Academy Bull 6/03 2

Spring/Summer ‘03 Volume 9, No. 1 Bulletin of the American Academy of Clinical Psychology PRESIDENT’S COLUMN board, but we’ll be working on means of imple- mentation and expending effort. We expect to work closely with ABCP on these endeavors. And although, we, as other groups, have always been limited in financial resources, what we do have in fairly abundant supply is the human capital of our members. We have taken steps to implement the policy of placing notices of new Fellows in their local newspapers and that task was placed in the capable hands of Dr. Martin Kenigsberg, Chair, Public Relations Committee. In the near future, that committee will have its work augmented by taking note of significant professional accomplishments of Fellows of the Academy. An editorial by Jack Ende, M.D., appearing Howard M.Cohen, Ph.D., FAACP in the May, 2003 Mayo Clinic Proceedings enti- tled “Rounding Alone: Assessing the Value of Grand Rounds in Contemporary Departments of I returned from the AACP Board of Medicine” resonated with me, since it had to do Directors meeting of April 5-6, 2003 (see with the education of physicians and the prolifer- Abbreviated Minutes, this issue) reinvigorated ation of subspecialties in departments of medi- and having a sense that we had not only cine. What we in the psychology specialty dealt with Academy housekeeping but focused boards view as the success of the precedent on our raison d’etre — to provide benefits setting medical specialty structure, now is expe- to and represent our members, and of course to riencing at least some difficulties, which the expand our membership through increasing can- ABPP BoT might want to take note of when con- didacy. All of these aspects of the Academy’s sidering additional boards. Ende describes mission are interdependent and essential if our Medical grand rounds as, “...the principle educa- Boards are to have impact in the national health tional conference offered by virtually all depart- picture. As in all meetings housekeeping and ments of medicine.” And that over time these procedures are important, but the flush of excite- ment arises when tangible steps are taken to implement the mission. Among some of the sub- stantive items were: exploring means to facilitate INSIDE self-study programs for our Fellows, looking into preparatory programs for potential candidates President’s Column ......................................... 1 and to urge that the beginning of the specialty Mourning ..................................................... 3 examination process be initiated earlier in the potential candidate’s training program. A wise Cognitive-Experiential Self-Theory ....................... 5 man, J.Frank Dobie, once said, “The average Ph.D.thesis is just the moving of bones from one What is Individualized, Collaborative Assessment?.. 10 cemetery to another.” So, up front I tell you the ideas are not new and just off the drawing Minutes ...................................................... 14 Bulletin of the American Academy of Clinical Psychology Spring/Summer ‘03 Vol. 9 (1) departments “... have been cleaved by increas- erably more, indeed 44% more than even the ingly strong forces of subspecialization....” He next country, Switzerland, “Americans are goes on to say that chairs are empty and “If receiving fewer (health) resources than are peo- attendance at grand rounds continues to decline, ple in the median OECD country.” (See, “It’s the in a few years will I be rounding alone?” Prices Stupid: Why is the United States Different Extrapolate that to some of our miniscule sized from Other Countries.” Anderson, G.F., boards, not subspecialties mind you, and I think Reinhardt, U.E., Hussey, P.S. and Petrosyan, V., we can see a depletion of what had been a Health Affairs, V 22, 1).The importance of health cohesive set of training and experience into care and ready availability is suggested by what easily may become a set of ever expanding Richard Conniff in The Natural History of the schisms. I am not suggesting that there are not Rich: a Field Guide, W.W, Norton & Co.2002, He bonafide boards under ABPP, but there is a clear makes the point that “We all hope to be rich our- benefit in some boards being subsumed under selves. We are descended almost by definition others. Dr. Ende concludes that there is a “core from people who liked food and sex. From them body of knowledge, both clinical and scientific...” we have inherited deeply imbedded biological that needs to be shared by the (medical) sub- drives for status, for waterfront real estate, for specialties. I believe the Clinical Academy would landscapes of the English country house vari- hold that statement to be even more applicable ety...”, etc....features often associated with the to many ABPP specialties. rich and famous. Moreover, all our disclaimers to Finally, writing a column such as this allows the contrary, we long to be like them. We mimic one to range far and provides an opportunity for them as aptly as a viceroy butterfly mimics the serendipity to underscore one’s views. This coloration of the monarch. Academy has an important function to concern He then goes on to talk about wealth, itself with the delivery of quality psychological health and longevity and cites a most services to the public. We have, as mentioned imaginative study. I leave it to Conniff to earlier, proven quality capital in our membership, describe. “In one of the stranger pieces of but it is only the quantity of that human capital demographic research on record, a team of epi- that for now limits our ability to impact the health demiologists and psychologists prowled the delivery system. Nevertheless, it is generally cemeteries of Glasgow in the mid-1990s armed accepted that there is a need to improve the with chimney sweep rods. They used them to accessibility to health care in the United States. measure the height of more than eight hundred It is a complex matter not easily resolved. nineteenth century obelisks. People buried under Neither the old fee-for-service nor the litany of obelisks tend to be affluent, and the researchers faults of managed care that appear on psycho- assumed that taller obelisks marked the graves logical and psychiatric list serves are ready of the more affluent people. The study revealed answers, but it does behoove us to look at the that every extra meter in height of an obelisk problems we face. The Organization for translated into almost two years of additional Economic Cooperation and Development every longevity for the people buried beneath.” It is year publishes data comparing the health sys- interesting that this was based on the article tems of thirty industrialized countries, studying “Some Observations on Health and factors such as: pharmaceuticals; health profes- Socioeconomic Status.” Carroll,D., Smith, G.D. sionals per capita beds; admissions; length of and Benett, P., Journal of Health Psychology. stay; acute care hospital days per capita; and That should at least point the way to the need use of sophisticated technologies. The compari- for universal affordable quality health insurance son of data for 2000, despite being perhaps sim- and the desirability of relief from the stress of it plified with respect to all possible variables, not being available. Hopefully, our Academy can seem to indicate that although we spend consid- expend more of its professional capital on the national mental health delivery system dialogue. 2 Bulletin of the American Academy of Clinical Psychology Spring/Summer ‘03 Vol. 9 (1) Mourning and Melancholia – substance-induced mood disorder with depressive Bereavement and Depression features, and so forth. In the chapter on “Other Conditions That May Be a Focus of Clinical Attention,” the authors of the DSM-IV-TR (2000) address bereavement saying, “This category can be used when the focus of clinical attention is a reaction to the death of a loved one. As part of their reaction to the loss, some grieving individuals present with symptoms characteristic of a Major Depressive Episode . The bereaved individual typically regards the depressed mood as ‘normal,’….” (p. 740). Although the number, severity, and duration of symptoms are considered in the diagnostic criteria for the differentiation of depression from bereavement (as well as in the differentiation of the various shades of depression), the dif- Edward W. L. Smith, Ph.D., FAACP ferentia specifica is the sense of worthlessness experienced by the depressed person. It is this Sorrow comes as a welcome visitor, sense of worthlessness-cum-low self -esteem, moving my losses to the archives of my life. possibly accompanied by corollary guilt and sui- But, depression is her monstrous half-sister cidal ideation, that sets depression apart from wanting to be a murderous wife. bereavement. (Nota bene: A grieving person may feel guilt over things done or not done to or for Thus personified, sorrow and depression are the one who has been lost. Likewise, she or he revealed as having quite different intentions. may feel better off dead than to be without the Although they are related, as I suggest in my lost one. These are qualitatively different from poem, bereavement and depression are two dis- the guilt and wish to die that may be manifesta- tinct entities. Their separate identities are formally tions of a sense of worthlessness.) noted in the Diagnostic and Statistical Manual of Just as the Augustinian monk Gregor th Mental Disorders (4 ed., Text Revision) Mendel, in his discovery of the basic laws of (American Psychiatric Association, 2000) (e.g., genetics, looked beneath surface appearances in pp. 355, 682, 740), but due to their surface resem- order to understand the genotypes unrevealed blance, they are not always distinguished in com- through phenotype, Freud looked beneath the sur- mon parlance or even in the professional litera- face of symptoms in order to understand the ture.

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