THE NATIONAL Psychologist Vol. 21 No. 2 The Independent Newspaper for Practitioners March/April 2012

behavioral research and non-pharmacologi- Alzheimer’s plan emphasizes biology over behavior cal interventions, but it is still woefully inad- equate in many things such as the area of By Paula E. Hartman-Stein, Ph.D. that is open through March 30. Alzheimer’s Association barely acknowl- neuropsychological assessment, research NAPA established an advisory council edged mental health and non-pharmacologi- beyond biomarkers, the proposed public The most recent draft released Feb. 22 to develop an ambitious national plan with- cal interventions and made no mention of the education campaign addressing risk factors for a massive federal plan to address out waiting for Congress to act, and the most role of psychology in research, practice or and geriatric workforce funding.” Alzheimer’s disease is considered “woefully recent draft of the plan includes five goals diagnosing of Alzheimer’s. According to Michael Friedman, inadequate” in incorporating psychology and for preventing and effectively treating In response, APA CEO Norman B. LMSW, co-founder of the Geriatric Mental behavioral health into prevention and treat- Alzheimer’s by 2025, optimizing the quality Anderson, Ph.D., sent 13 pages of comments Health Alliance of New York, “The revised ment. The national plan stems from the and efficiency of care, expanding support for to HHS. He wrote, “It is surprising that there national plan acknowledges that mental National Alzheimer’s Project Act (NAPA) people with Alzheimer’s as well as their is no mention of the role of psychology in health problems occur in dementia, but the signed into law in January of last year. families, enhancing public awareness and the draft framework. Most notably, neu- authors of the plan don’t seem to understand NAPA makes the secretary of Health tracking progress. ropsychological evaluation, a component of how common anxiety, apathy, moodiness and Human Services (HHS) responsible for According to an HHS press release, the the original and current gold standard for AD and behavioral difficulties are.” He said the the “creation and maintenance of an inte- goals as well as the supporting strategies and diagnosis, is not mentioned.” plan is not specific about what good practice grated national plan to overcome action steps proposed in the plan reflect According to Debbie Digilio, director of is and what people should be trained to do. Alzheimer’s, provide information and coor- input from the Advisory Council on the APA Office on Aging, APA will again In a recent phone interview Peter dination of Alzheimer’s research and accel- Alzheimer’s Research, Care, and Services provide detailed comments on this new Whitehouse, M.D., Ph.D. geriatric neurolo- erate the development of treatments that and almost 100 public comments received draft. She said, “It is encouraging that at gist at Case Western Reserve University in would prevent, halt or reverse the course of on an initial draft released Jan. 9. least psychologists are now listed multiple Alzheimer’s.” The first draft from the National times and that there is a tiny bit more about Continued on Page 3 But the emphasis so far on biological approaches and the short shrift given non- pharmacological interventions has generated Technician ban divides New York psychologists a torrent of criticisms from the mental health By Richard E. Gill, Assistant Editor Accepting the policy would have elimi- use technicians. community, which is seeking wider support nated the way the vast number of neuropsy- Soon after passage of the bill, an official during the current public comment phase Neuropsychologists have split from the chologists practice. This was considered of the New York State Department of New York State Psychological Association totally unacceptable to neuropsychologists, Education issued a statement that firmly Inside this issue (NYSPA) over disagreement on the use of who concluded that NYSPA was out of step denied the use of technicians, said Joanne 10 years of RxP ... Page 5 technicians in their practices. with national practice standards and neu- Festa, Ph.D., president of the New York Staff writer Gill dies ... Page 6 The State Department of Education, ropsychologists could not have their inter- State Association of Neuropsychology APA Council wrap up ... Page 9 which regulates psychology and 47 other ests represented by a group composed of so (NYSAN), which neuropsychologists professions, ruled that no psychologists may many disparate factions that do not under- formed last year independent of NYSPA. Psychology of auto racing ... Page 10 use technicians and when the NYSPA exec- stand the intricacies of neuropsychological Festa said Kathleen M. Doyle, execu- Bullying & cyberbullying ... Page 11 utive board endorsed the ban in December, practice. tive secretary for the education department’s Economics of practice ... Page 13 neuropsychologists walked out. With the mass resignations from Board for Psychology, also wrote an inter- NYSPA, the association’s Neuropsychology pretation that disallowed the use of techni- Division ceased to exist. The division for- cians. “So this is what we have been fighting merly had about 200 members, including all these years. When the scope of practice about 30 student members. bill was put through the people who were “This has been such a contentious and working on it in NYSPA never intended for bloody issue that it has divided our organi- technicians to be banned,” Festa said.

zation,” said Peter Kanaris, Ph.D., member But when the interpretation of the bill Address service requested service Address at large of the NYSPA executive committee. was issued, some divisions of NYSPA “The issue of technicians has been discussed approved of it as a way to protect them-

and argued for about eight years.” selves. “They feared for their jobs,” Festa Gahanna, Ohio 43230 Ohio Gahanna,

Permit # 40 # Permit Following the passage of a state scope said. 620-A Taylor Station Rd. Station Taylor 620-A

Madelia, MN Madelia, of practice bill in 2003, an interpretation by Kanaris admitted that the letter inter- PAID

The National Psychologist National The

U.S. Postage U.S. the state education department led to the preting the use of technicians was unintend- PRSRT STD PRSRT elimination of the ability of psychologists to Continued on Page 3 Page 2 March/April 2012 T H E N A T I O N A L P S Y C H O L O G I S T Page 3 T H E N A T I O N A L P S Y C H O L O G I S T March/April 2012 or treatment focuses on behavioral strate- program, “Maintain Your Brain,” that Therapy slighted in Alzheimer’s plan gies. They are not slam dunk, but in this day emphasized behavioral lifestyle factors for and age, the best we have is behavior.” cognitive health. When asked why, Erin Continued from Page 1 vented through a serum similar to the cure for polio virus.” Hector Gonzalez, Ph.D., an associate Heintz, senior associate director of public Cleveland, Ohio, said, “The national plan is “Whether the etiology of Alzheimer’s is professor at Wayne State University’s relations for the association said, “There is dominated by the old thinking that with tau or amyloid (marker deposits in the brain) Institute of Gerontology in Detroit, Mich., is no definitive way to prevent Alzheimer’s.” enough research Alzheimer’s can be eradi- or a combination, it will still take 10 to 20 a member of the APA Task Force to update cated, tending to make people think a cure is years before anything comes of this develop- the Guidelines for the Evaluation of New funding allocated close. There is no honesty that this is com- ment into biopharmaceutical research. There Dementia and Age-Related Cognitive On Feb. 7 the Obama administration plicated and multifactorial.” are at least 7 million people today with some Decline published in the January issue of announced allocation of $50 million for Whitehouse added that the Cochrane degree of dementia and in 10 to 15 years The American Psychologist. research on Alzheimer’s. The press release Collaboration recently published a 77-page there will be 20 million with dementia. In an email interview, Gonzalez said, from HHS said its 2013 budget will provide review on the positive impact of cognitive Those people need a life worth living. The “Of all the 6,713 studies of risks and protec- an additional $80 million, including an addi- stimulation on cognitive functioning in peo- only way we can do this is to emphasize the tive factors for cognitive decline examined tional $26 million in caregiver support and ple with dementia. role of behavioral science.” in a task force charged by the National provider education. In another phone interview, John Zeisel, Adam Brickman, Ph.D., a neuropsy- Institutes of Health, only cognitive training The priorities of the funding are contro- Ph.D., founder of Hearthstone in New York chologist at Columbia University, also was and behavioral factors were associated with versial. According to Whitehouse, $50 mil- City, voiced a similar perspective. Zeisel reached by phone. “The best interventions sizable risk reduction.” lion is being shuffled from money allocated said, “The emphasis on biology in the that we have to help diminish or slow down for general genetic research with some of it national plan is short-sighted because it the progression are all behavioral, Brickman Plan calls for worldwide coordination likely to fund a trial for intra-nasal insulin. treats dementia as if it could be cured or pre- said. “Everything we know about prevention The national plan announced that in Zeisel said, “Some of the new money May 2012 an Alzheimer’s Research Summit should be going to study meditation and will take place that will include national and other innovative behavioral strategies.” Scope of practice divides NYSPA international experts. Friedman said, “Of the $156 million According to Zeisel, a groundbreaking added to the budget for AD, $130 million is Continued from Page 1 the appropriate use of trained technicians. global effort began in Spain and Portugal in for research; $26 million is for all the other “We have regulations and guidelines September 2011. “At this conference we had goals – such as improved care, training and ed. “I think it affected many psychologists, from the different governing bodies. All the an equal number of non-pharmacological public education. That amounts to $4.81 per neuropsychologists the hardest.” major national organizations of neuropsy- and pharmacological interventions.” “The person with AD. It is still striking how Neuropsychologists lobbied against the chology support the use of technicians and second version of the National Plan unbalanced the priorities really are and how interpretation and tried to get a change in the have published papers on the appropriate use acknowledges that non-pharmacological much apparent indifference there is to law so they could once again use techni- of them.” Festa said. interventions exist, he said. “The problem, I improving care now despite the fact that cians, which they had been doing freely for “It is very idiosyncratic for our state to fear, is that when it comes to major public there’s very little on the horizon by way of decades, Kanaris said. make a determination about this particular events such as an international conference, prevention or cure.” But the effort to try to change the law practice that goes against Medicare and the behavioral health issues will be relegated concerned school psychologists because Medicaid that supports the use of technicians to the children’s table.” Public comments accepted they saw this as a potential opening for tech- and pays for their services,” Festa said. Zeisel said that he along with through March nicians to step into school districts normally “With the support of federal agencies Whitehouse and others debated the use of Public comment on the National Plan populated by psychologists. “I think basical- that governs the billing and coding of all dif- the term non-pharmacological. To character- will be accepted through March 30 and ly what they did was to express a concern ferent kinds of medical procedures, includ- ize a whole other dimension of interventions should be submitted to HHS’ assistant secre- that changing the language of the law would ing psychotherapy and mental health, all Whitehouse created a new term, “ecopsy- tary for planning and evaluation, Helen let technicians do some of the work of psy- these codes are based on reviewing what is chosocial (EPS).” Lamont, Ph.D., at [email protected]. In chologists in schools.” appropriate practice. CMS (the Centers for Nancy Pachana, Ph.D., is a clinical psy- addition to submitting comments, interested The second problem raised was that Medicare and Medicaid Services) supports chologist and neuropsychologist who is an persons can use the email to register to somehow the meaning of the scope of prac- the use of technicians.” associate professor at the University of attend the May summit. tice law would be lost, Kanaris said, that a Many New York psychologists believe Queensland in Brisbane, Australia. She is One of the 12 non-federal members on change in the law would say anybody could the use of technicians will harm their prac- national chair of the Australian the NAPA advisory council is Jennifer do the work of a psychologist. “It was prob- tices and benefit only neuropsychologists. Psychological Society’s Psychology and Manly, Ph.D., associate professor of neu- ably more of something that created fear for “This has been the perception and that is the Aging Interest Group and a member of the ropsychology at Columbia University psychologists in general, particularly clinical basis of the decisions by NYSPA,” Kanaris APA Task Force to update the Guidelines for Medical Center. “I can say that the advisory psychologists,” who joined with school psy- said. the Evaluation of Dementia and Age-Related council is committed to an ongoing process chologists to fight any changes, he said. Festa said, “There is no evidence from Cognitive Decline. that includes public comments and feed- When clinical psychologists joined years prior to 2003 that it ruined school psy- In an email interview Pachana said, “In back,” Manley said. CE school psychologists in support of the ban, chologists’ practice. People are fearful now Australia the federal government has had ------the NYSPA automatically went along. Most and everyone is afraid for their jobs,” Festa several funding rounds targeting dementia, some of which have specified psychosocial Paula E. Hartman-Stein, Ph.D., is a states allow the use of technicians. “New said. She said there is no evidence that clin- research and excluded more basic neurobio- member of the APA Task Force to update the York and New Jersey are the outlaws on this ical practices in other states were ever logical research.” She said the “Mind Your Guidelines for the Evaluation of Dementia position,” Kanaris admitted. harmed by the use of technicians. Mind” program that emphasizes life style and Age-Related Cognitive Decline. She is States that support the use of technicians “They are reacting to their own fears. factors in cognitive health is still going co-editor of the 2011 book, Enhancing developed and promulgated regulations in When people get scared they do things they strong in Australia. Cognitive Fitness in Adults. Her website is: accordance with the literature of psychology, would not normally do. They do irrational Festa said. She added that there are many In 2011 the U.S. National Alzheimer www.centerforhealthyaging.com. things. We need to get ourselves back to Association withdrew its public education professional articles and statements about where we started before 2003,” Festa said. Page 4 March/April 2012 T H E N A T I O N A L P S Y C H O L O G I S T through the titles of “psychologist-master” psychological practice. West Virginia doctoral push and “psychologist-doctorate.” During another break in the council ses- Vermont’s representative to the APA sion, Katherine Nordal, Ph.D., executive has heavy APA support council, William L. Cunningham, Ph.D., said director of the APA Practice Organization By James Bradshaw, Senior Editor expressed that mental health centers would most psychology practitioners in the state are (APAPO), said the APAPO is very supportive have staffing difficulties if the standard is satisfied with that distinction and there is no of the WVPA effort. “West Virginia is the only Washington, D.C. – West Virginia’s rep- adopted, although that is really not a problem. appreciable movement for change, although state where they (masters) are called psychol- resentative to the APA Council of “There’s absolutely no intention to do harm to some interests outside the state would like to ogists with no modifier,” Nordal said. Representatives believes the “almost heaven” any professionals in the state,” Linton said. see the more common doctoral standard She declined to speculate on whether the state will in time adopt the doctoral standard “We’re not trying to do anything radical.” adopted as a matter of uniformity. effort would succeed this year. “The legisla- for psychologists – but maybe not this year. The proposal calls for grand-parenting He said the titles sufficiently distinguish ture is always an unknown,” Nordal said. In an interview during a break at the currently licensed master-trained practitioners doctoral-trained psychologists for the most Dan Abrahamson, Ph.D., who oversees council’s February meeting, John C. Linton, to let them continue to be called “psycholo- part, although he knows of one “renegade” state advocacy programs for the APAPO, said Ph.D., a clinical practitioner in Charleston, gists,” including those now in training who master-trained practitioner who is regularly the WVPA was awarded a $29,000 grant to W.Va., said it’s an election year for many state are completing the required five years of chastised for placing the master designation pursue the doctoral standard. The grant has legislators and they may not be ready to vote supervised practice. first – “master psychologist” – to give the been used in part to hire professional lobbying on an issue that has created a controversy in The bill would create two titles for future impression that he is an exceptional practi- services. the profession. master-trained practitioners: a certified psy- tioner, as in the differentiation of a “master Abrahamson said he also traveled to Still, Linton said, Senate Bill 560 pro- chological associate, who could practice plumber” from a lesser qualified plumber. Charleston, W.Va., to testify before the House posed by the West Virginia Psychological under the supervision of a psychologist, and a Meanwhile, in an email communication, Government Organization Committee. He Association (WVPA) to bring the state in line licensed psychological practitioner, who C. David Blair, Ph.D., WVPA president, said said the Committee for the Advancement for with standards adopted by 49 states (or 48, could practice independently after successful- masters practitioners, who dominate the cur- Professional Practice (CAPP), which sets pol- depending on how Vermont is counted) has ly completing three years of supervised prac- rent West Virginia Board of Examiners of icy for the APAPO, felt “that this was very, made the lawmakers conscious that the tice. Psychologists, are using “the sky is falling” very, very high priority – it’s long overdue.” “West-By-God” state is out of step with The WVPA’s contention that West scare tactics to make legislators believe the He said he pointed out to legislators that national standards. Virginia is the only state still permitting mas- change would reduce psychological services all other states have statutes recognizing the “There’s no way to put the genie back in ter-trained practitioners to call themselves in the state, particularly rural areas, which he importance of doctoral training for psycholo- the bottle,” Linton said, predicting that if the psychologists is disputed somewhat (see said is not true. gists, which is backed up by a half century of standard is not adopted this year it will be Letters to the Editor, Page 16) because of Senate Bill 560 calls for a board made up studies and reports. passed in some upcoming session of the legis- nomenclature used in Vermont where masters of four doctoral psychologists, two masters or “They’re completely out of sync,” lature. may practice independently but are differenti- licensed psychological practitioners and one Abrahamson said. He said much concern has been ated from doctoral-trained psychologists lay member who may be associated with a Page 5 T H E N A T I O N A L P S Y C H O L O G I S T March/April 2012 Within the Indian Health Service, pio- A look back at10 years of RxP neers such as Floyd Jennings, Ph.D., pre- The National scribed with standing orders at the Santa Fe Indian hospital in New Mexico during the An impressive evolution mid-1980s, where quality assurance reviews Psychologist of cases were quite positive. In June 1994, The National Psychologist is published six times By Pat DeLeon, Ph.D. norm. APA President Bob Resnick, Ph.D., attended a year, January, March, May, July, September and The administration is providing the the graduation ceremony for the first two November.. Offices are located at: 620-A Taylor On March 6, 2002, then-Gov. Gary states with sufficient flexibility to craft the Department of Defense psychopharmacolo- Station Rd., Gahanna, Ohio 43230; Tel: 614-861-1999; Johnson signed New Mexico’s HB170 into health care environment which best fits their gy training graduates, Cmdr. John Sexton, Fax: 614-861-1996; Ph.D., and Cmdr. Morgan Sammons, Ph.D. E-mail: [email protected], public law, authorizing appropriately trained unique situations. Within this broader policy www.nationalpsychologist.com psychologists to prescribe. On Jan. 7, 2005, frame of reference, I would suggest that psy- When one studies the literature for vari- This publication is intended to keep psychologists Mario Marquez applied for his “conditional chology’s prescriptive authority quest funda- ous subpopulations, such as the elderly, chil- informed about practice issues. Contributions and let- certification.” In May 2004, Louisiana fol- mentally represents an important evolution dren, ethnic minorities, etc., the picture is ters are invited. The editorial staff reserves the right to lowed suit and medical psychologist John of the field into primary care health psychol- again quite clear: psychologists with pre- edit articles and submissions for clarity and/or length. Bolter wrote his first script on Jan. 20, 2005. ogy. And, I would also suggest that over the scriptive authority provide the highest quali- Publication staff is not responsible for opinions or facts ty of care. in bylined articles. Both the New Mexico and Louisiana next decade there will be an increasing num- Copyright 2012 by Ohio Psychology Publica- State Psychological Associations had been ber of psychologists providing integrated Although I have been involved in this tions, Inc. All rights reserved. Articles may be copied working on their ultimately successful legis- care as employees in organized systems, movement over the years, it is impossible to for personal use, but proper notice of copyright and lation for over five years. When did psychol- such as federally qualified community health predict with any sense of certainty which credit to The National Psychologist must appear on all ogy’s prescriptive authority quest actually centers (FQCHCs) and ACOs, rather than will be the next state to enact prescriptive copies. This permission does not apply to reproduction begin? working in traditional independent small authority legislation. Will, for example, for advertising, promotion, resale or other commercial Hawaii and Oregon be successful in reviving purposes. In 1984, U.S. Sen. Daniel K. Inouye, D- practices or community mental health cen- Classified advertising rates are $9.00 per line; Hawaii, urged the Hawaii Psychological ters. Times are changing. their vetoed bills? 35-40 characters per line; six line minimum charge. Association to seek this authority. In 1972, As I reflect upon the professional litera- The numbers of psychologists complet- Display advertising rates and mechanical requirements visionary APA President Nick Cummings, ture over the past 25 years, there have been ing their advanced training continues to available on request. The National Psychologist is not Ph.D., raised this possibility with the board consistent and increasing calls for the inte- grow. As of the fall of 2010, 276 graduates responsible for content or claims in paid advertising. of directors. In August 1995, the APA gration of mental health (now frequently had been admitted to take the APA PEP (Psychopharmacology Examination for Martin Saeman, Managing Editor & Mktg. Dir. Council of Representatives formally called “behavioral health”) services within James Bradshaw, Senior Editor endorsed prescriptive authority. primary care. Whether one considers Psychologists) developed by the APA Richard Gill, Assistant Editor By the end of 2008, Glenn Ally, Ph.D., “Healthy People: The Surgeon General’s Practice Organization’s College of ISSN 1058-6776 estimated that 200,000 psychotropic medica- Report on Health Promotion and Disease Professional Psychology. With the advances tially across the nation and to be appropriate tion orders had been written by his Louisiana Prevention” (1979) or the Institute of occurring in educational technology, I would for their training. They are calling for colleagues. Today, Morgan Sammons, Ph.D., Medicine report “Health and Behavior: expect that those on their clinical internships patients to have the freedom to be treated by who is now dean of the California School of Frontiers of Research in the Biobehavioral will soon have ready access to medication the practitioners of their choice. Sound Professional Psychology, postulates that Sciences” (1982), the underlying message is decision protocols. Over the years, slightly familiar? between 800 and 1,000 colleagues have very clear. Primary care providers, with con- more than one third of our state associations I am confident that psychology’s leader- completed their formal psychopharmacolog- siderably less mental health training than have established task forces to coordinate ship will appreciate the growing importance ical training. The numbers are indeed psychologists, have been providing care for prescriptive authority activities, with nearly of proactive vision and action. As Harvey V. impressive. 60 percent to 80 percent of those with dis- a quarter having introduced relevant legisla- Fineberg, M.D., president of the Institute of cernible mental health disorders. tion. Medicine, has stated: “Dealing equally with With the passage of President Obama’s Most practicing psychologists have health care for mental, substance-use and landmark Patient Protection and Affordable been trained in a traditional mental health Fundamental change always takes time; general health conditions requires a funda- Care Act more than 32 million Americans setting, pursuant to the community mental oftentimes, longer than one might initially mental change in how we as a society and will soon have access to high quality, health center movement of President expect. Today, several of the states pursuing health care systems think about and respond patient-centered primary care for the first Kennedy’s era, the psychological services prescriptive authority, such as Arizona and to these problems and illnesses. Mental and time in their lives. The president’s vision organization of the VA, and/or university- New Jersey, were initially considered to be substance-use problems and illnesses should calls for the utilization of the most up-to- based mental health clinics. Collectively we among those that their leaders felt would be not be viewed as separate from, and unrelat- date advances in communications and com- have not been aware of the far reaching com- the “last in the nation” to undertake such ed to, overall health and general health care puter technology, an emphasis upon preven- munity health center initiatives of President action. (2006).” CE tion and wellness care and the steady devel- Johnson’s Great Society era, which provide Leadership changes, as does the nation’s opment of comprehensive systems of care the federal safety net for millions of health care environment. Looking over the Aloha. (Accountable Care Organizations (ACOs)) Americans. Congressional landscape, it is evident that ------throughout the land. we will continue to see an increasing number Under previous administrations, these Those federal (and increasingly civil- of non-physician primary care providers Pat Deleon, Ph.D., M.P.H., J.D., often would probably have been considered ian) psychologists who do possess prescrip- adopting the doctoral level of training as called “the father of the RxP movement,” is Health Maintenance Organizations (HMOs – tive authority have emphasized that their their standard and expanding their scopes of a past president of the APA and served 38 President Nixon) and/or Managed Care clinical skills are in definite demand and that practice to fully utilize their clinical expert- yeas on the staff of U.S. Sen. Daniel K. (President Clinton). Interdisciplinary care, their integrated skills have allowed them to ise. The right to prescribe medications by Inouye, D-Hawaii, until his retirement as comparison across diagnoses and patient clinically modify prescribed regimens of nurse practitioners and doctors of nursing chief of staff at the end of 2011. He may be populations and reliance upon objective gold psychotropic medications more appropriate- practice, as well as by clinical pharmacists, reached at [email protected]. standards will increasingly become the ly for their patients’ benefit. for example, continues to mature exponen- Page 6 March/April 2012 T H E N A T I O N A L P S Y C H O L O G I S T TNP writer/editor Richard E. Gill dies after battle with cancer Assistant Editor Richard E. Gill died Feb. 26 from pneumonia following an extend- ed battle with cancer. A trooper to the end, Gill continued contributing to The National Psychologist even in his final weeks, pursuing information by telephone when failing health confined him to his home. (See his final story on Page 1.) Marty Saeman, managing editor said, “Dick was an integral part of our editorial team. He was always thinking and suggesting story ideas, angles and had a way of focus- ing on the unique side of psychology. His wit, humor and infectious smile will be missed especially during editorial staff meetings”. Gill had been a valued member of the staff since 2005. He was an experienced newspaperman, having worked more than 20 years at The Columbus Dispatch covering many areas of news in Ohio’s capital city including the police beat and a stint as editor of the religion pages. At The National Psychologist Gill, an ex-Marine, followed closely the lack of suf- ficient care for returning war veterans, many of whom suffer from traumatic brain injuries and/or post-traumatic stress disorder. He was particularly impressed when psychologists volunteered their time for veter- ans, such as in “Give an Hour” program. He was equally touched by other pro bono activities of psychologists, such as working with survivors after natural disasters A graduate of the Ohio State University School of Journalism, Gill was an avid fan of the Buckeyes, particularly the football team, and loved to play golf, often on his alma mater’s Scarlet and Gray courses in Columbus, where he also worked part time during retirement. He is survived by his wife of 42 years, Linda, five children, 10 grandchildren and seven great-grandchildren. He was 75.

the risk for smokers. The study compared Sleeping aids 10,529 people using prescription sleeping linked to cancer pills to nearly twice that many people in a control group not taking sleeping pills. A study at the Scripps Clinic in La Jolla, Calif., shows a 35 percent increased risk of The study had some weaknesses: It was cancer among people taking sleeping pills, not determined why patients were prescribed such as Ambien, Restoril, Sonata or Lunesta, sleeping pills, creating the possibility that compared to people with similar health his- people at risk of cancer are more likely to tories who did not take sleeping pills. take sleeping aids. It did not control for psy- chiatric conditions. Also, the overall number Daniel Kripke, M.D., who led the of deaths was small. research, said the risk of developing lym- phoma, lung, colon or prostate cancer asso- ciated with taking the drugs was greater than Page 7 T H E N A T I O N A L P S Y C H O L O G I S T March/April 2012 Risk Management: First HITECH suit filed against ‘business associate’ The first lawsuit under the HITECH Act Rothman said Accretive’s debt collec- Licensing boards often enforce codes of conduct against “a business associate” of a health tions license could be reinstated if the com- care facility was filed in January in pany meets certain conditions, including By Ed Zuckerman, Ph.D. things can go wrong. Minnesota. providing debt collector training materials Second, the national codes are deliber- The state attorney general’s office filed and appropriate “policies and procedures for In most cases the statutes that created ately written at an abstract level – principles the suit against Accretive Health Inc. of protecting and safeguarding of consumers’ our licensing boards included the basics of – eschewing specifics so that they can be Illinois, which was acting as a debt collec- personal information.” training necessary for licensing, continuing applied across situations. By incorporating tion agency for two Minneapolis hospitals, Under HITECH’s penalty provisions, education requirements, license fees, proce- these into licensing board considerations it according to the Minneapolis Star Tribune. fines of $100 to $50,000 per violation can be dures for releasing records and local and becomes possible to lose one’s license for imposed, and each individual breach could specific issues and practices. Although some violating an abstract principle such as failure Minnesota Commerce Commissioner be considered a violation. ethical guidelines might be included the to “respect the client’s autonomy.” Mike Rothman suspended the company’s All health care providers, including psy- statutes were not considered the venue to Third, the national codes are meant to debt collections license based on informa- chologists, are required to maintain confi- explicate moral principles or society’s val- be aspirational. While it is hoped that mem- tion in the lawsuit. Accretive agreed not to dentiality of patients’ information whether ues. bers of the association will endeavor to live fight that action. kept on paper or electronically. Health care However, the boards were given the up to these guidelines, the codes do not cre- Company officials also said they will providers also must insist on appropriate right to make their own rules (regulations) to ate minimum standards or legal expecta- work with the attorney general’s staff to information security from any “business carry out their statutorily created responsi- tions. While this is often stated in the code it resolve the issues in the lawsuit. The lawsuit associates,” such as accounting firms or debt bilities. may be ignored. was based on breaches of privileged health collectors. Many state licensing boards have by Fourth, this adoption adds another layer information when an Accretive employee’s now added to their initial list more ethical of words, concepts and guides to the already laptop computer was stolen from a rental car, HIPAA’s been around awhile rules and guidelines as our society has devel- confusing context of practice. We function according to the newspaper. oped greater awareness of the problems and under dozens of kinds of laws (criminal, A spokesman for Accretive said its An article in the January/February issue challenges of relationships and as our pro- civil, health law, family law, contract law, security procedures have been upgraded of The National Psychologist erroneously fession has interacted with other professions HIPAA, etc.) which are not well integrated since the computer was stolen. The laptop stated that HIPAA came into being in 1996. (especially law and medicine). with each other and sometimes in conflict. contained information on approximately It was actually enacted in 1986. Many boards have chosen to incorpo- These laws use different concepts and 23,500 patients. rate the codes of conduct put forward by our words than do our licensing board regula- The action is pending in the U.S. national professional organizations such as tions and previous decisions (case law) District Court in Minneapolis. the American Psychological Association and which carry great weight in decisions. The the Association of State and Provincial board’s statutes and regulations will usually Psychology Boards. address ethics and practices and these do not Incorporating these codes is done “by mesh with the concepts and wordings of the reference” and the code is not reproduced. national codes. Law, ethics and board deci- Some boards state the code will be consulted sions and practices will be in conflict and no as guidance as one of several elements to be procedures are in place to resolve these con- considered in deliberations and other boards flicts. imply that the code’s wordings are in addi- And last, incorporation of the national tion to what is in the board’s rules. codes compels all licensees to conform to We can understand this inclusion. the national code, even those who are not Citizens expect professionals to be ethical, members of the association. Some may have expect the boards to hold clinicians to the well-reasoned moral positions for not join- licensing laws and, when they learn there are ing the association and yet will be held to the national codes, expect clinicians to obey code to which they have objected. these as well. They reasonably expect the I don’t foresee any reasons for boards to board to enforce all of these rules and push remove this incorporation and so we have to their legislators to have the boards include learn to cope with it. CE these rules in their responsibilities. ------But, the incorporation of national codes into local licensing board’s standard greatly Ed Zuckerman, Ph.D., is the author of increases the risk of negative licensing board The Paper Office: Forms, Guidelines, and decisions. Let me explain. Resources to Make Your Practice Work First, these codes are large. They Ethically, Legally, and Profitably now in a address hundreds of issues and concerns fourth edition from Guilford Press. He has because they incorporate ideas accumulated presented both Ethics and Risk Management over many years of experience of the associ- workshops for many years. He may be ations, including tens of thousands of psy- reached by at: [email protected]. chologists. In effect, when adopted by licensing boards, they add hundreds of “moving parts” and so add many ways Page 8 March/April 2012 T H E N A T I O N A L P S Y C H O L O G I S T Dr. Puzzled that he discovered when class certainly not in the process of committing Ethics for Psychologists activity involved reading, if he acted out, the any ethical breach but the omission of fur- other children would think he was funny and ther investigation beyond the diagnoses and Now you see it … would not learn that he couldn’t read. He had declarations of the parents and teachers simply been categorized as a behavioral could have led Dr. Puzzled down a path of problem early on and the label stuck. failed treatment for the wrong diagnoses. now you see something else In interviewing Sam’s sibling stepchil- Dr. Puzzled also was reminded that By Linda Campbell, Ph.D. was a protective mother and that she was dren, Dr. Puzzled learned that Sam got along medications are not always managed by one playing down Johnny’s problems. with them just fine. When consulting with professional. The pediatrician was not man- Dr. Puzzled is a part of a general group Sam’s pediatrician, Dr. Puzzled found that aging the growth hormone, only the ADHD practice although lately referrals have been The second child, Sam, was brought in Sam had been diagnosed with mild ADHD meds. Only when Dr. Puzzled made the for child cases. Dr. Puzzled received refer- by both parents who were most distressed and was taking medication for the ADHD as inquiry was the real culprit of side effects rals for therapy with two children a few with Sam and told Dr. Puzzled that Sam was well as growth hormones for his delayed revealed. Psychotherapy is sometimes like a months ago that, on the face of it, seemed being oppositional and defiant. The mother development. The ADHD meds had a side magic show. When we look only at what the like totally different cases but Dr. Puzzled was divorced from Sam’s father several effect of suppressing appetite and Sam was magician wants us to see, we miss what we would soon discover very important com- years ago and recently married Sam’s stepfa- taking the meds in the morning which need to understand to see through the illu- monalities that would ethically inform the ther who had several children. They were accounted for his not being hungry during sion. CE decisions for an effective treatment plan for now living in a blended family resulting in the day. Further, the growth hormone med------both children. Sam needing to get along with new children ication had a side effect of increasing The first child, Johnny, was brought in in the house. Sam was refusing to eat during appetite and Sam was taking the growth hor- Linda Campbell, Ph.D., is a professor at by his mother who was told by the teacher regular meal times and did not want to just mone medication at night which explained the University of Georgia and director of the that Johnny was so disruptive in class that sit at the table with the rest of the family. why he was hungry during late evening. Doctoral Training Clinic that serves north- she was on the brink of having him evaluat- This behavior was viewed as a rejection of east Georgia. She is past president of the ed for a behavioral problems class. The his new family by the parents. He would get Ethical Standard 9.01(a), Bases for Georgia Psychological Association. She is mother had gotten rumblings of this problem up during the night and get food out of the Assessment is nested in the Assessment an APA Council Representative for Division last year from Johnny’s teacher but nothing refrigerator and eat by himself. The parents Section of the Ethics Code; however, as Dr. 29 and vice president of the Georgia Board this drastic. The mother and father did not had begun putting a lock on the refrigerator Puzzled knew, diagnosis and treatment plan- of Examiners of Psychologists. She may be see this behavior at home nor when Johnny to show him a lesson. ning are an important part of evaluation and reached at [email protected]. would play with other children but he After seeing both boys for several ses- assessment and often takes the psychologist seemed to change dramatically in the school sions, Dr. Puzzled did not see behavioral beyond the information provided by the par- environment. The teachers suspected she problems in Johnny or oppositional defiance ents or clients themselves. Dr. Puzzled was in Sam. Dr. Puzzled realized that he could not rely on the accuracy of the parents’ pre- senting problems. Even though these were not bona fide assessment cases, Dr. Puzzled thought about the Ethical Standard 9.01(a), Bases for Assessment. “Psychologists base the opinions con- tained in their recommendations, reports, and diagnostic or evaluative statements …on information …sufficient to substantiate their findings.”

Dr. Puzzled acquired informed consent to interview others involved in the cases of both children which included teachers, Individualized Education Programs (IEPs) and school reports for Johnny and for Sam. He also spoke with other family members and Sam’s pediatrician. Dr. Puzzled discovered through Johnny’s school records that he had reading problems early on before his behavioral problems developed. Additionally, in ses- sions with Johnny, Dr. Puzzled learned that Johnny was self-conscious about perform- ance, that he didn’t think he “fit in” at school and that during math and science classes, he did not act up as much as when the subject required reading. Dr. Puzzled decided to have Johnny tested and found that Johnny had a reading disability. Johnny confessed to Page 9 T H E N A T I O N A L P S Y C H O L O G I S T March/April 2012 heavily on dues and opposed eliminating the gestions for streamlining governance to keep APA Council meeting discounts. up with technological change. Gerald Koocher, Ph.D., a past APA pres- The results are to be on the council’s Canadians retain full status in APA ident who represents Massachusetts, said August agenda in Orlando, Fla. depending on how many Canadians retained The council budgeted $240,300 for 2013 By James Bradshaw, Senior Editor session, was included in a recommendation full membership and how many chose inter- and $249,900 for 2014 to continue working by the APA membership board to simplify the national affiliation the change could have cost with the World Health Organization (WHO) Washington, D.C. – After a year of dis- dues structure by eliminating many discounts APA as much as $225,000. so that psychology’s interests are reflected in cussions, sometimes heated, the APA Council offered for members who are also members Douglas C. Haldeman, Ph.D., represent- the revision of the International Classification of Representatives voted at its February of other professional associations. The dues ing Division 42, Psychologists in of Diseases and Related Disorders (ICD-10) meeting to maintain reciprocity with the restructuring was completed except for the Independent Practice, said, “We stand to lose that is scheduled to be completed in 2014. Canadian Psychological Association (CPA). CPA discount, she said. much more than dollars.” Haldeman said Koocher pointed out that this year’s Members voted 124 to 28 with seven Several council members spoke against there is a special relationship between U.S. council cannot legally encumber funds for abstentions to allow members of the CPA to eliminating the discounts, pointing to the his- and Canadian colleagues and most U.S. coun- two upcoming councils, but Johnson allowed retain full membership in APA with a 50 per- toric alliance of the APA and the CPA that cil members have substantial interactions the vote for passage. She said future councils cent dues discount. APA members who join dates back to the 1892 creation of the APA, with Canadians. could amend earlier actions but the intent to the CPA also receive a 50 percent discount. which was organized by Canadian and U.S. By the time APA President Suzanne fund is needed to keep in place a partnership The motion to abolish the APA dual psychologists working together. Bennett Johnson, Ph.D., called for a vote the with the International Union of Psychological membership discount was outlined by Elena Charles J.S. Hayes, Ph.D., representing outcome was a formality that generated Science, an umbrella organization of 73 J. Eisman, Ed.D., a member of the board of Nova Scotia, said if the motion passed small- resounding applause. national psychology associations. directors. The motion also would have er provinces, such as his, would not have The council used one day of its four-day The WHO ICD revision team is led by changed the bylaws to let Canadians become enough APA members to retain representation session to engage in a “good governance” psychologist Geoffrey Reed, Ph.D., a former either non-voting international affiliate mem- on the council. “For a long time (until the experiment under the direction of Sandra L. APA assistant executive director for profes- bers or pay full dues to be full members. CPA was organized in 1939) APA was a true Shullman, Ph.D., who heads the Good sional development. Dues for a full membership for 2012 are North American Association,” Hayes said, Governance Project council. Finally, in a slap at a former APA presi- $247 while the dues for an international affil- adding that eliminating most Canadian mem- Members were divided among tables of dent, the council voted 104 to 54 to forbid a iate are $42. About 1,100 CPA members and bers would make it more or less a psycholog- about 10 members each and presented topics member who has served as president from 50 APA members make use of the dual mem- ical association of the United States. on technology – which technologies could be running again until at least 10 years has bership discounts. Dues fund only about 12 percent of the most useful to psychologists, how they could passed. James M. Bray, Ph.D., the 2009 APA Eisman said the discount elimination, APA budget, which is bolstered by publishing be encouraged, short- and long-range plans president, made an unsuccessful bid last year first proposed at the February 2011 council profits and investments, but the CPA relies for incorporating them into practice and sug- as a candidate for the 2013 presidency. Page 10 March/April 2012 T H E N A T I O N A L P S Y C H O L O G I S T Sport psychology The psychology of auto racing Motorsports are popular and dangerous Motorsport racing is divided into several annual class competitions, the most wide- ly known being the NASCAR Sprint Cup and the Nationwide IndyCar Series. The NASCAR competition is a series of 36 races that began this year with the Feb. Pit crew at work at NASCAR race 26 Daytona 500 in Daytona Beach, Fla. The IndyCar series includes the Indianapolis 500 degree-plus temperatures of their cars on pre-injury level. Unfortunately for drivers, and opens this year with the March 25 Honda Grand Prix in St. Petersburg, Fla. race day. After each race, most drivers have the next bad accident could be his or her last, In the accompanying article on the psychology of auto racing, Shaun Tyrance, lost 10 to 15 pounds of water weight. and many drivers find it difficult to get back Ph.D., refers to the fate of British racing driver Dan Wheldon to exemplify the danger of the A driver’s mental toughness is not only behind the wheel after surviving a big wreck. sport. Wheldon, the 2005 winner of IndyCar series and winner of the Indianapolis 500 in tested through the ability to navigate these As a result of the mental complexities of both 2005 and 2011, died Oct. 16, 2011 at age 33 from injuries suffered in a collision at the conditions, the driver must also have the racing, a number of NASCAR and Indy Car 2011 IZOD IndyCar World Championship in Las Vegas. ability to drive “on the edge.” NASCAR and teams employ therapists trained in sport psy- Shaun Tyrance, Ph.D. have been killed as a result of injuries suf- Indy Car drivers drive at speeds in excess of chology to work with their drivers. I worked fered from racing accidents, and four drivers 180 mph, and in order to be great in their full-time for a NASCAR team that raced The recent untimely death of Dan have been killed in Indy Car since its incep- sport, they must be willing to race at these three Cup cars and two Nationwide cars. I Wheldon (former Indianapolis 500 winner) tion in 1980. speeds less than two feet from their compe- have also worked with more than 10 is a stark reminder of As a therapist who has worked with tition. NASCAR developmental drivers as a con- the danger NASCAR numerous Cup, Nationwide, K&N and In my experience, this willingness is the sultant. and Indy Car drivers Whelen series drivers, I have found that the single biggest deciding factor on whether a face every time they physical and psychological makeup of a suc- driver has “it” or not. If a driver is not will- With the start of the race season upon strap on their helmets cessful race car driver is very similar to that ing to drive a car into tight spaces on the race us, each weekend we are reminded of how and get behind the of elite athletes in every sport. track, then he or she will bring the car home mentally tough these drivers are for truly wheel. in one piece but will not compete for cham- putting their life on the line for the sport they Regardless of the Elite drivers have the ability to focus for pionships. love. The sport is more than just a bunch of Tyrance sport, all athletes risk long periods of time with little to no break in left turns! serious injury when competition. A typical NASCAR Cup race is It takes a unique blend of smarts and ------they compete, but “stick and ball” athletes four hours long and covers 400 to 600 miles. daredevil to compete at the highest levels of rarely face the dangers that are an accepted Contrary to popular belief, most of the best motorsports. Unfortunately, when drivers Shaun Tyrance, Ph.D., is a licensed way of life in motorsports. Since NASCAR drivers in the sport are in great physical con- push their cars to the edge, accidents occur. therapist who specializes in sport psycholo- was formed in 1947, 26 Sprint Cup drivers dition, as they have to endure the 120 As in the case of Dan Wheldon, sometimes gy. He earned his Ph.D. in counseling from these wrecks can be fatal. Drivers at every the University of North Carolina at level understand the dangers they face while Charlotte and his masters in sport psycholo- competing, and drivers who are unwilling or gy from the University of North Carolina at unable to take chances with their lives on the Greensboro. He was a four-year varsity let- track do not last long in the sport. ter winner in football at Davidson College. Race car drivers have some of the hard- He worked for the football program at North est jobs in sports. In order to be successful, Carolina State University for three years, they must put themselves in harm’s way. and after NCSU he became the sport psy- Elite drivers have the ability to push their chology consultant at Chip Ganassi Racing cars over the edge (which typically leads to in NASCAR. At Chip Ganassi Racing, horrific crashes) and jump back in the car the Tyrance helped Cup and Nationwide Series next weekend and drive with the reckless drivers and pit crew members perform at abandon needed to win races. their highest levels during races. As a con- sultant, he has worked with hundreds of It is widely known in racing circles Division I and professional athletes from which drivers have lost their ability to com- various institutions including: Revolution pete due to not being able to mentally recov- Racing (NASCAR), UNC Charlotte, er from bad accidents. This is similar to a Davidson College, NC State, University of running back who tears an ACL or a golfer Florida and others. His website is who has shoulder surgery and is unable to www.90percentmental.com and his email is: trust one’s body enough to compete at the [email protected]. Changing a tire on pit row Page 11 T H E N A T I O N A L P S Y C H O L O G I S T March/April 2012 Addressing bullying and cyberbullying By Elizabeth Englander, Ph.D. and their lack of life experience means that they often fail to consider if there are times Those in clinical practice today can play when face-to-face contact is more appropri- a significant role in preventing and addressing ate. Not only does texting lack the nonverbal bullying and cyberbullying. However, it’s cues so important in some conversations, but important to keep in mind a few key points it may actually escalate emotional situations. when dealing with these behaviors. Children are unlikely to realize these facts Bullying today is about minor, repetitive independently and they need to be coached to social cruelty – so don’t expect to hear about think about situations where talking might be dramatic violence. Many adults conceptualize the best way to relate to others. bullying as a largely physical behavior, but Do not neglect school age and pre-teen that is not what is dominating the bullying patients. Both bullying and cyberbullying landscape today. start at a young age. Although adults tend to In 2010 and 2011, researchers at the neglect these topics until adolescence, the Massachusetts Aggression Reduction Center seeds of bullying – and that includes cyber- (MARC) found that it was the “gateway bullying – are actually sewn long before that. behaviors” that were by far the most frequent In Massachusetts, over 90 percent of third in victim reports. These rude, insolent acts – graders are already interacting online (usually such a eye rolling, pointedly whispering in playing games). The good news is that ele- front of others, or snickering – usually do not mentary students are very willing and able to break any specific rules and in isolation may internalize rules about behavior. have limited impact. But their repeated use Take a moment to reinforce patient, kind normalizes disrespect or even rewards it and and friendly behaviors. may be cumulatively devastating for targets. One unfortunate effect of the increase in You can still talk with young patients bullying and cyberbullying is the tendency of about cyber-issues that you may not feel you adults to focus only on negative behaviors. fully understand. Avoiding cyber-problems is But reinforcing good behavior is even more not just about technical knowledge; it is also important than how one responds to poor about maturity and common sense. Adults behavior. If a patient mentions positive social need to ask children about their social experi- behaviors (e.g., having good friends), be sure ences online. Allow your patients to explain to note and praise these. their experiences to you. Even if you feel less Educate your patients’ families about proficient in cyberspace, you can be loud and these issues. clear about the absolute necessity to watch Free educational materials for parents, what one says, whatever the format, and to written in a very practical and concrete style, remain civil to others at all times. are available online at the Massachusetts Take parental reports of bullying prob- Aggression Reduction Center’s website lems seriously and ask detailed questions. (www.MARCcenter.org). You can direct par- A report of bullying can mean many ents there or print the materials and hand them things. Parents sometimes view incidents as out. (Parent materials are available in English, bullying even when the child in question does Spanish, Portuguese, and Haitian Creole.) not. At other times, children may misinterpret More information is available accidents or unintentional behaviors as delib- MARC is an academic center at erate bullying. Bridgewater State University in Massa- Both children and adults may be motivat- chusetts. By running a training program for ed to view social problems as bullying, since graduate and undergraduate students in higher in bullying situations the target is completely education, MARC offers free programs and innocent. Sometimes bullies themselves are services to K-12 schools in Massachusetts. targets or portray themselves as targets. It’s Everyone benefits: future psychologists and important to be aware of these tendencies and educators receive unique field training and K- to consider asking patients to walk you 12 schools receive high-quality, no-cost pro- through reported incidents. If a situation is grams and services. The website offers many clearly not bullying, then it is an opportunity free downloads, games, tips and curricula for for education. all schools, as well as parent downloads. CE Regardless, the appropriate action is to ------focus on resolving the social problem – not to debate the appropriate label. Plant the idea Elizabeth Englander, Ph.D., is director of that some situations require verbal talking, the Bridgewater State University’s Massa- either on the phone or face-to-face. chusetts Aggression Reduction Center. She Children today tend to assume that using may be reached by email at: digital communications is always appropriate, [email protected]. VIEWP By John Caccavale, Ph.D. Is APA really leading the charge ------John Caccavale, Ph.D., ABMP, is execu- s an organization of professional tive director of the National Alliance of psychologists, the National against medicalization of mental health? Professional Psychology Providers. He may Alliance of Professional review. We have pub- The prescription of dangerous opioids, be reached at [email protected]. PsychologyA Providers (NAPPP) fully sup- lished and advocate for example, is so out of control that the FDA ports APA’s Division 32 with their open letter for model legislation now requires PCPs and other physicians to be References petition drive to bring attention to the further for prescribing psy- “trained” in their potential for harm and 1. Cummings, N.A., O’Donohue, W. (24 increase in medicalization that the proposed chotropic medications addiction. One would think that physicians April 2008). Eleven Blunders That Cripple DSM-5 will bring. They deserve wide sup- [9] and have produced would know this and not need special train- Psychotherapy in America: a Remedial port from all of us, and NAPPP is a signatory a major infomercial ing. If physicians are so lacking in skills that Unblundering. CRC Press. . of supporting organizations. advocating for doctor- they need training to prescribe narcotics, for 2. Cummings, N.A., Cummings, J.L. (3 However, Division 32 is not APA. APA al level practice and what other classes of medications should we March 2000). The Essence of Psychotherapy: has not and is not leading any charge against against medications as mandate training? Reinventing the Art in the New Era of Data. the medicalization of mental, emotional and first line treatments There is no question that prescribing Elsevier. behavioral health. Nevertheless, it is also Caccavale that will start airing on psychotropics is an area in which we believe 3. Cummings, N.A., Sayama, M.K. (1 clear that simply opposing additional and PBS and cable outlets in March and will play physicians need special training. Despite con- August 1995). Focused Psychotherapy: a questionable diagnostic schemes is not suffi- for an entire year and reach 60 million view- vincing data questioning both their effective- Casebook of Brief, Intermittent Psychotherapy cient to address the real problems with med- ers. ness and appropriateness, physicians continue Throughout the Life Cycle. Psychology Press 4. Wright, R.H.; Cummings, N.A. (2005). icalization. Our position remains that we Ours is not merely an organizational dis- to prescribe and over-prescribe anti-depres- Destructive Trends in Mental Health: the Well- must confront the overall shift of mental pute with APA. Our issues go deeper. Instead sants, anti-psychotics, anti-convulsants and a intentioned Path to Harm. Psychology Press. health into primary care and the subsequent of joining us in the fight against the wholesale host of many other psychotropic medications. 5. Wright, R.H., Cummings, N.A. use of medications as first line treatments for shift of mental health into medications, APA Anti-psychotic medications are so over- (September 2001). The Practice of mental, emotional and behavioral issues. joined with physicians and even provided prescribed that they now outsell statins. If we Psychology: the Battle for Professionalism. For two years NAPPP has been leading them with guidelines that have increased look at the 58 million prescriptions for anti- Zeig Tucker and Theisen Publishers. the campaign to promote public and profes- medication use as psychotherapy has psychotics written in 2010, we have become 6. Principles to ensure youth and adults sional awareness of the increasing problems declined. a nation of schizophrenics. About 50 percent have access to effective, evidence-based care with medications as first line treatments for Until this petition drive, APA officials of these drugs are being prescribed for for emotional, mental and behavioral health. these disorders. Some psychologists and APA and paid staff have been silent on medicaliza- patients who are not psychotic at a cost of bil- www.nappp.org/standards.pdf. in particular have questioned the wisdom of tion. NAPPP wants psychologists to once lions of dollars. Some are being prescribed 7. Changes to Reimbursement Rules for NAPPP taking on the medical establishment again become the premier providers of men- these drugs for simple sleep issues. Prescribing Psychotropic Medications: Small for the wanton misuse of medications for tal health care with psychotherapy as the first Prescribing for conditions that patients Changes That Can Significantly Reduce Total mental and behavioral disorders. line treatment for mental disorders. do not have has become so frequent in medi- Healthcare Costs While Increasing the Quality What our critics fail to understand is that Moreover, if our standards were adopted and cine that most people have no idea that off- of Care for Patients. NAPPP’s criticisms and campaign against the applied to other classes of medications, such label prescribing has become the norm. www.nappp.org/pdf/NAPPP_ Caccavale.pdf. medicalization of mental health come from as statins, cardiac health would increase and Patients are routinely subjected to “guinea 8. Failure to Serve: A White Paper on The those of us who support prescriptive authori- diabetes would decrease. pig” clinical trials. At the same time health Use of Medications as a First line Treatment ty and are long term advocates of RxP. Our Being on the right side of history many care costs are under attack. It’s not psycholo- and Misuse in Behavioral Inter-ventions. training in psycho-pharmacology is the foun- times is not popular but leadership demands gists who are the problem yet funds for men- ww.nappp.org/Exec_summary.pdf. dation for our opposition. that we take this assertive stand. Increas- tal health are the first to be cut. There are hun- 9. The Patient Safety Evidence Based NAPPP’s advocacy also is consistent ingly, unbiased research shows that we are dreds more examples of why we need to Prescribing Act. www.nappp.org/model.pdf. with the history of psychologists as patient right to pursue this course. The research sup- question and challenge the way mental health 10. Data Mining Reveals Dangerous Side advocates. Much of the warnings are not new ports new standards for treating and prescrib- has been medicalized. Effect of Common Antidepressant/ Cholesterol- and our colleague, Nicholas Cummings, ing medications. This is not a personal attack on any one Lowering Drug Combination. Stanford Ph.D., has been the siren for many of the physician. It is advocacy for patients and our University Press Release, May 11, 2011. destructive trends we are now seeing [1-5]. What the research shows responsibility as health care professionals. 11. Vigen, C.L., Mack, W.J., Keefe, R.S., We have published standards [6] that we Daily, news and scholarly articles are This role may not be popular with those who et al. Cognitive Effects of Atypical believe are necessary for better patient care. appearing challenging both the effectiveness want to maintain the status quo and it never Antipsychotic Medications in Patients with We have published a policy paper [7] that and the potentially dangerous prescribing is. Those who have a vested interest in stop- Alzheimer’s Disease: Outcomes. American would decrease health care costs while practices rampant in medicine [10-12]. ping reform will always be against change. Journal of Psychiatry. In Press. increasing the quality of care if we stop the Medications should no longer be seen as the Professional psychology cannot afford to be 12. Rush, J.A., Trivedi, M.H., Jonathan W. Stewart, J.W., et al. Combining Medications to over-prescribing of these medications. We “life savers” but must cautiously be viewed part of this. Our path is clear and NAPPP Enhance Depression Outcomes (CO-MED): have published a major policy paper [8] on and considered alongside many other options. remains steadfast and committed to being on Acute and Long-Term Outcomes of a Single- why anti-depressant medications, for exam- The problem clearly resides with primary the right side of history with these issues. Blind Randomized Study. American Journal of ple, should not be a first line treatment for care providers who most patients see first for Questioning the DSM-5 is just another in a Psychiatry published May 2, 2011. depression that has received wide, positive their health care needs. long line of issues to be confronted. CE POINT Michigan with a ratio of 1/346, Arkansas Without the ability to change where and with a ratio of 1/357, Florida with a ratio of how Americans get services, a national The future economics of practice 1/360, Georgia with a ratio of 1/381, Illinois health care plan with universal coverage By Jerry Morris, Psy.D. percent, Maine 34 per- with a ratio of 1/419, Delaware 1/485, Utah (whether most are herded into cent, North Carolina 1/548, Ohio 1/583 (http://www.statehealth- Medicaid/Medicare with the ACA flexible 30.6 percent, Oregon facts.org/comparetable.jsp?ind=649&cat=1) entry portals or forcing managed care and 32.4 percent, Vermont . insurance companies to compete with the have been writing for some 31.3 percent, Washing- If a psychologist is in these states they state and federal programs on a level playing time about the changing demo- ton 29.6 percent, know that the real service to humanity, their field), the ability to stop carpet bagging by I graphics in America and how Connecticut 28.8 per- state and for improving market share in the imposing the requirement of “scientifically they will affect a doctor of psychology’s cent, South Carolina next 10 years will be in treating the validated” approaches and the use of least education, practice and personal financial Morris 26.1 percent, Colorado Medicaid population. Further, if they have restrictive and equally effective (compared planning. 25.7 percent and Georgia 25.4 percent. neglected to do the planning, public health to higher priced drugs or procedures) servic- Soon Spanish will be the predominant Strapped states will have great difficulty advocacy and psychology advocacy to get es, we can’t bring the system back under language in Texas with 42 percent of the meeting the new health care and Medicaid psychologists approved as Medicaid vendors rational control and efficacy. state’s population using it as the primary lan- guidelines. and to get fair psychotherapy and diagnos- Psychologists who are wise and their guage, and the Hispanic group is rapidly Economics affect practice. The future in tics reimbursement rates negotiated in state core practice associations will understand expanding. Similar trends are occurring in health care and implementation of the Medicaid plans (modified and filed annual- the science, health economics and national Arizona, California, and New Mexico Affordable Care Act (ACA) is in Medicaid ly), they have done a poor job of preparing economic dynamics and presses and will (http://www.statehealthfacts.org/). and Medicare treatment. More and more for the future and overcoming market make sure they are included and well paid in I have been pointing out for years that people will be retiring with the baby myopia. Medicaid and Medicare systems (and poverty is also a major problem for the boomers becoming eligible to retire, expand- If you come from the following states remember managed care and insurers usual- future psychologist, but especially in the ing Medicare rolls. Medicaid coverage will your foreclosure rate and the downturn in the ly follow these programs on price and pro- emerging future of practice and for those expand due to increasing poverty and a economy seems to be of less impact: States gram reform). They will adopt this thrust as practicing in certain parts of this country. In lengthy economic recovery from a “masked with the lowest foreclosure rates are: North one of their top three advocacy and political most states one in four to one in three indi- depression” and due to ACA allowing the Dakota at a ratio of 1/316,435 and the investment initiatives (along with illuminat- viduals will live below the 139 percent of middle class to subscribe to Medicaid for District of Columbia, 1/47,573, followed in ing the limits of many of the medical model poverty level (about $19,000 per year for a health care if the spin down and co-pays are order by Vermont, West Virginia, South approaches and extension of scope of prac- family of three), which is the 2014 level for cheaper than private insurance (which will Dakota, Arkansas, Wyoming, Mississippi, tice as necessary to bring quality psycholog- mandatory state minimum qualifications for be in the web health exchanges by 2014). New York, New Jersey, Montana, Maine, ical care into the psychologist’s practice and coverage in Medicaid (without the current Thus, I have been challenging psychol- Maryland, Alaska, Alabama, Kentucky and primary care centers). categorical limits) in order to get health care. ogists that are in one of the states that don’t Nebraska. Psychologists – and states – keeping New Mexico, Texas, Arizona, Arkansas, reimburse our discipline in Medicaid to If you look at the picture of what is hap- their heads in the sand on these dynamics Hawaii, Louisiana and Mississippi lead the focus on our inclusion in this federal/state pening in the economy from an “economic will get what the similar Ostrich gets – the nation in poverty. Psychologists will need health plan (their individual state federally stress indices” (including unemployment, bad end of the deal! CE good skills in dealing with the poor and poor filed Medicaid plans). changes in food stamp data, unemployment ------families and in screening for health prob- Notice what is happening. If you prac- and foreclosures) you note that leading the lems that are much more prevalent in the tice in some states the economics of poverty pack for trouble in the next 10 years are: Jerry Morris, Psy.D., MSPharm, MBA poor. The psychologist will also need skill at and masked depression will affect your prac- Iowa, Hawaii, Illinois, Wisconsin, Georgia, (in management), ABMP, ABPP, is owner dealing with the treatment needs of the dis- tice income for the next 10 years. Delaware, New Jersey, Arizona, California, and clinical director of Community Mental abled and the aging. Psychologists able to participate in federal Colorado, North Carolina and Rhode Island. Health Consultants Inc. with offices in and state reimbursement plans may actually Nevada and Missouri. He has served on the Further, since two in three individuals in find their state’s bad luck a boom for prac- The country will be moving toward a APA Council of Representatives and finance poverty by these standards are women, psy- tice. single payer system due to the economic committee and is the past chair (11 years) of chologists will need good training in The states that will have the greatest press to reduce the burden of uncompensat- the APA Division of Psychologists in woman’s issues and treatment techniques. Medicaid populations under the ACA have ed care, expensive emergency department Independent Practice. He is a member of the Additionally, the states are in economic dis- become very clear in emerging economic and hospital care for what could efficiently board of directors and president of the tress. In 2011 estimates concerning annual data. The top 10 leaders in per capita home be outpatient services and to deal with the American Board of Medical Psychology and revenues indicated Nevada expects a 54.5 foreclosures are: Nevada with nearly one in carpet bagging of hospitals and pharmaco- is on the board of the National Alliance of percent budget shortfall, Illinois 40.2 per- 177 households in foreclosure, California logical houses on health care facilities and Professional Psychology Providers. Morris cent, Arizona 39 percent, New Jersey 38.2 with one in every 254 homes in foreclosure, the economy. also has taught economics at the college level. He may be reached through email at: Earn one CE credit for reading this issue. [email protected]. See the CE Quiz on Page 21 References available from the author Page 14 March/April 2012 T H E N A T I O N A L P S Y C H O L O G I S T LETTERS TO THE EDITOR ADHD divergent view welcomed Is the child troubled or gifted? A child is impulsive, strong-willed and often impatient with classmates. He sometimes It was wonderful to see The National be the reason for the child meeting the crite- seems deeply absorbed in his own interests at the expense of giving attention to others, such as Psychologist (November/December 2011) ria. Teaching and even treating the assigned classwork, and regularly seems overly sensitive. put forth a refreshingly honest “divergent” parents absolutely can eliminate the thoughts, Is he suffering from Attention Deficit Hyperactivity Disorder? view on ADHD by Dr. Dathan Paterno. The feelings and behaviors. It is not “bad” parent- Members of the nonprofit organization SENG (Supporting Emotional Needs of the Gifted) personal attack on Dr. Paterno mirrors the ing per se, as children can often develop caution that instead the child may be extremely gifted, which can be mistaken for a behavioral academic bullying in the peer reviewed super-sensitivities to feeling inadequate, problem. research. You need only look at that research small, inferior, “dumb” and “stupid.” It is the James T. Webb, Ph.D., ABPP-CI, is quoted in a SENG press release: “Some of these traits to understand there continues to be a debate child’s perception as they develop, and in include being strong-willed, impulsive, impatient with the relative slowness of others, perfec- about the nature of ADHD, and the lack of turn, they develop cognitive schemas about tionism, heightened sensitivity and intense focus on personal interests and experiences.” neuro-causal proof (e.g. Cohen, D. and Leo, their abilities and sense of self identity. It is Webb is a leader in SENG and coauthor of Misdiagnosis and Dual Diagnoses of Gifted J., 2004). often in reaction to their environment, Children and Adults and points out that many of the traits and behaviors characteristic of gifted- Real diseases are discovered by examin- friends, teachers and yes ... parents. ness – particularly in the very young – can be misunderstood as ADHD. ing a patient with biological tests, scans Children manage injuries to their human- SENG is working up an international campaign to educate pediatricians of the dangers of showing damage and thorough patho-physio- ity (e.g. redirection, put downs, teasing, being misdiagnosing giftedness, which can result in unnecessary medication and unintended harm. The logical tissue and discovery. ADHD was cre- yelled at) through behavior, not words. Heck, ated after a group sat down without it is hard enough to get adults to express their need was seen as increasingly great when the American Academy of Pediatrics recently revised any patient in front of them and decided what feelings, excluding psychologists from its guidelines to expand routine ADHD diagnosis and treatment formerly recommended for chil- are acceptable and not acceptable behav- Washington and Florida. Therefore, children dren 6 to 12 years old to include children from age 4 to 18. More than doubling the covered age iors. ADHD scans show how medications are not the disease, but rather the symptom of span obviously increases the chances of misdiagnoses. negatively impact brains, how those meeting a greater growing problem in our society, After the new guidelines were released Webb and two other SENG leaders – Marianne the criteria think “differently” and that there community and households. We can continue Kuzujanakis, M.D., M.P.H., and Rosina M. Gallagher, Ph.D., NCSP, – sent a letter to the acade- is no true pathology, only correlation. to treat children’s brains as the problem, or my requesting revisions to alert physicians to take the possibility of giftedness into considera- ADHD is a social construct and can not we can begin to actually do what we used to tion, pointing out the ADHD rating scales so far have not incorporated that information. “Our be any more of a neurological disease than do: Provide effective emotional empathic opinion is that a substantial number of intellectually gifted children are being incorrectly diag- Socialism, as Socialists may also use their psychotherapy! nosed as having ADHD,” the letter said. brain differently than Capitalists. Let’s be The academy responded that it will submit the information to its committees reviewing the honest. ADHD is check off list, a “behavioral Toby T. Watson, Psy.D. guidelines and evaluate the feedback in its next revision. disorder,” and yes, the parents can sometimes Sheboygan, Wisc. SENG proposes that the DSM and ICD diagnostic manuals should provide specific codes for giftedness in medical records and pediatric clinicians should take them into account when rul- ADHD proponents offer ‘frantic’ defense ing in or out relevant behavioral or mental health conditions, including – but not limited to – attention deficit disorders. I am shocked by the bellicose tone of the labeled ADHD. But differences do not equate two Letters to the Editor in the January/ to illness. Further, genetic marker differences February 2012 issue of The National among people also do not equate to illness. It Email Letters to the Editor to: Psychologist (“Divergent view of ADHD far is not a surprising finding that people who off-base” and “Denying ADHD shows dan- demonstrate better attention (and exercise the [email protected] gerous bias”) which attack Dr. Dathan areas of the brain involved in attention) will Paterno’s views of ADHD. The authors’ have different structure and functioning in indignation and proposed censoring of anoth- those areas. It is also not surprising that peo- Facts on ADHD distorted er professional’s views demonstrates a frantic ple have different genetic bases for a whole I found the “Divergent view on ADHD” solidly established. He reviews research on defense of unjustified conventional wisdom. host of abilities, attention as one among them. a welcome assertion of that which I have the nature and development of the disorder Dr. Paterno does not place blame on par- Physiological and functional differences seen in 28 years as a clinician working with and on the effectiveness of medication and ents for their children’s difficulties. Neither occur in many forms that have nothing to do children and as a psychologist using, teach- finds that any short-term improvements in does he deny the reality of the problems con- with illness. For instance, more athletic peo- ing and supervising psychological testing to focus from medication fade altogether in the ventionally labeled with this faux ple tend to have more developed muscles diagnosis. His major thrust is that ADHD is because they use those muscles more than evaluate attention disorders in children. The long term. Dr. Sroufe also finds that there is not an illness, and therefore, should not be less athletic people. And, there are likely to be letters in the January/February 2012 issue, evidence that environmental causes may be handled by the widespread drugging of chil- genetic bases for the development of more or however, distorted the facts and overall part of the development of ADHD and of the dren with daily doses of stimulants. He sug- less muscular structure. However, it does not importance of Dr. Paterno’s article. He was brain anomalies which tend to be cited as gests that a better way to handle any behav- follow that less athletic people are ill. And we accused of ignoring “overwhelming” evi- causes for the attention problems. ioral problems is through psycho-social inter- actually scorn the person who uses perform- dence, formulating “antiquated assump- There is much more to say on this clear- ventions, to include parenting help. ance enhancing drugs to correct this “deficit” tions” and of being “grossly inaccurate,” ly polemical issue, and I would suggest that The letters’ authors proclaim that the sci- (although recent news reports show an appar- “narcissistic” and “self-promoting.” as psychological professionals we all refrain entific evidence is overwhelming, and vali- ent condoning of stimulant drug use by ath- As Dr. L Alan Sroufe, professor emeri- from personal hostilities and pay more atten- dates ADHD as a neurobiological dis- letes to “treat” their ADHD). tus of psychology at the University of tion to the facts, such as they are. order. This is blatantly false. The research Minnesota’s Institute of Child Development, they point to merely has shown that people Chuck Ruby, Ph.D. explains in his New York Times article of Lynn B. Means, Ph.D. labeled with ADHD have brains that differ in Waldorf, Md. 1/29/2012, the true nature of what we call Rockville Centre, N.Y. terms of structure and function from those not ADHD and its treatment are far from clear or Page 15 T H E N A T I O N A L P S Y C H O L O G I S T March/April 2012 Page 16 March/April 2012 T H E N A T I O N A L P S Y C H O L O G I S T LETTERS TO THE EDITOR actual training or education to add to the States policies vary on licensure of those with masters training base materials learned in school. It is puz- zling why anyone would feel that someone Editor’s note: In the majority of states, Doctorate, with no difference between them Dr. Blair responds with a third of the training should be seen as the designation “psychologist” is reserved in privileges or responsibilities. In Vermont, equal, professionally, and should represent for doctorally trained clinicians, but in some I am not aware of any serious consideration Dr. Meyer, the profession. states those with master’s degrees can use of taking away full licensure from masters Thanks for your feedback about the arti- Access to care is also addressed in our the title or something very similar. The email level psychologists. In fact, given that the cle. We did consider Vermont, and note that proposal, via the tiered system which is communications that follow were exchanged state is already underserved by psycholo- Vermont does make a clear distinction in the designed to provide more of the practitioners through The National Psychologist concern- gists, especially in the area of evaluation, it title, which properly informs the public needed by the state. To our knowledge, this ing an article in the January/February issue: is clear that we would be very hard pressed about who they are dealing with. This leaves type of system seems to work well in “West Virginia psychologists pursue doctor- to meet clinical needs in our state if we West Virginia as the only state to license Kentucky and elsewhere. al standard.” The article was prepared by the moved to doctorate-only licensure. masters-level providers without a distinct As an aside, conversations with psy- West Virginia Psychological Association’s title difference that recognizes the differ- chologists in Vermont indicate that there board of directors. C. David Blair, Ph.D., is While I value my own APA-approved ences in education, if not scope of practice. continues to be a good deal of tension president of the association. doctoral training, I have also worked closely There appear to be some significant dif- around licensure, and the masters folks are with many masters level psychologists dur- ferences between our states. I understand often fearful and react vocally if they think Dr. Blair, ing my 30 years of licensed practice. Anyone that your masters providers have to be they might be disenfranchised or pushed out, I read the article on West Virginia’s in West Virginia who wishes to gain the per- trained as outlined by CAMPP (which is not even after some 10 years with your current debate over Master’s level licensure with spective of another state’s experience in this accreditation, I believe), although not by system. There are, of course, concerns about interest. I was surprised to see the statement area should contact the Vermont APA standards, and must have some 4,000 reimbursement, although those are generally that West Virginia is the only state in the Psychological Association (www.ver- hours of supervised practice. not under the control of the profession. country to grant “unrestricted licensing of montpsych.org). In West Virginia, “supervision” general- Fortunately, Medicaid does not seem to masters-level providers with the title of psy- ly seems to mean that a licensed person be a problem for practitioners in Vermont, chologist.” As I hope you know, Vermont Gus Meyer, Ph.D. looks over the shoulder of the masters super- and we are engaged in efforts to ensure that also continues this practice. Vermont Psychologist-Doctorate visee for several years and signs off on their it isn’t in West Virginia. work, basically making sure that they con- We have two designations, tinue to do what they were trained to David Blair, Ph.D. Psychologist-Masters and Psychologist- do. There is no system in place to provide President, WVPA Page 17 T H E N A T I O N A L P S Y C H O L O G I S T March/April 2012 BOOK REVIEWS Small volume raises big issue of $$$ Money and Psychotherapy: A Guide for have benefited here from Trachtman’s expe- Collaborative guide is well organized and needed Mental Health Professionals by Richard rience, as the strategies are presented in a Trachtman, Ph.D. (2011) NASW Press. passing manner with little to ground them in Pediatricians and Pharmacologically ing disorders. I especially enjoyed the discus- Washington, D.C. $27.99. practice. Hence, this is one area where skim- Trained Psychologists: Practitioner’s Guide sion of collaborative treatment of pediatric ming detracts from the utility of the infor- to Collaborative Treatment Edited by George diabetes and gastrointestinal disorders. Reviewed by Karen Weisgerber, Ph.D. mation presented. M. Kapalka (2011) Springer. New York. $169. Pharmacologically trained psychologists, Money and Psychotherapy: A Guide for Trachtman then traverses the impact of bringing to bear their integrated expertise, can Mental Health Professionals sets out to be money on role, identity, personality and Reviewed by Matthew B.R. Nessetti, M.D., lend a great hand in alleviating suffering in an introduction to the topic of money and its pathology to its intersection with class, gen- Ph.D., ABFM, ABMP these commonly found diseases in the physi- multiplicity of meanings. This is an ambi- der, race, ethnicity and nationality. In this My initial response when asked to write a cian’s office. tious goal. The ubiquity of money in life sweeping narrative the reader will find use- review of Dr. Kapalka and company’s Part IV, Future Directions in makes an introduction somewhat complex. ful insights regarding the intimate connec- Pediatricians and Pharmacologically Trained Pharmacological Collaboration, was an inter- By its nature, an introduction brings some- tion of money with personal meaning and Psychologists: Practitioner’s Guide to esting read. This section highlighted the man- the emotional context of money. Perhaps the Collaborative Treatment was hesitancy. I was ner in which our study of pharmacology is an thing to light and, as such, fosters utility of most eye opening is the window into what unsure I was the right professional for the job outgrowth of our study of the biological bases new information. Difficulties arise when the Trachtman terms “wealthism” – the preju- and I was unsure the seemingly narrow focus of behavior. The discussion of brain markers, topic is something we transact every day of dice our culture carries regarding wealth. of the text would be very enlightening. perhaps a little misplaced, was motivating to our lives: How does one go beyond skim- I have found my initial impression was read. It pointed to the ever closing gap erro- ming the surface to actually introduce a new This topic is rarely if ever addressed in train- completely wrong. It just goes to show you neously created by Cartesian dualism and thematic? ing, yet the negative connotation is perva- the veracity of first impressions. The preface speaks to psychology’s emerging leadership Author Richard Trachtman tackles this sive. The psychic impact of having some- alone is historically informative and the vol- role in bridging that gap. challenge with his primer, noting that tradi- thing (money) in abundance that most envy, ume as a whole is well organized into four The remaining subsections spoke elo- tional mental health training is woefully coupled with the fact that that the very topic sections; a summary of basic principles, a quently to the deepening integration of phar- inadequate on the topic of money. Indeed, is one of our greatest taboos, is a mental review of environments collaborating profes- macological training in psychology. many a reader may recall the issue summed minefield our profession has unwittingly sionals will find themselves in, a review of Discussions of pre-doctoral, internship and up either by lectures on class inequity ignored. Trachtman takes the unpopular (yet specific disorders especially suited to collabo- post-doctoral training issues were thought between therapist and client or discussions valid) position that being rich places one in a rative care and a discussion of future direc- provoking. The final subsection touched on of how one handles fee negotiations and act- minority and carries the psychological tions for collaboration. the role a pharmacologically trained psychol- ing out regarding payment. The ever-pres- import of such. Although the order of subsection presen- ogist must take when supervising any of a ence of money is coupled with the apparent The sweep across gender, race and the tation seems backward, the first section, plethora of non-pharmacologically trained taboo about speaking of it in a personally rest, however, is far less successful. Here, in Foundations of Collaborative Care, is an mental health professionals. relevant way. This psychic admixture of an effort to touch all the bases, Trachtman informative review of the history of profes- Pediatricians and Pharmacologically public and private becomes fertile soil for falls into stereotypes himself despite his sional issues both physicians and psycholo- Trained Psychologists is an excellent read psychic relevance. efforts to the contrary. These profound topics gists will find grounding. Both professional albeit pricey at $169. It takes a broad sweep at Money, Trachtman notes, in and of are treated with nods in their direction and groups will find a kinship with the presented the general issues pharmacologically trained itself, has no meaning – and, one might offers the reader little, if any, practical infor- issues within. A discussion of when to treat, psychologists will encounter in their day-to- argue, no inherent value. Creating socially mation or insights. Unfortunately from this when to collaborate and when to refer is day practice. It endeavors to inform us on ascribed meaning necessitates active psychic point on, the book falls prey to doing too included and lends to the sense of why this issues of advocacy and training. The text functioning, and as such, involves every much with so little, ending with a conclusion volume is needed. offers discussions on specific settings and on human mind. The therapist is well advised to that detracts from the weight of his message. Part II, Collaboration with Pediatricians specific disorders. A volume such as this is an discern his/her own relationship to, struggles If a reader is looking for a short work in Specific Settings, is a “meat and potatoes” excellent entrée into an increasingly needed with, desires for and avoidance of money with a few insights into the topic of money section of the book (Part III is as well). The domain of texts discussing integration and (and all it symbolizes). Importantly, the in the mental profession, this book may be fine review of clinical experiences, advocacy collaboration. author invites the reader to move beyond the worth a look – as much for these as the ref- and experiences in prescriptive authority Psychologists in general and pharmaco- erences to Trachtman’s other works and a states versus yet-to-prescribe states is made. logically trained psychologists specifically typical topics of fee, payments and gifts to solid bibliography. Personal anecdotes, yet again, lend a sense of will to find themselves in increasingly more an exploration of personal meaning as well ------unity and reduce anonymity to the reader, complex and integrated environments. Similar as countertransference tendencies. especially the pharmacologically trained psy- texts for adult/family medicine, cardiology, Money touches the life of the client at chologist, who can, at times, feel especially women’s health, etc. would all be welcome levels ranging from the concrete to the Karen Weisgerber, Ph.D., is a senior isolated. I especially enjoyed the inclusion of editions. Dr. Kapalka, et al. do what a good abstract. Therapists are often aware of the advisor at the Center on Wealth and collaborative and integrated care discussions entrée should do… leave you wanting more. more tangible topics of financial constraint Philanthropy at Boston College where she is in rural and Indian Health service settings. ------or freedom and tend to find the greatest currently a co-investigator on the Family Part III, Collaboration with Pediatricians degree of comfort conversing in this realm. Wealth Impact Project – a project exploring in Treatment of Specific Disorders, is the Matthew B.R. Nessetti, M.D., Ph.D., Yet, the taboo of talking about money on a the risk and resiliency factors for families of other “meat and potatoes” section. This sec- ABFM, ABMP, is a board certified family personal level (such as income, inheritance, wealth. Prior to joining the staff at CWP, tion adeptly reviews some of the more salient physician and a board certified medical psy- debt) can result in unexplored yet important Weisgerber was on the faculty of the disorders we see in pediatric medicine that are chologist and psychopharmacologist. He is resonances in clients’ lives. Trachtman offers Department of Counseling, Developmental either frankly psychological or have serious the medical director at AllCare Medical a brief schematic regarding the introduction Psychology and Research Methods at psychological sequelae. A review of collabo- Centers in Lakewood Ranch, Fla. He may be of money matters into the therapeutic ses- Boston College for 18 years. She may be ration among providing professionals is reached at [email protected]. sion, with a particular and useful focus on reached at: [email protected]. adeptly completed for mood, anxiety and eat- the money biography. The reader might well Page 18 March/April 2012 T H E N A T I O N A L P S Y C H O L O G I S T Page 19 T H E N A T I O N A L P S Y C H O L O G I S T March/April 2012 STUDENT VOICES ------multicultural clients, as well as conduct Lost in translation Sahar Maknoon is a third-year doctoral research on the acculturation process of student at The Wright Institute in Berkeley, Iranian-Americans. She can be reached at By Sahar Maknoon iarity that is conducive of a strong therapeutic Calif. She continues to work clinically with [email protected]. relationship and alliance. In a field as diverse and evolving as psy- It is true that our shared culture seems to chology, being culturally aware has become contribute to the level of comfort in the room; Working with black males in a clinical setting as much of a clinician’s skill set as formulat- however, another aspect of culture – age – By Steven D. Kniffley Jr., MA cially with non-minority clinicians). ing cases and planning interventions. Clients seems to be equally present in the room. As a To harness the influence of a progres- immigrating to America often experience younger therapist, most of my clients are Racism and discrimination are chronic hardship during their move and acculturation older than I, which is also true of my Persian elements of the black male experience. A sive racial/ethnic identity in therapy, a clini- process. clients. There is an almost innate pull for me recent survey found that more than 60 per- cian must be willing to sit with the negative Working with these clients in therapy to be slightly submissive toward them, and cent of African Americans report experienc- aspects, as well as the positive, of the black proves even more challenging when English their maternal way of regarding me at times is ing chronic racism. Negotiating the deleteri- male experience. The process of immersion is not their first language and the therapist is a clear example of how culture plays a power- ous effects of racism significantly affects the in the black male culture will help the clini- less than fluent in the client’s native tongue. ful role in the therapeutic relationship. psychological well-being of African cian gain insight that will benefit the thera- Moving to a foreign country to relocate one’s It is a personal preference of mine to not Americans (e.g., increased anxiety, depres- peutic relationship. The process of immer- life can be difficult and emotionally taxing for accept gifts from clients. However, when the sive symptoms). sion refers to more than just superficial cul- anyone; culture shock and trauma are not Persian New Year comes around (the biggest When black males present to treatment, tural encounters. The clinician must develop uncommon to this adjustment process, espe- of holiday celebrations), gift giving is not they bring with them years of societal dis- a basic working knowledge of African only essential, but it is expected. As always, it cially for women coming from Middle crimination and a generationally transmitted American idiosyncrasies (e.g. dress, lan- is unheard of to decline a gift in lieu of the Eastern countries without much social support mistrust of institutions. Within the confines guage, familial roles). Going beneath the here in the states. upcoming year, which puts the psychodynam- of the therapeutic setting, institutional mis- surface will help the clinician join with the Working in therapy with Iranian women ic therapist in quite a bind. Here, my theoreti- trust and negative perceptions of their envi- client as well as identify cultural strengths who are monolingual Persian speakers has cal orientation must take a back seat to my ronment and themselves serve as barriers to (e.g., identity development) that can signifi- proved to be a difficult experience, specifical- cultural knowledge about the client’s back- effective treatment. cantly influence the process of therapy. ly given the differences between us within our ground. Lastly, the clinician must apply the shared Persian culture. As these clients com- Overall, though the slight language barri- The key to navigating these barriers involves increasing cultural competency awareness gained through the immersion prehend and speak very little English, my er and cultural nuances create a few extra process and the knowledge of the salience of Persian language skills are challenged weekly obstacles in our treatment, the experience of with the black male population including developing an understanding of the conver- the black male identity. The culturally during every session. While this does not bur- working with these clients is even more informed clinician can use the black male den the therapy itself, language proficiency rewarding, as I feel that I am supporting an gence of racism and racial/ethnic identity, finding opportunities to immerse one’s self racial/ethnic identity developmental process nonetheless remains a difference between my underserved population that happens to share as a therapeutic intervention by providing thousands of years of history with my ances- in the black male experience and developing clients and me. Regardless, sharing culture space for dialogue concerning the influence with another person inevitably creates a famil- tors. a skill set that applies both the knowledge and experiences of black males to the thera- of racism and discrimination. In addition, the peutic setting. clinician can work with the individual to Racial/ethnic identity is a salient com- explore how these events influenced their Student subscription form ponent of the black male identity. For exam- psychological well-being; while concurrent- _____ One year student subscription $20 ple, a recent study found that more than 70 ly strengthening their racial/ethnic identity percent of African Americans report their as a buffer against the negative effects of dis- Name ______racial identity as being very important to criminatory practices. CE them. A more advanced racial/ethnic identity ------Steven D. Kniffley Jr. is a doctoral can- Address ______serves as a buffer against the influence of racial prejudice. Furthermore, the buffering didate in clinical psychology with an empha- potential of racial/ethnic identity reduces the sis in child and family therapy using multi- City ______State______Zip ______expression of psychological symptoms. cultural interventions at Spalding University Clinicians can use this information to meas- in Louisville, Ky. He is also a recipient of the American Psychological Association minor- Phone: ______Email: ______ure racial/ethnic identity development, progress in treatment and the development ity fellowship. He may be reached by email of a positive therapeutic relationship (espe- at [email protected]. Method of Payment: _____ Visa _____ MasterCard _____ check ______Are you a psychology graduate student Credit Card Number Expiration Date with something to say? Signature (required for credit card use) ______Write a short article for Student Voices. Return this form with payment to: The National Psychologist, 620-A Email your ideas to us prior to writing. Taylor Station Rd., Gahanna, Ohio 43230; call toll-free 800/486-1985 Subscribe on our secure website at: www.nationalpsychologist.com tnp 3/11 Our email address is: [email protected] Page 20 March/April 2012 T H E N A T I O N A L P S Y C H O L O G I S T Page 21 T H E N A T I O N A L P S Y C H O L O G I S T March/April 2012 7. Parental reports on bullying: in dealing with which of the following groups? a. are the most reliable indicators that bul- a. individuals who are newly insured CE QUIZ (earn one C.E. credit) lying is actually occurring under a national health plan b. are sometimes based on a child’s misin- b. returning military personnel and their Continuing Education Credits the practice is likely to continue to grow terpretation of unintentional behaviors families You can earn one (1) Continuing Edu- because: c. are only rarely based on parents viewing c. the poor and poor families, particularly cation (CE) credit for studying the current a. there have been consistent and increas- their children as innocent targets women issue of The National Psychologist (TNP). This ing calls for the integration of behavioral d. should generally be disregarded unless d. patients in need of acute mental health offer is made in collaboration with health services and primary care the child corroborates the report services in hospital emergency care depart- Professional Development Resources, a b. primary care physicians have been pro- ments provider approved by the American viding very little care for those with discernible Medicalization of mental health… Psychological Association to sponsor continu- mental health disorders 8. Which of the following does Caccavale see Working with black males… ing education credits for psychologists. Under c. under the Patient Protection and as happening today in the widespread practice 10. Which of the following does Kniffley sug- this agreement, Professional Development Affordable Care Act, psychologists will proba- prescribing of psychotropic medications by gest as a way of doing effective clinical work Resources reviews TNP content in advance, bly work under a physician’s supervision physicians? with black males? selects substantive articles, formulates the CE d. research on psychologists’ work with a. physicians are curtailing their prescrip- a. Help clients to overcome the black male quiz and maintains responsibility for the CE subpopulations like the elderly, children, and tion of psychotropic medications because of racial/ethnic identity and develop a more adap- program. ethnic minorities is lacking convincing data questioning both their effec- tive approach to life After reading the articles marked "CE", tiveness and appropriateness b. Use the black male racial/ethnic identity complete the quiz by circling the correct Licensing boards… b. psychologists are being blocked from developmental process as a therapeutic inter- answers and return it to: 4. Regarding the inclusion of national codes of participating in medical aspects of mental vention conduct by state licensing boards, Zuckerman health practice c. Encourage the development a new iden- Professional Development Resources takes the position that: c. use of medications is being cautiously tity as a buffer against the negative effects of P.O. Box 550659 a. citizens expect professionals to be ethi- viewed and considered alongside many other discriminatory practices Jacksonville, FL 32255-0659 cal, and therefore the codes should be included treatment options d. Clinicians need to gain at least a super- If you are a paid subscriber to TNP, in board decisions d. physicians are frequently prescribing for ficial understanding of African American idio- enclose a check for $15.00, (non-subscribers b. the incorporation of national codes into conditions that patients do not have syncrasies $25.00), made payable to Professional Devel- local licensing board’s standards increases the opment Resources. Professional Development risk of negative board decisions The future economics… Resources will then (1) score your test (80% c. local licensing boards have few guide- 9. Morris contends that, in view of current correct to pass); (2) provide you with a certifi- lines for their decisions beyond the tenets of trends in healthcare and the economy, psychol- cate documenting your credit; and (3) maintain codes of conduct ogists will need to have or acquire good skills secure records of all participants. d. board statutes and regulations generally National Psychologist Quiz mesh well with the concepts and wordings of Vol 21 No 2 Mar-Apr 2012 the national codes Alzheimer’s plan… 1. According to Hartman-Stein, a torrent of Ethics: now you see it… criticism from the mental health community 5. Campbell’s conclusion regarding a consider- concerning the federal Alzheimer’s plan is cen- ation of the two cases studies was that ethical tered around: standards for the bases of assessment: a. incorporating psychology and behav- a. require limiting assessment to the infor- ioral health into prevention and treatment mation given by those who know the client b. the fact that the secretary of Health and best; in the case of a child: the parents Human Services (HHS) is responsible for the b. are best served by giving maximum plan weight to the psychologist’s own observations c. the emphasis so far on biological and inferences approaches and the short shrift given nonphar- c. often take the psychologist beyond the macological interventions information provided by the parents or clients d. the inclusion of a public education cam- themselves paign addressing risk factors and geriatric d. giving minimal credence to the asser- workforce funding tions of parents, who may be too close to the situation to be reliable reporters 2. Peter Whitehouse, M.D., Ph.D., a geriatric neurologist at Case Western Reserve Bullying… University, created the term ______to 6. According to Englander, which of the fol- characterize the whole other dimension of lowing characterizes bullying today? interventions (beyond biological ones). a. it is mostly about minor, repetitive a. nonpharmacological social cruelty like rude, insolent acts b. psychosocial b. it most often involves incidences of c. biopsychosocial physical violence d. ecopsychosocial c. by definition, it is manifested in face-to- face acts of aggression Ten years of RxP… d. it generally includes overtly breaking 3. 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[email protected] or Order from: Ohio Psychology Publications, Inc., 620-A Taylor Station Rd., Gahanna, OH 43230, 1-800-486-1985 Fax: 614/ 861-1996 Phone: 800/486-1985 Page 23 T H E N A T I O N A L P S Y C H O L O G I S T March/April 2012 Page 24 March/April 2012 T H E N A T I O N A L P S Y C H O L O G I S T What’s happening across the USA California –Senate Bill 9 that has been the mental health treatment system and the less and less important to meaningful, Texas – Texas is already short on men- introduced in the California legislature criminal justice system” with the goals of “... nuanced communication. Interest in technol- tal health professionals, including psychia- would allow juveniles to ask the court to re- improved public safety, decreased recidi- ogy-assisted therapy – telecounseling using trists, psychologists, licensed counselors, examine their life sentences after they have vism and fair and just criminal adjudication Skype, instant messaging, etc. – has grown nurses and social workers. But another issue served 15 years behind bars. The argument is for those who are found to be mentally chal- enormously. Therapists can imagine any compounds the problem: a disparity in diag- that at early ages children don’t have the full lenged.” Green indicated that the Circuit number of client needs that can be served nosing and treating the state’s rapidly grow- capacity to understand their crimes and sim- Court Judges will have discretion in deter- electronically. However, rules and best prac- ing minority communities. The state’s cur- ply locking them up is not the answer. mining which offenders (with and without tices for it are still hazy. The Oregon Board rent cadre of licensed psychiatrists is lacking Massachusetts – Frances Mervyn, prior mental health diagnoses) will be eligi- of Licensed Professional Counselors and in cultural and ethnic diversity. In 2009, 64 Ph.D., a community mental health expert, ble for the program. It is not yet known Therapists has enacted rules regarding dis- percent of all psychiatrists were white, 3.5 teacher and dean at the Massachusetts whether only misdemeanor criminal defen- tance counseling. Much of the language percent were African-American and 12.4 School of Professional Psychology, has dants will be eligible and or whether other matches wording from the American percent were Hispanic, according to statis- received the 2011 Elizabeth Hurlock serious violent felony offenders also will be Counseling Association’s 2005 Code of tics in the latest Texas State Health Plan for Beckman Award. Mervyn received the honor eligible. Ethics. The board’s rules address the use of 2011-2016. The Kaiser Family Foundation, at ceremonies at the Carter Center in Atlanta, “technology-assisted services,” which is the in a 2010 report, found that people of color Ga. As one of 15 distinguished teachers cho- North Carolina – The state is failing to same term used in the code. experience worse access than whites to both sen in 2011, Mervyn received a $25,000 one- make sure mentally ill children who have Tennessee – The Tennessee Criminal health care and mental health treatment. And time cash award from the Gail McKnight other disabilities get proper care, an advo- Justice/Mental Health Liaison Project is a even when patients do seek treatment, they Beckman Trust. cate’s report said. Disability Rights North community endeavor that examines the are often unable to find providers who are Carolina used stories of children left in issues affecting adults with serious mental sensitive to their cultural and language dif- Mississippi – Senior Hinds County emergency rooms for weeks and bounced illness who are involved in the criminal jus- ferences. Circuit Court Judge Tomie T. Green sent a from one hospital to another to illustrate the tice system. The purpose of the project is to Memo/Notice to “All Criminal Defense problems families face when they have men- facilitate communication/coordination be- West Virginia – Fulfilling the mission Attorneys, the Office of the Hinds County tally ill children with learning disabilities or tween the community, the criminal justice of its Public Education Grant, the West District Attorney and the Office of the Hinds autism. Families need more help keeping and the mental health systems to achieve Virginia Psychological Association (WVPA) County Public Defender.” He announced children at home and more special foster common goals. One is to support the estab- has distributed its newest publication, “A that the Hinds County Circuit Court has homes where children can live with adults lishment of services that would promote Legislator’s Guide: Dealing with Distressed recently begun to pilot a Mental Health specially trained to help them. diversion activities and provide liaison activ- Constituents,” to all members of the West Court for mentally ill offenders in an effort Oregon – In the past decade, geograph- ities for adults with serious mental illness Virginia Legislature, along with information to “... increase effective cooperation between ical distance between people has become incarcerated or at risk of incarceration. about WVPA and its member psychologists. Setting the record straight Misconception: The National Psychologist (TNP) is subsidized by APA or a state psychological association. Fact: TNP is NOT subsidized by APA or a state psychological association. TNP is an independent newspaper and NOT affiliated with any association, organization, foundation or other group. To continue to recieve each issue without interruption, we encourage you to become a paid subscriber. We often remove names from our unpaid list without notice.

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