B Psychotherapy OFFICIAL PUBLICATION OF DIVISION 29 OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION

www.divisionofpsychotherapy.org U In This Issue L Perspectives on Psychotherapy Integration L Psychotherapy for Poorly Performing Trainees: Are There Limits to Confidentiality? E 2006 Nominations Ballot T I E O

C N

2005 VOLUME 40 NO. 4 Division of Psychotherapy Ⅲ 2005 Governance Structure

ELECTED BOARD MEMBERS

President Board of Directors Members-at-Large Alice Rubenstein, Ed.D., 2004-2006 Leon VandeCreek, Ph.D. Norman Abeles, Ph.D. , 2003-2005 Monroe Psychotherapy Center 117 Health Sciences Bldg. Michigan State Univ. 20 Office Park Way School of Professional Psychology Dept. of Psychology Pittsford, NY 14534 Wright State University E. Lansing, MI 48824-1117 Ofc: 585-586-0410 Fax: 585-586-2029 Dayton, OH 45435 Ofc: 517-355-9564 Fax: 517-353-5437 Email: [email protected] Ofc: 937-775-3944 Fax: 937-775-5795 Email: [email protected] E-Mail: [email protected] Libby Nutt Williams, Ph.D., 2005-2007 James Bray, Ph.D., 2005-2007 Department of Psychology President-elect Dept of Family & Community Med St. Mary’s College of Maryland Abraham W. Wolf, Ph.D. Baylor College of Medicine 18952 E. Fisher Rd. Metro Health Medical Center 3701 Kirby Dr, 6th Fl St. Mary’s City, MD 20686 2500 Metro Health Drive Houston , TX 77098 Ofc: 240-895-4467 Fax: 240-895-4436 Cleveland, OH 44109-1998 Ofc: 713-798-7751 Fax: 713-798-7789 Email: [email protected] Ofc: 216-778-4637 Fax: 216-778-8412 Email: [email protected] E-Mail: [email protected] APA Council Representatives Charles Gelso, Ph.D., 2005-2006 Patricia M. Bricklin, Ph.D., 2005-2007 Secretary University of Maryland 470 Gen. Washington Rd. Armand Cerbone, Ph.D., 2005 Dept of Psychology Wayne, PA 19087 3625 North Paulina Biology-Psychology Building Ofc: 610-499-1212 Fax: 610-499-4625 Chicago IL 60613 College Park, MD 20742-4411 Email: [email protected] Ofc: 773-755-0833 Fax: 773-755-0834 Ofc: 301-405-5909 Fax: 301-314-9566 email: [email protected] Email: [email protected] Norine G. Johnson, Ph.D., 2005-2007 Treasurer 13 Ashfield St., Jan L. Culbertson, Ph.D., 2004-2006 Jon Perez, Ph.D., 2003-2005 Roslindale, MA 02131 Child Study Center IHS Ofc: 617-471-2268 Fax: 617-325-0225 University of Oklahoma Hlth Sci Ctr Division of Behavioral Health Email: [email protected] 1100 NE 13th St 12300 Twinbrook Parkway, Ste 605 Oklahoma City , OK 73117 Rockville, MD 20852 John C. Norcross, Ph.D., 2005-2007 Ofc: 405-271-6824, ext. 45129 Ofc: 202-431-9952 Department of Psychology Fax: 405-271-8835 Email: [email protected] University of Scranton Email: [email protected] Scranton, PA 18510-4596 Ofc: 570-941-7638 Fax: 570-941-7899 Past President E-mail: [email protected] Linda F. Campbell, Ph.D. University of Georgia 402 Aderhold Hall Athens, GA 30602-7142 Ofc: 706-542-8508 Fax: 770-594-9441 E-Mail: [email protected] COMMITTEES AND TASK FORCES COMMITTEES Finance Program Fellows Chair: Jan Culbertson, Ph.D. Chair: Alex Siegel, Ph.D., J.D. Chair: Lisa Porche-Burke, Ph.D. 915 Montgomery Ave. #300 Phillips Graduate Institute Education & Training Narbeth, PA 19072 5445 Balboa Blvd. Chair: Jeffrey A. Hayes, Ph.D. Ofc: 610-668-4240 Fax: 610-667-9866 Encino, CA 91316-1509 Counseling Psychology Program E-mail: [email protected] Ofc: 818-386-5600 Fax: 818-386-5695 Pennsylvania State University Email: [email protected] 312 Cedar Building Psychotherapy Research University Park, PA 16802 Chair: William B. Stiles, Ph.D. Membership Ofc: 814-863-3799 Department of Psychology Chair: Rhonda S. Karg, Ph.D. E-mail: [email protected] Miami University Research Triangle Institute Oxford, OH 45056 3040 Cornwallis Road Continuing Education Ofc: 513-529-2405 Fax: 513-529-2420 Research Triangle Park, NC 27709 Chair: Steve Sobelman, Ph.D. Email: [email protected] Ofc: 919-316-3516 Fax: 919-485-5589 Department of Psychology Loyola College in Maryland The Ad Hoc Committee on Student Development Baltimore, MD 21210 Psychotherapy Chair: Adam Leventhal, 2005 Ofc: 410-617-2461 Linda Campbell, Ph.D. and Department of Psychology E-mail: [email protected] Leon VandeCreek, Ph.D., Co-Chairs University of Houston Jeffrey Hayes, Ph.D. and Craig Shealy, Houston, Texas 77204-5022 Diversity Ph.D., Education and Training Ofc: 713-743-8600 Fax: 713-743-8588 Chair: Jennifer F. Kelly, Ph.D. Jean Carter, Ph.D. and Alice E-mail: [email protected] Atlanta Center for Behavioral Medicine Rubenstein, Ed.D., Practice 3280 Howell Mill Road Suite 100 Bill Stiles, Ph.D., Research Nominations and Elections Atlanta, GA 30327 John Norcross, Ph.D., Chair Chair: Abe Wolf, Ph.D. Ofc: 404-351-6789 Fax: 404-351-2932 Publications Board E-mail: [email protected] Norine Johnson, Ph.D., Representative Professional Awards Chair: Linda Campbell, Ph.D. PUBLICATIONS BOARD

John C. Norcross, Ph.D., 2005-2007 Psychotherapy Journal Editor Department of Psychology Charles Gelso, Ph.D., 2005-2010 University of Scranton University of Maryland Scranton, PA 18510-4596 Dept of Psychology Ofc: 570-941-7638 Fax: 570-941-7899 Biology-Psychology Building E-mail: [email protected] College Park, MD 20742-4411 Ofc: 301-405-5909 Fax: 301-314-9566 Jean Carter, Ph.D., 1999-2005 [email protected] 3 Washington Circle, #205 Washington, D.C. 20032 Psychotherapy Bulletin Editor Ofc: 202-955-6182 Craig N. Shealy, Ph.D., 2004-2006 [email protected] Department of Graduate Psychology James Madison University Lillian Comas-Dias, Ph.D., 2001-2006 Harrisonburg, VA 22807-7401 Transcultural Mental Health Institute Ofc: 540-568-6835 Fax: 540-568-3322 908 New Hampshire Ave. N.W., #700 [email protected] Washington, D.C. 20037 [email protected] Internet Editor Bryan S. K. Kim, Ph.D., 2005-2007 Raymond A. DiGiuseppe, Ph.D., 2003-2008 Counseling, Clinical, and School Psychology Program Psychology Department Department of Education St John’s University University of California 8000 Utopia Pkwy Santa Barbara, CA 93106-9490 Jamaica , NY 11439 Ofc & Fax: 805-893-4018 Ofc: 718-990-1955 [email protected] [email protected] Student Website Coordinator Alice Rubenstein, Ed.D., 2000-2006 Nisha Nayak Monroe Psychotherapy Center University of Houston 20 Office Park Way Dept of Psychology (MS 5022) Pittsford, NY 14534 126 Heyne Building Ofc: 585-586-0410 Fax 585-586-2029 Houston, TX 77204-5022 [email protected] Ofc: 713-743-8600 or -8611 Fax: 713-743-8633 [email protected] George Stricker, Ph.D., 2003-2008 Institute for Advanced Psychol Studies Adelphi University Garden City, NY 11530 Ofc: 516-877-4803 Fax: 516-877-4805 [email protected]

PSYCHOTHERAPY BULLETIN

Psychotherapy Bulletin is the official newsletter of Division 29 (Psychotherapy) of the American Psychological Association. Published four times each year (spring, summer, fall, winter), Psychotherapy Bulletin is designed to: 1) inform the membership of Division 29 about relevant events, awards, and professional opportunities; 2) provide articles and commentary regarding the range of issues that are of interest to psychotherapy theorists, researchers, practitioners, and trainers; 3) establish a forum for students and new members to offer their contributions; and, 4) facilitate opportunities for dialogue and collaboration among the diverse members of our association.

Contributors are invited to send articles (up to 4,000 words), interviews, commentaries, letters to the editor, and announcements to Craig N. Shealy, Ph.D., Editor, Psychotherapy Bulletin. Please note that Psychotherapy Bulletin does not publish book reviews (these are published in Psychotherapy, the official journal of Division 29). All submissions for Psychotherapy Bulletin should be sent electronically to [email protected]; please ensure that articles conform to APA style. Deadlines for submission are as follows: February 1 (spring); May 1 (summer); August 1 (fall); November 1 (winter). Past issues of Psychotherapy Bulletin may be viewed at our website: www.divisionofpsychotherapy.org. Other inquiries regarding Psychotherapy Bulletin (e.g., advertising) or Division 29 should be directed to Tracey Martin at the Division 29 Central Office ([email protected] or 602-363-9211).

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

AMER Mesa, AZ 85215 Paid Utica, NY ASSN. I Permit No. 83 C L www.divisionofpsychotherapy.org A A N PSYCHOLOGI C PSYCHOTHERAPY BULLETIN Official Publication of Division 29 of the American Psychological Association

PSYCHOTHERAPY BULLETIN 2005 Volume 40, Number 4 Published by the DIVISION OF CONTENTS PSYCHOTHERAPY American Psychological Association President’s Column ...... 2

6557 E. Riverdale Student Column: How Should Mental Mesa, AZ 85215 Health Professionals Respond to a 602-363-9211 Large-Scale Disaster? ...... 4 e-mail: [email protected] Perspectives on Psychotherapy Integration ...... 8

EDITOR Integrating Research Findings on Therapeutic Craig N. Shealy, Ph.D. Alliance Into Your Practice ...... 13

CONTRIBUTING EDITORS Ad Hoc Committee Initiatives on Psychotherapy: Advancement of Washington Scene Psychotherapy Training ...... 17 Patrick DeLeon, Ph.D. Interview: A Discussion with Practitioner Report Ronald F. Levant, Ed.D. Dr. Marvin Goldfried ...... 19 Washington Scene: The Steady Evolution of Education and Training Psychology into the 21st Century...... 21 Jeffrey A. Hayes, Ph.D.

Psychotherapy Research 2006 Nominations Ballot ...... 25 William Stiles, Ph.D. Education: Psychotherapy for Poorly Student Feature Performing Trainees: Are There Limits to Adam Leventhal Confidentiality? ...... 29

STAFF Practice Research Networks in Central Office Administrator Psychotherapy ...... 39 Tracey Martin Call For Award Nominations ...... 44

Global Realities: Intersections & Transitions ....45

Membership Application...... 48 Website www.divisionofpsychotherapy.org

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

Leon VandeCreek, Ph.D., ABPP

This is my final of Scientific Affairs, and the Board of column as President Professional Affairs. Dr. George Striker has of Division 29. Time agreed to serve as our liaison with BSA; as really flies. It has been of this writing, we are still finalizing our an honor to serve the appointments for the other two positions. Division of Psycho- The Board is convinced that the affairs of therapy in this and our Division can be significantly enhanced several other capaci- by having our voice heard in several ties over many years. venues. As an example, the Board As I describe some of approved a policy statement that expresses our ongoing initia- serious concern about the use of generic tives, I hope you get a sense of the excite- terms to describe the health-care activities ment and energy that is present in the of psychologists. Generic terms such as Division today. “therapist” are often used in psychology literature and contribute to the confusion One of our important ongoing initiatives is of psychology with other professions. The the development of a position paper that policy asks that the Division, APA, and addresses federal funding of psychothera- other groups representing psychology py research. The Division is alarmed that avoid the use of generic terms such as psychotherapy research is endangered by “clinician,” “intervention,” and “assess- current funding polices and guidelines. ment” when referring to psychologists and Specifically, many categories of psy- instead use terms such as “psychothera- chotherapy research fail to fit into the cur- py,” “psychological assessment,” and rent federal funding guidelines. For exam- “psychological treatment.” ple, process research, naturalistic studies, qualitative and single case designs, among At its recent meeting, the Board generated others, are less and less likely to be funded, considerable enthusiasm for both member- while preference is given to randomized ship recruitment and membership devel- clinical trials research on manualized treat- opment activities. This fall we will begin ments of patients who fit neatly into diag- our first large scale membership recruit- nostic categories. In response, our Research ment campaign for psychologists who are Committee, under the leadership of Bill not APA members. In the first step, all Stiles, and with input from many of our licensed psychologists in Ohio, including top psychotherapy researchers, is writing a those who are not APA members, will position paper that will lay out the argu- receive an invitation to join the Division. ments for federal funders to be more inclu- While bringing new members into the sive in their funding criteria. Linda Division is important, we also know that Campbell and others have drafted a brief we lose members every year and we need executive summary that will be shared to do more to keep current members with the leadership of APA and other attracted to us. Jean Carter has expressed groups to assist in advocacy efforts. These an interest in spearheading a membership documents should be in final form by the development initiative and you should be end of this year. hearing more about that in the coming months. The Division will begin to send liaisons to the Board of Educational Affairs, the Board We also know that new career psycholo-

2 gists are eager for information that will join the committee and we are still looking assist them in establishing their careers. for one or two others who have strong Rhonda Karg is developing a resource doc- financial planning expertise. ument for new psychologists in practice careers and Libby Williams, a new board I am pleased to say the Division is doing member, will assist in creating or collecting very well. The members of the Board have resources for new psychologists with inter- a high level of energy and enthusiasm and ests in careers in teaching, training, and we continue to bring in new faces in lead- research. ership positions who generate fresh ideas.

Finally, with our Division now in stronger The Division will be in very good hands in financial shape than it has been in several 2006 under the leadership of Abe Wolf and years, the Finance Committee (Jan then in the next year with Jean Carter. Abe Culbertson is chair) will be expanding to has been working on his initiatives for the include members who have expertise in past year and will assume the presidency in long-range financial planning. Steve full stride. He has described some of his ini- Sobelman and Larry Ritt have agreed to tiatives in other pieces in the Bulletin.

LEON 1/2 PAGE AD

3 STUDENT COLUMN How Should Mental Health Professionals Respond to a Large-Scale Disaster? By Amber L. Paukert, University of Houston

After the recent hurricane sent thousands many individuals recover naturally from of displaced Louisianans to Houston, exposure to a traumatic event (at least licensed psychologists in Houston were 42%). This means that crisis intervention asked to report to the shelters to volunteer actually has the potential to do harm if it their services. In these post-disaster situa- causes those who would have otherwise tions, should mental health professionals recovered to develop PTSD (McNally, utilize the same basic skills used in the Bryant, & Ehlers, 2003). treatment of post-traumatic stress disorder (PTSD), even though when treating PTSD There appears to be some confusion in the the event generally is weeks, months, or field regarding the terms used for different years in the past? After examining some of types of crisis intervention. Mitchell, a for- the recent reviews of the field of early crisis mer firefighter and paramedic, developed intervention, it appears that there is no CISD as a system comprised of 7 steps, consensus about what treatment is best for which are designed to help those who have disaster relief, suggesting that much more been exposed to a traumatic event research is needed in this area. However, (Mitchell, 2005). Psychological debriefing, there are some psychologists who vehe- however, is a generic term for crisis inter- mently oppose what was in the past the vention that is usually delivered within standard for counselors who are involved several days of a traumatic event (McNally, in crisis intervention: psychological Bryant, & Ehlers, 2003). The most impor- debriefing or Critical Incident Stress tant fundamentals of psychological Debriefing (CISD). This paper reviews the debriefing include discussing thoughts, nature of CISD, evidence contraindicating feelings, and reactions with a mental health and supporting its use, the response of professional who, in turn, provides psy- CISD proponents to evidence contraindi- choeducation about traumatic stress cating its use, and how opponents to CISD responses and attempts to normalize these recommend mental-health practitioners reactions (Bisson, McFarlane, & Rose, provide disaster relief. 2005). Some authors state that Mitchell’s CISD form of psychological debriefing is PTSD can be a debilitating disorder; esti- generally recognized as the most widely mates of its prevalence among those used in the world (McNally, Bryant, & exposed to traumas have large ranges Ehlers, 2003). Although originally recom- depending on the type of traumatic event mended for either individuals or groups, and the degree of exposure to the event, CISD is now recommended only for but these estimates can be as high as 58% groups (McNally, Bryant, & Ehlers, 2003; (Yehuda, Marshall, Penkower, & Wong, Mitchell, 2005). A CISD session lasts 2002). This high risk of developing PTSD as between 3 and 4 hours and is typically con- a consequence of being exposed to a life- ducted between 2 and 10 days after a trau- threatening event makes it clear why there ma (McNally, Bryant, & Ehlers, 2003). A is such a strong desire in the psychological debriefing session normally includes the community to somehow reduce this risk following elements: an explanation of the through some form of crisis intervention. procedure, each participant describing This is why CISD was developed. what happened, their thoughts about and However, this estimate also indicates that their emotional reactions during the trau- 4 ma, each participant describing their phys- the second part of this model is focused on, ical or psychological symptoms as a result it seems that psychological debriefing of the trauma, normalization of stress reac- should theoretically be effective in prevent- tions, and a summary by the facilitator. ing PTSD, as it would help individuals to Proponents of this type of intervention fully elaborate and contextualize the mem- now stress that it should never be provided ories of the event just after they have outside of an integrated package of inter- occurred. This process then should prevent ventions within a Critical Incident Stress the memory from being cued in unwanted Management (CISM) program (Mitchell, times. That attempts to avoid thinking 2005). CISM is not really a technique, but about the traumatic experience are associ- more like a set of procedures that includes ated with persistent PTSD symptoms the following: educating individuals in (McNally, Bryant, & Ehlers, 2003) gives fur- high-risk occupations about the kinds of ther weight to the theory that CISD should stressors they may encounter, common be an effective intervention, as this avoid- stress reactions, stress-management tech- ance is prevented immediately after the niques, providing food, rest, and informa- trauma. However, there are a few hypothe- tion to disaster personnel, psychological ses regarding the purported ineffectiveness debriefing, encouraging family support, of CISD. First, CISD does not address the and providing referrals for further help excessively negative appraisals of the after the immediate crisis period is over event. The presence of excessively negative (McNally, Bryant, & Ehlers, 2003). appraisals can effectively discriminate individuals with PTSD from individuals Several meta-analyses have found that without PTSD (McNally, Bryant, & Ehlers, CISD does not have any beneficial effects, 2003), indicating that these thoughts are and some studies have even found that it particularly important in the development may impede the natural recovery process, of a disorder. Second, thinking and talking resulting in fewer reductions in PTSD about the event (such as during CISD) symptoms (for a review of these studies, see often takes the form of rumination about McNally, Bryant, & Ehlers, 2003). It is the event rather than going over what actu- important to note that all of the randomly ally happened, which can worsen PTSD controlled trials finding that CISD may be symptoms (McNally, Bryant, & Ehlers, harmful have used individual debriefing as 2003). Third, the one-time nature of CISD they believe that it is the most commonly and the immediacy of it may prevent it practiced form of psychological debriefing from being an effective intervention tech- (McNally, Bryant, & Ehlers, 2003). Bisson, nique. In fact, cognitive interventions have McFarlane, and Rose (2005) state that been shown to be efficacious in the treat- although there are some negative outcome ment of PTSD, but they do not seem to be studies existing, most find that the impact of efficacious if administered within a few early psychological debriefing is neutral. weeks of the traumatic event (McNally, Bryant, & Ehlers, 2003). People appear to Arecent paper on the cognitive model of alternate between periods of avoidance PTSD (Ehlers & Clark, 2000) theorizes that and processing when recovering from a PTSD develops because a heightened sense traumatic event. Thus, it may actually be of threat is maintained after the actual counterproductive to encourage individu- threat is no longer present. According to als who are using avoidance as an adap- the cognitive model, this heightened sense tive, protective function to discuss the trau- of threat occurs because individuals have ma early in the recovery process (McNally, excessively negative appraisals of the trau- Bryant, & Ehlers, 2003). Perhaps avoidance ma or its effects and the memories of the and excessively negative appraisals should trauma are poorly contextualized, such only be addressed by systematic exposure that the events are not stored in the context to the trauma memories and cognitive of emotions and other memories. If only therapy when they become maladaptive in 5 the extended time period after the trauma. thoughts and feelings about the event (McNally, Bryant, & Ehlers, 2003). Mental In response to the evidence indicating that health professionals should concede the CISD is not effective and may actually be importance of the trauma and reassure sur- detrimental to those exposed to traumatic vivors that it is normal to have symptoms events, Mitchell (2005) states that fatal flaws of PTSD after a traumatic event. As is in the negative studies render them uninter- emphasized in CISM, recommendations pretable. First, Mitchell states that the are also made to facilitate social support. International Critical Incident Stress Essentially, “psychological first-aid” is rec- Foundation did not properly train the treat- ommended, which includes the following: ment providers in the studies that suggest consoling, protecting from further threat or the ineffectiveness of CISD. In contrast, the distress, providing physical necessities, International Critical Incident Stress providing goal orientation and support for Foundation trained 79.5% of those specific reality-based tasks, facilitating researchers who found positive results for meeting with social supports, facilitating CISD. Mitchell also emphasizes that CISD some telling of the traumatic memories as must only be performed in the group for- desired by the individual while profession- mat. However, CISD was used in a one-on- als actively listen but do not press for one setting in all studies, contraindicating its details or emotional responses, and provid- use. Lastly, Mitchell states that CISD should ing referrals for ongoing services (McNally, not be used without the entire CISM pro- Bryant, & Ehlers, 2003). Thus, it may be gram. Consumers of CISD often state that that supportive and noninterventionist they enjoy the intervention, and these data interventions are indicated in the after- are often used to support its effectiveness, math of a traumatic event rather than any but other researchers argue that this may just specific form of psychological debriefing. be a reflection of polite expressions of grati- tude (McNally, Bryant, & Ehlers, 2003). References Bisson,J.I.,McFarlane, A., and Rose, S. (2005). In general, there is very little evidence that ISTSS treatment guidelines related to psycho- early psychological debriefing prevents logical debriefing. Retrieved Sept. 22, 2005 PTSD and some evidence that it may actu- from International Society for Traumatic ally inhibit the natural recovery process Stress Studies Web site: www.istss.org (Bisson, McFarlane, & Rose, 2005). Ehlers, A & Clark, D.M. (2000). A cognitive Research contraindicating the use of CISD model of posttraumatic stress disorder. often does not incorporate the entire CISM Behaviour Research and Therapy, 38, 319-345. package and it seems, that when used McNally, R. J., Bryant, R. A., & Ehlers, A. properly in the CISM package, CISD may (2003). Does early psychological interven- have some value (McNally, Bryant, & tion promote recovery from posttraumat- Ehlers, 2003; Mitchell, 2005). Thus, the ic stress? Psychological Science in the Public question remains about whether to pro- Interest, 4(2). mote the use of an intervention technique Mitchell, J. T. (2005). Crisis intervention and that may have promise, but when used critical incidence stress management: A improperly may actually cause harm. defense of the field. Retrieved September Recent recommendations in the literature 22, 2005 from International Critical do not encourage the use of CISD but do Incidence Stress Foundation Web site: encourage the use of parts of it and of www.icisf.org CISM (McNally, Bryant, & Ehlers, 2003). Yehuda, R., Marshall, R., Penkower, A., & The literature suggests that individuals Wong, C.M. (2002). Pharmacological treat- providing crisis intervention offer support ments for posttraumatic stress disorder. In and information about the trauma and its P. E. Nathan & J. M. Gorman (Eds.), A consequences as necessary without forcing Guide to Treatments that Work (pp. 411-445). survivors to disclose their personal New York: Oxford University Press. 6 DIVISION 29 AWARDS AND RECOGNITIONS

2005 APA Convention

John C. Norcross, Ph.D., ABPP Recipient of the 2005 APA Award for Distinguished Contributions to Education and Training

Dr. Norcross was acknowledged at the awards ceremony for his positive influence in the teaching of students, engagement in education and training research, development of instructional materials that influence the direction of training, professional governance, and promotion of continuing education.

Dr. Diane Willis introduced Dr. Norcross for his award presentation, entitled “The Psychotherapist’s Own Psychotherapy: Educating and Developing Psychologists.”

7 FEATURE

Perspectives on Psychotherapy Integration

By George Stricker, Ph.D. Argosy University/Washington DC

This is the first in what will be a regular reasonable, but too often it is based on series providing perspectives on psy- imprecise memories of past experience chotherapy integration. Although orga- without any reference to theory or research nized by the Society for the Exploration of data. In contrast, psychotherapy integra- Psychotherapy Integration (SEPI), contribu- tion differs from eclecticism in that it tions for this series are welcome from mem- attends to the relationship between theory bers and non-members of SEPI, and may and technique. also be submitted directly to Psychotherapy Bulletin. We are very grateful to the editor, The term psychotherapy integration has Craig Shealy, for introducing a series that been used in several different ways will provide insights from what may be the (Stricker & Gold, 2003). The term has been cutting edge of developments in psy- applied to a Common Factors approach to chotherapy. For readers who wish to learn understanding psychotherapy, to more about psychotherapy integration, Assimilative Integration, to Technical SEPI maintains a website Integration, and to Theoretical Integration. (www.cyberpsych.org/sepi) that contains several articles, information about the next Common Factors conference, an application for membership, Common Factors refers to aspects of psy- and other materials of interest. For readers chotherapy that are present in most, if not who may wish to have articles considered all, approaches to therapy. These tech- for inclusion in this column, please send niques cut across all theoretical lines and them to me at [email protected]. are present in all psychotherapeutic activi- This first column presents an introduction ties (Grencavage & Norcross, 1990). to psychotherapy integration, and draws Because the techniques are common to all heavily on material I prepared previously approaches to psychotherapy, the name for inclusion in The Gale Encyclopedia of Common Factors has been given to this Mental Disorders. variety of psychotherapy integration. There is no standard list of common fac- Psychotherapy integration is defined as an tors, but if a list were to be constructed, it approach to psychotherapy that includes a surely would include: a therapeutic variety of attempts to look beyond the con- alliance established between the patient fines of single-school approaches in order and the therapist; exposure of the patient to see what can be learned from other per- to prior difficulties, either in imagination spectives. It is characterized by an open- or in reality; a new corrective emotional ness to various ways of integrating diverse experience that allows the patient to expe- theories and techniques. Psychotherapy rience past problems in new and more integration can be differentiated from an benign ways; expectations by both the eclectic approach in that an eclectic therapist and the patient that positive approach is one in which a therapist choos- change will result from the treatment; ther- es interventions because they work with- apist qualities, such as attention, empathy, out looking for a theoretical basis for using and positive regard, that are facilitative of the technique, but relies solely on sup- change in treatment; and the provision by posed efficacy. The rationale of efficacy is the therapist to the patient of a reason for 8 the problems that are being experienced. ship. Finally, the patient must be provided with a credible reason for the problems No matter what kind of therapy is prac- that he or she is undergoing. This reason is ticed, each of these common factors is pre- based in the therapist’s theory of personal- sent. It is difficult to imagine a treatment ity and change. The same patient going to that does not begin with the establishment different therapists may be given different of a constructive and positive therapeutic reasons for the same problem. It is interest- alliance. This relationship has been found ing to speculate as to whether the reason to be integral to any change that occurs in must be an accurate one or whether it is treatment (Norcross, 2002). The therapist sufficient that it be credible to the patient and the patient agree to work together and and not remarkably at variance with reali- they both feel committed to a process of ty. As long as the reason is credible and the change occurring in the patient. Within patient has a way of understanding what every approach to treatment, the second of previously had been incomprehensible, the common factors, the exposure of the that may be sufficient for change to occur. patient to prior difficulties, is present. In This discussion of common factors com- some instances the exposure is in vivo, and bines the early and important work of the patient will be asked directly to con- Goldfried (1982), that of Weinberger (1995), front the source of the difficulties. In many and especially the seminal work of Frank cases, the exposure is verbal and in imagi- (1973). nation. However, in every case, the patient must express those difficulties in some Assimilative Integration manner and, by doing so, re-experiences The second major approach to psychother- those difficulties through this exposure. In apy integration is Assimilative Integration successful treatment, the exposure usually (Messer, 1992). Assimilative Integration is is followed by a new corrective emotional an approach in which the therapist has a experience (Alexander & French, 1946). commitment to one theoretical approach The corrective emotional experience refers but also is willing to use techniques from to a situation in which an old difficulty is other therapeutic approaches. re-experienced in a new and more positive way. As the patient re-experiences the As an example, a therapist may try to problem in a new way, that problem can be understand patients in terms of psychody- mastered and the patient can move on to a namic theory, because he or she finds this more successful adjustment. most helpful in understanding what is going on in the course of the treatment. Having established a therapeutic alliance, However, the therapist may also recognize and being exposed to the problem in a new that there are techniques that are not sug- and more positive context, both the thera- gested by psychodynamic theory that pist and the patient always expect positive work very well, and these may then be change to occur. This faith and hope is a used in the treatment plan. The psychody- common factor that is an integral part of namic therapist can occasionally use cogni- successful therapy. Without this hope and tive-behavioral techniques such as home- expectation of change, it is unlikely that the work, and may occasionally use humanis- therapist can do anything that will be use- tic approaches, such as a two-chair tech- ful, and if the patient does not expect to nique, but always retains a consistent psy- change, it is unlikely that he or she will chodynamic understanding (for an exam- experience any positive benefit from the ple, see Gold & Stricker, 2001). The treat- treatment. The therapist must possess ment can take place in a way that is benefi- some essential qualities, such as paying cial to the patient and is not bound by the attention to the patient, being empathic restrictions of the therapist’s favorite way with the patient, and making his positive of intervening. The patient may not be regard for the patient clear in the relation- aware that integration is taking place, for 9 he or she feels that a consistent approach is Eclecticism is that both rely on a wide vari- being maintained. Most patients are not ety of therapeutic techniques, focusing on familiar with theory, don’t realize that dif- the welfare of the patient rather than on ferent techniques are generated by differ- allegiance to any particular school of psy- ent theoretical understandings, and only chotherapy. The major difference between are concerned with whether or not the the two is that Assimilative Integration is treatment is helpful. Inherent in any bound by a unifying theoretical under- attempt to achieve assimilative integration standing whereas Technical Eclecticism is is the challenge of accommodation, an free of theory and relies on the experience understanding of how the home theory of the therapist to determine the appropri- must be altered in order to embrace the ate interventions. There are some excellent value of the technique that was not sug- examples of technical eclecticism, although gested by that approach. these are so well worked out and systemat- ic that they may belong in another catego- Inherent in psychotherapy integration is ry (Beutler, Consoli, & Lane, 2005; Lazarus, the conviction that there is no one 2005). For Beutler, the unifying principle is approach to therapy that is suitable to treatment matching based on well-devel- every patient. Both in single-school oped research findings. For Lazarus, there approaches and in psychotherapy integra- is a core adherence to social learning theo- tion, the treatment must be suitable for the ry, girded by a systematic rubric (BASIC- individual patient. In making the treat- ID) for understanding the breadth of the ment suitable for the individual patient, patient’s difficulty. the therapist must understand the patient, and that establishes a place for theory. Theoretical Integration Assimilative Integration is particularly The fourth approach to psychotherapy useful in that theory helps in the under- integration is called Theoretical standing of the needs of the patient, but Integration. This is the most difficult level then several different approaches to tech- at which to achieve integration because it nique can help to design a treatment that requires integrating theoretical concepts fits that particular understanding. The from different approaches, and these treatment plan then must undergo contin- approaches may differ in their fundamen- uous revision as the understanding of the tal philosophy about human behavior. patient gets fuller and deeper over the Whereas Assimilative Integration begins course of the treatment. with a single theory and brings together techniques from different approaches, Technical Eclecticism Theoretical Integration tries to bring Technical eclecticism is a variation of together those theoretical approaches Assimilative Integration and is most com- themselves and then to develop what in mon among those practitioners who refer physics is referred to as a “Grand Unified to themselves as eclectic. In Technical Theory.” Neither psychotherapists nor Eclecticism, the same diversity of tech- physicists have been successful to date in niques is displayed as in Assimilative producing a Grand Unified Theory. It is Integration, but there is no unifying theo- difficult for me to imagine a theory that retical understanding that underlies the really can combine an approach that has approach. Rather, the therapist relies on one philosophical understanding with a previous experience and on knowledge of different approach that has a different the theoretical and research literature to philosophical understanding (Messer & choose interventions that are appropriate Winokur, 1984). For example, a psychody- for the patient. namic approach believes that an early diffi- culty leads to a pattern of behavior that is The obvious similarity between repetitive, destructive, and nearly impossi- Assimilative Integration and Technical ble to resolve. In contrast, behavior therapy 10 sees problems as much more amenable to (2nd ed.). Baltimore: Johns Hopkins change. This difference may represent a University Press. basic incompatibility between the two the- Gold, J., & Stricker, G. (2001). Relational psy- ories. Therefore, theoretical integration choanalysis as a foundation of assimilative would be faced with the task of integrating integration. Journal of Psychotherapy a theory about the stability of behavior Integration, 11, 43-58. with a theory about the ready changeabili- Goldfried, M.R. (Ed.), (1982). Converging ty of behavior, and unless this obstacle can themes in psychotherapy: Trends in psy- be overcome, Theoretical Integration will chodynamic, humanistic, and behavioral not be achieved. practice. New York: Springer. Grencavage, L. M., & Norcross, J. C. (1990). Nonetheless, there have been many Where are the commonalities among the attempts to develop such high level inte- therapeutic common factors? Professional grative approaches, and some of these are Psychology: Research and Practice, 21, 372- imaginative and highly influential. The 378. first and perhaps still the most important Lazarus, A. A. (2005). Multimodal therapy. of these (Wachtel, 1997) combined psycho- In J. C. Norcross & M. R. Goldfried (Eds.), dynamic and behavioral approaches. Even Handbook of psychotherapy integration if the grand vision of a unified theory is not (2nd ed., pp. 105-120). New York: Oxford accomplished, much of value can be done University Press. when the most valuable aspects of different Messer, S. B. (1992). A critical examination of theoretical efforts can be joined in a syner- belief structures in interpretive and eclectic gistic way. psychotherapy. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychother- In any case, the general point in three of apy integration (pp. 130-165). New York: these approaches, Common Factors, Basic Books. Assimilative Integration, and Theoretical Messer, S. B., & Winokur, M. (1984). Ways of Integration, is that there is a clear value to knowing and visions of reality in psycho- the role of theory in psychotherapy integra- analytic therapy and behavior therapy. In tion, whether the theory deals with the way H. Arkowitz & S. Messer (Eds.), integration works (Theoretical Integration), Psychoanalytic therapy and behavioral the framework that governs the choice of therapy: Is integration possible? (pp. 63- interventions (Assimilative Integration), or 100). New York: Plenum. the organizing principle for understanding Norcross, J. C. (Ed.). (2002). Psychotherapy the Common Factors that are present in all relationships that work: Therapist contri- psychotherapy. The fourth approach, butions and responsiveness to patients. Technical Eclecticism, is not concerned with New York: Oxford University Press. theory, but does view the benefit of the Stricker, G., & Gold, J. R. (2003). Integrative patient to be of more significance than the approaches to psychotherapy. In A. S. adherence to any single theory. Gurman & S. B. Messer (Eds.), Essential psychotherapies: Theory and practice (2nd References ed., pp. 317-349). New York: Guilford Alexander, F., & French, T. (1946). Psycho- Press. analytic therapy. New York: Ronald Press. Wachtel, P. L. (1997). Psychoanalysis, behav- Beutler, L. E., Consoli, A. J., & Lane, G. ior therapy, and the representational (2005). Systemic treatment selection and world. Washington, DC: American prescriptive psychotherapy. In J. C. Psychological Association. Norcross & M. R. Goldfried (Eds.), Weinberger, J. (1995). Common factors aren’t Handbook of psychotherapy integration so common: The common factors dilemma. (2nd ed., pp. 121-143). New York: Oxford Clinical Psychology: Science and Practice, 2, University Press. 45-69. Frank, J. D. (1973). Persuasion and healing 11 DIVISION 29 AWARDS 2005 APA Annual Convention

Dr. Gerald P. Koocher, Ph.D., ABPP 2005 Distinguished Psychologist Award

Dr. Gerry Koocher was presented the Distinguished Psychologist Award by Dr. Linda Campbell, past president of the division. Dr. Koocher has served as President of Division 29, Treasurer of APA and is currently President-elect of APA. He has been elected Fellow of twelve divisions of APA and has served as president of two divisions in addition to Division 29.

Dr. Koocher continues to make important contributions to our profession through his work in pediatric psychology and as Dean of the School for Health Studies at Seminar College in Boston.

12 RESEARCH Integrating Research Findings on Therapeutic Alliance Into Your Practice By Mark J. Hilsenroth Ph.D., Adelphi University

Contemporary psychotherapy research has and noting adaptive changes across the underlined the importance of the technical treatment process were significantly relat- and relational aspects of therapeutic ed to higher alliance. In addition, higher alliance. Decades of research have consis- alliance was related to therapist techniques tently found a significant relationship of that increased a patient’s understanding of alliance with therapy process and outcome the problems that brought them to treat- (Horvath, 2001; Martin, Garske, & Davis, ment through greater exploration and in- 2000; Norcross, 2002). These research find- depth (i.e. full, special, powerful) discus- ings may help therapists who have a range sion of these topics as well as accurate of experience and practice various forms of interpretations (high quality and case-spe- psychotherapy develop stronger therapeu- cific interpretations, not simply a larger tic connections with their patients. Yet, quantity). Techniques that closely attended how does one translate these research find- to and maintained focus on the patient’s in- ings on therapeutic alliance into applied session subjective experience (i.e. reflec- clinical practice? tion) and affect, or that facilitated the expression of these emotions, were also Interventions Associated with Alliance related to higher alliance. Finally, it seems Strength and Weakness that a more active, involved, and engaged Two reviews by Ackerman and Hilsenroth stance by the therapist was important in a (2001, 2003) have integrated information positive therapeutic relationship. from several empirical studies in a way that helps clarify the relation between a Therapist interventions that were found to therapist’s specific in-session interventions have negative effects on the alliance and therapeutic alliance. The studies cov- seemed to be at extreme ends of particular ered in these reviews suggest that thera- technical continua. For instance, the over- pists’ use of techniques drawn from a structuring and managing of the therapy in range of psychotherapy orientations (cog- an inflexible manner as well as a failure to nitive-behavioral, experiential, interper- structure the treatment in any organized or sonal, family therapy, psychodynamic, etc.) coherent manner were both negatively may influence the therapeutic alliance in related to alliance. Also, the therapist talk- both positive and negative ways. Table 1 ing either “too much” concerning superfi- summarizes therapist techniques identi- cial information not related to key treat- fied in these reviews that were reported to ment issues or self-disclosure of the thera- be important in the development and pist’s own emotional conflicts (as opposed maintenance of a strong alliance or, con- to “self-involving” exploration of thera- versely, related to lower levels of, or even pist’s in-session process, see Teyber & to deterioration in, the alliance. McClure, 2000) as well the therapist talking “too little” through the misuse of extended Therapist techniques found to contribute silence or withdrawal from the in-session positively to the alliance could generally be process were detrimental to alliance. The categorized as: Supportive, Exploratory, use of transference interpretations in a sus- Affective, or Engaged. Research indicated tained and unremitting manner can be therapists’ techniques that specifically con- detrimental to the therapeutic alliance, par- vey support, understanding, affirmation, ticularly for patients with Axis II disorders 13 (see Ogrodniczuk & Piper, 1999). However, resolve similar patterns in other relation- it is important to note that a therapist’s ships. Resolution of alliance ruptures often continued focus on the transference rela- entails therapist techniques and processes tionship (i.e. linking patient, therapist, and similar to the interventions positively past others from a closed, single person, impacting the alliance described above. To theoretical perspective or system) is not successfully manage the resolution of rup- necessarily the same as exploring the in- tures in the alliance, Safran and Muran session process, including thoughts and (2000, 2005) recommend that the therapist feelings of the treatment relationship (i.e. acknowledge and explore his/her contri- exploring patient-therapist interactions bution to the rupture experience, convey without linking to a past other from an an affirming and understanding stance as open, two-person, theoretical perspective well as validate the patient through explo- or system; Greenson, 1967; Summers, 1994; ration of their experience to gain a greater Wachtel, 1993). This is an important dis- understanding. Additionally, the therapist tinction that I will return to in the discus- examining in-session affect, experience, sion of alliance ruptures. Finally, of little and process is a crucial element to the suc- surprise, communication of hostility, disre- cessful resolution of an alliance rupture. spect, or belittling by the therapist toward These recommendations converge with the patient was found to be significantly previous findings that therapist explo- related to lower alliance. ration, depth, interest, affirming, under- standing, and the discussion of in-session Rupture and Repair of the Alliance process contribute to the development of a It is interesting to note that the research stronger alliance. identifying a therapist’s significant contri- butions to the alliance are similar to fea- Finally, several studies have found that tures salient in the rupture and repair of therapeutic alliance established very early the alliance. Research on alliance ruptures in psychotherapy (i.e. by approximately support the notion that such ruptures are the 3rd session) is often related to later an expected and normal part of the treat- process and outcome (Horvath, 2001; ment process (Safran & Muran, 2000, 2005). Martin, Garske, & Davis, 2000). Recent Ruptures in the alliance are most likely to studies have begun to extend this research occur when a patient experiences negative and examine therapeutic alliance devel- feelings toward the therapist or therapeutic oped during the initial interview, consulta- process. Not surprisingly then, therapist tion or psychological assessment interventions found to be related to the (Hilsenroth, Peters, & Ackerman, 2004; development or exacerbation of ruptures Huber, Henrich & Brandl, 2005; Rumpold were similar to the techniques reported as et al., 2005; Sexton, Littauer, Sexton & contributing negatively to the alliance gen- Tommeras, 2005). Each of these studies has erally. Attention to these interventions is demonstrated that these initial patient- important as unresolved ruptures can lead therapist interactions have a significant to treatment failures and, more important- impact on subsequent treatment process ly, the continuation of maladaptive rela- and outcome. These findings suggest that tional patterns in the patient’s life. careful awareness of the therapeutic rela- However, alliance ruptures are also fertile tionship as early as possible in treatment (i.e. ground for positive patient change and initial interview or psychological assessment) present an opportunity for deepening the may provide patients with a secure foun- therapeutic relationship (Safran, 1993; dation for therapeutic progress. Safran & Muran, 2000, 2005; Wachtel, 1993). Thus, resolution of alliance ruptures References can lead to deeper exploration of relational Ackerman, S., & Hilsenroth, M. (2001). A patterns and help patients develop the Review of Therapist Characteristics and skills necessary to understand as well as Techniques Negatively Impacting the 14 Therapeutic Alliance. Psychotherapy, 38, Psychotherapy for Patients with 171-185. Personality Disorders. Journal of Ackerman, S., & Hilsenroth, M. (2003). A Personality Disorders, 13, 297-311. Review of Therapist Characteristics and Rumpold, G., et al. (2005). Changes in Techniques Positively Impacting the Motivation and Therapeutic Alliance Therapeutic Alliance. Clinical Psychology During a Pretherapy Diagnostic and Review, 23, 1-33. Motivation-Enhancing Phase Among Greenson, R. R. (1967). The technique and Psychotherapy Outpatients. practice of psychoanalysis. New York: Psychotherapy Research, 15, 117-128. International Universities Press. Safran, J. (1993). Breaches in the Hilsenroth, M., Peters, E., & Ackerman, S., Therapeutic Alliance: An Arena for (2004). The Development of Therapeutic Negotiating Authentic Relatedness. Alliance During Psychological Psychotherapy, 30, 11-24. Assessment: Patient and Therapist Safran, J., & Muran, J. C. (2000). Negotiating Perspectives Across Treatment. Journal of the therapeutic alliance in brief psychothera- Personality Assessment, 83, 332-344. py. New York: Guilford Press. Horvath, A. (2001). The Alliance. Safran, J., & Muran, J. C. (2005). Brief rela- Psychotherapy, 38, 365-372. tional therapy and the resolution of rup- Huber, D., Henrich, G., & Brandl, T. (2005). tures in the therapeutic alliance. Working Relationship in a Psychotherapy Bulletin, 40, 13-17. Psychotherapeutic Consultation. Sexton, H., Littauer, H., Sexton A., & Psychotherapy Research, 15, 129-140. Tommeras, E. (2005). Building an Martin, D. J., Garske, J. P., & Davis, M. K. Alliance: early Therapy Process and the (2000). Relation of the therapeutic alliance Client-Therapist Connection. with outcome and other variables: A Psychotherapy Research, 15, 103-116. meta-analytic review. Journal of Consulting Summers, F. (1994). Object Relations Theories and Clinical Psychology, 68, 438-450. and Psychopathology. NJ: Analytic Press. Norcross, J. (Ed.). (2002). Psychotherapy rela- Teyber, E., & McClure, F. (2000) Therapist tionships that work: Therapist contributions Variables. In C. Snyder & R. Ingram and responsiveness to patient needs. New (Eds). Handbook of Psychological Change York: Oxford University Press. (pp. 62-87). New York: Wiley. Ogrodniczuk, J., & Piper, W. (1999). Use of Wachtel, P. L. (1993). Therapeutic communi- Transference Interpretations in cation: Principles and effective practice. New Dynamically Oriented Individual York: Guilford.

Table 1

Summary of Therapist’s Techniques Found to be Significantly Related to Therapeutic Alliance Techniques Positively Related to Alliance Techniques Negatively Related to Alliance Supportive Over structuring the therapy Understanding Managing Affirming Failure to structure the therapy Noting past therapy success Exploration Superficial interventions Depth Inappropriate self-disclosure Accurate interpretation Inappropriate use of silence Attend to patient’s experience Unyielding transference interpretations Reflection Facilitate expression of affect Active Belittling 15 Dr. Mark J. Hilsenroth is an Associate and his wife Jessica, a Midwife, live in Professor at The Derner Institute of Centerport, NY on the North Shore of Long Advanced Psychological Studies, Adelphi Island. (Web site: www.adelphi.edu/facul- University, Garden City, NY. He also main- ty/profiles/profile.php?PID=0097). tains a part-time private practice. He is Associate Editor of the Journal of Address correspondence to: Personality Assessment and on the editori- Mark J. Hilsenroth, Ph.D., ABAP al board of the journals Psychotherapy and The Derner Institute of Advanced Psychotherapy Research. He was the recip- Psychological Studies, Adelphi University ient of the Division 29 Krasner Early 220 Weinberg Bld. Career Award from Division 29 in 2004 and 158 Cambridge Ave. the Early Career Award from the Society Garden City, NY, 11530 for Psychotherapy Research in 2005. He Email: [email protected]

16 AD HOC COMMITTEE ON PSYCHOTHERAPY Advancement of Psychotherapy Training Linda Campbell, Ph.D., Past-President and Co-Chair

The Presidential skills, values, attitudes, and core knowl- Column written by edge that should be accomplished in the Dr. Leon VandeCreek doctoral practicum experience. The APA reflects the many Accreditation Guidelines also highlights accomplishments of criteria that must be met for practicum his administration, training within the doctoral program. This but is modest document was reviewed and endorsed by regarding his central the Council of Chairs of Training Councils. role in the advance- ment of our division The Division of Psychotherapy notes that over the last three competence training specifically in psycho- years. Leon has continued to focus his therapy has not been identified. The practice energy and attention on the training, and training dimensions of our profession research, and practice goals set two years are moving ahead admirably in promoting ago. He has also inspired and encouraged criteria and advancing knowledge that the governance of the division to hold contributes to standards in the practice of steadfast in our mission to promote and professional activities. Certainly, the recent enhance the presence of psychotherapy in product of the APA Task Force on the profession. I urge you to read Leon’s Evidenced Based Practice is an important column to learn the exciting and important example of our continued commitment to advances being made by our division. quality practice. The Division of Psychotherapy Ad Hoc Committee and the Leon described one of our important initia- Education and Training Committee are tives of this past year, led by Bill Stiles our most interested in exploring the status of Research Committee Chair. In collabora- psychotherapy competency training and tion with psychotherapy researchers who informing our membership and ourselves are members of our division, Bill has writ- of the existing need for development of ten a seminal article on the state of psy- standards. chotherapy research. A synthesis of that article is being developed, as Leon noted, In 2004, Leon and I held many focus that will serve as a position paper for the groups of Division 29 members regarding division in continued advocacy for the their perspectives on the state of psycho- funding of psychotherapy research. therapy. The student focus groups we held reflected several themes. One prominent As this very significant achievement is cul- observation and concern by students was minating, we will additionally focus on that their practicum experiences did not training goals that the division identified meet a uniform standard and that, in fact, as priorities. During recent years, efforts students were facing instability in site loca- have been made by several entities within tion, quality and quantity of supervision, APA to develop competencies in several access to clients, and several other logisti- areas of training. Under the guidance of Dr. cal and training problems. Neither Robert Hatcher and Dr. Kim Lassiter, The Division 29 nor the students interviewed Association of Directors of Psychology have taken the position that all programs Training Clinics, developed a draft of should meet the same standard of psycho- Practicum Competencies that identify therapy training. Our interest, however, is 17 (a) in assisting students in identifying [email protected] or me at those programs that do have quality train- [email protected]. ing in psychotherapy and (b) in developing a means by which students and psycholo- As Leon mentioned in his column, Dr. Abe gists involved in training can work with Wolf will become our president in January, similar expectations regarding the quality followed in the next year by Dr. Jean and presence of psychotherapy in their Carter. Both of these individuals are training. extremely dedicated to the division and they both have very exciting and signifi- As always, Leon and I are very interested cant goals planned for our future. We urge in the involvement of our membership in you to get on board and participate in the these initiatives. We encourage you to let very rewarding activities and the impor- us know of your interests in any aspect of tant mission that your leadership has these activities. Please contact Leon at developed.

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

18 INTERVIEW ADiscussion with Dr. Marvin Goldfried by Rachel Hamilton, Miami University of Ohio

Dr. Marvin Goldfried in the mental health field. Furthermore, Dr. is a psychologist who Goldfried notes that GLBT status is a ‘con- believes that when cealable stigma’—since sexual orientation traditionally distinct is not apparent, those who are GLBT are groups, approaches, often assumed to be heterosexual. Such or ideas are brought social invisibility masks the true preva- into dialogue, all lence and diversity of GLBT people, as well may be positively as the unique issues they face. transformed. His Commenting on the recent changes in pub- career has included lic awareness and presence of GLBT peo- considerable work in ple, Dr. Goldfried wonders, “How can soci- the field of psychotherapy integration, ety and the media be so aware of gay issues addressing issues such as the integration of and the profession be so ignorant?” research with practice, of past with current findings, and of techniques, terminology, This lack of awareness is particularly prob- and theories across theoretical orientations. lematic for clinicians. GLBT people are Dr. Goldfried was co-founder of the more likely than heterosexuals to seek psy- Society for the Exploration of Psycho- chological services, and therefore clinicians therapy Integration (SEPI), the founding are likely to encounter GLBT clients. editor of In Session: Psychotherapy in Unfortunately, most clinicians have Practice, and a past president of the Society received little if any clinical training in for Psychotherapy Research. While he is GLBT-specific treatment issues, and there currently involved with research examin- is a relative lack of GLBT-focused research ing commonalities across theoretical orien- due to stigma still surrounding this topic. tations at the State University of New York Without adequate knowledge of specific at Stony Brook, Dr. Goldfried’s research for treatment and life issues for GLBT clients, the past several years has focused on inte- clinicians may attempt to show acceptance grating gay, lesbian, bisexual and transgen- of their GLBT clients by treating them iden- der (GLBT) issues within mainstream psy- tically to heterosexual clients. While well- chology. As a proud father of a gay son, he intentioned, Dr. Goldfried stresses that this is committed both to enhancing the lives of strategy can “deny significant issues of dif- GLBT individuals through psychology and ference and miss the boat clinically.” To to enhancing psychology through the promote competence in treating GLBT incorporation of GLBT individuals and clients, Dr. Goldfried suggests that clini- their experiences. cians read, learn from their GLBT clients and younger generations who may be Dr. Goldfried observes that GLBT issues more aware of GLBT issues, and advocate have not been made a priority by main- for greater GLBT-focused research and stream psychology. While there is a disci- training opportunities within the field. pline-wide movement toward multicultur- al sensitivity, sexual orientation has Dr. Goldfried notes that one of the crucial received little attention within this move- issues for GLBT people is family support ment compared to other minority statuses. for their GLBT identity. It has been Dr. Goldfried attributes this oversight to observed that when a family member several factors, including existing cultural comes out, families frequently “go into the attitudes about homosexuality and histori- closet” about their GLBT relative’s sexual cal biases against GLBT populations with- identity. While families may come private- 19 ly to accept a family member as GLBT, they events and research of interest, and advo- often fail to acknowledge publicly their rel- cate for GLBT issues in psychology educa- ative’s GLBT identity due to internalized tion, research, and clinical work. Dr. stigma and a fear of social discrimination. Goldfried is pleased to note that AFFIRM is This may communicate to GLBT individu- currently moving from its member recruit- als the presence of shame and absence of ment phase to a more proactive phase support within the family. He points out focusing on raising consciousness of GLBT that GLBT people often refer to their close issues within the field. His dream for friends and lovers as their “chosen family,” AFFIRM is to extend its concepts to other which speaks to the meaningfulness to professions, particularly those that deeply GLBT individuals of having a family who affect GLBT individuals such as teaching, can accept them in their entirety. medicine, social work, and law. If such net- works were established across professions, The importance of family support is part of social change could occur through the why Dr. Goldfried is a strong proponent of sheer number of people publicly promot- Parents, Families and Friends of Lesbians ing acceptance and resisting stigmatization And Gays (PFLAG), a support and advoca- of their GLBT family members. cy group for GLBT people and their loved ones (http://www.pflag.org). He views Currently, AFFIRM has over 600 members. PFLAG as a powerful organization for creat- Given the approximately 80,000 member- ing a shift in consciousness. Through the ship of the American Psychological exchange of dialogue between both GLBT Association, the existing membership in and non-GLBT people at different stages of AFFIRM is considerably lower than its esti- acceptance, PFLAG transforms anger at mated potential. Dr. Goldfried acknowl- GLBT people and loved ones into empathy edges that many family members of GLBT for their perspectives. By facilitating person- individuals do not see themselves as having al contact with GLBT individuals, PFLAG a personal interest in GLBT issues. fosters cognitive dissonance with negative Nevertheless, he considers relatives of GLBT and simplistic social stereotypes. Finally, individuals to be those with the greatest PFLAG presents an alternative to main- stake in improving the social climate for stream attitudes about GLBT people their GLBT family members. He therefore through group modeling of GLBT-positive views organizations made up of GLBT fam- norms. Due to these aspects of PFLAG, Dr. ily members—such as PFLAG and Goldfried views it as potentially more pow- AFFIRM—as powerful agents of advocacy. erful than individual therapy in helping family members adjust to and embrace a rel- Dr. Goldfried firmly believes that coming ative’s GLBT identity. Witnessing the influ- out, both as GLBT and as family and ence of PFLAG was part of what motivated friends of GLBT people, is a key to chang- Dr. Goldfried to start AFFIRM (short for ing negative social attitudes and stereo- Psychologists Affirming their Lesbian, Gay, types. The more people come out in public Bisexual and Transgender Family) in 2000. support of GLBT individuals, the greater the pressure will be on society to recognize AFFIRM is a network of psychologists with that GLBT people and those who love them GLBT family members (see also the recent truly “are everywhere,” and that they will article on AFFIRM in the October APA not accept social stigmatization or invisi- Monitor, http://www.apa.org/monitor/ bility. Dr. Goldfried urges psychologists oct05/affirming.html). The primary pur- who wish to join AFFIRM to visit the web- pose of AFFIRM is to demonstrate a public site at www.sunysb.edu/affirm Any non- presence of psychologists who are proud to psychologists who have interest in starting come out in support of their GLBT family an AFFIRM-like network within their own member(s). AFFIRM operates through an profession are also highly encouraged to Internet-based listserve to share GLBT- contact AFFIRM. relevant information and resources, post 20 WASHINGTON SCENE The Steady Evolution of Psychology into the 21st Century by Pat DeLeon, Ph.D., ABPP, former APA President

AGlimpse Into The Future—Earlier this he confided in others that it was only a year, the Hawaii Psychological Association matter of time before psychologists had (HPA) was successful in having two com- prescriptive authority. His job was to stave mittees of the Hawaii State Senate recom- off the inevitable as long as possible. I mend the enactment of legislation (SB 1239) might have felt some sympathy for his sit- which would have allowed properly uation, were it not for the fact that he had trained psychologists, working within com- little to offer in the face of the desperate munity health centers, to prescribe psy- need for mental health services in our state. chotropic medications. During the process, We, like most areas of the country, have a Jill Oliveira-Berry and Robin Miyamoto critical shortage of psychiatrists, particu- were successful in obtaining the support of larly in rural and underserved areas and each of the health center medical directors, we have a desperate need for pediatric the Hawaii Primary Care Association, and a psychiatrists in particular. Inpatient ado- number of other “interested parties” lescent units have had to close due to a lack (including the Native Hawaiian healthcare of psychiatrists. organization, Papa Ola Lokahi), pursuant to the recommendations of our colleagues in “Is there any chance they will be able to New Mexico regarding the importance of improve this situation in the future? The developing visual grassroots support. In answer is a resounding ‘No.’ Psychiatry March, the bill failed to pass Third Reading residencies have to pull 40% of their resi- by the full Hawaii Senate, on a vote of 12-12- dents from foreign countries due to a lack 1. However, the legislature eventually of U.S. applicants. Only three percent of enacted House Concurrent Resolution 255 psychiatry graduates have plans to work in which established a six person Interim Task rural or underserved areas. Hawaii psy- Force On The Accessibility Of Mental chologists, on the other hand, can be found Health Care To Consider The Feasibility Of in almost all areas of the state. A large per- The State Authorizing Trained and centage are providing psychological ser- Supervised Psychologists To Safely vices to children. Psychologists are found Prescribe Psychotropic Medications For The in most of the federally-designated com- Treatment Of Mental Illness. Jill and Ray munity health centers (CHCs), whose char- Folen represent HPA on the task force. Ray’s ter is to provide services in underserved report on their first meeting this October: areas. The CHC psychologists work collab- oratively with the primary care physicians “The first meeting of the legislatively man- to provide their patients with appropriate dated RxP Task Force started with a park- therapy and adjunctive pharmacological ing lot encounter with the anti-RxP psychi- interventions when needed. atrist assigned by organized psychiatry to represent them during the discussions. He “Prescriptive authority is only meaningful greeted me with an obvious dig – ‘So what in appropriate context, and the primary do you guys do? Testing, right?’ I didn’t care psychology model is one that makes offer him the courtesy of a reply as we the most sense to us. Primary care psychol- walked to the State Capital for our meeting ogists work in a primary care clinic. They with the legislators chairing the task force. provide traditional behavioral health ser- One thing was clear, though: he was feel- vices (e.g., treatment of depression, anxiety, ing threatened. My colleagues and I knew substance abuse), as well as more specialized 21 behavioral medicine services (e.g., treat- 1984-1985. Jim Quillin, President of the ment of obesity, high blood pressure, dia- Louisiana Psychological Association, betes, headache). In our experience, family recently noted that: practitioners welcome psychologists in “Louisiana’s Medical Psychology statute their clinics. These psychologists not only was signed into law on May 6, 2004, and provide an opportunity for the immediate the rules governing this landmark statute referral of the distressed patient, but also were finalized on January 20th of this year provide truly comprehensive treatment in clearing the way for the certification of the primary care environment. The medical psychologists (MPs) under state patients welcome the seamless continuity law. This represented the culmination of a of their overall health care and appreciate decade of hard work by a small group of the lack of stigma that has been historically extremely dedicated psychologists who associated with behavioral health care. believed in themselves and in their ability Additionally, insurance companies are to effect progressive health care change beginning to realize that services provided through the political process.” Under in this manner are leading to a reduction in President Tanya Schwartz’s leadership, overall healthcare costs. HPA has now established a political action committee (PAC). Hopefully, Hawaii’s “Many primary care psychologists (almost time has finally arrived. all of those in Hawaii) have received addi- tional training in psychopharmacology. ALook To The Past This is particularly valuable as psycholo- One of the rewards of being a former APA gists are often the sole behavioral health President is that from time to time, one gets provider in our rural clinics. Over the last invited to address psychology’s next gen- several years, the primary care providers, eration. This fall, David Baker, Director of with an average of six weeks of mental the Archives of the History of American health training and limited formalized psy- Psychology, invited me to present a public chopharmacologic education, have come to lecture on “Psychologists and Prescription rely on our expertise in this area. It is note- Privileges” at the University of Akron. Not worthy that the CHC medical directors only is the Midwest beautiful at this time of wrote a letter to the state legislature year, I also had the opportunity of meeting endorsing prescriptive authority for psy- with a number of APA President Ron chologists last legislative session. Levant’s new colleagues. Long time friend and colleague Ludy Benjamin has often “This scenario could be repeated in other spoken eloquently of the importance of places. Federally-qualified CHCs can be psychology reflecting upon its past. He is found in every state. Primary care psychol- so correct. David’s report: ogists have clearly demonstrated their pro- ficiency in this venue and it is imperative “The Archives of the History of American that we continue to do so. As more psy- Psychology, located on the campus of the chopharmacology-trained psychologists University of Akron, is the largest archival provide services in the primary care envi- collection of its kind in the world. ronment, it will offer an increasingly con- Established in 1965, the Archives’ mission vincing argument for the value this exper- is to promote research in the history of tise provides to our patients and our com- psychology by collecting, cataloging, and munities alike. Unlike some of our psychi- preserving the historical record of psychol- atric colleagues, we have begun to respond ogy. In the early 1960s, a small group of to the behavioral health care crisis by ‘walk- psychologists, led by John A. Popplestone ing the walk, not simply talking the talk.’” and Marion White McPherson, recognized that materials critical to understanding the To place this legislative accomplishment in development of psychology in America perspective, the HPA quest began back in were being lost because there was no 22 nationwide effort to preserve them. These psychological organizations including concerns led to the founding of the the American Group Psychotherapy Archives of the History of American psy- Association, the Association for Women in chology at the University of Akron. Central Psychology, Psi Chi, Psi Beta, the to its mission is the preservation of person- Association for Humanistic Psychology, al papers, artifacts, and media that tell the the International Council of Psychologists, story of psychology in America. In archival and the Psychonomic Society. State and terms, ‘papers’ refers to one of a kind regional association records that can be (unique) items. Papers can include such found at the Archives include the things as correspondence (both personal Midwestern Psychological Association, the and professional), lecture notes, diaries, Ohio Psychological Association, and the and lab journals. The term ‘American’ is Western Psychological Association. The used to refer to all range of psychologists, test collection includes more than 8,000 artifacts, and objects that bear on the histo- tests and records. There are more than ry of psychology as it is expressed in 15,000 photographs, and 6,000 reels of film American culture and society. Recently including home movies of Freud [which I named a Smithsonian Affiliate, the must say were absolutely fascinating], Archives of the History of American footage of Pavlov’s research institute, and Psychology houses more than 1,000 objects research film from Arnold Gessell and the and artifacts that offer unique insights into Yale Child Study Center. the science and practice of psychology. Instruments from the brass and glass era of “Without question the APA is well repre- the late 19th century share space alongside sented in the holdings of the Archives. such significant objects as the simulated Over the last 38 years, 16 APA Divisions (2, shock generator used by Stanley Milgram 6, 9, 12, 14, 16, 17, 18, 22, 24, 25, 26, 27, 32, in his famous studies of obedience and 33, and 36) have deposited records that are conformity, the flags of the Eagles and maintained at the Archives. Consider that Rattlers of the Robbers Cave experiment by the papers of 12 APA Presidents are housed Muzafir and Carolyn Sherif, and the at Akron (Raymond Dodge, Knight props that supported Professor Phil Dunlap, Harry Hollingworth, Walter Zimbardo’s well-known Stanford prison Miles, John Dashiell, Gardner Murphy, studies. Jack Hilgard, Abraham Maslow, Anne Anastasi, Leona Tyler, Brewster Smith, “From small beginnings in the 1960s, the and Jack Wiggins). Twenty-five recipients Archives in Akron have grown to house of APA’s Awards for Distinguished the largest collection of historical materials Scientific Contributions are found at on psychology in the world. It contains the Akron, as are three winners of the Award personal papers of over 700 psychologists. for Distinguished Contributions to the There are papers of those representing pro- Public Interest, and four awardees of the fessional (David Shakow, Edgar Doll, Leta Distinguished Career Contributions to Hollingworth, Herbert Freudenberger Education and Training. [one of the founders of the Division], Sidney Pressey, Joseph Zubin, Erika “As Director of the Archives, I have a Fromm, Jack Bardon, Robert Waldrop, strong personal commitment to ensuring Marie Crissey, and Morris Viteles), and that the historical record of psychology be experimental (James McConnell, Leo and as complete as it can be. One manifestation Dorothea Hurvich, Kenneth Spence, of this was the convening in 2000 of a Ward Halstead, Mary Ainsworth, Frank national conference at the Archives to Beach, Knight Dunlap, Dorothy honor Robert V. Guthrie, a psychologist Rethlingshafer, and Hans Lukas-Tuber) and historian, and the first psychologist of psychology, to name but a few. Also color to be included in the Archive’s man- included are the records of more than 50 uscript collection. The presence of tradi- 23 tionally underrepresented groups in the University of Akron to allow the Archives historical record is a priority for the to expand its offerings and to create the Archives of the History of American Center for the History of Psychology. This Psychology. Center will include a museum, archive, educational center, library, and facility “The materials in the Archives form a data- space for visiting scholars. Ron Levant, as base that is crucial to understanding our the new Dean for Akron University under past, present and future. The size of the col- whom the Archives is located, is undoubt- lection is now more than 5,000 linear shelf edly entering a most exciting next phase of feet (placed end to end, the collection would his professional career. The extraordinary stretch for a mile) and it grows daily. advances occurring within the technology Scholars and researchers from around the and communications fields (i.e., distance world travel to Akron to work in the collec- learning, virtual realities, etc.) will ulti- tion. Over a period of three decades, the mately allow world-wide audiences to per- results of that work can be seen in the pub- sonally experience psychology’s rich histo- lication of hundreds of books and journal ry. Ludy Benjamin was indeed correct and articles, as well as several conferences, is a true visionary. If one ever wonders exhibits, and displays. The Archives repre- whether the past points the way to the sents the science and practice of psychology future, I would only note that after return- with permanent displays on view at the ing from my Akron visit, I received an Ellis Island Museum (psychological testing) e-mail from David indicating that the and the National Zoo (primate learning). In University’s School of Nursing had agreed 2003, the APA Science Directorate made a to allow counseling psychology graduate gift of the APA Traveling Exhibit to the students to take their nursing psychophar- Archives and it is now on display along macology course during the Spring semes- with more than 100 artifacts at the National ter—a possibility raised during my public Inventors Hall of Fame. lecture. Psychology’s prescriptive authori- ty quest is very nicely on track and defi- “The Archives at Akron represents the nitely maturing. national archives of psychology. It is the national database for psychology in the The Importance of Possessing United States. Its mission is very different That Bigger Picture from the APA Archives, which exists to When one is personally involved in the house the records of the Association and its public policy (i.e., political) process, one constituent members. The Archives of the soon develops an appreciation for the critical History of American Psychology and the importance of conceptualizing one’s per- APA Archives share an excellent working sonal agenda (i.e., issue) within the larger relationship.” societal context that is evolving. From this frame of reference, the prescriptive author- I was especially pleased to learn that ity agenda is all about access, consumer although during my approximately 25 choice, and ensuring the highest possible years of service within the APA governance quality of care. It is about bringing the all there was very little discussion regarding important cultural-psychosocial-economic the importance of “remembering our past” gradient of health care to society’s defini- (and the Archives in particular), that today tion of “quality” care. It has been our expe- the Council of Representatives has rectified rience, however, that our colleagues in psy- this by directing APA to provide some chology are often overly concerned with (albeit limited) financial support to pre- the minute details of what they want in the serve our history. It was impressive to immediate future, rather than stepping learn from David that under his leadership back, reflecting, and looking at the larger in April of this year, Roadway Express context which might be evolving around donated a 70,000 square foot facility to the them. It is as if we do not understand the 24 2006 NOMINATIONS BALLOT

Dear Division 29 Colleague: The best talent in the American Psychological Association belongs to the Division of Psychotherapy (29), and we hope to draw from that pool to serve in the governance structure. It is time for us to put our combined talents to work for the advancement of psychotherapy.

NOMINATE YOURSELF OR SOMEONE YOU KNOW TO RUN FOR OFFICE IN THE DIVISION OF PSYCHOTHERAPY. THE OFFICES OPEN FOR ELECTION IN 2006 ARE: President-elect (1) Member-at-large (2) Treasurer (1) All persons elected will begin their terms on January 2, 2007.

The Division’s eligibility criteria are: 1. Candidates for office must be Members or Fellows of the division. 2. No member many be an incumbent of more than one elective office. 3. A member may only hold the same elective office for two successive terms. 4. Incumbent members of the Board of Directors are eligible to run for some position on the Board only during their last year of service or upon resignation from their existing office prior to accepting the nomination. A letter of resignation must be sent to the President, with a copy to the Nominations and Elections Chair.

Simply return the attached nomination ballot in the mail. The deadline for receipt of all nominations ballots is December 31, 2005. We cannot accept faxed copies. Original signatures must accompany ballot.

EXERCISE YOUR CHOICE NOW! If you would like to discuss your own interest or any recommendations for identifying talent in our division, please feel free to contact Dr. Jean Carter , 5225 Wisconsin Ave., N.W. #513, Washington DC 20015, Ofc: 202– 244-3505, Email: [email protected]

Sincerely,

Leon VandeCreek, Ph.D. Abe Wolf, Ph.D. Jean Carter, Ph.D. President President-elect Chair, Nominations and Elections Committee

NOMINATION BALLOT

President-elect Members-at-large Treasurer

______

______

Indicate your nominees, and mail now! In order for your ballot to be counted, you must put your signature in the upper left hand corner of the reverse side where indicated. 25

Name (Printed) Name

______

Signature ______

FOLD THIS FLAP IN.

Fold Here.

______

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

Fold Here. importance of the media, for example, in Committee with smaller expenditures. We shaping our nation’s priorities. were productive and satisfied. This year, with great sadness, I decided to resign During my APA Presidential year, I came to from two other divisions (thereby saving appreciate how we really are all one large over $100.00). I had been a founding mem- family, with many diverse strengths and ber of one, from which I had been elected interests. Psychology has so much to offer to the Council of Representatives; I had society. And yet, as I was filling out my served as President of the other. I am a APA membership renewal form this year, I Fellow in both. I deeply believe in their began to think that perhaps too many of us mission, but I have come to the conclusion do not understand this simple, yet funda- that APA cannot serve us well, if we collec- mental concept. We all seem to want our tively use our limited resources to splinter own way, rather than working together our focus. Wouldn’t these funds be better and sharing resources. What crystallized utilized if they were instead made avail- this notion was the realization that my able to either the Practice or Education division dues payments had become sig- Directorates? Perhaps I am merely a single nificantly greater than the APA dues. I sim- voice in the wilderness; however, I sincere- ply could no longer justify this expenditure ly believe that the time is rapidly to my wife. When I was President of approaching when we will have to rethink Division 29, our newly elected Treasurer our APA divisional structure. Aloha, Stanley Graham was able to recommend a reduction in the division’s annual dues. We Pat DeLeon, former APA President had a vibrant and visionary Executive

27 DIVISION 29 SOCIAL HOUR AND AWARDS PRESENTATION 2005 APA Annual Convention

Dr. John Norcross, Publications Board Chair Jay Cohn is presented the Matty B. and outgoing Internet Editor Dr. Abe Wolf Canter Education and Training Student Paper Award by President Leon VandeCreek

Dr. John Norcross acknowledges outgoing Publications Board member Dr. Jean Carter

Past and current presidents of Division 29 and Education Directorate Director Dr. Cynthia Belan recognize Dr. John Norcross for his APA Award

28 EDUCATION Psychotherapy for Poorly Performing Trainees: Are There Limits to Confidentiality? By Linda Forrest, Ph.D, University of Oregon and Nancy S. Elman, Ph.D., University of Pittsburgh

Note: Correspondence concerning this treating psychotherapists’ relationship to article should be addressed to Linda training programs. For the great majority of Forrest, Counseling Psychology Program, trainees who seek psychotherapy as part of College of Education, University of training, there is no need for faculty or pro- Oregon, Eugene, OR 97405. Email: for- gram intrusion into confidentiality of psy- [email protected]. chotherapy. Yet, in those exceptional cases in which serious personal difficulties and During annual trainee evaluations by faculty, problematic functioning interfere with the student A’s practicum supervisor raised concerns trainee’s capacity to attain appropriate com- about her developing clinical skills, citing an petence, the role of personal therapy as inability to engage clients at deeper levels, and to remediation intersects with a training pro- hold clients across sessions. Other faculty men- gram’s ethical and legal responsibilities to tioned A’s interpersonal skills, noting a hesitancy graduate competent professionals. In these to engage in more complex or challenging issues cases, the nature of confidentiality in a with peers during classroom discussions. The trainee’s psychotherapy and treating thera- student’s advisor agreed to talk with the student pist’s relationship with training programs about the benefits of personal therapy that might requires further examination. In these more help her understand herself and her hesitancies. serious cases, we suggest that maintaining The faculty was hopeful that A would address confidentiality in all aspects of the psy- these issues without a formal remediation. chotherapy is not an “all or nothing” deci- sion, but a more nuanced decision that pro- During the same faculty review, faculty tects trainees’ privacy, yet creates options reviewed student B’s efforts to address serious for the training programs and treating psy- concerns identified during her previous annual chotherapist to determine whether the psy- evaluation. The supervisor’s report included chological issues that affect professional continued concerns about client welfare due to competence are being adequately B’s hostility and anger, an unabated defensive addressed. Confidentiality need not be an and argumentative style, and continued ratio- inviolate and unquestioned assumption. nalizations for her behavior. Faculty wondered Challenges to our traditional beliefs about whether she had been attending and making confidentiality need careful thought and progress in the personal psychotherapy recom- much dialogue among training programs, mended during the previous review. Some facul- trainees, and treating therapists, so that a ty wished they had required the therapy, but balance is attained between the student’s were concerned that both B and her therapist right to privacy and due process and the might perceive this as intrusive to the therapeu- program’s need for accountability to the tic relationship. Faculty members were frustrat- profession and the public. ed and there were differences of opinion, espe- cially about the personal therapy. Background Amajority of psychologists report having In this article, we want to focus on (a) the received personal psychotherapy at some role of psychotherapists who treat psychol- time, many during graduate training, sug- ogy trainees, particularly those who are per- gesting that a great many psychologists in forming poorly during training, and (b) practice are providing treatment to trainees 29 or other professionals (Geller, Norcross & appropriate collaborations will assist us in Orlinsky, 2005; Guy, Stark, & Poelstra, accomplishing the goals of (a) providing 1988; Pope & Tabachnick, 1994). For the psychotherapy for trainees who are strug- most part psychologists report that psy- gling, and (b) meeting programs’ ethical chotherapy has been important for their and legal responsibilities to maintain qual- growth and development as professionals. ity assurance in the services provided by They comment that the experience of being trainees and program graduates. To do so “on the other side” of the role for which we believe, requires faculty, treating psy- they are training, and the ability to reduce chotherapists, and trainees to rethink the distress and manage personal problems boundaries of confidentiality in trainees’ make psychotherapy a beneficial experi- personal psychotherapy when professional ence (Wise, Lowery, & Silverglade, 1989). competence is threatened. The empirical literature on whether psy- chotherapy affects later outcomes as a psy- Although not a new problem, there has chologist is inconclusive (Clark, 1986; been an increased number of publications Greenberg & Staller, 1981; Macaskill, 1988; in the last 10 years focused on the topic of Macran, Stiles, & Smith, 1999), possibly inadequate, diminished or unethical pro- because there has been no effort to distin- fessional functioning by trainees (Elman, guish between (a) those who seek therapy Forrest, Vacha-Haase, & Gizara, 1999; for professional development and personal Elman & Forrest, 2004; Forrest, Elman, growth, and (b) those who seek therapy Gizara, & Vacha-Haase, 1999; Gaubetz & because serious psychological problems Vera, 2002; Gizara & Forrest, 2004, Huprich interfere with the capacity to become com- & Rudd, 2004; Oliver, Bernstein, Anderson, petent psychologists. Blashfield, & Roberts, 2004; Rosenberg, Getzelman, Arcinue, & Oren, in press; The challenges to behave ethically with Vacha-Haase, Davenport & Kerewsky, regard to trainee and psychologist compe- 2004). Similarly, several national training tence, combined with the high use of per- and professional organizations have sonal psychotherapy in the training of psy- focused on this topic with invited address- chologists and the lack of clarity about its es at their annual meetings (Elman, 2001a, role, particularly with trainees who have 2001b; Forrest, 1998, 2001, 2005; Kaslow, psychological problems, has fostered our Mitnick, & Baker, 2002; Thorn, Rudd, & interest in writing about the role of treating Bernstein, 2003). The 2002 National psychotherapists and their relationships to Competencies Conference on Future training programs. As the two case exam- Directions in Education and Credentialing ples above indicate, the range of motiva- in Professional Psychology (Kaslow et al., tions and psychological problems that 2004) focused on issues of identifying, bring trainees to psychotherapy have training, and assessing core competencies implications for the trainee/client, the in psychology. Many of the work groups therapeutic intervention, and the trainee’s on core competencies mentioned the progress in the program. The second case importance of determining minimum suggests great challenges for all parties acceptable levels of professional compe- involved. tence. Also, the Council of Chairs of Training Councils (CCTC) established a We will argue herein that we need a dia- Student Competence Taskforce. This 17 logue among treating psychotherapists member Taskforce representing the various and training programs that identifies sys- training councils developed a model policy temic gaps in our current practices and cre- statement that describes the comprehen- ates the framework for possible new and sive evaluation of student-trainee compe- ethical models of collaboration among tence in professional psychology training trainees, treating therapists, and training programs. Based on recommendations programs. A fuller understanding of made in the national presentations and 30 publications cited above, this document personal information may be required attempts to disclose and make evaluation (Section 7.04) and personal psychotherapy expectations explicit for trainees prior to may be mandated (Section 7.05) (these two entry and at the outset of their education sections are not found in earlier versions of and training. The model policy also makes the Code of Ethics). Faculty may now explicit training programs commitment to require disclosure of personal information not advancing, recommending or graduat- and personal psychotherapy if appropri- ing students or trainees with demonstrable ate, so long as due process concerning problems that interfere with professional issues of privacy and confidentiality are competence (Student Competence addressed in advance. Similarly, the recog- Taskforce of CCTC, 2004). This model poli- nition of the importance of students’ due cy has been approved by CCTC and the process rights is well articulated in the majority of the training councils. On the Guidelines and Principles of the practice side, the Advisory Committee on Committee on Accreditation (APA, 2002b). Colleague Assistance (ACCA) of APA’s Two threads run through the current writ- Board of Professional Affairs (BPA) has ings on psychologist and trainee impair- been working for several years to increase ment and incompetence: (a) a systemic the capacity of state and territorial psycho- rather than an individual focus and (b) ter- logical associations (SPTAs) and licensing minology and definitional problems. boards, via the Association of State and Provincial Psychology Boards (ASPPB), to Toward a Systemic Focus address more effectively issues of impair- Historically, we have treated the trainee or ment or incompetence by creating collabo- psychologist as though problematic behav- rations and developing models for inter- ior or impairment existed in isolation – as vention from self-care and early identifica- an individual intrapsychic problem. It has tion, to remediation interventions that both become clear, however, that the problem is assist the psychologist and protect the pub- a systemic one. The individual psycholo- lic (ACCA, 2005; Allen & Elman, 2004a, gist or trainee is influenced by and influ- 2004b; Johnson & Campbell, 2002; Johnson, ences peers (fellow students or profession- Porter, Campbell, & Kupko, in press; als), faculty and supervisors, administra- Forrest, 2005; Yarrow, 2004). Other profes- tors, professional associations, and regula- sions (notably medicine and law) have tory boards (Elman et al., 1999; Schoener, long held that when professional compe- 1999; Vasquez, 1999). A systemic focus also tence is in question, authorizing the release encourages a deeper understanding of of reports on attendance and progress in how individual, group, and institutional psychotherapy is expected, tracked and diversity issues intersect with professional utilized in decision-making by licensing competence evaluations (see Forrest et al., boards or professional associations. 1999 and Vasquez, 1999)

The Code of Ethics of APA (2002a) man- Our research and anecdotal reports of oth- dates practicing within our competence ers suggest that a more developmental and (Section 2.03) and addressing issues with organizationally seamless approach to other professionals who do not appear to problems of incompetent functioning will be meeting this standard (Sections 1.04 and improve identification, assessment and 1.05), a standard some research suggests is intervention. Such an approach will not often met (Bernard & Jara, 1986; encourage a developmental focus over the Bernard, Murphy, & Little, 1987; Wilkins, life course of the therapist from novice McGuire, Abbott, & Blau, 1990). trainee to career-long practitioner as well Specifically relevant to graduate trainees as across organizational systems from are two new sections in the Standard on training programs to internship through Education and Training that specify condi- licensing boards and SPTAs, organizations tions under which student disclosure of that effect and regulate practice. 31 Terminology and Definitions personal psychological problems (Huprich There is a lack of clarity about the definition & Rudd, 2004; Procidano et al., 1995; of impairment that contributes to the difficul- Vacha-Haase, 1995), which probably direct- ty in adequately addressing problems in ly relates to why personal psychotherapy is professional functioning. The use of the the most common form of intervention. term impairment is problematic in several Yet, little is known about how faculty make ways. First, it is often used to describe decisions to use personal psychotherapy as diminished professional functioning, which part of a remediation plan. In fact, the lim- implies a previously attained level of com- ited empirical or conceptual writing on the petence, despite the fact that in training sit- topic of personal psychotherapy as remedi- uations, competence may never have been ation leaves training programs without acquired. Second, the term is a global one guidance about: (a) the types of profession- and may refer to any number of specific al behavior or performance problems that challenges (for example, impairment does personal therapy can address successfully; not differentiate among lack of knowledge (b) the appropriate balance between or experience, personal characteristics, or trainee confidentiality in personal therapy professional functioning). Third, impair- and the training program’s accountability ment as currently used does not differenti- for graduating competent professionals; (c) ate between causes and the behavior itself the type and quality of disclosures (e.g., (e.g., alcohol abuse). Fourth, and perhaps about what, level of detail, by whom, to the most serious challenge to use of the term whom, with whose consent) about person- impairment is that the same term is used in al therapy to the training program; and (d) the Americans with Disabilities Act (ADA, the roles, responsibilities, and expertise of 1990). The ADA uses the term impairment the treating therapist. interchangeably with the term disability and requires educational and employment Training Directors’ Views of accommodations for individuals with dis- Psychotherapy as Remediation abilities so that they can perform the essen- To address this lack of knowledge, we con- tial functions of the job. ADA language, ducted exploratory interviews with 14 grad- alone, makes it essential that we find anoth- uate program training directors (TDs) about er term to describe the circumstances under how faculty handle the complex dilemmas which programs identify, assess and place associated with recommending or requiring trainees on remediation. Thus, in the personal therapy for trainees whose person- reminder of this article we avoid using the al problems interfere with their ability to term impairment. function at an acceptable level of profes- sional performance (Elman & Forrest, 2004). Psychotherapy as Remediation We used semi-structured interviews to gath- When psychology training programs er information about the issues identified in decide to intervene with a student due to the previous paragraph. problem behaviors or performance, the most common recommendation is person- The interview data revealed that faculty al psychotherapy, whether as part of a gen- struggle to find a balance among the tle suggestion, a recommendation, or a for- trainee’s need for privacy, the profession’s mal remediation plan. At least six studies long standing commitment to confidential- (Burgess, 1994; Huprich & Rudd, 2004; ity as an important aspect of the success of Kaczmarek & Connor, 1998; Olkin & personal therapy, and the training pro- Gaughen, 1991; Procidano, Busch- gram’s responsibility to assure the quality Rossnagel, Reznikoff, & Geisinger, 1995; of the psychological services provided by Vacha-Haase, 1995) confirm that personal its trainees and graduates. Thirteen of the therapy is the most common remediation 14 TDs described an implicit “hands-off” strategy. The majority of remediations are approach to the trainee’s therapy, recom- established to address personal and inter- mending, but not requiring therapy. 32 “Hands-Off” Approach Active Involvement Approach When reporting psychotherapy as being Five TDs described seven cases that includ- recommended rather than required, due to ed more active involvement by faculty concerns about trainee’s confidentiality, with the treating therapist; four TDs TDs described both low-risk and develop- reported a decision to shift to more active mentally focused cases as well as high-risk, involvement in the trainee’s psychothera- serious concerns (e.g., personality disor- py because the trainee’s behavior did not ders, substance abuse) that resulted in seri- improve or became progressively more ous interference with professional func- problematic. These TDs differentiated tioning and clear concerns about client between low-risk cases in which therapy safety. Several TDs described ambivalence could be recommended for developmental about requiring therapy and cited concerns and professional growth and high-risk about the power differential between stu- cases that required more active involve- dents and faculty and the risk of coercion, ment and decision making by the faculty. which might undermine the therapeutic These TDs also articulated greater concern relationship and ultimately the psy- about client welfare as well as protection of chotherapy outcomes. the profession, and wanted greater treating psychotherapist involvement including The TDs describing hands-off approaches updates on attendance and progress. had no information about whether or not the trainee was attending therapy, the Of these five TDs, one TD from the onset of identity of the treating therapist, or infor- developing a remediation plan described mation about the therapist’s qualifications active program involvement with treating and expertise, unless the trainee volun- psychotherapists. This program required teered that information. Yet, TDs described (a) the trainee to select a therapist from a a belief that treating therapists needed to program-approved list of psychologists, have special expertise to address the (b) meeting with the treating therapist and unique issues that arise when treating trainee to establish goals of therapy specif- trainees (see Kaslow & Friedman, 1984) ic to the professional functioning concerns and some TDs were concerned about treat- identified by faculty, and (c) establishing ing therapists’ expertise, especially for up-front an agreement with trainee and trainees with more serious problems that treating therapist that both attendance and interfere with professional functioning. progress in therapy would be reported to the training program. This TD spoke Although TDs described desirable charac- directly to the need for information from teristics and qualifications of treating psy- the treating therapist to determine the suc- chotherapists, no programs with hands-off cess of the remediation. This TD also practices initiated a collaboration between described a more balanced approach the psychotherapist and program to assure between trainee confidentiality and pro- that treatment goals were relevant to the gram responsibility for quality assurance trainee’s specific performance problems. in their interactions with trainees and treat- Several kept a referral list of psychologists ing therapists, thus addressing the issue of in the community who were familiar with potential harm to future clients of the the program, perhaps were even graduates trainee and the risk of not being able to of the program, and had previously been attest to competence when knowledge of known to treat program trainees. These the remediation is unavailable. TDs who described “hands-off” practices emphasized the trainee’s privacy and con- Our conclusion after analyzing these inter- fidentiality rather than the program’s views with TDs was that personal therapy responsibilities for accountability and as remediation during training may require quality assurance. a more nuanced and sensitive model of trainee privacy and confidentiality. Such a 33 model would distinguish between informa- Some questions for consideration are: Do tion revealed in therapy that should always current practices of little or no interaction remain private and protected (e.g., dreams, between training programs and treating fears, personal histories) and information therapists increase the likelihood of split- pertinent to trainees’ professional compe- ting on the trainee’s part? Would meetings tence and efforts to ameliorate difficulties among the parties (faculty, trainee, and that interfere with professional performance treating therapist) early in the process of (e.g., boundary problems, excessive anger developing remediation plans, with the or anxiety, substance abuse). We further goal of creating more openness and clarity, concluded that the hands-off approach does work to everyone’s benefit? Might explicit not facilitate communication between train- triangulation among trainee, treating ther- ing programs and treating psychotherapists apists and training programs create clearer nor does it allow faculty, trainees, and treat- expectations about each party’s roles and ing therapists to explore boundaries that responsibilities? Might such arrangements might more adequately addresses both con- create a larger and safer holding environ- cerns for trainees’ privacy and program ment for trainees to address psychological responsibilities for graduating competent issues that interfere with their ability to be professionals. Also hands-off practice does successful in their training program? not provide faculty with opportunities to model professional yet effective boundary Questions we have for treating psychothera- management in complex professional situa- pists include: When treating a client/ tions. In fact from student perspectives, fac- trainee, do you wonder about his/her abili- ulty hands-off approaches may model ty to develop into a competent therapist? Do behavior for trainees that reinforces future you wonder what the program faculty is “hands-off” approaches and this, in turn, doing to address the potential issues of pro- may explain why practicing psychologists fessional competence that you observe often do not apply known ethical mandates based on your therapeutic relationship with when colleagues are believed to be harming the client? Do you sometimes wish there their clients (Bernard & Jara, 1986; Bernard was an ethical way to identify to the pro- et al., 1987). gram your concerns about a trainee/client’s capacity to function as a psychologist? When Encouraging Dialogue between Treating trainee/clients indicate they are struggling Therapists and Training Programs with faculty, do you wonder what part of the Because the above research focused on psy- problem is the client’s, what part is attribut- chology training programs, most of the rec- able to the natural stressful demands of ommendations were directed to academic graduate training, and what part has to do and internship training programs. Yet the with faculty and/or larger programmatic or systemic problems? When a trainee/client lessons learned seem equally important to describes a remediation plan, do you ask to treating psychotherapists. Recognizing that see the plan? Might it be helpful to have con- many members of Division 29 in all likeli- tact with training programs when you are hood are treating clients who are currently seeing a trainee/client who is on a remedia- trainees in psychology graduate programs, tion plan? When you see practicing thera- we want to take this opportunity to open a pists and trainees in your caseload, have you dialogue. Conversations with treating thera- developed special skills for understanding pists would be helpful in examining current how to work more effectively with them? Do practices, their strengths and limitations, as you think that there is special expertise or well as new and innovative possibilities for additional responsibilities you hold when addressing the ethical conundrums that rest treating trainees or practicing psychologists? at the intersection of trainees in personal If you have treated practicing psychologists therapy remediations, their psychothera- or other professionals mandated to treat- pists and training programs. ment by a licensing board, what from this 34 experience is pertinent to treating addressing confidentiality issues and trainee/clients? Has your interaction with appropriate roles and responsibilities for licensing boards helped you think through trainees, treating therapists and training how you interact with training programs programs in instances when psychothera- when seeing trainee/clients on remediation py is used as a remediation strategy. plans? Might you be able to provide training programs with some guidance based on Conclusions your experience? In conclusion, research on psychology trainees with problems of professional We hope that these questions pique your functioning has moved beyond a focus on interest in further communications with the individual trainee or professional trainee/clients who are on remediation towards larger systemic perspectives plans, graduate training program faculty (ACCA, 2005; Elman et al., 1999). New in your area, and other treating psy- models for psychotherapy as remediation chotherapists about the ethical dilemmas need to be developed that better balance at the nexus of these questions. We believe the trainee’s need for privacy with the pro- meetings among program faculty and gram and the profession’s need for treating psychotherapists to discuss these accountability. Challenges to confidentiali- ethical dilemmas will be productive in ty deserve more careful scrutiny suggest- identifying what is and is not currently ing action toward (a) building intercon- working from different perspectives. necting relationships between practicing Recent surveys of students in training pro- psychotherapists and training programs, grams suggest that students are deeply (b) further examining the systemic nature concerned about peers who are not per- and impact of our interactions on each forming competently (Mearns & Allen, other, and (c) opening up the possibility of 1995; Oliver et al., 2004; Rosenberg et al., in more integrated and effective systems of press; Swann, 2003); their perspectives communication. We welcome comments might further our understanding of the from readers of Psychotherapy Bulletin as we systemic interactions surrounding psy- continue research on these questions. chotherapy as remediation. References More forthright descriptions of the dilem- Advisory Committee on Colleague mas from different perspectives may pro- Assistance (2005). Advancing colleague vide (a) a larger understanding of each assistance in professional psychology. party’s experiences, (b) help develop a [Monograph]. Washington, DC: more refined consideration of confidential- American Psychological Association. ity that honors the profession’s commit- Allen, M., & Elman, N. (2004a). Promoting ment to quality assurance standards, and wellness within the profession of psychology. (c) create an opportunity to develop new Invited presentation at the annual meet- standards for communication among pro- ing of the Association of State and gram faculty, trainees and their treating Provincial Psychology Boards, psychotherapists when trainee/client Allen, M.F., & Elman, N.S. (2004b). Fitness problem severity warrants it. The treating to practice: International perspectives on psychotherapists and faculty are in rela- impaired psychologists. Invited presenta- tionships with respect to trainee/clients tion at the Third International Congress that have been described as a “black hole.” on Licensure, Certification, and Open dialogue and testing out new strate- Credentialing of Psychologists, gies might create a more tenable position Montreal, Canada. for all parties and provide opportunities to Americans with Disabilities Act of 1990, 42 develop and study different models of U.S.C.A. 12101 (West 199_) intervention. Ultimately, psychology as a American Psychological Association. profession could create guidelines for (2002a). Ethical principles of psycholo- 35 gists and code of conduct. American sented at the annual meeting of the Psychologist, 57, 1060-1073. Association of Directors of Psychology American Psychological Association. Training Clinics, Dallas, TX. (2002b). Guidelines and principles for Forrest, L. (2005). Addressing competency accreditation of programs in professional problems during professional training. psychology. Washington, DC: Author. Invited address at the annual meeting of Bernard, J.L., & Jara, C.S. (1986). The failure the Association of State and Provincial of clinical psychology graduate students Psychology Boards. Portland, OR. to apply understood ethical principles. Forrest, L., Elman, N., Gizara, S., & Vacha Professional Psychology: Research and Haase, T. (1999). Trainee impairment: A Practice, 17, 313-315. review of identification, remediation, Bernard, J.L., Murphy, M., & Little, M. dismissal, and legal issues. The (1987). The failure of clinical psycholo- Counseling Psychologist, 27, 627-686. gists to apply understood ethical princi- Geller, J.D., Norcross, J.C., & Orlinsky, D.E. ples. Professional Psychology: Research and (Eds.). (2005). The Psychotherapist’s Own Practice, 18, 489-491. Psychotherapy: Patient and Clinician Burgess, S. L. (1994). The impaired clinical Perspectives. New York: Oxford. and counseling psychology doctoral student. Gizara, S.S., & Forrest, L. (2004). Unpublished doctoral dissertation, Supervisors’ experience of trainee California School of Professional impairment and incompetence at APA- Psychology, Berkley/Alameda, CA Elman, accredited internship sites. Professional N. (2001a). Dealing with problem students. Psychology:Research and Practice, 35, 123- Presented at the midwinter meeting of 130. the National Council of Schools of Guy, J., Stark, M., & Poelstra, P. (1988). Professional Psychology, Freeport, Personal therapy for psychotherapists Grand Bahamas. before and after entering professional Elman, N. (2001b). Communication between practice. Professional Psychology: Research graduate programs and internship programs and Practice, 19, 474-476. about problematic trainees: Honesty versus Huprich, S.K., & Rudd, M.D. (2003). A politics. Presented at the Association of national survey of trainee impairment in Psychology Postdoctoral and Internship clinical, counseling, and school psychol- Centers Membership Meeting and ogy doctoral programs. Journal of Clinical Conference, New Orleans, LA. Psychology, 60, 43-52. Elman, N., & Forrest. L. (2004). Johnson, W.B., & Campbell, C.D. (2002). Psychotherapy in the remediation of psy- Character and fitness requirements for chologytrainees: Exploratory interviews professional psychologists: Are there with training directors. Professional any? Professional Psychology: Research and Psychology: Research and Practice, 35, 123- Practice, 33, 46-53. 130. Johnson, W.B., Porter, K., Campbell, C.D., Elman, N., Forrest, L., Vacha-Haase, T., & & Kupko, E.N. (in press). Character and Gizara, S. (1999). A systemic perspective fitness requirements for professional on trainee impairment: Continuing the psychologists: An examination of state dialogue. The Counseling Psychologist, 27, licensing board applications. 712-721. Kaslow, N.J., Borden, K.A., Collins, F.L., Forrest, L. (1998). Personal psychotherapy Forrest, L., Illfelder-Kaye, J., et al. (Eds.). as remediation. In N. Elman (Chair), (2004). Competencies Conference: Future Traineeimpairment. Symposium presented Directions in Education and at the annual meeting of the Council Credentialing in Professional ofCounseling Psychology Training Psychology [Special issue]. Journal of Programs, Scottsdale, AZ. ClinicalPsychology, 60(7). Forrest, L. (2001). Trainees in trouble: Clinic Kaslow, N., & Friedman, D. (1984). The directors’ dilemmas. Invited address pre- interface of personal treatment and clini- 36 cal training for psychotherapist trainees. psychology programs. Professional In F. W. Kaslow (Ed.), Psychotherapy with Psychology: Research and Practice. psychotherapists (pp. 33-57). New York: Schoener, G. (1999). Practicing what we Haworth Press. preach. The Counseling Psychologist, 27, Kaslow, N., Mitnick, M.K., & Baker, J. 693-701. (2002). Difficult interns and postdoctoral Student Competence Taskforce of the residents: Identification, assessment and Council of Chairs of Training Councils intervention. Presented as a preconven- (2004). The comprehensive evaluations tion workshop at the annual meeting of of student-trainee competence in profes- the Association of Psychology sional psychology programs. Retrieved Postdoctoral and Internship Centers. November 9, 2005, from Kaczmarek, M., & Connor, C. (1998). A sur- http://appic.org/downloads/CCTC_C vey of doctoral programs: Remediation. omprehensive_Ev82AA3.doc In N. Elman (Chair), Trainee impairment. Swann, C. (2003). Students’ perceptions of Symposium presented at the annual due process policies, procedures and meeting of the Council of Counseling trainee problematic functioning. Psychology Training Programs, Unpublished doctoral dissertation, Scottsdale, AZ. University of Pittsburgh, Pittsburgh, PA. Mearns, J., & Allen, G. J. (1991). Graduate Thorn, B.E., Rudd, M.D., & Bernstein, J. students’ experiences in dealing with (2003). Panel on impaired trainees. impaired peers, compared with faculty Presented at the annual meeting of the predictions: An exploratory study. Ethics Council of University Directors of and Behavior, 1, 191-202. Clinical Psychology. Olkin, R., & Gaughen, S. (1991). Evaluation Wilkins, M.A., McGuire, J.M., Abbott, and dismissal of students in master’s D.W., & Blau, B. I. (1990) Willingness to level clinical programs: Legal parameters apply understood ethicalprinciples. and survey results. Counselor Education Journal of Clinical Psychology, 46, 539-547. and Supervision, 28, 276-288. Vacha-Haase, T. (1995). Impaired graduate Oliver, M.N., Bernstein, J.H., Anderson, students in APA-accredited clinical, counsel- K.G., Blashfield, R.K., & Roberts, M.C. ing, and school psychology programs. (2004). An exploratory examination of Unpublished doctoral dissertation, Texas student attitudes toward “Impaired” A& M University, College Station, TX. peers in clinical psychology training pro- Vacha-Haase, T., Davenport, D.S., grams. Professional Psychology: Research &Kerewsky, S D. (2004). Problematic stu- and Practice, 35, 141-147. dents: Gatekeeping practices of academ- Pope, K.S., & Tabachnick, B.G. (1994). ic professional psychology programs. Therapists as patients: A national survey Professional Psychology: Research and of psychologists’ experiences, problems, Practice, 35, 115-122. and beliefs. Professional Psychology: Vasquez, M.T. (1999). Trainee impairment: Research and Practice, 25, 247-258. Aresponse from a feminist/multicultur- Procidano, M.E., Busch-Rossnagel, N.A., al retired trainer. The Counseling Reznikoff, M., & Geisinger, K.F. (1995). Psychologist, 27, 687-692. Responding to graduate students’ pro- Yarrow, C. (2004). Fitness to practice: fessional deficiencies: A national survey. Canadian perspectives. Invited presenta- Journal of Clinical Psychology, 53, 426-433. tion at the Third International Congress Rosenberg, J.I., Getzelman, M.A., Arcinue, F., on Licensure, Certification, and & Oren, C.Z. (in press). An exploratory Credentialing of Psychologists, look at students’ experiences of problem- Montreal, Canada. atic peers in academic professional

37 DIVISION 29 AWARDS AND RECOGNITIONS

Dr. Marvin Goldfried, Ph.D., ABPP 2005 Rosalee G. Weiss Award for Outstanding Leaders in Psychology

Dr. Marvin Goldfried received recognition from the Division 29 past president, Linda Campbell, for his outstanding contribution to the advancement of psychology.

Dr. Goldfried is also a past recipient of the APA Distinguished Psychologist Award for Contributions to Knowledge and the Distinguished Psychologist Award from the Divisions of Psychotherapy, Clinical Psychology, General Psychology, and Gay, Lesbian and Bisexual Concerns. He is also past president of the Society for Psychotherapy Research.

38 PRACTICE RESEARCH NETWORKS IN PSYCHOTHERAPY

By Abraham W. Wolf, Ph.D. Departments of Psychology and Psychiatry MetroHealth Medical Center Case Western Reserve University

Presentation at the 112th American Psycho- Congress enacted legislation to make sure logical Association Annual Convention, that the federal investment in research Honolulu, Hawaii, July 31, 2004, Presidential translates into practical application. This Symposium: Psychotherapy Practice and gap between research and practice is called Research—Collaborative Directions and technology transfer and less, frequently, Common Grounds. translational bock.

During the recent practice focus group con- The Cochrane Collection, a clearinghouse ference calls, the theme of bridging the gap of meta-analyses and systematic reviews between researchers and practitioners was for all areas of health care, summarize the raised again and again. How to dissemi- literature on best practices to encourage nate research findings in such a way that implementation of research-based recom- practitioners will implement these find- mendations and to ensure changes in prac- ings? How to get practitioners to partici- tice. These reviews indicate that the pas- pate in collecting data for these studies? sive dissemination of information through Ron Fox, as he always does, reduced the journals was generally ineffective in alter- issue to its basic parts: How are you going ing practices no matter how important the to get practitioners to “buy-in” to research issue or how valid the methods. The use of both as consumers and producers? computerized decision support and, espe- cially, educational outreach visits resulted This is not a problem unique to psy- in practice changes. The drug companies chotherapy. Evidence-based medicine rep- know this; that’s the reason drug reps per- resents a major shift in how all health care sistently knock on physicians’ doors. providers conceptualize the clinical deci- sion making process. One solution to the The practice research network— problems of getting practitioners to “buy- Astrategy for bridging the gap in,” is provider-based research networks, In 1999, Congress enacted legislation or practice research network. The follow- encouraging the Agency for Healthcare ing is a brief discussion of what they are, Research and Quality (AHRQ) to develop why they are important, how they have initiatives that expand our understanding been used both in primary care and mental of translating research to practice, especial- health, and some ideas about how they ly the use of practice research networks in have been and can be implemented in psy- primary care and to address issues of dis- chotherapy research. parities in health care quality, outcomes, cost and access. Dissemination/implementation Gap— technology transfer/translational blocks Practice research networks are groups of This year’s NIH budget is in excess of $25 practicing clinicians who cooperate to col- billion. Nevertheless, the U.S. ranked 72nd lect data and conduct research studies. in the world for disability adjusted life These networks use the practice setting expectancy by World Health Organization. both as a laboratory and as a vehicle to The problem of implementing research implement research findings. Initially findings has become so critical that established in Europe and the United 39 States in the late 1960’s in primary care and by 600 psychiatrists, they found that psy- family practice settings, they vary consid- chiatrists in independent practice with erably in terms of their mission, funding, non-salaried income were more likely to and the types of data they collect. modify treatment decisions for patients under utilization management. When com- The advantage of these networks is that pared to evidence-based treatment recom- they provide systematic, patient-level clin- mendations, these changes seem likely to ical data that document treatment process result in less than optimal care. and outcome across a broad range of prac- tice settings. As a research methodology in American Psychological Association basic clinical services, network generated Our own APA has a practice research data are useful to both clinicians and poli- network. Since 2001, PracticeNet has done cy makers working to ensure that clinical five studies using an Internet based as well as economic issues are considered methodology. Developed by the Practice when making health policy decisions. Directorate with grant support from the Because network members are practicing Center for Substance Abuse Treatment, clinicians who participate directly in the PracticeNet uses real time behavior sam- selection, development, and implementa- pling to capture specific moments of prac- tion of studies, these networks succeed in titioner activity. Participants include facilitating the transfer of research into licensed psychologists as well as APAGS practice. members, interns, and postdocs.

Since 2002, AHRQ provided support to 36 These volunteer samples participated in practice research networks comprised of surveys on reactions to 9/11, on the effects over 10,000 primary care clinicians with of war and terrorism, clinical practice pat- practices in 50 states, serving almost 10 terns and two substance abuse surveys. million primary care patients. Sample sizes varied between 200 and 300. One interesting finding from the practice PRACTICE RESEARCH NETWORKS IN patterns survey was that 24% of patients MENTAL HEALTH with private insurance do not use that ben- efit, presumably because of privacy con- American Psychiatric Association cerns. Slide presentation of survey results In 1993, the American Psychiatric are available at www.apapracticenet.net. Association, formed a network of psychia- trists in clinical practice to study their prac- Hampstead Index tice patterns and patient characteristics. It An example of a practice research network was funded by the ApA as well as the fed- in a training setting comes from a source eral Center for Mental Health Services and not usually associated with evidence-based private sources. Membership in the net- methods—child psychoanalysis. Since work included both a randomly selected the mid-1950’s the Hampstead Child group of practitioners in order to increase Therapy Clinic—the Anna Freud Center— generalizability but also a “volunteer” has collected and organized case material group for more intensive long-term stud- using the Hampstead Index. ies. Data were collected through mailed paper-and-pencil questionnaires. It was developed as follows: Child thera- pists documented daily analytic sessions Since 1993 there have been about 20 publi- that were summarized weekly and every cations from this project. The American two months. In order to retrieve that mate- Journal of Psychiatry recently published a rial for teaching and research purposes, an study examining the relationship between index of reference terms was constructed. utilization management techniques and The goal was to provide a comprehensive psychiatrists’ modification of treatment system of classification for clinical material. plans. In a sample of 1,800 patients treated Trainees would consult with supervisors to 40 breakdown their notes for indexing. Data embedded in this therapy process study were organized as general case material, that involves random assignment of consecutive is, demographic data, and psychoanalytic patients to conditions in which they do or material. The result of indexing a case was a do not complete the ratings and content set of typed cards each containing a “unit of forms after each session in an effort to test observation” and a set of cross-references whether explicit focus on significant session using the indexing system. Examples of events and feedback from the patient to the index terms are object relations, defenses, therapist about such events impact on ther- superego, transference, and so forth. Joseph apist behavior and on ultimate patient out- Sandler’s work on the representational come. 100 patients from 18 therapists were world and work by Peter Fonagy utilize this followed for 18 months. The group hopes to data base to assess outcome. present their findings this year.

The Pennsylvania Psychological National Training Clinics Practice Association PRN Research Network In 1994 the Pennsylvania Psychological The dream of the founders of the Association formed a task force for empiri- Pennsylvania network is the creation of cal documentation of psychotherapy effec- collaborative practice research networks in tiveness through increased collaboration all graduate training program clinics and between researchers and practitioners. The internships. They hope that cohorts of new goal was to create a practice research net- Ph.D.’s raised in such a system enter the work—a functional integration of practi- work force where they recreate the collabo- tioner and scientist roles. With funding rative networks in which they were from the APA Practice Directorate and the trained. This will lead to the creation of a Pennsylvania Psychological Association, National Practice Research Network where committees were formed to create a Core large numbers of practicing clinicians and Battery assessment tool and to investigate clinical scientists can do rigorous research ethical issues involved in such a network. in a naturalistic setting. The clinical psy- chology program at the Penn State has Phase I of the project started in 1996. 205 already begun efforts to establish such a volunteers responded to a call for partici- research infrastructure. pants and of these, 77 returned therapist variable forms; 57 of those therapists APROPOSAL obtained initial assessments on 220 patients. Data on 75 of these patients were Louis Castonguay, an organizer of the available at mid-assessment (7-8 weeks) Pennsylvania network recently wrote, and these indicated significant improve- “It became clear to me that simply asking ment on all symptom measures and global clinicians to provide data within the indices. The termination data on 42 context of an already developed research patients indicated significant decreases in protocol would preclude the establishment problems in all functioning areas. These of a long and productive relationship. This were some interesting findings, such as a amounts to what I now call ‘empirical less improvement on some patient out- imperialism’.” The data from the American come measures among therapists with Psychiatric Association, the American heavier caseloads. Psychological Association, and Pennsyl- vania all point to the same problem: In Phase II , practicing clinicians in Central recruitment and retention of participants in Pennsylvania are collaborating with clini- a practice research network. There are 6000 cal scientists to investigate, on a session- licensed psychologists in Pennsylvania; by-session basis, the most significant less than 5% responded to the call for par- events that occur in therapy from both the ticipation in the network. Of these, only therapist’s and the patient’s perspective. 38% submitted therapist variable forms, An additional experimental manipulation 20% obtained initial assessments, and 9% 41 submitted termination assessments. of visits and cancellations could be retrieved. Additional components could Some of the major lessons learned from the include structured initial assessments that Pennsylvania project are that clinicians include basic demographic information need an incentive to participate in these and clinical parameters. The pay-off for the networks. Not just continuing education practitioner is the creation of an intake credit but 1) reimbursement for time, 2) note; the payoff for the network is a patient minimal time needed for the project, 3) profile. This part is not fantasy. Vendors at clinically useful material for patients, and, this conference already offer this program - 4) practitioners having an equal voice in most with billing software. determining research questions. Such a computer program can be integrated This gets back to Ron Fox’s question? with a curriculum of continuing education “How do we get practitioners to ‘buy-in’ to courses that can be completed online. In such a project?” order to participate in specific studies, practitioners would be required to complete I think that computer technology may help such courses. They don’t have to— they here. Increasingly, major medical centers just won’t participate in that study on and individuals are relying on computer- process and outcome. Courses could be ized medical records. A collection of practi- offered on how to do a detailed case study, tioners sharing the same computer pro- an area of research with a long history that gram to store and retrieve patient informa- is again becoming popular. Completing the tion is a network. A collection of practition- course would allow one to use specific pro- ers sharing the same computer program grams for completing the study. and who use the same assessment battery and outcome measures is a practice Many, perhaps most, psychotherapy research network. researchers and most practitioners are increasingly disillusioned with a model of What I envision is a computer program clinical research and practice that idealizes that can be utilized to store patient infor- the randomized clinical trial. That does not mation at different levels. At its most basic, make us real scientists or real doctors. What this program can be used for scheduling. does, is taking a hard look at what we in fact At this level, information about frequency do and what is best for our patients.

42 DIVISION 29 SOCIAL HOUR AND AWARDS RECEPTION

Dr. Leon VandeCreek acknowledging outgoing Past President Dr. Pat Bricklin

Drs. Gerry Koocher and Linda Campbell welcome Dr. Tom DeMaio, APA Board students Alicia Jackson, James Lee and Tanette of Directors Robinson

43 CALL FOR AWARD NOMINATIONS

The APA Division of Psychotherapy invites nominations for its two annual awards in 2006

The Distinguished Psychologist Award recognizes lifetime contributions to psychotherapy, psychology, and the Division of Psychotherapy.

The Jack D. Krasner Memorial Award recognizes promising contributions to psychotherapy, psychology, and the Division of Psychotherapy by a Division 29 member with 10 or fewer years of post-doctoral experience.

Letters of nomination outlining the nominee’s credentials and contributions should be forwarded to the Division 29 2006 Awards Chair: Leon VandeCreek, School of Professional Psychology, Wright State University, 117 Health Sciences Bldg., Dayton, OH 45435, Ofc: 937-775-4334; Fax: 937-775-4323; E-Mail: [email protected].

The applicant’s CV would also be helpful. Self-nominations are welcomed. DEADLINE IS JANUARY 1, 2006

44 GLOBAL REALITIES: INTERSECTIONS & TRANSITIONS February 2, 2006

Through his “focus on family” platform, APA President-Elect Dr. Gerry Koocher plans to spotlight three areas that span all of psychology’s constituencies, one of which is: Diversity in Psychology: “Our society is becoming diverse in ways that couldn’t have been imagined 20 years ago,” says Koocher, noting that not only are minority populations growing, but so are transracial marriages and international adoptions. “Psychology has the potential to help to move America in greater acceptance of multiculturalism.”

Registration: available beginning 9/1/05 at www.Reisman-White.com Earlybird Rate: $135 (before 12/15/05) Regular and On-Site Rate: $150 (on or after 12/15/05)

Confirmed Plenary Speakers: Dr. Mary Pipher: Clinical psychologist and an adjunct clinical professor at the University of Nebraska; NY Times bestselling author of Reviving Ophelia and In the Middle of Everywhere in which she “unites refugees, people who have fled some of the most repres- sive regimes in the world, with all of us...”

Dr. Donald J. Hernandez: Professor in the Department of Sociology at the University at Albany (SUNY); had overall responsibility for the National Research Council report titled From Generation to Generation: The Health and Well-Being of Children in Immigrant Families and Children of Immigrants: Health, Adjustment, and Public Assistance

Dr. Carola Suarez-Orozco: Co-Director of Immigration Studies at NYU and co-author of Children of Immigration and Transformations: Migration, Family Life, and Achievement Motivation Among Latino Adolescents. She is also a co-editor of the award-winning six vol- ume series entitled Interdisciplinary Perspectives on the New Immigration.

Acall for Conference Poster presentationsis forthcoming through participating Divisions (Div 12 Section VI, Divisions 12, 16, 17, 29, 35, 37, 39, 42, 43, 45, 48, 51, 52, 53, 54). Check your newsletters for more information.

Location: St. Anthony- A Wyndham Historic Hotel, 300 East Travis, San Antonio, TX, 78202 (210) 227-4392. Room Rate: $139.00 (single/double) before January 9, 2006

Co-Sponsors: The American Orthopsychiatric Association; SRCD (Society for Research on Child Development); CEMRRAT-2 (Commission on Ethnic Minority Recruitment, Retention and Training), Division 45- Society for the Psychological Study of Ethnic Minority Issues, Division 35 - Society for the Psychology of Women, Texas Psychological Association

Summit Co-Chairs: Toy Caldwell-Colbert, PhD, President of Div 45 and Cynthia de las Fuentes, PhD, President of Div 35

Continuing Education: Society of Counseling Psychology (Division 17) is approved by the American Psychological Association to offer continuing education for psychologists. Society of Counseling Psychology (Division 17) maintains responsibility for the program. 45 46 Bulletin ADVERTISING RATES

Full Page (8.5” x 5.75”)$300 per issueDeadlines for Submission Half Page (4.25” x 5.75”)$200 per issue August 1 for Fall Issue Quarter Page (4.25” x 3”)$100 per issue November 1 for Winter Issue Send your camera ready advertisement, February 1 for Spring Issue along with a check made payable to May 1 for Summer Issue Division 29, to: All APA Divisions and Subsidiaries (Task Division of Psychotherapy (29) Forces, Standing and Ad Hoc Committees, 6557 E. Riverdale Liaison and Representative Roles) materials Mesa, AZ 85215 will be published at no charge as space allows. 47 48