaders of state and ask for demographic information, mak- Column provincial psychology associations, lob- ing a systematic investigation of these al- bied members of Congress for inclu- legations impossible. However, the con- BY TAMARA DUCKWORTH sions of legal accountability in the versation sparked by these reports Patients’ Bill of Rights. An APAGS’ sub- highlighted two needs: 1) to make stu- UNIVERSITY OF FLORIDA committee, the Advocacy Coordinating dents more aware of the grievance Team (ACT), is currently organizing a process available through ASARC, and This column will National Psychology Graduate Student 2) to educate clinical training directors focus on two areas. Rally to take place on the Lower West about appropriate questions and com- First, I would like to Terrace of the U.S. Capitol on August munciation with applicants. update the APPIC 4th, just prior to opening of the 2000 Other internship applicants indicated membership on APA Convention in DC. The purpose of frustration with the travel costs associ- some of the recent the Rally is to increase recognition of the ated with interviewing for internship. activities and accom- services provided by graduate students Several students noted that they had to plishments of the in psychology to traditionally under- fly to same geographical location more American Psycho- served populations, such as low-income than once during the application logical Association and minority clients, and to increase process. Some expressed the view that a Graduate Students (APAGS). Second, I funding for psychology training. The uniform application deadline and/or in- would like to highlight some of the feed- Rally is modeled after a successful event terview notification date would help to back I have received from students and in- planned by psychology graduate stu- keep down the cost by enabling students terns about the internship application dents in San Francisco area in 1998. to better manage interview schedules. process, which I was able to share with the Briefly, other APAGS accomplish- Difficulties associated with moving to a APPIC Board of Directors at their meeting ments of note include: uniform interview notification date were in April. • creation of a comprehensive discussed by APPIC Board members, Survival Guide for Ethnic particularly the diverse needs and APAGS’ Accomplishments Minority Graduate Students, schedules of internship sites as varied as APAGS’ influence has been growing which provides helpful informa- counseling centers and VAs. In addition, by leaps and bounds during the past tion for all students on a variety of applicants also noted that the 10-15% year. Shortly after we entered the year topics including mentoring, net- travel discounts offered by APPIC were 2000, APA’s Board of Directors made an working, research, teaching, and not as competitive as discounts offered historical decision: to grant a seat to a professional development. by travel agents, online travel sites, representative of APAGS. The decision • creation of a new position on the email notification programs for last- marks an important turning point in APAGS committee with a focus on minute deals, or online bidding services APAGS’ development. Twelve years issues related to diversity, includ- such as Priceline. after its inception, APAGS has moved ing gender, sexuality, ethnicity The post-Match Clearinghouse from a restless childhood into a more and disability. process was perceived by several appli- mature adolescence. As the largest sub- • plans to co-host a two-day pre- cants as “unfair,” particularly because committee of APA with over 50,000 Convention institute for graduate the openings and closings of some sites members, APAGS’ representation on the students, post-docs and early ca- took only a matter of hours. One former Board of Directors is a logical step in its reer faculty who are interested in applicant, for example, suggested a continuing evolution. teaching and academic careers. process in which “the student with the APAGS’ work on behalf of graduate The Developing Teachers of fastest fax machine doesn’t ‘win.’” students has also been recognized re- Psychology workshop is co-spon- Another reported receiving an email cently by the APA Monitor on Psychology. sored by the APA Education that a site had closed, while waiting to at- Space has been reserved for a quarterly Directorate and Division 2 tempt to send a fax for the 5th or 6th column devoted to issues affecting grad- (Teaching of Psychology). time to machines that were continuously uate students. In addition, the cover occupied for 24 to 36 hours. Time zone story of the May edition of the Monitor, Internship Application Issues differences between east and west coast “The Postdoc Trap,” is a direct result of In preparation for my attendance as sites also apparently contributed to this efforts of APAGS’ Task Force on New the APAGS liaison to the APPIC Board perception of unfairness. Suggestions Psychologists (TFNP) to highlight some meeting in April, I solicited feedback for improvement included advance noti- of the obstacles encountered by the lat- from students on the internship applica- fication to students who did not match est generation of entrants into the pro- tion process. Three of the more promi- and a three-day post-Match moratorium fession. Notably, the TFNP’s advocacy nent issues raised were: 1) site viola- on offers so sites with openings and stu- efforts also sparked, in part, the forma- tions of APPIC standards, 2) the dents without internship can coordinate tion of the Commission on Education financial burden of the application information less frantically. It was con- and Training Leading to Licensure in process, and 3) the chaotic nature of the cluded, however, that attempting to reg- Psychology in February by APA’s Clearinghouse process for students that ulate the Clearinghouse process would Council of Representatives. did not match. only result in Match II, a project that In addition to advocacy efforts within In the weeks following Match Day, APPIC is not willing to undertake. APA, APAGS has worked to increase its there was a great deal of activity on the Rather, more education about the involvement in advocacy efforts at the APPIC-sponsored listserv for internship process as a “bulletin board service” and national level. For the first time, the en- applicants. A number of non-traditional tire APAGS’ committee was invited to at- female applicants reported being asked Ms. Duckworth is APAGS Liaison to the tend the State Leadership Conference inappropriate questions by internship in- APPIC Board of Directors and a graduate sponsored by the APA Practice terviewers, including queries about age, student at the University of Florida.

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opening the Clearinghouse after 8:00 makeup tests in the cardiovascular/pul- two marginal courses, the court rejected a.m. Pacific Standard Time are more fea- monary block and still did not receive a that request as not meeting the defini- sible alternatives for helping to alleviate “satisfactory” grade in it. tion of a “reasonable accommodation.” some of the anxiety for students and Students who receive marginal sites that do not match. grades in more than fifteen per cent of NOTE BENE Finally, other issues raised for discus- their first-year courses must repeat the Internship training is an integral part sion were the length of the standardized first year or leave the program. of a professional psychology doctoral application, setting standards for addi- McGuinness chose not to repeat the student’s academic education. Training tional application materials, and develop- first-year curriculum. Instead, he sued directors would do well to keep in mind ment of a more formal process of solicit- the medical school based on his disabil- that courts will give them deference ing student feedback on the internship ity, claiming violations of the ADA and when determining whether an intern application process, including an inde- Section 504 of the Rehabilitation Act, has performed satisfactorily. Courts ex- pendent evaluation of sites. which bar discrimination in the provi- pect educators to uphold the standards Conversations also continue regarding sion of programs and benefits. of their discipline, and courts support development of a policy for dealing with The lower court found that those efforts. Indeed, liability may exist applicants who violate match guidelines. McGuinness was not disabled under ei- where educators fail to meet this re- An article in the upcoming Summer ther the ADA of the Rehabilitation Act. sponsibility. 2000 APAGS newsletter is slated to pre- McGuinness appealed. See McGuinness v. University of New sent APPIC feedback on these issues to First, the appeals court examined the Mexico School of Medicine, 170 F.3d 974, students. APAGS is pleased to be able to ADA’s definition of disability, i.e., “a U.S. Court of Appeals, 10th Cir. 1998. participate in these conversations, pro- physical or mental impairment that sub- vide a voice and advocate on behalf of stantially limits one or more of the major Q. May an individual educational students, and work towards improving life activities of the individual,” such as, staff member, such as an adminis- psychology training, in general. I wel- caring for oneself, performing manual trator or faculty member, be sued come comments and questions are wel- tasks, walking, seeing, hearing, speak- personally for discrimination under come at [email protected] ing, breathing, learning and working. In the ADA or Section 504 of the assessing whether McGuinness was Rehabilitation Act? substantially limited in the major life ac- Internships and tivity of learning, the court listed the fol- A. Only in rare cases. In a recent case, lowing factors: (1) the nature and sever- a nursing student claimed he had a the Law: ity of the impairment, (2) the duration or learning disability and requested accom- expected duration of the impairment, modations. When the university denied Questions and and (3) the permanent or expected long- some or all of his requests, he sued, term impact of the impairment. claiming discrimination under the ADA Answers When the appeals court looked at the and Section 504 of the Rehabilitation facts surrounding McGuinness’ entire Act. He named as defendants not only BY PATRICIA A. HOLLANDER, ESQ. academic career, it noted that his test the university, but also individuals, such anxiety did not prevent his earning a as two presidents, the dean of the School Q. Is an anxiety disorder, known doctorate in clinical psychology. The of Nursing, and an assistant professor of as “test anxiety,” a disability under court said that while test anxiety may nursing. the Americans with Disabilities Act prevent McGuinness from pursuing a The court said the proper question is (ADA) or Section 504 of the career in medicine, an ability to pursue who may be sued. The court then held Rehabilitation Act? one career rather than another does not that at a private university, such as this, A. Not in this case. Here, a clinical constitute a severe enough impact for an the university is the entity that has the psychologist, McGuinness, decided to ADA discrimination claim. power to make accommodations, so only train to become a medical doctor, and Second, the appeals court found that the university may be sued. At public enrolled at the University of New under Section 504 of the Rehabilitation universities, individual staff members, Mexico medical School in 1992. He had Act, “test anxiety” is examined differ- such as administrators, faculty, and experienced anxiety in chemistry and ently. Under Section 504, “an impair- other staff, usually are deemed to be math courses in undergraduate and ment limited to specific stressful situa- “public officials,” so, in some instances, graduate school, but developed study tions, such as the mathematics and they may be sued personally in their “of- habits that allowed him to overcome his chemistry exams which trigger Mr. ficial capacities.” difficulties. McGuinness’ anxiety, is not a disability Additional Comments: Courts con- In medical school, the professors ex- under the Rehabilitation Act.” The ap- tinue to analyse personal liability in dis- plained the school’s written grading poli- peals court dismissed this claim. ability discriminations cases on a case- cies at the beginning of each class. Additional Comments: This case by-case basis. While an individual staff During his first-year basic biochemistry points out that courts continue to assess member could be the proper person to course, McGuinness told the professor disabilities on a case by case basis to de- sue under the ADA or Section 504 of the about his anxiety but said he needed no termine if, for a particular student, the Rehabilitation Act, the Court said that test-taking accommodation, just clear alleged disability qualifies as one under would be a rare case. grading standards. the ADA or Rehabilitation Act. Courts See Coddington v. Adelphi University, 45 McGuinness received a marginal give great deference to educational insti- F.Supp.2d 211, U.D. Dis. Ct, E.D.N.Y., 1999. grade in two first-year courses, bio- tutions making academic decisions, Note: Readers are cautioned that the chemistry and cardiovascular pul- such as the level of competency needed information contained herein is intended monary physiology; and asked that his for an academic degree, which review- only to call attention to new legal devel- grade be changed, but it was not. He re- ing what constitutes a reasonable ac- opments and is not meant to be definitive fused the opportunity to take a makeup commodation. When McGuinness re- in all circumstances or relied on without test in biochemistry. He did take three quested a passing grade in one of his prior consultation with legal counsel.

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FROM THE ASSOCIATE EDITORS

CHILD CLINICAL Long Term Care (PLTC). This is an in- for June 24-25 in Washington DC) on formal network of psychologists that “providing optimal mental health ser- PSYCHOLOGY provides a forum for communication vices in long term care” that will con- BY JON V. THOMAS, PH.D. among psychologists who are employed vene a panel of experts from both phar- or do research in LTC settings. We meet macological and psychological every year at APA and the intervention viewpoints. My column Gerontological Society conventions and Given that few internship and post- for the July issue is are promoting a variety of projects that doctoral programs specialize in working a story of good should be of interest to this readership. with LTC patients, we still have a long news. It seems Even more so than older patients in way to go in educating psychologists there is always general, residents of LTC institutions about LTC practice. One good way to something to com- are underserved in terms of their mental start would be to join PLTC, get on our plain about in this health needs. At least half of the patients Listserve, access the website, and read health care, but in nursing homes exhibit significant cog- the newsletter. At $35 to join ($10 for stu- there is also good nitive impairment, which surprisingly is dents) it’s a great deal, and it’s sure news to be told. an impediment for reimbursement of to keep you updated on this exciting The Surgeon General’s recent release of psychological services under Medicare. and expanding area of practice and re- Mental Health: A Report of the Surgeon This is unfair because of recent anecdo- search. For further information, contact General, is truly a landmark occasion. It tal and empirical research suggesting Margie Norris @ 409-845-8427 or was good news for mental health in gen- the effectiveness of psychological inter- [email protected] eral, but very good news for child psy- ventions for treating early stage demen- chologists. tia, behavioral difficulties associated For those of us who serve children, it INTERNATIONAL ISSUES with dementia, and overburdened family was truly an affirmation. It is great to be members. PLTC has recently formed a BY JANICE S. COHEN, PH.D. included the very first time the U.S. subcommittee that will be addressing re- Surgeon General has ever written about imbursement issues in LTC settings, In this column I would like to high- mental health. It leaves me with the feel- and we hope to ally ourselves with vari- light some issues ing that we have arrived. Children are ous APA initiatives to help remedy this related to students no longer an afterthought. An entire situation. seeking or attend- chapter (chapter 3) was devoted to Legislation allowing reimbursement ing internships out- “Children and Mental Health.” of psychologists for the provision of side of the country Chapter 3 is wonderfully detailed with mental health services to non-demented in which they are discussion of many important topics. nursing home residents has generated citizens or landed Those topics include child development, steady growth in the numbers of psy- immigrants. risk factors and prevention, mental dis- chologists working in LTC sites. Canada and the orders, treatment, service programs, However, some psychologists do not United States share service delivery, cultural appropriate- provide state of the art care due to lack similar sequences of training, with the ness, family support and the systems of training at the graduate, internship, predoctoral internship representing the model. It is indeed a very impressive and CE levels. To remedy this situation, culmination of graduate training in both piece of work. PLTC has been spearheading a venture countries. The shared culture of accred- So what does this mean for intern to develop educational materials that will itation in both countries, as well as the training? I believe it should be required be made accessible to geropsycholo- fact that many Canadian graduate and in- reading. Not only does it affirm the im- gists to assist them in training non- ternship programs are accredited by the portance of working in children’s mental geropsychologists in this important American Psychological Association, in health, it sets the agenda politically for area. We are now putting the finishing addition to the Canadian Psychological the immediate future. All political and touches on the LTC slides, and develop- Association, makes it a natural choice funding discussions will necessarily in- ing a manual to guide the presentation. for Canadian and American students to clude children as part of the agenda. Other resources are becoming avail- consider internship opportunities across That is perhaps the best news of all; chil- able for LTC training. I have recently the border. Often graduate students are dren are definitely on the agenda. edited a book on Professional Psychology motivated to seek an internship in an- in Long Term Care (Hatherleigh Press, other country to broaden their horizons GEROPSYCHOLOGY 2000) that has sections on assessment, and obtain a particular type of training interventions, and professional issues experience, or because of personal rea- BY VICTOR written by leading experts in the field sons (e.g., a spouse who is in another MOLINARI, PH.D. (most of whom are members of PLTC). country). Data collected by the The next issue of the Division 12 Journal Canadian Council of Professional For the last Clinical Psychology: Science & Practice Psychology Programs indicates that an- year and one-half, I will feature a series of articles on profes- nually, for the past three years, between have been the sional psychology in long term care. The 11 to 27 students from American gradu- Coordinator for a American Association of Geriatric ate programs attended a predoctoral in- group called the Psychiatry will be sponsoring a multidis- ternship in Canada. Similarly, annually Psychologists in ciplinary consensus conference (slated between 4 to 7 students from Canadian

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graduate programs have attended an in- me to this position. As a member of the This leads to the identification of one ternship in the United States. executive of the Canadian Council of essential and core competency: the abil- At recent meetings of various training Professional Psychology Programs ity to work with individuals from very councils in both countries, anecdotal ac- (CCPPP), I have enjoyed serving as the different cultures and backgrounds, and counts suggest that students and train- liaison to APPIC during the past year. with different abilities, in respectful ing directors often encounter unantici- The CCPPP is a 62 member group with partnership and discovery. I was struck pated difficulties in obtaining the representatives from Canadian graduate by a portion of a recent statement issued relevant documentation to allow a stu- programs and internships in profes- by a group with long histories of fighting dent to cross the border. This has some- sional psychology (clinical, counseling, for human rights in mental health: “In times resulted in delays in an intern be- neuropsychology and other applied psy- the Highlander tradition, we came away ginning an internship, interns being chology disciplines). The participation from those three days on the mountain retained at the border because of inade- of both academic and internship pro- determined that we will not allow any- quate paperwork, or at the extreme a grams in the organization provides a one to do for us, to discount us, or to pat program rescinding an offer once they productive forum for jointly discussing us on the head instead of looking us in realized the complexity of what was in- and addressing training issues in ap- the eye. We came away invigorated and volved in arranging for an intern to plied psychology. Among the activities of ready to act individually and collectively cross the border. As a training director, I CCPPP is the publication of an annual to insure that self-determination, re- have personally experienced one of Internship Directory, the operation of a spect, ethical behavior, and humane vol- these roadblocks first hand, as valuable clearinghouse following Computer untary services and supports become weeks were lost trying to explain the Match Day, and the organization of an the foundation of a reinvented mental concept of a psychology internship to a annual workshop during the Canadian health system.” (The Highlander Canadian immigration officer who had Psychological Association convention. Statement of Concern and Call to Action, initially applied some restrictive rules CCPPP also has a web site (www. March 25, 2000) pertaining to medical interns. One usask.ca/psychology/ccppp/) which in- This resonated for me with the recent would not want these incidents to be- cludes resources for training programs. passage by APA Council of the come deterrents to programs accepting I look forward to using future columns Guidelines for Psychotherapy with students from other countries, as long as to communicate information about the Lesbian, Gay, and Bisexual Clients, this in keeping with their immigration training and practice of applied profes- guidelines well over a decade in the and employment laws. At the same time, sional psychology in Canada, and hope process of development and passage. I think that there are a number of im- to highlight some of the linkages and That document cited instances where portant steps that programs can take to shared training concerns that we have clinical practitioners automatically at- insure that the process goes smoothly. with our American counterparts, and tributed client’s problems to a homosex- A first step, in keeping with the recent more broadly in the international con- ual orientation, or made sexual orienta- emphasis on “truth in advertising”, is for text. tion a focus of treatment even when programs to clearly state in their intern- irrelevant. Different folks, same strokes. ship brochures their policies about con- Folks diagnosed with SMI have often sidering applicants from foreign coun- had to deal with psychologists who tries. In addition, if a program is ISSUES CONCERNING make the diagnosis the focus, rather considering ranking a foreign applicant PERSONS WITH SERIOUS than the person. Partnership in service it is important that they obtain informa- MENTAL ILLNESS of recovery and rehabilitation calls in- tion about all of the necessary immigra- stead for a dialogue about values, priori- tion and employment procedures prior BY SANDRA E. TARS, PH.D. ties, and individual needs and desires. It to the time that they submit their rank also requires recognition of strengths, order lists, and that they clearly commu- resilience and compensating abilities nicate this information to the student. Emerging Priorities for Training and supports. As individuals with SMI This would allow any potential hurdles My musings recently have been fo- live in the community within an increas- to be identified early on in the process cused on what it takes to equip psychol- ing complex healthcare system, they and hopefully circumvent some of the ogists to work successfully with individ- may from time to time find a need for past difficulties which have been en- uals with serious mental illness in this some professional assistance. One of the countered. Finally, once a student from a rapidly changing mental health land- challenges for professionals is in re-ori- foreign country is matched with an in- scape. Some thoughts converge from re- enting from a system in which long-term ternship setting, the Director of cent APA meetings, raging listserv de- professional support and treatment was Training should initiate the process of bates, and my daily experience as a considered the norm, to one in which obtaining the necessary documentation senior administrator in a rapidly chang- the recipient of service defines the focus as soon as possible. Often the foreign ing public service setting. of any given transaction. As with other student office within a university based First and foremost, our training needs groups in which stereotypes have domi- setting, or the personnel office within a to nurture the ability to recognize and nated service provision for many years, hospital or community setting can be in- promote growth potential in individuals. psychologists need to face their own valuable resources. Hopefully, if pro- Research demonstrates that even those proclivities for prematurely diagnosing grams are proactive in taking the neces- with the most serious illnesses do have the “problem” as that “symptom” which sary steps the experience will be the ability to live productive and satisfy- is most obvious or troublesome to them. positive for all involved. ing lives in the community. Consumer Which brings me back to core com- I am very pleased to be assuming the advocates are increasingly vocal about petencies. If I had my druthers, I would- position of Associate Editor for ways in which mental health profession- n’t let anyone out of our training pro- International Issues, and would like to als hinder, rather than help, by focusing grams who couldn’t first, find a way to thank the APPIC Board for appointing on deficits and disabilities. engage in a culturally competent way

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with individuals diagnosed with a seri- the time to reflect and to write meant at- can be obtained from the American ous mental illness, and discover their tending once again to the underlying val- Psychological Association and docu- central concerns. And second, having ues that motivate me to remain faithful ment managed care’s pressure on psy- discovered those concerns, creatively to this profession. Often I found that ar- chological assessment. The Meyer et al. devise a way to work with them to ad- ticulating those values strengthened my report documents the importance and dress and grow beyond those concerns. will to act on them. I discovered, repeat- validity of psychological assessment. It As we move into an era where indi- edly, that I care deeply that new psy- appears to us that it will be important to viduals diagnosed with serious mental chologists be well trained and well cared develop detailed data regarding the cur- illness are treated in the community, for. Each time I had this experience, my rent status of training in psychological where new treatments offer both new thoughts about issues such as training assessment during internship. So, if you hope and new challenges, it is essential models or postdoctoral internships or are asked to participate in studies of psy- that we grow beyond our old stereo- how to conduct a search became clearer chological assessment training during types. When we sit down with an indi- and more firmly grounded. I seriously internship, please cooperate because vidual diagnosed with SMI, the symp- believe that I have been more effective this knowledge is needed. toms which at first blush are most because I took the time to reflect, time There were fewer studies published obvious to us may turn out not to be the that would so easily disappear without this year compared to the banner years issues which most stand in the way of the inexorable demands of a writing of 1997 and 1998. In fact, I could find health and happiness for a particular in- deadline. only six but will also review a study from dividual at a moment in time. And some So I leave with the unshakable con- our group that is due out in June. of these concerns will require us to viction that action rooted deeply in val- stretch our minds and talents in new di- ues which are clearly articulated will The Reviews rections. lead to good outcomes. Not a new idea, I 1. Bartle, D.D. & Rodolfa, E.R. (1999). I’d say it was easy if I weren’t faced grant. Nevertheless, I am grateful for Internship hours: Proposing a na- daily with the challenges of cultural the opportunity that writing this column tional standard. Professional change, both at the institutional and pro- has given me, and I am grateful to all of Psychology: Research and Practice, 30, fessional levels. As always, I welcome you who read it over the years, re- 420-422. This study explored the accu- your thoughts and comments at sponded to my ideas, and let me know in mulation of hours of supervised expe- [email protected] or huisset@gw. that way that our values matter most of rience obtained during internship. omh.state.ny.us. all. And now, I look forward to reading They found that internships report a about what someone else thinks is im- mean of 1,991 hours, with a range portant. from 1,550 to 2,496 hours. These num- ISSUES GERMANE TO bers are reported to licensing boards UNIVERSITY LITERATURE REVIEW and other interested parties. The au- COUNSELING CENTERS thors recommend that a national stan- BY JAMES M. STEDMAN, PH.D. dard of 1,800 hours be adopted. BY ANNA BETH PAYNE, PH.D. 2. Holmes, G.R., et al. (1998). First, a personal thanks to all of you Adolescent group psychotherapy su- This is the last column I will write for who responded to our pleas for research pervision in a group format: An the APPIC newsletter. It has been a plea- data over the last two years. We appreci- emerging model. Journal of Child and sure and a privilege to be able to com- ate your efforts and the first paper based Adolescent Group Therapy, 8, 197-206. ment on a wide range of training issues. on this data will be out in June. I will This study describes a supervision I actually had to look up when I started echo thanks for all the authors, cited process using group supervision jour- doing this (Fall of ’92) because I couldn’t below, who also depended on you for nals and documents the participation remember any more! That was one clue their data. of clinical psychology interns and their I had that it was time to move on. I have Our research team has been inter- supervisors. The authors propose this been able to reflect on issues that moved ested lately in the status of psychological as a training model for adolescent me, that made me curious, that reflected assessment and psychological assess- group psychotherapy supervision. my pride in our work as trainers, and, fi- ment training. As most of you probably 3. Constantine, M.G. & Gloria, A.M. nally, those that challenged me to think know, psychological assessment has (1999). Multicultural issues in pre- about changes I should be making in my been under serious economic pressure doctoral programs: A national survey. own work and my own program. from managed care. I recommend that Journal of Multicultural Counseling It is tempting to make this my own you obtain two position documents from and Development, 27, 42-53. This personal retrospective, but I think I will APA, one entitled “Benefits and Costs of study examined internship training resist. Instead, I will comment on one Psychological Assessment in Health addressing multicultural issues. thing that I have learned from the Care Delivery: Report of the Board of Findings indicated that university process of writing this column. Professional Affairs Psychology counseling centers pay greater atten- Writing forces one to focus on what is Assessment Work Group, Part I” by tion to multicultural issues than did important in a way that day to day living Gregory J. Meyer, et al., published in most other internship settings. The does not. Each time the deadline rolled 1998. A companion document is entitled authors believe their results point to- around, I would wonder what I would “Problems and Limitation in the Use of ward the need for more attention to write about. Each time, something sig- Psychological Assessment and multicultural training issues during in- nificant was happening in the world of Contemporary Health Care Delivery: ternship. training that I wanted to react to. (Of Report of the Board of Professional 4. Piotrowski, C. & Belter, R.W. (1999). course, sometimes “significant” means Affairs Psychological Assessment Work Internship training in psychological going through intern selection, but we Group, Part II by Elena J. Eisman, et al., assessment: Has managed care had all know how that feels!) Actually taking again published in 1998. Both of these an impact? Assessment, Vol. 6, 381-389.

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This study is, of course, correlated numbers of students have been unsuc- The list of ten strategies could per- with the two position documents men- cessful in securing an internship. haps be posted in all trainees’ offices as tioned earlier in the column. These a sort of “Ten Commandments” to be authors surveyed 84 APA-accredited kept in mind. Here is the list: internship programs and found that SETTING-RELATED ISSUES 1. Always obtain written informed con- 43% of the training directors reported sent. that assessment training was affected BY ROBERT H. GOLDSTEIN, PH.D. 2. Get “arms-length” consultation. by managed care; however, the major- 3. Maintain professional competence. ity of programs reported slight or no On The “Ten Strategies” 4. Know the law and ethics code. impact from managed care. Additional and The “Two Minds” 5. Avoid or plan for high-risk patients findings included only a slight de- Even though many and situations. of us would un- crease in the emphasis on assessment 6. Do not use collection agencies. doubtedly agree training, with some decreased empha- 7. Keep good written records. sis on projective methods. However, that trainees need to 8. Maintain confidentiality. there was increased emphasis on neu- have some signifi- 9. Be extra careful with managed-care ropsychological assessment. cant exposure to the and insurance companies. 5. Rodolfa, E.R., et al. (1999). Internship fundamental ethical selection: Inclusion and exclusion cri- principles of our pro- 10. Get help when needed. teria. Professional Psychology: Research fession, it is difficult Plante’s paper discusses each of these and Practice, 30, 415-419. This study to find sources of strategies in detail and gives sugges- examined exclusion and inclusion cri- basic and useful in- tions for further reading about many of teria at APA-accredited internships. formation for this purpose. There are lots them. Most of these may seem obvious, The most important inclusion crite- of scholarly works dealing with this topic and it would be unusual for a training rion was a match between applicant and of course the APA’s various books and program not to have stressed these goals and training opportunities. Four statements of ethical principles are obvi- points somewhere along the way. But it’s exclusion criteria included the lack of ous starting points for exploring the whole not a bad idea to keep them in plain view completion of a proposal, lack of APA- matter of professional ethics. and maybe even build a seminar series accredited status of the doctoral pro- But even these remain a focus of dis- around the issues raised by each of gram, poor fit between applicant goals pute and disagreement. Should ethical these points. and training opportunities, and incom- statements, for example, be aspirational The real world lurks out there and plete doctoral course work. statements indicating what is the ideal? our trainees need to be prepared to con- 6. Stedman, J.M., Hatch, J.P., & Or should they represent the practical front it from the very start of their ca- Schoenfeld, L.S. (2000). Pre-intern- day-to-day rules governing our behavior reers. Remember, there are lots of attor- ship preparation in psychological test- in terms of which psychologists should neys coming out of law schools and they ing and psychotherapy: What intern- be judged by investigatory or prosecu- all need something to do to make a liv- ship directors say they expect. tory bodies? And how should ethical val- ing. Let’s not make it too easy for them. Professional Psychology: Research and ues connect with legal principles and And while suggesting useful reading for trainees, let me add one quite recent Practice, 31, in press. This study at- rules? These are obviously complex questions. book that will, I suspect, attract a good tempts to quantify the testing and psy- My attention was caught recently by deal of attention among mental health chotherapy elements of clinical expe- an article by Dr. Thomas Plante of the professionals. It’s by an anthropologist, rience, variables highly prized by Santa Clara University and Stanford Tanya Luhrmann, who’s at the intern directors in their selection of Medical School which appeared in the University of California, San Diego. She potential interns. Results quantify pre- Winter 1999 (Vol. 36, No. 4) of spent over four years of fieldwork study- internship expectations regarding the Psychotherapy, the journal of APA’s ing the process by which psychiatric res- numbers of integrated psychological Division of Psychotherapy (Div. 29). The idents become educated and accultur- reports and neuropsych reports. paper’s title, “Ten Strategies for ated into the intellectual and Additionally, they quantify expected Psychology Trainees and Practicing philosophical frameworks which charac- pre-internship psychotherapy experi- Psychologists Interested in Avoiding terize the current practice of psychiatry. ences according to the following cate- Ethical and Legal Perils” pretty much In particular, she explores the enor- gories: long-term psychodynamic, tells you what this paper is about, and it mous gulf which has opened up between short-term psychodynamic, cognitive is a piece which can comfortably be rec- the biomedical and the psychodynamic behavioral, group, marital, family, in- ommended as an excellent and practical ways of thinking about and treating terpersonal, and child modalities. In set of concise guidelines for training pro- mental disorders. Hence, the book’s general, folks, we expect a lot. grams to promulgate to their trainees. title, Of Two Minds (published by Alfred 7. Thorn, B.E. & Dickson, K.E. (1999). Plante sets out his thoughts on the A. Knopf, New York, 2000) nicely cap- Issues of internship supply and de- kinds of defensive and real-world strate- tures the divergence between these two mand: A survey of academic counsel- gies that could serve to keep people, es- very different ways of conceptualizing ing and clinical programs. Professional pecially trainees, out of trouble. This is disturbed or distressed human behavior. Psychology: Research and Practice, 30, no recitation of abstract or theoretical Luhrmann traces the history of the shift 198-202. This study looks at intern- principles. Rather, he highlights the during the last half of the 20th century ship placement rates since 1992. Data kinds of steps that should be taken in from psychoanalytic/psychodynamic from the 1997-1998 year suggests that matters of daily practice that could help dominance in psychiatric approaches to rates have remained relatively stable, ensure that the underlying ethical and the present-day emphasis on neuro- but as others have documented, larger legal precepts are not violated. transmitter-altering drug therapies. She

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also shows how HMO’s have played a plex issues that are involved. major role in bringing about this funda- Luhrmann’s historical and anthropologi- ASSOCIATE EDITOR mental change in the way the human cal perspective will help them better condition is understood. Psychologists- comprehend what’s been going on. VACANCIES: in-training really need to gain some per- spective on what a major transformation CALL FOR has taken place in our society’s view of deviant human behavior. CANDIDATES This book lays out the dilemma faced Announcement: APPIC is searching for new by psychiatric residents: how to recon- APPIC Change of Address Associate Newsletter Editors for cile the humane psychotherapeutic goal Effective July 15, 2000 HEALTH PSYCHOLOGY and for IS- of treating people’s minds, on the one SUES GERMANE TO COUNSEL- hand, and the co-existing practical and ING CENTERS. Interested individu- economically-based pressures towards APPIC has moved to: als should send vita and brief adjusting the chemistry of their brains? 10 “G” Street, NE statement of interest to R. W. As the bandwagon for prescription privi- Goldberg, Ph.D., APPIC Newsletter leges for psychologists gains speed and Suite 750 Editor, at APPIC Central Office. A pe- momentum, what is described in the Washington, DC 20002 rusal of this and past Newsletter is- book’s subtitle as “The Growing Phone: 202-589-0600 sues gives a good idea of the range Disorder in American Psychiatry” will and types of contributions that work perhaps soon no longer be the unique Fax: 202-589-0603 well. problem of psychiatry, and our trainees would do well to understand the com-

Minutes APPIC Board of Directors Meeting

APRIL 7-8, 2000 ST. PETERSBURG, FL

Present: Dr. Kaslow, Chair; Drs. lished in July and submissions are re- Problem: Inadequate brochure Boggs, Garfield, Goldberg, Keilin, quested. Dr. Goldberg expressed appre- Solution: Links to doctoral and post- Leventhal, and Rodolfa; Ms. Hollander, ciation to the regular contributors and doctoral brochures on the website. and Ms. Hercey, Administrative welcomes feedback. A subgroup of Doctoral committee Director. chair, Postdoctoral committee chair, and Liaisons present: Drs. Janice Cohen Interview Questions Doctoral Review Committee chair will (CCPPP), Frank Collins (CUDCP), Dr. Kaslow announced that APPIC suggest changes to be made to the initial Nancy Elman (CCPEP), Judy Hall will address the issue of inappropriate doctoral and postdoctoral applications. (National Register of Health Service applicant interview questions in several Dr. Schmaling will chair this subgroup. Providers), Leonardo Marmol (NCSPP), places: 1) Dr. Rodolfa in the Newsletter’s The subgroup will make recommenda- and Mary Willmuth (ASPPB); Ms. Tips for Trainers column, 2) Dr. Kaslow tions, consult with their Board contacts Tamara Duckworth (APAGS). in her Chair’s column. 3) New Public and the Board contact will present the APPIC Appointees: Drs. Michael Member, Ms. Mitnick will write in the recommendations to the Board for ap- Carey (Chair, Doctoral Membership Newsletter and add to the Legal Issues proval. Committee), Robert Hall (Directory manual. She will also research the Equal Editor), Stephen Holliday (Chair, Employment Opportunities Commission New Consortia Guidelines Postdoctoral Membership & Review), and hyperlink to our site a list of appro- Motion: Dr. Garfield moved that Jeanette Hsu (Directory Editor), Karen priate and inappropriate questions. APPIC will incorporate where appropri- Schmaling (Chair, Doctoral ate the consortia criteria to internships Membership Review), J. Gordon Doctoral Membership Review with multi-site programs and rename it Williams (Clearinghouse Coordinator/ Committee The Consortia and Multi Site Webmaster), and Carl Zimet (Chair, The committee is deferring approval Guidelines. Standards and Review Committee); Ms. on a number of programs until revised Motion passed 7-0-0 Mona Mitnick (forthcoming Public materials in question are presented and Member). in compliance with criteria. A Newsletter Unfunded Internships and article has been published twice on how Captive Internships Newsletter to avoid deferring approval. Unfunded internships are not encour- The APPIC Newsletter is published 3 Problem: Sites have difficulty demon- aged but there are no criteria against un- times a year. This year’s Archival Issue strating a planned program sequence funded internships. There is no APPIC will be published, but theme issues will Solution: Put models of postdoctoral criterion against captive internships. be the norm in the future. A second and doctoral planned program sequence APPIC does require both situations to Journal of Training issue will be pub- on the website be disclosed.

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Certificate of Completion will be mailed to postdoctoral sites only All Board members who wish to have The APPIC Board decided to allow in a few weeks. the right to post on the List need to sub- the sites to determine how certificates of scribe to the first level on the News completion are worded. APPIC Research Committee Lists. Dr. Rodolfa reported that the Due Process Guidelines Research Committee has completed one CUDCP The samples on the web do not cover project on the Match Dr. Keilin has writ- Dr. Frank Collins, liaison from both kinds of the required due process ten a paper to be published in August CUDCP, reported that CUDCP repre- models: intern against site and site 2000 in Professional Psychology. It dis- sents 140 university-based scientist prac- against intern to address “due process”. cusses implications of Supply and titioner programs with a strong commit- Drs. Rodolfa, Schmaling and Ms. Demand. Dr. Keilin noted that the num- ment to the science practitioner model. Hollander will examine at the due ber of slots available and number of first Dr. Bev Thorn has been reelected to process model guidelines on-the website time applicants are almost equal. Chair CUDCP for two years. The pri- and make certain they represent our cri- Approximately two-thirds of applicants mary activity this year was the January teria. not placed in the Match get placed after Joint Council Training Council Meeting Match Day. A greater backlog is not in Miami. Future Joint Training Council APPIC’s Appeal Process being created, but we are merely trying meetings will include APPIC. He recog- Drs. Garfield, Rodolfa and Kaslow are to absorb unplaced applicants from the nized that issues between CUDCP and the APPIC Appeals committee. Pro- previous year. The committee is cur- APPIC are more similar than different grams out of compliance with APPIC rently researching what the appropriate and further highlighted them: can submit new materials to this com- models of training are at the Internship Commonalities include: mittee for review. There has been a pos- Level. They are working with APA and — A need to expand and enhance out- itive result from sites going through this CoA for data as well as surveying the come measures with more attention process. Threatened with termination, APPIC membership. The Committee given to innovations in addition to tra- the sites have used this as a bargaining will also devote some time at the ditional assessment tool, e.g., to get the additional full time Membership Meeting and Conference — Better solutions for dealing with stu- staff required. to this subject. Committee members are dents with disabilities Drs. Keilin, Kaslow, Madonna — Diversity training Doctoral Membership Committee Constantine (CCPTP) Bev Thorn, — Effective mechanisms for dealing Drs. Carey and Leventhal reported (CUDCP) an APAGS representative, with impaired students that programs struggle with the number and will be inviting other liaisons to col- — Influencing public policy laborate or join the committee. of practicum hours. Dr. Kaslow will re- Differences include: view the Practicum survey through — How science is defined CCTC and from Dr. Jessica Kohout. It Web and List Serves — Student faculty ratios may have useful numbers to use as a Dr. Williams highlighted results of — Admission decisions based upon benchmark, looking at the minimum the last 17 months of website activity. class size, number of internships and mean, median, and modal number of There have been over 10 million hits so job available hours. far and every day about 500 different — Entrepreneurial models of training people use the APPIC website. Most fre- — Emphasis on Practicum hours Postdoctoral Membership and quently visited pages were Forms Page, Dr. Collins emphasized that the rela- Review Committee Membership applications, and AAPI. tionship between CUDCP and APPIC is The next meeting for this committee The most downloaded file is the strong. They are very supportive of re- will be April 19, 2000. There are 8 new Directory Order form. Dr. Kaslow will cently implemented programs such as applications to be reviewed. The April remind Dr. Williams to announce the the Computer match and the Director meeting will be the last for Chair Dr. Annual Business Meeting at APA on the on line. It appears that the demand Philinda Hutchings. Dr. Steven Holliday website. placed upon students to request ranking will begin his term as Postdoctoral information has diminished. CUDCP Membership and Review Committee List Serves feels the current supply and demand Chair after the April 2000 meeting. APPIC’s Currently Active List Serves problem is regional from applicants who Motion: Dr. Boggs moved that the are: insist on applying only within a narrow Discussion Lists Board approve the new Postdoctoral geographical area, e.g., Southern Intern network—for discussion of in- Clarification Document with the California and New England. There is a ternship issues Criterion that a Postdoctoral agency perception among CUDCP members must have a minimum of one full time Postdoc network—for discussion of postdoctoral issues that more practicum hours are neces- equivalent postdoctoral fellow at the Members network—APPIC members sary to effectively compete and the fact postdoctoral level of training on site and only that these hours are assessed on the ap- in training and on site at the time of ap- Trainer’s network—for a broad spec- plication, feeds this perception. CUDCP plication. trum of trainers recommends the hours eliminated, and Motion passed: 7-0-0 instead have a checklist that specifies Motion: Dr. Boggs moved to approve News Lists (one-way communication) the minimum number of hours. the revised Postdoctoral application Clearinghouse List Unofficially CUDCP has endorsed a res- form which includes the new criterion. Members News olution: Any student from a CUDCP pro- Motion passed: 7-0-0 Subscribers News gram that does not comply with the The Postdoctoral Committee has de- Match news APPIC Match requirements will be in- veloped a Postdoctoral Survey which Public news vestigated by the member program.

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APPIC will respond to the issue ini- There is also a link on the APPIC web- BEA tially at the Membership Meeting and site. Their current chair is Dr. Bill Poke. Dr. Rodolfa is the new BEA Conference by having regional tables They are having a pre-convention work- Representative. discussions at lunchtime and do some shop on evaluation methods in clinical problem solving. psychology training: reliability, validity, PER The new DOL will ask programs for and worst experiences. They hope to APPIC is responsible for planning their minimum practicum hours and the have programs submit examples of their PER in 2001. PER will meet the first average number of hours from the in- evaluation forms and approaches during week of January in New Orleans, LA at terns accepted last year. this full-day workshop. Once they have the Le Pavillon Hotel. these resources, they will put them on CCPTP their website to share. CCTC Dr. Nancy Elman reported that there CCPPP Member Feedback: CCTC is increasing political action are about 75 accredited member pro- — The Computer Matching went very seeking seats at various tables. Dr. grams. Colly Conoley is the current well. They suggested that the data Kaslow is the Chair-elect Chair. CCPTP will combine forces with from Canadian sites might be evalu- Division 17 next year for a National ated separately and communicated to Tri-Lateral Forum Psychology Conference in March 2-4, CCPPP. The next meeting will be in May 2000. 2001, Houston, TX. The conference will — CCPPP drafted a set of voluntary Dr. Rodolfa is the Board contact to this address the needs of counseling pro- Guidelines available on their website forum. grams at the national level not just train- that are meant to supplement the ing issues. Ted Strickland will be a APPIC guidelines. CCPPP will make keynote speaker. CCPTP welcomes additions to the guidelines for this Directory On Line Committee APPIC representation there as well. Dr. year, including advance clarification APPIC began the Directory on Line Elman thanked Dr. Boggs for the posi- of criteria for crossing the border mo- Project in April 1999. Drs. Hall and Hsu, tive ongoing liaison relationship with bility. Dr. Kaslow suggested that Drs. have been heading the project. The DoL CCPTP. CCPTP Member feedback indi- Cohen and Pierre Ritchie write an ar- will offer more information to the user cates overwhelming support for the ticle for the Newsletter and the than previous hard copy editions. Match and desires for APPIC do some- APPIC web page. The situation is Access will be defined by the user’s pur- thing to reduce stress associated with best resolved when a program is uni- pose. Users will now be able to search the application process. versity connected. on a single or combination of fields such as geographical location, APA accredita- NCSPP tion status, stipends, etc. Members will APAGS Dr. Marmol reported that NCSPP in- update their own member page and the Ms. Duckworth reported that APAGS cludes 41 full members, (APA accred- editors will approve changes before it is has 48,000 members. They have been ited). There are 15 associate members visible to the users. Future e-commerce granted a seat on the APA Board of who must be regionally accredited and projects includes paying dues, ordering Directors. Mitch Pristein is on the working toward APA accreditation, and the directory, conference registration, Board. Carol Williams is the current 5 observer programs who are in some and paying subscriber fees. Chair of APAGS and Marcus Patterson level of development. They meet twice a Nontechnical issues were: is the Chair-elect. An accomplishment year. Although S & D anxiety has dimin- 1. Development cost was more than an- has been creation of a Young ished, the professional schools have ticipated. Professionals Task Force which will be been made to feel they are the reason 2. Pricing the on line directory searches absorbed into APA. APPIC issues in- for the over supply, although 90-95% find and hardcopy is an issue. APPIC clude grievance procedures and making jobs and get licensure. There is linger- wants to be sensitive to student cost the process less intimidating. There is ing bias against professional scholar pro- and the plan for pricing will be for only still fear of reprisal. Students need feed- grams vs. science practitioner model. one year. back about member sites violating This is not made obvious is the applica- There was a discussion of alterna- guidelines. tion materials. It is legitimate for a site to tives. have a preference, but NCSPP asks that Dr. Collins noted that fee per use can- preferences should be clearly stated in ASPPB not be put into a financial aid package the directory. Dr. Kaslow noted that Dr. Willmuth reported that the EPPP but a fee per student can be a part of fi- Psy.D. vs. Ph.D. field is not a choice in exam on line will be easier, cheaper, and nancial aid. this year’s DoL; however next year: permit candidates to take when ready Proposal #1— Ph.D. vs. Psy.D. will be considered. rather than twice a year. Results will be Require all students to order a direc- released by the Boards. Research is also tory and give them unlimited searches CCPPP under way on mobility issues. ASPPB of- for a fixed price when they register for Dr. Janice Cohen liaison from CCPPP, fers the Certificate of professional the Match. reported on the 62-member Canadian Qualifications for psychologists. ASPPB Negatives were that all may not want membership. 27 are academic programs participates on the APA Ad Hoc one or the other and Canadian students and 35 are internship programs. They Committee on Training and Licensure, would not be interested in the print ver- also publish a directory of only represented by Asher Pacht. sion and would only have a very narrow Canadian sites. They operate a search. Clearinghouse of Canadian sites and do The National Register Proposal #2— an annual supply and demand question- Dr. Hall reported that NR is offering Require purchase of either unlimited naire for Canada. Their website address graduate students a credentials registra- web searches for a fixed price, or a hard is: www.usask.ca/psychology/ccppp. tion package. copy of the Directory when they register

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for the Match. This proposal was better graduate school and the internship site 5. Prior to ROL submission, APPIC will received by the liaisons and invited twice a year for non-problem students. require sites to notify ALL of their ap- guests. Nonsubscriber sites and their The internship training director and the plicants if they add a track that was students would pay much more. graduate training director should begin previously not advertised. The site Students with disabilities (with docu- to dialogue as problems develop. Dr. must send the Match Coordinator a mentation from the DCT) will receive a Elman suggested that the issue be re- copy of the notice or some proof they complementary copy of the hard copy searched further across training coun- have done this. directory. The beginning of the cils. Dr. Kaslow added this to the CCTC 6. A statement will be added to the ROL Subscriber year has been moved to June agenda. for TD’s to sign that “to the best of 1. Students will order the APPIC direc- my knowledge at the time of this tory searches after the Subscriber fees Violations of APPIC Rules signing the funding is in place.” are paid. A Postdoc plan is needed be- There were many suggestions from li- 7. If a student matches with a site that cause they do not go in to the Match. aisons. loses its funding, the student is free Dr. Kaslow noted that APPIC must be to leave that site without penalty. Directory Public Relations very careful about handling anonymous 8. The procedure for handling the On a monthly basis, the List Serves complaints because there must be due change in a student’s status (e.g. such as Member and Subscriber News, process for both applicant and program. placed on probation) is not currently Intern and Postdoc Network will have There was an extended discussion of vi- in place. APPIC will make clear on news updates about the DoL. This infor- olations of APPIC rules. Dr. Collins said the Verification Form that it is the mation can then be forwarded to other there have been fewer complaints since DCT’s responsibility to let interested list serves. the Match. Dr. Holiday suggested APPIC/NMS know if a change oc- anonymous reporting to reduce fear of curs in very specific areas. Dr. AAPI and the Verification Form retaliation coupled with informal feed- Garfield will revise the Verification Dr. Garfield, the AAPI author, ex- back. Dr. Collins felt university DCT’s form for 2001 to reflect this. plained that the AAPI evolves each year might discourage reporting. Dr. 9. Communicating ranking information. from feedback from students who took Williams noted that the complainant is The student can say `yes’ or `no’ to a the Zoomerang Survey. Issues include: anonymous beyond APPIC. Ms. track. Can they rank order the track? (1) practicum hours, (2) documentation, Duckworth said that if the APPIC 10.There are between 50 and 60 non (3) the verification form, (4) a need to Member admitted wrongdoing, why APPIC member sites that were al- educate programs and applicants. The could not APPIC act? Dr. Kaslow noted lowed to use the Match for two years revised form will be ready in June 2000. that there was no clear basis for APPIC and will be approaching their last Overall there was mostly positive initiating its own action. Dr. Hall noted year of eligibility. The sites will be feedback. Dr. Garfield solicited volun- that there had been few sanctions in 3 sent a reminder letter and application teers from each liaison group to work on years. ASARC will soon meet and de- materials to join APPIC. the AAPI committee to modify to the velop procedures for informal com- The Match Policies will be rewritten form. plaints. The Chair wishes to emphasize to better clarify the following communi- Regarding the Verification Form, is- and expand this informal process. cation guidelines: sues included: (1) Need for Original sig- Motion: Dr. Garfield moved that for nature of the DCT, (2) “Truth in adver- Deadlines and Dates only the 2000-2001 Match, internship tising” (need to be answered honestly by Dr. Goldberg will survey the mem- sites may not ask applicants to provide DCT’s), and the 1-5 rating scale, (3) bers and subscribers and offer the fol- ranking related information about pro- Who should sign the verification form, lowing options for changing Match Day: gram tracks within their sites. DCT or the advisor? The DCT is admin- (1) The current date, middle of Applicants may provide yes/no informa- istratively responsible to contact the site February, (2) 4th week of March, (3) tion indicating interest in a track; they and inform it of any changes in the stu- middle of April. The Survey will also cannot be asked to rank order their pref- dents’ status. The Chair directed the query members and subscribers about erence of tracks. subcommittee working on the AAPI to changing the Uniform Application dead- Motion passed: 6-1-0 also look at the Verification Form. Dr. line. The chair asked for a straw vote on Garfield will write a Newsletter article the same issue from all present. educating on Verification Form issues. Match Issues Straw vote was: 18-1-0 1. A reminder that the match is legally Consortium Issues binding will go on the Rank Order Directory on Line Demonstration Dr. Boggs suggested that Board List. Drs. Hall and Hsu using an LCD Members give feedback to the proposed 2. Student violations: Dr. Kaslow ex- Monitor and a connection the Internet consortia document and defer discus- pressed appreciation for the CUDCP demonstrated the new Directory on sion and adoption to a conference call to resolution. She expressed a desire Line. It was impressive and very well re- include the Board and Drs. Schmaling, that the other professional training ceived by all present. Carey, and Holliday. groups will support some form of this as well. Interview Deadline Problem Interns and 3. There will no `Internship Fair’ by The possibility of a deadline date for Communication APPIC at APA Convention. inviting applicants to onsite interview Many times problems with interns do 4. Central Office and NMS will refine was raised. Members definitely do not not appear severely until the internship. the notification and communication want such a deadline and Dr. Kaslow Letters of Recommendation are not abid- process for when Subscribers and stated that APPIC cannot mandate this. ing by ‘truth in advertising’. There Members join and terminate mem- A survey question on this will be devel- should be verbal feedback between the bership. oped.

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Match 2001 Early notification to both unmatched at the Membership conference talk Dr. Keilin noted Match ROL dates students and sites with slots - 5 about specialties. could be either February 7 or February Regular notification with immediate 9, 2001. Applicants will submit ROL’s on Clearinghouse - 18 line. Dr. Willmuth wondered if we would Regular notification with 48 hour Consortia consider a uniform application deadline. delay of Clearinghouse - 1 Consortia criteria, when approved, It was decided that the time when DOT’s The Board will review these choices will be published in the Directory. There may contact matched applicants to their in Executive Session or the next confer- are now 39 consortium APPIC mem- program will be beginning at 11AM EST ence call after Dr. Keilin speaks with Mr. bers. Dr. Holliday noted that some con- on Match Day. Peranson at NMS to see if there is an ad- cerns may be the same for consortia and Match results will ONLY be sent by ditional cost to Early Notification. for multiple programs. There will be a regular mail to Member internships final vote on the document on the May next year by special request. The list of Postdocs and APPIC 23 Conference Call. Suggestions for im- where a Member’s other applicants APPIC Postdoctoral Members will be proving the document draft were so- were matched will again be sent by reg- surveyed separately from the licited. The following steps were sug- ular mail. Internships sites and asked if they want gested: More communication guidelines and a Postdoctoral Match. APPIC is inter- 1. Drs. Carey and Sheridan were asked examples from APPIC will be provided ested in increasing the Postdoctoral to author an article for the APPIC concerning what is or is not acceptable membership. Issues included: Newsletter on the Advantages and communication between applicant and 1. Nonmember sites which do not meet Disadvantages in a Consortia pro- sites for Match 2001. and do not want to meet nor want to gram. APAGS would like to reprint comply with APPIC Criteria that article with permission in their Removing Students from the 2. DCT’s want to keep the unstructured newsletter to help change perceptions Match `buddy’ system about consortia with students. There were 6 instances this year and 3. There is no Match or Uniform appli- 2. Consortia guidelines will go in to the the circumstances were explained. The cation or Directory on Line for Directories as well as in the following was agreed as procedure: Postdocs Newsletter. Once the criteria are ap- 1. If the university DCT calls, the Chair, 4. Everyone needs an internship but not proved there will be an assurance that DCT, and student can agree on re- a Postdoc APPIC will be monitoring for compli- moval. 5. Postdoc can access the List Serve. ance. 2. APPIC will not release a ROL but will The List Serve is new, has been very 3. There will be a Consortia break-out tell a DCT is a student has or has not active and has been used for listing group at the Membership Meeting listed a particular program. training opportunities outside of and Conference. Dr. Holliday sug- 3. If there is no agreement among the APPIC gested we define consortia more nar- DCT, APPIC Chair, and the student, 6. There were no responses in the last rowly and exclude programs with out- then the APPIC Chair, the Match survey from sites that only have a side rotations that are administered Coordinator, and one Board Member Postdoctoral program. and funded by a single entity. He sug- can decide. APPIC could remove a Solutions included: gested “a consortium is a program student from the Match. 1. APPIC will begin to write more arti- that has multiple funding streams for cles on Postdoctoral issues in the the internship for multi programs.” Clearinghouse newsletter. Drs. Boggs, Carey and Holliday will Ms. Duckworth reported that post- 2. Drs. Karen Schmaling and Stephen revise the current document for Board Match position-seeking by unmatched Holliday will write articles on their approval on the April 25th Conference applicants was chaotic and anxiety Postdoctoral Primary Care models for Call. arousing. The Chair said that the post- the next newsletter. Dr. Kaslow will The Consortia Task Force recom- Match process is like the job market and write about why its important to have mends that when a consortium site loses APPIC will attempt to prepare students Psychologists in Primary Care or gains its component members, it better through their Subscriber pro- 3. Dr. Leventhal suggested we have must inform APPIC and it is the respon- grams. We can encourage our member poster sessions and continue to have sibility of the Committee Chair sites to put out better materials. APPIC break-out sessions for our postdoc- (Membership or Membership Review) will not regulate the post-Match process. toral members. to do the Review. If it is within the first The Clearinghouse is a place to post and 4. Dr. Steve Holliday’s model of an ac- three years, the program goes for re- host information. It is not Match Two. credited postdoctoral program will be view before the Membership Variations of a `scramble’ procedure placed on the APPIC website. Committee. If three years or more have were discussed. 5. Dr. Kleiger from the Menninger passed, it will be in the next round of Foundation will be asked to share his programs to be reviewed. Central office Early Notification Straw Vote Postdoctoral model with APPIC mem- will supply the Chairs with previously A straw vote among those present bers. submitted application materials by the was conducted with the first choices be- 6. Drs. Boggs and Holliday will increase Membership Application Review tween outreach and communication to Committee on the program. Review Early notification in some form - 12 APPIC must be made by the Chair within 60 Regular notification - 7 days of notification. The Consortia There was then breakdown of prefer- Postdoctoral Members Committee will decide what is to be ences for alternate procedures for Early They will be offering examples and done to consortia sites that have made Notification and regular Notification: advice on how to get APA accreditation substantive changes to their programs Early notification of students only - 14 but did not notify APPIC.

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Non Board Member Attendance at Board Meetings Attendance once per year at the NEW MEMBERS Spring Meeting will be the norm for li- The Board congratulates and welcomes the following internship and postdoctoral aisons and committee chairs. There will programs which were recently recommended by the Doctoral Membership be leeway for special invitees. The direc- Committee and the Postdoctoral Membership and Review Committee, respectively, tory editor(s) will need to attend two and approved by Board action. Board meetings per year for the next two years due to the exigencies of the Doctoral Psychology Internships Online Directory. The liaisons are also Dallas Metropolitan Consortium in Psychology invited to the Biennial Membership Dallas, TX Meeting and Conference and Meeting in 2001 and beyond. Loyola University of Chicago Counseling Office Chicago, IL Third APPIC Membership Meeting and Conference Northeastern Illinois University Conseling Center Dr. Leventhal, Conference Chair, up- Chicago, IL dated everyone on the progress in plan- Northeastern University Counseling Center ning for the Conference. It will be held Boston, MA in New Orleans, LA, Le Pavilion Hotel, March 29, 30, 31, 2001 Child Development Center Thursday, March 29, APA Workshop West Palm Beach, FL on Accreditation and Site Visitor Superior Court of D.C. Child Guidance Clinic Training (included with registration fee) Washington, DC Thursday, March 29, APPIC Opening Rooftop Reception (weather permitting) Woodhull Medical & Mental Health Center New offerings and possibilities are: Brooklyn, NY Poster sessions for Postdoctoral pro- Austin Internship Consortium in Professional Psychology grams and an optional organized Austin, TX evening activity such as Mardi Gras World with dinner and music (at addi- Postdoctoral Programs tional $50 cost to participants). Cincinnati VAMC Organizational Development Postdoctoral Fellowship Additional topics were suggested by Cincinnati, OH liaisons. Respectfully submitted, Loyola Marymount University Student Psychological Services Robert W. Goldberg, Ph.D., ABPP Los Angeles, CA University of Southern California Student Counseling and Disability Services and Programs Los Angeles, CA The MENTA Group, Inc. Oak Brook, IL

P Announcement: P IC APPIC Change of Address A Effective July 15, 2000

APPIC has moved to: F 10 “G” Street, NE o 8 u 6 Suite 750 n d 1 9 Washington, DC 20002 e d Phone: 202-589-0600 Fax: 202-589-0603

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Availability of Training Table 1. continued from page 6 Percentage of Programs in which Interns Administer the Five Categories of Psychological Tests Table 2 presents findings regarding the percentages of programs in which Test Categories interns conduct the eight categories of Internship Objective Projective Neuro- psychotherapy. Of note are the high lev- Type Intelligence Achievement Personality Personality Psychological els of access to training in many of the eight categories of psychotherapy. Of VAH 100 43 100 82 96 particular note were cognitive-behav- (n=45) ioral/behavioral therapy (100% access MED SCH 100 80 100 75 90 for all program types), group therapy (n=39) (92 to 100% access for all program CONSORTIA 96 73 100 89 73 types), short-term psychodynamic ther- (n=26) apy (over 75% access in 10 of the 12 pro- CMHC 100 86 97 97 78 gram types), marital therapy (over 75% (n=36) access for 6 program types), family ther- PRIV GEN 100 93 93 93 79 apy (over 75% access for 8 program (n=14) types), and interpersonal therapy (over PRIV PSY 100 80 100 100 73 75% access in 6 program types). Hence, (n=15) the conclusion is that in most types of in- STATE 100 45 100 100 90 ternship settings interns have access to (n=28) a wide diversity of psychotherapy train- UCC 55 33 88 53 10 ing. In sharp contrast, access to long- (n=59) term psychodynamic therapy was rela- MIL FAC 100 75 100 75 100 tively lower across all program types (0 (n=4) to 68%). CHILD 97 79 94 100 58 (n=36) Implications CORRECT 100 85 92 92 62 These results present a current and (n=11) comprehensive picture of the availability OTHER 100 70 100 80 70 of training in the major categories of psy- (n=12) chological testing and psychotherapy Marginal M 95.7 70.2 97.0 86.3 73.3 across all types of internship programs. Means SD 12.9 19.2 4.2 14.1 23.8 These findings update previous studies examining the availability of training in The “self portrait” of internship train- namic therapy training). Our data offer neuropsychological evaluation, objective ing in psychotherapy is more complex. If no clues regarding why traditional psy- and projective testing, and group ther- “very high access” is defined as avail- chodynamic training is being taught in apy and expand the psychotherapy find- ability in 75 to 100% of each type of in- fewer internship programs. No doubt, ings of Crits-Christoph, Frank, ternship setting, then cognitive-behav- some will quickly point to economic fac- Chambless, Brody and Karp (1995) by ioral/behavioral therapy (100% in all tors and the predominance of cognitive- documenting access to the majority of internship settings), group therapy (92 behavioral theories as probable factors. the important categories of psychother- to 100% in all internship settings), and apy. Additionally, these findings have im- short-term psychodynamic therapy Implications for Students plications for students. (over 75% in 10 of the 12 internship set- Our data offer students a picture of tings) are the most widely taught ther- the array of testing and psychotherapy Internship Training Profiles apy modalities. These are the most avail- training events available during intern- Internship programs offer high levels able psychotherapy training modalities ship. The picture is highly positive and of access to all major categories of test- of the late 1990s. encouraging; interns have access to ing instruments, particularly the fre- A second tier of training availability training in a broad array of psychologi- quently used combinations of intelli- includes family therapy (over 75% in 8 of cal testing categories and psychother- gence, objective personality, and the 12 internship settings) and marital apy modalities. Of course, prospective projective personality testing. University therapy and interpersonal therapy (over interns are quite selective regarding Counseling Centers, which often stress 75% in 6 of the 12 internship settings). their internship training needs. In fact, other forms of evaluation such as voca- As would be expected, child therapy previous research (Stedman, Neff, tional measures and structured inter- training is most accessible and most val- Donahoe, Kopel & Hays, 1995) demon- views, are the exception; however, half ued by child programs but is also acces- strated that a match between interns’ in- offer training in intelligence and projec- sible and valued by community mental terests and the training experiences of- tive evaluation. Access to neuropsycho- health centers and private psychiatric fered by internships was the primary logical testing is less common but still is hospitals. Training availability is least variable differentiating “first choice in- quite high in those programs serving for long-term psychodynamic therapy. ternships” from “middle” and “last adult populations. The “self portrait” No type of internship setting offers 75%+ choice internships.” generated by these data appears to be access; and, in fact, only an average of In that light, Tables 1 and 2 offer very positive; most types of internship 49% of the internship settings offer this mostly good news to students. Most in- programs are providing comprehensive training at all (contrasted to an average ternship programs will match student training in psychological testing. of 84% offering short-term psychody- desires for training in testing and psy-

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chotherapy because most offer high Table 2. rates of access to both. In fact, Tables 1 Percentages of Programs in Which Interns Conduct the Eight Categories of and 2 might be used like a shopping list. Psychotherapy For example, a student desiring training in most categories of testing would find Psychotherapy Categories in Table 1 that medical school and hos- Long-Term Short-Term pital sites offer high access levels. Internship Psycho- Psycho- Cognitive Inter- Students interested primarily in adult Type dynamic dynamic Behavior Group Marital Family personal Play psychotherapy training can scan Table 2 and find that VAH sites offer very high VAH 59 93 100 100 96 73 82 4 rates of access to most adult oriented (n=43) therapy modalities, with the exception of MED SCH 51 66 100 100 73 81 61 68 long-term psychodynamic therapy. After (n=41) satisfying issues of access, the student CONSORTIA 50 89 100 96 92 89 88 can then turn his/her focus to other is- 69 sues. Students seeking training in long- (n=25) term psychodynamic psychotherapy will CMHC 68 100 100 100 81 95 76 87 have to be selective. Table 2 demon- (n=37) strates that it is still available but only on PRIV GEN 57 79 100 100 86 100 86 71 a more limited basis. Students desiring (n=13) this training will need to inquire care- PRIV PSY 53 93 100 100 73 100 67 80 fully about its availability. (n=14) STATE 55 79 100 100 31 76 76 27 References (n=29) Bacorn, C. N. & Conners, G. J. (1989). UCC 61 98 100 96 82 17 98 0 Alcohol treatment training in psychology (n=56) internship programs. Professional MIL FAC 0 75 100 100 100 100 50 25 Psychology: Research and Practice, 8, 51-5. Carmody, T. P. & Zorn, J. (1980). APA-ap- (n=4) proved group treatment internship oppor- CHILD 42 69 100 92 34 93 68 89 tunities: Present status and future direc- (n=33) tions. Professional Psychology, 11, 213-219. CORRECT 46 77 100 92 46 69 62 62 Cripe, L. L. (1995). Listing of training pro- (n=12) grams in clinical neuropsychology. Clinical OTHER 46 91 100 100 36 27 64 0 Neuropsychologist, 9, 327-338. Crits-Christoph, P., Frank, E., Chambless, D. (n=10) L., Brody, C. & Karp, J. (1995). Training in Marginal X 49.0 84.1 100 98.0 69.2 76.7 73.2 48.5 empirically validated treatments: What are Means SD 17.0 11.4 0.0 3.19 25.5 27.8 13.7 34.8 clinical psychology students learning? Professional Psychology: Research and Practice, 26, 514-522. Dahlstrom, G. W., & Moreland, L. K. (1983). Teaching the MMPI: APA-approved clini- McCaffery, R. J., Malloy, P. F., & Brief, D. J. Rodolfa, E. R., Kraft, W. A., Reilly, R. R., & cal internships. Professional Psychology: (1985). Internship opportunities in clinical Blackmore, S. H. (1983). The status of Research and Practice, 14, 563-569. neuropsychology emphasizing recent INS Research and training in hypnosis at APA- Durand, M. V., Blanchard, E. B., & Mindell, J. training guidelines. Professional Psychology: accredited clinical/counseling internship A. (1988). Training in projective testing: Research and Practice, 16, 236-252. sites: A national survey. International Survey of clinical training directors and in- Malouf, J. L., Hass, L. J., & Farah, M. J. Journal of Clinical and Experimental ternship directors. Professional Psychology: (1983). Issues in preparation of interns: Hypnosis, 31, 284-292. Research and Practice, 19, 236-238. Views of trainers and trainees. Professional Stedman, J. M., Neff, J. A., Donahoe, C. P., Hall, R. G., Cantrell, P. J., & Boggs, K. R. Psychology: Research and Practice, 14, Kopel, K. & Hays, J. R. (1995). Applicant (1997). APPIC Directory: Internship and 624-631. characterization of the most desirable in- postdoctoral programs in professional psy- Piotrowski, C. (1984). The status of projective ternship programs. Professional Psychology: chology. Washington, D.C. Association of techniques: “Wishing won’t make it go Research and Practice, 26, 396-400. Psychology. Postdoctoral and Internship away.” Journal of Clinical Psychology, 40, Centers. 1495-1502.

PPIC A F o 8 u 9 6 n d e d 1

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Addiction Treatment health specialists (Magill, & Garrett, substance use disorders, their tendency continued from page 7 1988). Generally, the prevalence of alco- to have high incidence in patients pre- holism and alcohol abuse in hospitalized senting with other major mental illness, havioral health center should expect to patients has ranged from 4% to 70% with and learn the scientifically validated identify between 50-70% of their de- most studies reporting these problems treatments available. This may require pressed patients as having a substance in one of four admissions (Baird, Burge, considerable commitment and energy use disorder or dependence (Galanter, & Grant, 1989; Conigrave, Burns, since the treatment of SUDs is a com- Castaneda, & Ferman 1988; Lehman, Reznik, & Saunders, 1983; Graham, plex skill with considerable body of the- Myers, Corty, & Thompson 1994; 1991; Hiller, Mombour, & Mittlehammer, oretical and research literature to mas- Rosenthal, & Westreich, 1999). Rarely, 1989; Jarman & Kellet, 1979; Moore, ter. This body of knowledge requires do psychologists identify and treat this 1971). foundations in genetics, family systems predicted incidence of these disorders The recidivism costs, and general diagnosis and treatment, learning the- in their depressed patients. The problem economic and health consequences of ory based approaches to SUDS, multi- is that substance abuse is equally poorly this under-diagnosing and treating are disciplinary team psychosocial treat- identified and treated by many psycholo- tremendous (Chan, Pristach, & Welte, ment, and psychopharmacology (Brown, gists with only 10% of graduate psychol- 1994). Training directors in psychology & Hester, 1996; Dodgen & Shea, 1997). ogy programs providing any formal internships and post doctoral residen- The training director should include course work in addictions (Margolis & cies are likely to supervise psychology the enhancement of these skills and Zweben, 1998, p. 19). Even though the trainees who have no (or very little) for- knowledge base in the faculty develop- treatment of depression is one of the mal training in the diagnosis and treat- ment plan, and identify at least one fac- most important skills of a psychologist, ment of substance use disorders ulty member who is willing and capable and there is an extremely high comor- (Margolis & Zweben, 1998, p. 19). These of assuming leadership in this area of su- bidity of substance use disorders in de- psychologists can hardly be expected pervision and training. That faculty pressives and other disorders who pre- to intercede effectively with primary member should be financially supported sent to psychologists for treatment, few care physicians who under diagnose in gaining the additional personal train- psychologists have the academic or pro- and refer patients with alcohol and ing and supervision needed to become fessional preparation to treat them. other psychoactive substance use disor- competent in treatment and supervision Evidence is mounting that the more ders (SUDs), and are likely to miss related to (SUDs). Ideally, this faculty counseling and psychosocial services a much of the SUDs in their own prac- member should eventually achieve the patient in some treatment populations tices. American Psychological Association, receives the better the outcome. This is This places a significant quality assur- National College of Professional particularly apparent in some substance ance, ethical, and training related finan- Psychology, Certificate of Proficiency in abuse sub-populations and related disor- cial burden on internship and residency the Treatment of Alcohol and Other ders (Baker et al., 1993; Durell, et al., directors and faculty. They must, in ef- Psychoactive Substance use Disorders 1993; McLellan, et al., 1993). fect, make up for the lack of course (1996) which required a doctorate de- Increasingly, primary care physicians, work, supervision, and formal training gree in a clinical sub-discipline in psy- psychologists, psychiatrically trained in SUDs occurring in interns and post chology, a year of post doctoral SUDs nurses, substance abuse counselors, doctoral residents. Because of the lack treatment with supervision, and passage and clinical and administrative social of attention to this core area of training of a national written examination. workers are collaborating to deliver ef- in psychology training programs, and The training director should build the fective coordinated care on the front because of the significant prevalence of resources in the staff library, faculty lines of health care (Boydston, 1983; SUDs, training directors often find su- continuing education, and staff training Broskowski, 1980; Buie, 1990; Burns, pervisors in other disciplines to impart leave time necessary to maintain state of Burke, & Ozarin, 1983; Candib, & training in addictions to their students. the art skills and knowledge related to Glenn, 1983; Celenza, & Fenton, 1981; The result is psychology enjoys a this area of training and service delivery. Dym, & Berman, 1986; Enright, & Blue, poor reputation for preparation to treat Training programs should attempt to 1989). To do so, doctors of medicine and SUDs among behavioral health disci- recruit at least one intern or resident per psychology must gain an understanding plines, treatment facility administrators, year from one of the graduate programs of the strengths and limits of their re- and the addiction treatment community. which offer formal training for psycholo- spective education and training, scope of While there are some very well trained gists in SUDs. These students can en- practice, and the enabling legislation, SUDs psychologists and research scien- rich the experience both faculty and rules and regulations which allow col- tists and a growing body of psychologi- other students. They can provide the laboration (APA Rural Task Force, cal literature in this area, our multi-disci- press for faculty to continue to grow to 1994). plinary facility managers and colleagues stay current (or even ahead). They can There is strong evidence that alco- are very aware that these psychologists stimulate intern and post doctoral resi- holism, particularly in its early stages, is are in the minority. Our colleagues are dent and faculty collaborative research. poorly recognized in general medical aware that while psychologists would When appropriate they may be re- practice settings, and in hospitals with never be trained for clinical work with- cruited to stay as future faculty and en- only physician diagnosticians available out formal course work and training in hance the program. (Bradley, 1992; Brown, Carter, & the diagnosis and treatment of depres- The training director should work Gordon, 1987; Coulehan, Zettler-Segal, sion, psychologists are being routinely with training faculty to develop didac- Block, McClelland, & Schulberg, 1987; trained without such preparation in ad- tics, reading assignments, and patient Moore & Malitz, 1986; Reid, Webb, dictions (a similar frequently occurring rotations which impart substance abuse Hennrikus, Fahey, & Sanson-Fisher, and co-occurring disorder). experience and knowledge. These 1986; Schuckit, 1987; Umbrecht- should emphasize SUDs related diag- Schneiter, Santora, & Moore, 1991). Recommendations for Training nostic procedures and instruments This fact is further complicated by the Directors: which should be included in the intake well documented reluctance of primary Training directors must themselves and treatment planning process care physicians to refer to behavioral become familiar with the prevalence of (Morris, & Wise, 1992), video and/or

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audio taped sessions with individuals un- APA Rural Task Force, (1994). Morris, J. A. Cummings, N. A., Dorken, H., Pallak, M. S., dergoing SUDs, and case presentations (Contributor). Caring for the Rural Henke, C. (1990). The Impact of demonstrating the use of empirically Community An Interdisciplinary Psychological Intervention on Health Care Curriculum. American Psychological Utilization & Costs: The Hawaii Medicaid supported techniques and treatment Association: Washington, DC. Project. (Report No. 11-C-98344/9). San plans appropriate for these patients Baird, M. A., Burge, S. K., & Grant, W. D. Francisco: Biodyne Institute. (Finney, & Moos, 1998). (1989). A scheme for determining the Durell, J., Lechtenberg, B., Corse, S., & Finally, the training director should prevalence of alcoholism in hospitalized Frances, R. (1993). Alcohol & Drug Abuse: establish a program vision and culture patients. Alcoholism: Clinical and Intensive Case Management of Persons which highly values the identification Experimental Research, 13, pp. 782-785. with Chronic Mental Illness Who Abuses and treatment of SUDs. This culture Baker, F., Jodrey, D., Intagliatia, J., & Straus, Substances. Hospital & Community H. (1993). Community support services Psychiatry, 44, 415-416, 428. should communicate the vision of the and functioning of the seriously mentally Dym, B., & Berman, S. (1986). The primary treatment of SUDs as a high status phe- ill. Community Mental Health Journal, 29, health care team: Family physician and nomena which is well supported and re- pp. 321-331. family therapist in joint practice. Family warded. The culture should provide fre- Barker, P., Manderscheid, R., Hendershot, G., Systems Medicine, 4, 9-21. quent notoriety and benefits tied to the Jack, S., Schoenborn, C., & Goldstrom, I. Enright, M. F. & Blue, B. A. (1989). treatment of SUDs and these should be (1989). Serious Mental Disability in the Collaborative treatment of panic disorders Adult Household Population: United by psychologists and family physicians. disseminated organization wide. These States, 1989. In R. Manderscheid & M. Psychotherapy in Private Practice, 7, 85-90. might include regular mention of trainee Sonnerschein (Eds.), Mental Health, Finney, J. W., & Moos, R. H. (1998). and faculty accomplishments in the com- United States, 1992. U.S. Government Psychosocial treatments for alcohol use pany newsletter, bonus pay and pay Printing Office, Washington, D.C. disorders. In P. E. Nathan & J. M. Gorman raises for faculty who achieve additional Boydston, J. C. (1983). Rural mental health: A (Eds.), A Guide to Treatments that Work. credentials, grants, or public notoriety in partnership with physicians. Practice New York: Oxford University Press. Digest, 6(1), 23-25. Galanter, M., Castaneda, R., & Ferman, J. the area, and travel support and time off Bradley, K. A. (1992). Screening and diagno- (1988). Substance abuse among general for students with SUDs related papers sis of alcoholism in the primary care set- psychiatric patients: Place of presentation, and poster session presentations, etc. ting. Western Journal of Medicine, 156, pp. diagnosis, and treatment. American 166-171. Journal of Drug and Alcohol Abuse, 14, 211- Summary: Broskowski, A. (1980). Evaluation of the pri- 235. The diagnosis and treatment of SUDs mary healthcare project-community men- Graham, A. W. (1991). Screening for alco- tal health center initiative: Executive sum- holism by life-style risk assessment in a is a very important component of patient mary. Department of Health and Human community hospital. Archives of Internal care in any training organization. Very Services, Alcohol, Drug Abuse, and Medicine, 151. pp. 958-964. few psychologists get formal training in Mental Health Administration, National Hartman-Stein, P. E., & Reuter, J. M. (1993). the treatment of SUDs. This situation Institute of Mental Health contract no. 278- Proactive Health Care Reform: Integrating represents a glaring weakness in psy- 79-0030. Physical and Psychological Care. chology graduate education and a lack Brown, R. L., Carter, W. B., & Gordon, M. J. Unpublished paper. of responsiveness to significant patient (1987). Diagnosis of alcoholism in a simu- Higgins, S. T., & Silverman, K. (1999). lated patient encounter by primary care Motivating Behavior change Among Illicit- and societal health care needs. physicians. The Journal of Family Practice, Drug Abusers. Washington, DC: American Internships and post doctoral residen- 25, pp. 259-264. Psychological Association. cies can address this problem by: 1) de- Brown, S., & Hester, R. (1996). The Hiller, W., Mombour, W., & Mittlehammer, J. veloping a formal SUDs sensitive trainee Assessment and Treatment of (1989). A systematic evaluation of the selection program; 2) selecting or devel- Psychoactive Substance Use Disorders: A DSM-III-R criteria for alcohol dependence. oping faculty with skills and knowledge Home Study Course. La Jolla, CA: Comprehensive Psychiatry, 30. pp. 403-415. University of CA, San Diego, Department Hoffman, A. L., & Slade, J. (1992). Following in the treatment of SUDs; 3) developing of Psychiatry. the Pioneers: Addressing tobacco in chem- formal SUDs training rotations; and 4) Buie, J. (1990). Rural therapists often advise ical dependency treatment. Journal of by developing a program culture which MDs on drugs. The APA Monitor 21(1), 19. Substance Abuse Treatment, 10, 153-160. recognizes and rewards a commitment Burns, B. J., Burke, J. D., Jr., & Ozarin, L. D. Hurt, R. D., Eberman, K. M., Slade, J., & to training and treatment in the area of (1983). Linking health and mental health Karan, L. (1993). Treating nicotine addic- SUDs. services in rural areas. International tion in patients with other addictive disor- This approach will reward students Journal of Mental Health, 12(1-2), 130-143. ders. In C. T. Orleans & J. Slade (Eds.), Candib, L. & Glenn, M. (1983). Family medi- Nicotine addiction: Principles and manage- from training programs with SUDs re- cine and family therapy: Comparative de- ment (pp. 310-326). New York: Oxford lated coursework and practica and de- velopment, methods, and roles. Journal of University Press. velop incentives for students and faculty Family Practice, 16, 773-779. Hymowitz, N. (1998). Tobacco. In R. J. to exercise their options to include Celenza, C. M., & Fenton, D. N. (1981). Frances & S. I. Miller (Eds.) Clinical text- SUDs studies in their graduate prepara- Integrating mental and medical health ser- book of addictive disorders (2nd ed.). New tion. Training directors can lead the psy- vices: The Kennebec-Somerset Model. York: The Guilford Press. New Directions for Mental Health Services, Jarman, C. M. B., & Kellet, J. M. (1979). chological community by identifying 9, 39-49. Alcoholism in the general hospital. British and addressing a training problem. Chan, A. W. K., Pristach, E. A., & Welte, J. W. Medical Journal, 2. pp. 469-472. Finally training directors and their fac- (1994). Detection by the CAGE of alco- Kaplan, H. I., & Sadock, B. J., (Eds.). (1985). ulty can become more responsive to holism or heavy drinking in primary care Comprehensive Textbook of Psychiatry/IV. their patients and local health system’s outpatients and the general population. Baltimore: Williams & Wilkins. needs and improve the image of psy- Journal of Substance Abuse, 6. pp. 123-135. Lehman, A. F., Myers, C. P., Corty, E., & chologists. Conigrave, K. M., Burns, F. H., Reznik, R. B., Thompson, J. W. (1994). Prevalence and & Saunders, J. B. (1991). Problem drinking patterns of “dual-diagnosis” among psychi- in emergency department patients: The atric inpatients. Comprehensive Psychiatry, scope for early intervention. Medical 35, 106-112. References Journal of Australia, 154. pp. 801-805. Magill, M. K., & Garrett, R. W. (1988). APA College of Professional Psychology, Coulehan, J. L., Zettler-Segal, M., Block, M., Behavioral and psychiatric problems. In R. (1996). Certificate of Proficiency in the McClelland, M., & Schulberg, H. C. B. Taylor (Ed.), Family Medicine (3rd ed., Treatment of Alcohol and Other (1987). Recognition of alcoholism and sub- pp. 534-562). New York: Springer-Verlag. Psychoactive Substance Use Disorders stance abuse in primary care patients. Margolis, R. D., & Zweben, J. E. (1998). [Brochure]. Washington, DC: American Archives of Internal Medicine, 147. pp. 249- Treating patients with Alcohol and other Psychological Association. 352. Drug Problems: An Integrated Approach.

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Washington, DC: American Psychological Substance Abuse and Mental Health Services discussing what it is like to be in such an Association. Administration. (1995). National McCrady, B. S., & Epstein, E. E. (Eds.). Household Survey on Drug Abuse: main experiential group. The experiential (1999). Addictions: A Comprehensive findings, 1993 (DHHS Publication No. group meets for 90 minutes per week for Guidebook. New York: Oxford University SMA 95-3020). Rockville, MD: National seven months. The leader of this group Press. Clearinghouse for Alcohol and Drug is a certified group psychotherapist who McLellan, A. T., Arndt, I. O., Metzger, D. S., Information. is brought in from outside of the medical Woody, G. E. & O’Brien, C. P. (1993). The Substance Abuse and Mental Health Services Effects of Psychosocial Services in Administration. (1998a). National center system. The proceedings of the Substance Abuse Treatment. JAMA, 269, Household Survey on Drug Abuse: experiential group are kept confidential. 1953-1959. Population estimates 1997 (DHHS The group leader makes no evalua- Moore, R. A. (1971). The prevalence of alco- Publication No. SMA 98-3250). Rockville, tive/supervisory report other than the holism in a community general hospital. MD: National Clearinghouse for Alcohol trainees’ attendance. While the distinc- American Journal of Psychiatry, 128. pp. and Drug Information. 130-131. Substance Abuse and Mental Health Services tion between training groups and ther- Moore, R. D., & Malitz, F. E. (1986). Administration. (1998b). Preliminary re- apy groups may at times become Underdiagnosis of alcoholism by residents sults from the 1997 national Household blurred, we take every precaution to in an ambulatory medical practice. Journal Survey on Drug Abuse (DHHS Publication maximize the sense of safety and trust of Medical Education, 61. pp. 46-52. No. SMA 98-3251). Rockville, MD: Morris, J. A. & Wise, R. P. (1992). The identi- National Clearinghouse for Alcohol and available. Guidelines for participation fication and treatment of the dual diagnosis Drug Information. are offered and trainees are allowed to patient. Alcoholism Treatment Quarterly, Schuckit, M. A. (1987). Why don’t we diag- decline participation without penalty. 9(2), 55-64. nose alcoholism in our patients? The Once they join the group, however, they Morris, J. A. (1994, December). The history Journal of Family Practice, 25, pp. 225-226. are encouraged to remain for the entire of managed care and its impact on psycho- Umbrecht-Schneiter, A., Santora, P., & dynamic treatment. The Journal of Moore, R. D. (1991). Alcohol abuse: seven months. The final sessions of the Psychoanalysis and Psychotherapy, 11, pp. Comparison of two methods for assessing experiential group are used to review 129-137. its prevalence and associated morbidity in and consolidate the learning that oc- Morris, J. A. (1997). The rural psychologist in hospitalized patients. The American curred throughout the year. the hospital emergency room. In J. A. Journal of Medicine, 91. pp. 110-118. Over the course of the past six years Morris (Ed.) Practicing Psychology in the VandenBos, G. (1993). U.S. mental health pol- Rural Setting: Hospital Privileges and icy. Proactive evaluation in the midst of in which we have offered an experiential Collaborative Care. Washington DC: healthcare reform. American Psychologist, group, we have found that most interns American Psychological Association. 48, 283-290. are enthusiastic about participating. It is Parker, D. A., & Harford, T. C. (1992). The often seen as a powerful venue for learn- epidemiology of alcohol consumption and dependence across occupations in the ing about group dynamics. United States. Alcohol Health & Research Group Therapy Training Apprehension often arises around issues World, 16, 97-105. continued from page 8 of self-disclosure, transference, and feel- Regier, D. A., Farmer, M. E., Rae, D. S., ings of awkwardness related to working Locke, B. Z., Keith, S. J., Judd, L. L., & with fellow participants outside of the Goodwin, F. K. (1990). Comorbidity of cuss issues pertaining to their co-ther- mental disorders with alcohol and other group setting. Naturally, group partici- drug abuse results from the epidemiologic apy relationship that might otherwise pants will experience and express a catchment area (ECA) study. JAMA, not be talked about. Furthermore, range of feelings. However, the depth of 264(19), 2511-2518. group supervision of group mirrors the emotional expression and personal reve- Regier, D. A., Myers, J. K., Kramer, M., treatment approach and fosters the lation are attenuated by the group Robins, L. N., Blazer, D. G., Hough, R. L., emergence of a parallel process which Eaton, W. W., & Locke, B. Z. (1984). The leader. Trainees do not air their personal may lend additional insight into the dy- NIMH epidemiologic catchment area pro- histories or explore transference/coun- namics of their own groups. We have gram: historical context, major objectives, tertransference issues in detail. and study population characteristics. tried offering group supervision of The experiential group is a multidisci- Archives of General Psychiatry, 41, 934-941. group less often (i.e., one time per Reid, A. L. A., Webb, G. R., Hennrikus, D., plinary endeavor involving trainees from month) but found the lack of continuity Fahey, P. P., & Sanson-Fisher, R. W. (1986). three different disciplines (i.e., psychol- inhibiting and less productive overall. General practitioner’s detection of patients ogy, psychiatry, and social work). As with high alcohol intake. British Medical Experiential Process Group: Upon Journal, 293. pp. 735-737. completion of the didactic seminar, in- such, we have found that natural cross- Rice, D. P. (1993). The economic cost of alco- terns are invited to participate in a train- disciplinary tensions found in the larger hol abuse and alcohol dependence: 1990. ing group in order to learn more about healthcare systems (e.g., medical cen- Alcohol Health & Research World, 17, 10-11. ter, psychiatric department) are often re- Rosenthal, R. N., & Westreich, L. (1999). group dynamics from an experiential Treatment of persons with dual diagnoses perspective. It is conducted as a training flected in the process of the experiential of substance use disorder and other psy- group and not a therapy group. groups. The potential for splitting, sub- chological problems. In B. S. McCrady & Psychology interns join with psychiatry grouping, and scapegoating is om- E. E. Epstein (Eds.), Addictions: A nipresent. This has led to various Comprehensive Guidebook. New York: residents and social work interns to ex- Oxford University Press. plore group processes and interaction trainees over the years to resist joining Shoptaw, S., Dow, S., Frosch, D. L., Ling, W., patterns. Participants are not encour- or seek permission to “drop out.” This Madsen, D. C., & Jarvik, M. E. (1999). aged to explore individual concerns or requires an empathic yet committed Reducing cigarette smoking in methadone stance on behalf of the training director maintenance patients. In S. T. Higgins and emotional struggles in this forum. K. Silverman (Eds.), Motivating Behavior Instead, they are asked to observe and and all training faculty that the trainees Change Among Illicit-Drug Abusers (pp. experience universal aspects of group be encouraged to “work through” these 243-264). Washington, DC: American formation and function (e.g., stages of commonly occurring tensions within the Psychological Association. group development, role of group frame of the group. Invariably, this fos- Slade, J. (1999). Nicotine. In B. S. McCrady & ters a fruitful exploration of the impor- E. E. Epstein (Eds.), Addictions: A leader, social roles that emerge in small Comprehensive Guidebook. New York: groups). Although the topical content is tance of safety, trust, and cohesion Oxford University Press. not directed, trainees typically begin by within group settings.

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The Need for Institutional Commitment: of Clinical Psychology at the Univer- faculty, training directors, and other rec- From a social systems perspective, sity of Rochester School of Medicine ommenders. Requiring the student’s ref- any training program that is to be suc- and Dentistry and can be reached at erees to submit multiple original copies cessful must be an integral part of the (716) 275-3612 or by e-mail at debo- of reference letters directly from faculty larger whole that values and supports its [email protected]. for inclusion in their application packet function. In the Department of constrains recommenders’ rights, may Psychiatry at the University of compromise the integrity of recommen- Rochester, we are fortunate to have a dation letters, and may trap students in strong group therapy program that pred- Watch Where You Walk an uncomfortable place between two icates the availability of group training continued from page 9 powerful entities (e.g., faculty and in- for interns. The development of this pro- ternship staff). gram has been a lengthy process and ing and time-consuming for students The process for documenting clinical mandates the investment of departmen- and faculty recommenders. hours, though improved, still is viewed tal resources (e.g., time, money, space Another confusing aspect of the in- as unrealistically specific for accurate re- allocation). Ongoing commitment to the ternship application process that was sponding. The specificity required by group program and group therapy train- rated negatively by applicants was the APPIC was seen as leading to overlap in ing on behalf of the Department of presence of unwritten, non-explicit rules the number of hours reported. These Psychiatry Chair, Group Program and policies in place for selecting inter- retrospective data also may have validity Director, Psychology Training Director, viewees and ultimately, interns. problems (Herschell & McNeil, 2000). and the general faculty has been crucial Examples include: (a) internship sites to the success we have accomplished so completely filling interview slots on a far. In addition, we are fortunate to have first-come-first-serve basis before the ap- Inflexibility Regarding Scheduled a number of well-trained seasoned fac- plication deadline date, and the lack of Interview Dates ulty and other clinicians who specialize any stated policies about interviews and The rigidity of many internship staff in group therapy. Although committed whether they are by invitation only or if regarding interview dates, in combina- to training, it has been important to en- not, how and when an applicant might tion with the emphasis placed on stu- sure incentives for the staff and faculty arrange for one; (b) internship sites elic- dents attending interviews during a time to continue their involvement in the pro- iting information about applicants from of the year in which the weather often is gram. For example, we have had to ne- interns who interviewed them while in- treacherous in many parts of the coun- gotiate and design an accounting system forming applicants that these interns are try, was noted as a negative component for tracking productivity such that su- not involved in the selection process; of the process. Enforcing rigid, non- pervisors are not penalized for having an and (c) internship sites informing appli- negotiable rules and policies for stu- intern as a co-therapist. Lastly, we have cants that interviews are not required, dents who lack the power to object found it helpful to have an identified di- but then penalizing applicants who do under any circumstances is a misuse of rector for group therapy training in psy- not come to interview. Students were un- power. For example, we are aware of one chology who oversees the training pro- sure about the sincerity of sites that student who chose to keep an interview gram and acts as a liaison with group stated that interviews were not required. at an internship site the day after therapy staff and faculty. This person is It may be helpful to indicate to appli- his/her mother’s death, not even in- responsible for assigning the co-ther- cants the number of people in the past forming the interviewer of the situation, apy/supervisory team, facilitating evalu- five years who did not interview, but fearing that s/he may not be provided ation process of and by the trainee, and who nonetheless were ranked such that the opportunity to interview again. This leading group supervision of group ther- they realistically could have been se- situation illustrates how extreme the apy. lected for the internship if they had power differential between internship Internship directors and supervisors ranked the site as a first choice. staff and students is and how harmful who would like to further develop their Students have found it particularly de- the control gap can be when internships group therapy program and expand moralizing not to be placed at a site do not communicate any flexibility in group training opportunities at their site when they do not fully understand the their rules. may first wish to investigate the avail- reasons for exclusion (Draper & Lopez, Another stunning example is the case ability of professional development op- 1997). Many individuals indicated that of a student who was responded to with portunities both locally and nationally. unspecified rules of internship pro- skepticism by an internship site and ca- For additional information on certi- grams left them engaging in guesswork joled to attend an out-of-town interview fication requirements for the and being skeptical. Unclear policies when the student attempted to resched- National Registry, contact the American and procedures also exaggerate student ule due to a widespread ice storm, in Group Psychotherapy Association at feelings of powerlessness and lack of which at least 11 people were killed due (212) 477-1600 or via e-mail at control. to weather-related traffic mishaps within www.GROUPSinc.com. Dr. Markus is a 24-hour period in a single, moderately- the Assistant Training Director of sized state. As this case illustrates, stu- Clinical Psychology and Director of the Inappropriate and Unrealistic Demands dent stress can be aggravated and stu- Predoctoral Internship Group Training Placed on Applicants and Recommenders dent safety can be put at risk when Program in Psychology at the University Students were displeased with having members of internship programs re- of Rochester School of Medicine and to send multiple original copies of tran- main inflexible regardless of the circum- Dentistry and can be reached at (716) scripts, letters of recommendations, and stances. Others have identified the need 275-3630 or by e-mail at howard. training director verification forms to for internship directors to be flexible [email protected]. He is a the same internship program, due to the and fair in situations of inclement Certified Group Psychotherapist of the expense of these requirements and the weather (Draper & Lopez, 1997; Tynan, AGPA. Dr. King is the Training Director inconvenience this procedure caused 1995).

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Lack of Time Available for Applicants to specified. These steps should be ex- 10. If sites make interviews available, Interact with Internship Faculty and plicit, so applicants do not have to they should be sure that the inter- Interns guess what is truly expected of them. views are meaningful in terms of Another negative aspect of the intern- In this way, students would have the time available from internship fac- ship application process raised by some chance to do what is wanted by in- ulty and interns. Students suggested was having a minimal amount of time to ternship staff, which is only fair. that sites offer applicants enough interview after having paid a substantial 6. Respondents requested that intern- time to speak with interns and fac- sum of money and traveled some dis- ships have greater regard for the ex- ulty with whom they are interested tance. We know of one student, for ex- penses that students accrue, and at- in working. Specifically, applicants ample, who traveled 1,200 miles on two tempt to minimize them whenever should be given time not only to be separate occasions, to two different sites possible. In cases where internship interviewed, but also to ask ques- of the same internship consortium (who programs have several sites, each of tions that they may have. This con- did not cooperate with one another), and which needs a copy of student appli- sideration for the applicants’ training was given only two half hour interviews cation materials, internship programs needs, as well as the amount of time at each place. Clearly, these visits were could permit one original and other and money that most applicants have wasteful of the student’s time and money photocopied materials instead of mul- spent traveling to an array of sites (and took time away from training activ- tiple originals (e.g., of transcripts). over a few months, would facilitate a ities such as work on the dissertation), Students recognize that internship more mutually respectful and power- but s/he believed s/he had “no choice.” programs cannot cover the cost of stu- balanced relationship. dent interview visits; however, per- haps they could arrange for students Conclusions Suggestions for Improvement to stay with interns or graduate stu- Just as an elephant needs to be cog- Making changes can never entirely dents, help them get discounted hotel nizant of the weight and power it pos- eliminate the stress of the internship ap- rates, or cover the cost of a meal. Such sesses (but did not choose), to ensure plication process for applicants, but it suggestions also have been recom- that it does not tread inappropriately on could decrease student duress and mended by others (Boggs, 1999). smaller, or more junior creatures around make them feel as respected and in con- 7. Only one original of each recommen- it, internship directors and staff need to trol as possible. Some suggestions for dation letter should be required, and be continually aware of their power, and improvement: sites should allow each one to be sub- take responsibility for it. Constant con- 1. Sites should ensure that information mitted either along with the student’s sideration of how easy it is to inadver- on the web is updated annually early packet of application materials, or sep- tently negatively impact applicants is in on a standard date (e.g., June 1) and arately by the referee. Internships order. Using power responsibly goes be- that these policies and procedures re- certainly could state a preference, but yond cordial interpersonal interactions, main unchanged for the upcoming ap- rigid rules requiring students to con- although that, too, is quite important. It plication year. If sites do not have the trol the behavior of faculty puts them extends as well to explicit, fair, and con- personnel to update web sites annu- in an untenable position. Moreover, siderate administrative policies and pro- ally, these sites should provide a clear only one original of the training direc- cedures. Increasing respect, sensitivity, caution to students that the informa- tor’s verification form should be re- and responsiveness to students might tion on their web site may not be cur- quired for each site, although a lim- make it less likely that students will go rent. ited number of additional photocopies to all ends of the earth, regardless of the 2. Downloadable internship site applica- could be requested. cost, and do anything they believe might tions, like the AAPI, should be avail- 8. APPIC could work with the various possibly be helpful, in securing in in- able on the web. This availability, as graduate training councils to arrange ternship slot. noted previously, would save time and for practicum hours to be systemati- We imagine that it is difficult for in- money for all involved. cally recorded on an ongoing basis ternship staff to have so much power 3. Ample information about research op- throughout a student’s graduate ca- when students have relatively little. portunities and post-internship possi- reer, and perhaps continuing through Further, we are aware of Cantrell’s bilities (if any) for interns should be internship and postdoctoral years. (1997) point that many internship staff provided. For example, five year data Such an arrangement would improve are impacted by the negative experi- about how many interns have stayed accuracy in applicant recording. At ences of applicants. This article is writ- on at the site for a postdoctoral year least one practicum hours database ten from a student and training director would be immensely helpful for stu- exists and is in use by psychology perspective, and so undoubtedly is dents in understanding the possibili- graduate students (Herschell & somewhat one-sided. Nevertheless, we ties (typically with no guarantee, of McNeil, 2000). hope these comments and recommenda- course) that would help in planning 9. Internship directors and staff could tions might be found useful. their lives, which may involve signifi- communicate some flexibility regard- Undoubtedly, internship directors and cant others. ing scheduled interview dates and staff would have suggestions for stu- 4. Internship sites could require appli- other requirements in exceptional cir- dents, training directors, and faculty to cants to complete only those ques- cumstances. Applicants should be make their role in the process, which tions that are included in the AAPI. If protected against punishment and cannot be easy, at least easier, and these a site feels compelled to ask additional treated with sensitivity (rather than suggestions would be welcome. The questions, they should ensure that annoyance or disrespect) when a small creatures scurrying around an ele- these questions do not overlap with grave or stressful event occurs that in- phant’s feet do have the potential to those listed in the AAPI. terferes with them attending an inter- annoy or even trip the elephant, causing 5. Steps in a site’s application process view, or when there is inclement it to fall, which might be disastrous for should be standardized and clearly weather that precludes safe travel. all concerned. Let us continue to work

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together sensitively and positively to in- The threat of a patient harming a ported that only 30% of those assaulted sure the successful training of future third party is distressing, but Guy and suffered any physical injury, while only generations of psychologists. Brady (1998) have asserted that few 10% reported moderate injury. Usually, challenges facing psychotherapists are the emotional distress was far more dis- more upsetting that the possibility of pa- turbing than any physical injury. Aside References tient violence toward the clinician him- from years of clinical experience, there Boggs, K. R. (1999, July). Helping stu- self or herself. In terms of the incidence is little in the literature that would sug- dents reduce internship application of violence directed at therapists, Tryon gest a set of characteristics attributable costs. APPIC Newsletter, XXIV, 6-7. (1986) reported on a national survey in to a typical therapist victim (Guy and Cantrell, P. J. (1997, Winter). Supply and which it was found that 12% of therapists Brady, 1998). demand internship problems. APPIC in private practice and 24% in hospitals Newsletter, XXII, 1, 30-33. and clinics had been victims of patient vi- Patients as Victims of Violence Draper, K. & Lopez, S. (1997, Summer). olence at some in their careers. In the national survey by Pope and The effects of the internship imbal- Moreover, 81% of those surveyed had Tabachnick (1993), 79% of the therapists ance on students: Personal accounts. experienced some form of verbal abuse in the survey reported having been APPIC Newsletter, XXII, 7, 29-30. or threat. In a more recent national sur- afraid that a patient of theirs would be at- Herschell, A. D. & McNeil, D. W. (2000). vey, Guy, Brown, and Poelstra (1990) re- tacked by a third party. Victimization by A method to track practicum hours ported that nearly 50% of their sample of interpersonal violence is, unfortunately, during psychology graduate training: psychologists had been threatened with not a statistically rare event. By way of Easy, cheap, and necessarily obses- physical attack by a patient and 40% indi- example, Boney-McCoy and Finkelhor sive. The Behavior Therapist, 23, 58- cated that they had actually been at- (1995) did a national survey of 2000 61, 70. tacked. The data from these studies sug- youths between the ages of 10-16 and Tynan, W. D. (1995, Summer). Intern se- gests that 35-40% of psychologists in found that 40.5% reported having experi- lection: Beyond simply following the clinical practice are at risk of being as- enced some form of violent victimiza- rules. APPIC Newsletter, XX, 16. saulted by a patient at some time during tion. For female adolescents, the most their professional careers. common form of victimization was sex- Guy, et al, (1990) found that a major- ual assault (15.3%), and for male adoles- ity of reported attacks occurred in inpa- cents, the most common form was ag- tient psychiatric settings; that is, 41% in gravated assault by a nonfamily Behavioral Emergencies public psychiatric hospitals and 22% in perpetrator (18.4%). In a national survey continued from page 10 private psychiatric facilities. Other stud- of over 4000 women, Resnick, Kilpatrick, ies, however, have found that a signifi- Dansky, Saunders, and Best (1993) Eighty-five (or 29.1%) reported having cant number of attacks (47%) occurred found that 35.6% of the sample reported had a patient who made a suicide at- in outpatient settings and private prac- at least one lifetime experience as a vic- tempt, and 33 (or 11.3%) reported having tice offices (Bernstein, 1981). Such find- tim of crimes such as rape, other sexual had a patient who actually completed ings suggest that clinicians must be assault, or physical assault. suicide. Thus, it appears that approxi- aware of the possibility of patient vio- Not all victims of violence develop mately 40% of graduate students in clini- lence in virtually any setting. symptoms of post-traumatic stress disor- cal psychology are likely to experience Although any clinician can become a der; however, it is known that rates of some form of serious patient suicidal be- victim, there are some findings that sug- PTSD are high in this population. havior (either a suicide attempt or a gest that the risk is greater for newer Resnick, Acierno, Holmes, Dammeyer, completed suicide) while still in training. and less experienced therapists. Thus, and Kilpatrick (1999) estimated that The studies just noted have method- Guy, et al, (1990) found that 46% of all at- 30%-50% of women who reported a his- ological limitations such as small and re- tacks on therapists involved graduate tory of assault had PTSD. While studies stricted samples and, in some cases, low students or trainees, and another 33% oc- comparing victims to non-victims have response rates. The findings nonethe- curred in the first 5 years after complet- found much higher rates of PTSD in vio- less seem to highlight the fact that pa- ing the doctoral degree. This data sug- lence samples as opposed to controls, it tient/client suicidal behavior is not rare gests that nearly 80% of patient assaults is difficult to estimate how many of in the experience of mental health clini- on therapists occur in their first 8-10 these individuals seek psychotherapeu- cians. years in the field. Guy and Brady (1998) tic treatment in the aftermath of a violent have suggested that there may be a event. As Pearlman and MacIan (1995) Patient Violent Behavior number of reasons for this phenome- have pointed out, it is only in recent Patient violence can be considered non. Newer therapists may be less alert years that survivors of violent crimes another occupational hazard for psychol- to cues of violence. They may set fewer have come forward for psychotherapy. ogists. In a national survey of psycholo- limits and allow aggressive behavior to In one survey of psychologists and fam- gists, Pope and Tabachnick (1993) escalate. They may be more likely to ily therapists (Follette, Polusny, and found that 89% of their sample reported work in inpatient settings, and there is a Milbeck, 1994), the clinicians reported episodes in which they were afraid that a practice in these settings to assign more that 42% of the clients in their caseloads patient might attack a third party, and severely impaired patients to clinicians claimed to have a history of childhood 60.7% reported having had a patient who in training. sexual abuse. Given such reports, it had physically attacked a third party. In While there have been instances in would not be surprising for a clinician, at addition, Whitman, Armao, and Dent which a patient assault resulted in seri- some point in his or her career, to treat a (1976) reported that, during a one year ous injury or death for the therapist, patient who has been traumatized by vi- period of practice, 81% of their sample of most patient attacks seem to result in olence. psychologists perceived a patient of minor injury or no injury at all. In their theirs as a threat to others. national survey, Guy, et al, (1990) re-

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The Impact of Patient thetic and ambiguous successes, and ob- less experienced, feel less prepared, feel Emergencies on Clinicians servable decrements in the typical qual- less secure in their roles, and are more Work with suicidal patients, poten- ity and quantity of work performed” (pg. surprised or shocked by suicide threats, tially violent patients, and victims of vio- 146). They go on to state that unrealistic gestures, attempts, or completions than lence can be very affect-laden and self-expectations have been identified as professionals. stressful. In the section that follows, the the single most critical factor in the de- Several recent articles suggest that findings on the impact of dealing with velopment of burnout (Scully, 1983; many clinicians, whether working alone, such patients on the clinician are pre- Freudenberger, 1980) and that clinicians as a trainee, or as a supervisor, are hesi- sented. Unfortunately, the emotional dis- who work with suicidal patients are es- tant to discuss their emotional reactions tress can sometimes linger long after a pecially prone to this. Most therapists to patient suicide with other due to con- critical clinical event. have great faith that their interventions cerns that what is said might be used will be successful and find it difficult to against them in subsequent legal pro- The Impact of Working with Suicidal accept that some patients will remain un- ceedings (Ellis & Dickey, 1998). In fact, Patients altered in their “preoccupation with Bongar (1991) has cautioned clinicians Feelings of guilt, shame, disbelief, in- death, dying, or self mutilation” despite that discussions with a colleague or competence, anger, depression, and fear concentrated treatment (Fox & Cooper, friend is considered non-privileged infor- are some of the emotional responses re- 1998). mation and is open to the legal discov- ported by psychology interns following The issue of whether trainees are ery process. Such fears have the poten- patient suicides (Kleespies, Smith, & more vulnerable to negative reactions to tial to block the most effective coping Becker, 1990). Even clinicians who ac- clients’ suicidal behaviors than profes- method available to clinicians, the shar- knowledge that they work with high risk sionals has been addressed in several in- ing of their emotional reactions in dis- patients, frequently use the term vestigations (e.g. Kleespies, et al, 1990, cussions with other clinicians. Without “shock” to describe their feelings upon 1993; Rodolfa, et al, 1988; Brown, this opportunity, clinicians can become hearing about a patient suicide 1987b). One theory is that clinicians in effectively isolated with their reactions. (Kleespies et al., 1990). In 1993, training who have a patient commit sui- Further, clinicians-in-training may be Kleespies, et al, found a positive correla- cide or make a serious attempt have a left with the fear that there will be acad- tion between the severity of patient sui- “protective advantage” from any result- emic and/or professional consequences cidal behavior and the clinician’s emo- ing negative emotional effects because resulting from the client suicide tional reaction when a full range of they are under direct supervision and do (Spiegelman and Rogers, 1999). suicidal behavior was included. In other not bear ultimate ethical or legal respon- words, more severe suicidal behavior sibility for the case (Brown, 1987a, The Impact of Patient Violence on the (attempts and completions) was associ- 1987b). Others have suggested that Clinician ated with more severe reactions on the trainees are more likely to assume re- Guy, Brown, and Poelstra (1991) part of clinicians; e.g., shock, disbelief, sponsibility for “fixing the client” found that 40% of clinicians who re- failure, sadness, self-blame, guilt, (Rodolfa, et al, 1988, p. 47) and thus have ported one or more instances of patient shame, and depression. By contrast, less stronger feelings of inadequacy when violence experienced a dramatically in- severe behavior (e.g., suicide ideation) treatment interventions are unsuccess- creased sense of vulnerability in the af- was associated with more attenuated re- ful. Empirical studies support the con- termath. The greater the extent of the actions (Kleespies et al., 1993). tention that mental health trainees are at resulting physical injury, the greater In regard to the more severe reac- least as vulnerable as those who have was the sense of fear and vulnerability tions, several studies which used the completed their training. Kleespies, that followed. These same investigators Impact of Event Scale (IES) indicated et al, (1993) found that the impact of also found that some clinician victims re- that patient suicide can and often does suicidal behavior on psychology in- ported a decrease in overall emotional result in intrusive symptoms of stress terns/trainees as measured by the well-being and in a sense of professional for the therapist that are comparable to Impact of Event Scale (Horowitz, competency. Despite the great difficulty post-trauma symptoms found in patient Wilner, & Alvarez, 1979) was as high, if in predicting patient violence, 39% of groups (Zilberg, Wiess, & Horowitz, not higher, than that found in compara- those clinicians who had been attacked 1982; Chemtob, Hamada, Bauer, Kinney, ble studies of professional psycholo- felt that the attack could have been pre- et al., 1988; Chemtob, Hamada, Bauer, gists. Furthermore, Kleespies, et al, dicted and 30% felt that it could have Torigoe, et al., 1988, Chemtob et al., (1993) found a negative relationship be- been avoided and dealt with in a more 1989; Kleespies, et al., 1990, 1993). tween intrusive thoughts and images helpful manner. This sense of personal Kleespies et al, (1990) and Brown and the year of training in which a pa- responsibility tends to heighten feelings (1987b) illustrated that such intrusive tient suicide was experienced (i.e., the of guilt, shame, and failure. Since, as symptoms usually diminish substantially earlier in training that the suicide oc- noted, many of the victims of patient at- over a period of weeks or months but curred, the greater the perceived acute tacks are students or early in their post- that some longer term emotional effects impact). Rodolfa, et al, (1988) examined doctoral years, it is easy to see how a (e.g., heightened anxiety when evaluat- three levels of clinicians (professionals, sense of self doubt and incompetence ing suicidal patients) can remain indefi- interns, and practicum students) and can be heightened even though our abil- nitely for some clinicians. found that patient suicidal statements ity to predict and prevent patient vio- Fox and Cooper (1998) have written and attempts were rated by all groups as lence is quite limited. that “working with suicidal clients pro- highly stressful. Thus, even though Although most of the clinicians in the duces all the effects frequently associ- trainees do not bear legal responsibility survey by Guy, et al, (1990) did not re- ated with burnout including loss of drive for their patients, patient suicidal behav- duce their workload after a patient at- and motivation, mental, physical and ior seems to impact them as much or tack, they did not carry on business as emotional exhaustion, professional isola- more than it impacts those at a staff usual either. The most common protec- tion, the drain of always being empa- level. This may be because trainees are tive measure was the refusal to accept

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certain patients who presented for treat- tive correlation between exposure to The Status of Psychological ment. This was especially true among trauma clients and symptoms of vicari- Training in Evaluating and clinicians who believed that they could ous traumatization. For example, Managing Behavioral have predicted and/or prevented the Schauben and Frazier (1995), in a sam- Emergencies previous episodes of violence. Rather ple of 118 female psychologists and 30 Despite the data on the incidence and than see potentially violent patients female rape crisis counselors, found that impact of patient life-threatening behav- themselves, they were much more likely the higher the number of survivor iors on clinicians, the profession of psy- to refer such individuals to other clini- clients in the therapist’s caseload the chology appears to have done little to cians. higher the reported extent of vicarious prepare clinicians specifically to cope Therapist victims were also much traumatization. Similarly, Munroe with such events. In the study by more likely to have an increased con- (1990), in a sample of 138 therapists in Kleespies, et al, (1993) on the stress of cern for the safety of their families as Veterans Administration facilities, found patient suicidal behavior during clinical well as for their own safety. Guy, et al, that current and cumulative exposure to training, it was reported that only an es- (1990) reported that they were typically combat related trauma clients was posi- timated 55% of a sample of former grad- more aggressive about implementing tively correlated with intrusive symp- uate students in clinical psychology had measures to reduce personal risk such toms. Finally, Kassam-Adams (1994), some form of didactic instruction on sui- as having their home phone number un- through a survey of 100 psychothera- cide during their graduate school years. listed and/or setting firmer limits. They pists, found the percentage of clients The instruction (when given) was quite were also more likely to formulate a con- who presented sexual trauma over the limited (i.e., one or two lectures). In a tingency plan for obtaining assistance therapist’s career was directly and posi- more recent survey of psychology in- should there be another such event in tively correlated with the therapist’s ternships and psychiatry residency pro- the future. PTSD symptoms. Only the survey by grams, Ellis and Dickey (1998) found Follette, et al, (1994) failed to find that that psychology programs seemed to lag The Impact of Working with Victims of the proportion of the therapist’s case- behind psychiatry programs in suicide- Violence load involving sexual abuse victims was related training in most formats; e.g., McCann and Pearlman (1990) define predictive of trauma symptoms in the seminars, journal clubs, case confer- vicarious traumatization as the effect therapist. ences, and assigned readings. Even in a that the clients’ graphic and painful ma- A seemingly unresolved issue in this format that psychology utilized more terial has on the therapist’s unique cog- area is the extent to which a therapist’s (i.e., workshops), the overall utilization nitive schemas, beliefs, expectations, personal trauma history is related to the rate was low. In a similar vein, Bongar and assumptions about self and others. development of symptoms of vicarious and Harmatz (1991) conducted national Often included in such a reaction are or secondary trauma. Pearlman and surveys of the Council of University symptoms of anxiety and intrusive MacIan (1995) found that a therapist’s Directors of Clinical Psychology thoughts about the patient’s trauma. trauma history was a powerful variable Programs and the National Council of Some clinicians report experiencing in this regard; i.e., therapists with a per- Schools of Professional Psychology and emotional numbing or engaging in sonal trauma history were found to have found that when all the efforts of these forms of avoidance of traumatic material experienced more disruptions in their groups were combined, only 40% of all in sessions. Moreover, bearing witness beliefs about safety, trust of self and oth- graduate programs in clinical psychol- to human cruelty can challenge the clin- ers, and intimacy with others than those ogy offered some formal training in the ician’s own beliefs and affect his/her without such a history. It was also found study of suicide. own outlook on life. that those with a trauma history experi- In their survey of patient violence, Astin (1997) has explained that the enced a significant increase in intrusive Guy, et al, (1990) reported that the psy- trauma therapist is put into a similar sit- thoughts, avoidance of traumatic mater- chologists in their sample had a mean of uation as his/her patient in that he or ial, and overall symptomatology. The 1 hour of clinical training on the man- she must incorporate what is often a studies by Follette, et al, (1994) and agement of patient violence during their schema discrepant event into an existing Schauben and Frazier (1995), however, predoctoral training years. After gradua- world view. One can change or re-inter- did not find that the therapist’s trauma tion, the mean was 2.3 hours. Could it be pret the event so that it is congruent history was significantly predictive of that lack of adequate training is related with already existing schemata (assimi- the development of secondary trauma to the findings that less experienced lation) or one can alter the schemata to symptoms; while Kassam-Adams (1994) therapists are at greater risk from pa- incorporate the previously discrepant distinguished between childhood and tient violence? event (accommodation). Like the pa- adult traumatization and found that only In terms of working with victims of vi- tients themselves, however, the clinician a history of childhood trauma was sig- olence such as sexually abused children, is at risk of either (1) over-accommoda- nificantly associated with the develop- Alpert and Paulson (1990) reported that tion which can cause him or her to be ment of vicarious or secondary trauma most professional degree programs in overly cynical in his/her world view or in the therapist. psychology had not incorporated child (2) blaming the victim to explain away Pearlman and MacIan (1995) re- sexual abuse in their training. Moreover, the trauma as less severe or avoidable. ported that therapists who were newer in a national sample of psychologists, Both of these are potentially damaging to trauma work experienced greater Pope and Feldman-Summers (1992) re- to the self of the therapist as well as to emotional and psychological difficulty. ported that “very poor” was the rating that of the patient, and either can be de- Moreover, they noted that few of the most frequently given to graduate train- structive to the therapeutic relationship. newest trauma therapists were receiving ing in the areas of sexual and physical Although the body of literature on vic- supervision and they tended to be work- abuse. Although the ratings were higher arious traumatization is small, there are ing in hospitals where the most acutely for more recent graduates, their ratings several studies which have found a posi- distressed patients are seen. were still extremely low for both gradu-

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ate school and internship training in Health Service, 1999). The last several age in psychology training clinics. these areas. decades have seen an elevated rate of Professional Psychology: Research and Kranz (1985) and Covino (1989) have youth suicide, and, in the wake of a se- Practice, 22, 204-208. suggested that psychology graduate and ries of school shootings, both youth vio- Boney-McCoy, S., and Finkelhor, D. professional school programs have been lence and youth suicide have, unfortu- (1995). Psychosocial sequelae of vio- deficient in teaching the skills needed nately, emerged as matters of national lent victimization in a national youth for dealing with behavioral emergen- concern. Domestic violence, child sample. Journal of Consulting and cies. Data that supports their contention abuse, and violence against women have Clinical Psychology, 63, 726-736. has been presented in the survey of increasingly come to attention as major Bongar, B. (1991). The suicidal patient: after-hours coverage in psychology problem areas in the U.S. The American Clinical and legal standards of care. training clinics by Bernstein, Feldberg, Psychological Association, by identify- Washington, DC: American Psycho- and Brown (1991) who concluded that ing behavioral emergencies as a core logical Association. “the current standard for training clinics topic for professional education and Bongar, B., and Harmatz, M. (1991). in emergency coverage appears to be training, is in a position to have a con- Clinical psychology graduate edu- less than adequate” (p. 207). Twenty-five structive impact on the education of psy- cation in the study of suicide: percent of the clinics in their sample pro- chologists while also supporting action Availability, resources, and impor- vided no emergency coverage. Among on these national concerns. tance. Suicide and Life-Threatening those that did, there were reports of dis- As noted earlier in this report, virtu- Behavior, 21, 231-244. array in the emergency policies and pro- ally all psychology practitioners have be- Brown, H. N. (1987a). The impact of sui- cedures, concern that the services havioral emergencies of one type or an- cide on therapist in training. would not be sufficiently responsive, other in their practice. It is the position Comprehensive Psychiatry, 28, 101-112. and uncertainty about continuity of stu- of this Task Force that all practitioners Brown, H. N. (1987b). Patient suicide dent and supervisor availability, particu- need to be formally educated and during residency training (1): larly during vacations and semester trained to deal with them. There may be Incidence, implications, and program breaks. The authors suggested that this a number of options for achieving this response. Journal of Psychiatric state of affairs reflects a general inatten- goal. Kleespies (1998a), in the book Education, 11, 201-216. tion to emergency services in the field of Emergencies in Mental Health Practice: Callahan, J. (1998). Crisis theory and cri- professional psychology. Evaluation and Management, has devel- sis intervention in emergencies. In P. As noted earlier, behavioral emergen- oped a curriculum for teaching a knowl- Kleespies (Ed.): Emergencies in men- cies confront the clinician with the need edge base in behavioral emergencies. tal health practice: Evaluation and to make decisions that can have very se- The curriculum is presented in Table 1. management (pp. 22-40). New York: rious, possibly irreversible conse- In addition to knowledge, however, psy- Guilford Press. quences. They can occur in virtually any chologists need to learn the clinical Callahan, J. (1994). Defining crisis and clinician’s practice. They can have far skills that are required to manage life- emergency. Crisis, 15, 164-171. reaching emotional, ethical, and legal threatening behaviors. To this end, Chemtob, C., Bauer, G., Hamada, R., repercussions. Society at large through Kleespies (1998b) has also proposed a Pelowski, S., and Muraoka, M. (1989). our legal system holds psychologists re- model program for teaching emergency Patient suicide: Occupational hazard sponsible for observing a reasonable service skills at the internship level. The for psychologists and psychiatrists. standard of care in managing behavioral Task Force recommends that the cur- Professional Psychology: Research and emergencies. They can be held liable for riculum and training model proposed by Practice, 20, 294-300. negligence in malpractice litigation if Kleespies (1998) be taken as a starting Chemtob, C., Hamada, R., Bauer, G., their emergency care is found to be sub- point for discussion of the content and Kinney, B., & Torigoe, R. (1988). standard. In this regard, if psychologists method of implementing this training at Patients’ suicides: Frequency and im- are to have a sound basis for fulfilling the graduate level. At the professional pact on psychiatrists. American the duties attendant to their professional level, it suggests that post-doctoral Journal of Psychiatry, 145, 224-228. role, it seems incumbent that they be courses and workshops be offered for Chemtob, C., Hamada, R., Bauer, G., provided with explicit education and continuing education credit. Torigoe, R., & Kinney, B. (1988). training on the evaluation and manage- Patient suicide: Frequency and impact ment of clinical emergencies. Some References on psychologists. Professional might also say that there is an issue of Alpert, J., and Paulson, A. (1990). Psychology: Research and Practice, professional ethics involved. Graduate-level education and training 19(4), 416-420. Psychologists are not to practice outside in child sexual abuse. Professional Covino, N. A. (1989). The general hospi- of their area of competence, yet is that Psychology: Research and Practice, 21, tal emergency ward as a training op- not what may happen if it is assumed 366-371. portunity for clinical psychologists. that psychologists will be able to deal Astin, M. C. (1997). Traumatic therapy: The Journal of Training and Practice with patients who are imminently suici- How helping rape victims affects me in Professional Psychology, 3, 17-32. dal or potentially violent or at serious as a therapist. In Marcia Hill (Ed.): Dubin, W., and Weiss, K. (1991). risk of victimization without specific More than a mirror: How clients influ- Handbook of psychiatric emergencies. training on how to manage such difficult ence therapists’ lives (pp. 101-109). Springhouse, PA: Springhouse. and complex cases and circumstances? Hayworth Press. Ellis, T., and Dickey, T. (1998). Bernstein, H. (1981). Survey of threats Procedures surrounding the suicide Task Force Recommendations and assaults directed toward psy- of a trainee’s patient: A national sur- The Surgeon General has declared chotherapists. American Journal of vey of psychology internships and suicide a major public health problem in Psychotherapy, 35, 542-549. psychiatry residency programs. this country, and he has issued a call to Bernstein, R. M., Feldberg, C., and Professional Psychology: Research and action to prevent suicide (U.S. Public Brown, R. (1991). After-hours cover- Practice, 29, 492-497.

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Table 1. PROPOSED CURRICULUM FOR A KNOWLEDGE BASE IN MENTAL Mental Health Practice: Evaluation HEALTH EMERGENCY SERVICES and Management. NY: Guilford Press. Kleespies, P., Deleppo, J., Gallagher, P., I. Foundations and Niles, B. (1999). Managing suici- dal emergencies: Recommendations 1. The domain of mental health emergencies for the practitioner. Professional 2. Crisis theory and crisis intervention in emergencies Psychology: Research and Practice, 30, 3. The emergency interview 454-463. 4. The emergency telephone contact Kleespies, P., Penk, W., & Forsyth, J. (1993). The stress of patient suicidal II. The evaluation and management of life-threatening behavior behavior during clinical training: Incidence, impact, and recovery. 5. The evaluation and management of the suicidal patient Professional psychology: Research and 6. The evaluation and management of the violent patient Practice, 24(3), 293-303. 7. The evaluation and management of the victim of violence Kleespies, P., Smith, M., & Becker, B. 8. The evaluation and management of the terminally ill patient who wishes to hasten death (1990). Psychology interns as patient suicide survivors: Incidence, impact, III. Risk management in a mental health emergency and recovery. Professional Psychology: Research and Practice, 21(4), 257-263. 9. Risk management with the suicidal patient Kranz, P. L. (1985). Crisis intervention: 10. Risk management with the violent patient A new training approach to crisis in- tervention: A mentor training mode. IV. Emergency-related crises and conditions Crisis Intervention, 14, 107-114. McCann, L., & Pearlman, L. A. (1990). 11. The evaluation and management of the self-mutilating patient Vicarious traumatization: A frame- 12. The evaluation and management of alcohol- and drug-related crises work for understanding the psycho- logical effects of working with victims. V. Medical conditions presenting as mental health or behavioral crises Journal of Traumatic Stress, 3(1), 131- 149. 13. Side effects of and reactions to psychotropic drugs Moscicki, E. (1995). Epidemiology of 14. Psychological/behavioral symptoms in neurological disorders suicidal behavior. Suicide and Life- 15. Psychological/behavioral symptoms in endocrine disorders Threatening Behavior, 25, 22-35. 16. Psychological/behavioral symptoms in cardiac conditions Munroe, J. (1991). Therapist traumatiza- tion from exposure to clients with VI. The impact of emergency service on the clinician combat-related post traumatic stress disorder: Implications for administra- 17. The stress of patient suicidal behavior for the clinician tion and supervision. Unpublished 18. The stress of patient violent behavior for the clinician doctoral dissertation. Northeastern 19. “Vicarious traumatization’’ in working with victims University, Boston. Pearlman, L., and MacIan, P. (1995). Vicarious traumatization: An empiri- Follette, V., Polusny, M., and Milbeck, K. chotherapists. Psychotherapy in cal study of the effects of trauma work (1994). Mental health and law en- Private Practice, 9, 35-44. on trauma therapists. Professional forcement professionals: Trauma his- Guy, J., Brown, C., and Poelstra, P. Psychology: Research and Practice, 26, tory, psychological symptoms, and im- (1990). Who gets attacked? A national 558-565. pact of providing services to child survey of patient violence directed at Pope, K., and Feldman-Summers, S. sexual abuse survivors. Professional psychologists in clinical practice. (1992). National survey of psycholo- Psychology: Research and Practice, 25, Professional Psychology: Research and gists’ sexual and physical abuse his- 275-282. Practice, 21, 493-495. tory and their evaluation of training Fox, R., and Cooper, M. (1998). The ef- Horowitz, M., Wilner, N., and Alvarez, and competence in these areas. fects of suicide on the private practi- W. (1979). Impact of Event Scale: A Professional Psychology: Research and tioner: A professional and personal measure of subjective stress. Practice, 23, 353-361. perspective. Clinical Social Work Psychosomatic Medicine, 41, 209-218. Pope, K., and Tabachnick, B. (1993). Journal, 26, 143-157. Kassam-Adams, N. (1995). The risks of Therapists’ anger, hate, fear, and sex- Freudenberger, H. J. (1980). Burn-out: treating sexual trauma: Stress and ual feelings: National survey of thera- The high cost of high achievement. secondary trauma in psychothera- pist responses, client characteristics, N.Y.: Anchor. pists. In B. H. Stamm (Ed.): Secondary critical events, formal complaints, and Guy, J., and Brady, J. L. (1998). The traumatic stress: Self-care issues for training. Professional Psychology: stress of violent behavior for the clini- clinicians, researchers, and educators. Research and Practice, 24, 142-152. cian. In P. Kleespies (Ed.): Emergencies Lutherville, MD: Sidran Press. Resnick, H., Acierno, R., Holmes, M., in mental health practice: Evaluation and Kleespies, P. (Ed.) (1998a). Emergencies Dammeyer, M., and Kilpatrick, D. management. New York: Guilford Press. in Mental Health Practice: Evaluation (1999). Emergency evaluation and in- Guy, J., Brown, C., and Poelstra, P. and Manage-ment. NY: Guilford tervention with female victims of vio- (1991). Living with the aftermath: A Press. lence: With an emphasis on victims of national survey of the consequences Kleespies, P. (1998b). Introduction. In P. rape. Journal of Clinical Psychology (in of patient violence directed at psy- Kleespies (Ed.): Emergencies in press).

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Resnick, H., Kilpatrick, D., Dansky, B., Put it in the Bank are waived for psychologists who were Saunders, B., and Best, C. (1993). continued from page 11 licensed before 1981 in the United States Prevalence of civilian trauma and post- or 1986 in Canada if they apply for the traumatic stress disorder in a repre- CPQ before December 31, 2000. There sentative national sample of women. will facilitate mobility by having a veri- is also a provision for waiving certain re- Journal of Consulting and Clinical fied record of qualifications. quirements for individuals who are Psychology, 61, 984-991. Receipt of the CPQ is based on an in- listed in the National or Canadian Rodolfa, E., Kraft, W., Reilley, R. (1988). dividual psychologist demonstrating Register of Health Service Providers in Stressors of professionals and compliance with ASPPB recommended Psychology (if they apply by December trainees at APA-approved counseling standards for licensure. All applicants 31, 2000) or for individuals who have a and VA medical center internship for the CPQ must possess a doctoral de- diploma from the American Board of sites. Professional Psychology: Research gree granted by an institution of higher Professional Psychology. and Practice, 19, 43-49. education that was regionally accredited Learn more about the Credentials Rudd, M. D., and Joiner, T. (1998). The (in the U.S.) or provincially chartered Bank, the CPQ, or about other ASPPB assessment, management, and treat- (in Canada) at the time the degree was programs and services, including the ment of suicidality: Toward clinically granted. Those applying under Option 1 Examination for Professional Practice in informed and balanced standards of (the standard process for most recently Psychology (EPPP), at http://www. care. Clinical Psychology: Science and licensed individuals) must have a doc- asppb.org. Feel free to contact ASPPB Practice, 5, 135-150. toral degree in psychology, have passed by phone, fax or e-mail with any ques- Schauben, L., and Frazier, P. (1995). the EPPP (i.e. the multiple choice licen- tions or to obtain the forms to open a Vicarious trauma: The effects on fe- sure exam) at the ASPPB-recommended credentials record or an application male counselors of working with sex- passing score, passed an oral exam and packet for the CPQ. ual violence survivors. Psychology of have two years of supervised experience Women Quarterly, 19, 49-64. (at least one of which is postdoctoral) Scully, R. (1983). The work setting sup- even if these qualifications were not re- Association of State and Provincial port group: A means of preventing quired by the jurisdiction(s) when origi- Psychology Boards burnout. In B. Farber (Ed.): Stress & nally licensed. To obtain the CPQ, the PO Box 241245 Burnout in the Human Service applicant must also have five years of Montgomery, AL 36124-1245 Professions (p. 93). N.Y.: Pergamon. post-licensure practice experience and Phone: 800-448-4069 Spiegelman, J., and Rogers, J. (April, no history of disciplinary action. Some Fax: 334-269-6379 1999). Suicide and supervision: of the requirements to obtain the CPQ E-mail: [email protected]. Postvention with trainees. Paper pre- sented at the 32nd Annual Conference of the American Association of Suicidology, Houston, Texas. Tryon, G. (1986). Abuse of therapist by 2000 APPIC ANNUAL patient: A national survey. Professional Psychology: Research and Practice, 17, BUSINESS MEETING 357-363. U.S. Public Health Service. (1999). The AT APA CONVENTION Surgeon General’s Call to Action to Prevent Suicide. Washington, DC: Department of Health and Human Services. FRIDAY, AUGUST 4, 2000 Whitman, R., Annao, B., and Dent, O. GRAND HYATT HOTEL (1976). Assault on the therapist. 1000 “H” Street NW American Journal of Psychiatry, 133, Constitution C 426-429. 8:00-10:50 AM Zilberg, N., Weiss, D., and Horowitz, M. A Continental Breakfast will be served (1982). Impact of Event Scale: A cross validation study and some empirical evidence supporting a conceptual Please view our website for continuous additions and changes in APPIC model of stress response syndromes. training community: www.appic.org Journal of Consulting and Clinical Psychology, 50, 407-414.

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APPIC Workshop Registration Form Thursday, August 3, 2000, Washington, DC

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Please check all statements that apply to you. Registration is open to everyone. One need not be a TD, Grad program director, or from an APPIC site to attend. ______Internship TD ______Postdoc TD ______APPIC member ______Interested in starting an internship program ______Graduate program director ______Supervise interns ______Supervise postdocs ______Other

Place a check mark by the workshop(s) you wish to attend: ______Workshop for New Training Directors ______Training in Multicultural Competencies for Internship and Postdoctoral Residents

Check enclosed for ______$60.00 or ______$110.00 (US Funds only) MC/VISA Card #: ______Expiration date: ______Please charge $ ______to my credit card. Signature: ______

Return to APPIC, 733-15th St. NW, Ste 719, Washington, DC 20005-2112, postmarked by July 24, 2000. Phone 202-347-0022. Fax 202-347-8480. Make checks payable to APPIC.

Cancellation/Refund Policy: Requests for full refunds of registration fees must be made in writing and received at APPIC’s Central Office no later than 7 calendar days prior to the date of the workshop. Fifty per cent (50%) of the registration fee will be refunded to those making a written request postmarked within 7 calendar days prior to the workshop. No refund will be granted to “no shows”.

Continuing Education Credits; Participants receive 4 CE credits for each workshop. APPIC is approved by the American Psychological Association to offer continuing education credits for psychologists and the MCEP to offer continuing education credits for California psychologists. APPIC maintains responsibility for this program.

APPIC NEWSLETTER JULY 2000 39 APPIC-June 2000 12/16/03 3:48 PM Page 40

THE APPIC APPIC NEWSLETTER DIRECTORY POLICY APPIC encourages its members to con- tribute to the Newsletter’s content. Contributions may take the form of es- FOR MEMBERS: APPIC members automatically receive a printed copy of the Directory, says, theoretical or data-based arti- the Newsletter, access to the APPIC Clearinghouse, and unlimited searches of the cles/studies, and brief reports on topics Directory-on-Line. To assure that your listing is current and accurate, we request that you and issues directly related to internship update the on-line version “as needed” throughout the year. training in psychology at the pre- and post-doctoral levels. APPIC reserves FOR NONMEMBERS: Individuals, nonmember institutions and non-subscribers can ob- the right to accept or reject submissions for publication in the Newsletter. The tain a printed copy of the Directory at a cost of $73.20 per copy. Students can obtain the opinions and statements in contribu- Directory at the reduced price of $38.20 by using their Subscriber program’s discount code. tions selected for publication in the Graduate Programs can become Subscribers. Every Subscriber program receives a com- Newsletter are the responsibility of the plementary copy of the printed Directory, the APPIC Newsletter, access to the APPIC author(s) and do not necessarily repre- Clearinghouse, unlimited searches on the Directory-on-Line, and a discount code for stu- sent the endorsement, views, or policies dents to purchase the Directory at a discount. The cost of a subscription for a doctoral psy- of APPIC or the Newsletter Editor. It is suggested that the APA Publication chology program is $225 per year. Both Members and Subscribers may obtain additional Manual guidelines be followed for sub- copies of the APPIC Directory at a discounted price of $33.20. Additional Newsletter copies missions. Please submit contributions are $10 each. Orders for the Directory should state to whom, and to what address the (hard copy) to the APPIC Newsletter Directory should be sent. Checks for subscriptions and for orders should be made payable Editor at Central Office. to APPIC and mailed to APPIC’s Central Office: 733-15th Street, NW, Suite 719, SUBMISSION DEADLINES: For Washington, DC, 20005-2112; 202/347-0077. Prepayment is required prior to shipping. submissions to be published in the Newsletter, manuscripts should reach the Newsletter Editor by May 15 for the July issue, by September 30 for the November issue, and by February 15 for the March issue.

APPIC NEWSLETTER NON-PROFIT Robert W. Goldberg, Ph.D. ORGANIZATION Editor U.S. POSTAGE PAID 733 - 15th Street, N.W., Suite 719 WASHINGTON, DC Washington, DC 20005 PERMIT NO. 4031