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VOLUME 38 NO. 1 SPRING 2003 B U L L E T I N Psychotherapy OFFICIAL PUBLICATION OF DIVISION 29 OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION O C E In This Issue The Added Value of RxP Training In Conversation with Dr. Al Mahrer Clinical Coaching: A Paradigm for Supervision The Unseen Diagnosis: Addiction Assessment Candidate Statements
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Page 1: Psychotherapy

VOLUME 38 NO. 1 SPRING 2003

BULLETIN

PsychotherapyOFFIC IAL PUBL ICAT ION OF D IV IS ION 29 OF THE

AMERICAN PSYCHOLOGICAL ASSOCIAT ION

O

C

E

In This Issue

The Added Value of RxP Training

In Conversation with Dr. Al Mahrer

Clinical Coaching: A Paradigm for Supervision

The Unseen Diagnosis: Addiction Assessment

Candidate Statements

Page 2: Psychotherapy

PresidentPatricia M. Bricklin, Ph.D. 2002-2004470 Gen. Washington RoadWayne, PA 19087Ofc: 610-499-1212 Fax: [email protected]

President-electLinda F. Campbell, Ph.D., 2001-2003University of Georgia402 Aderhold HallAthens, GA 30602-7142Ofc: 706-542-8508 Fax:[email protected]

SecretaryAbraham W. Wolf, Ph.D., 2002-2004Metro Health Medical Center2500 Metro Health DriveCleveland, OH 44109-1998Ofc: 216-778-4637 Fax: [email protected]

TreasurerLeon VandeCreek, Ph.D., 2001-2003The Ellis Institute9 N. Edwin G. Moses Blvd.Dayton, OH 45407Ofc: 937-775-4334 Fax: [email protected]

Past PresidentRobert J. Resnick, Ph.D., 2002-2003Department of PsychologyRandolph Macon CollegeAshland, VA 23005Ofc: 804-752-3734 Fax:[email protected]

Board of Directors Members-at-LargeNorman Abeles, Ph.D. , 2003-2005Michigan State Univ.Dept. of PsychologyE. Lansing, MI 48824-1117Ofc: 517-355-9564 Fax: [email protected]

Mathilda B. Canter, Ph.D., 2002-20044035 E. McDonald DrivePhoenix, AZ 85018Ofc/Home: 602-840-2834 Fax: 602-840-3648E-Mail: [email protected]

Patricia Hannigan-Farley, Ph.D. 2003Office: 440- 250-4302 Fax: 440-250-4301Email:[email protected]

Jon Perez, Ph.D., 2003-2005Washington, D.C. [email protected]

Alice Rubenstein, Ed.D., 2001-2003Monroe Psychotherapy Center20 Office Park WayPittsford, New York 14534Ofc: 585-586-0410 Fax [email protected]

Sylvia Shellenberger, Ph.D., 2002-20043780 Eisenhower ParkwayMacon, Georgia 31206Ofc: 478-784-3580 Fax: [email protected]

APA Council RepresentativesJohn C. Norcross, Ph.D., 2002-2004Department of PsychologyUniversity of ScrantonScranton, PA 18510-4596Ofc:570-941-7638 Fax:[email protected]

Jack Wiggins, Jr., Ph.D., 2002-200415817 East Echo Hills Dr.Fountain Hills, AZ 85268Ofc: 480-816-4214 Fax: [email protected]

Alice F. Chang, Ph.D., 2003-20056616 E. Carondelet Dr.Tucson, AZ 85710Ofc: 520-722-4581 Fax: [email protected]

STANDING COMMITTEES

FellowsChair: Roberta Nutt, Ph.D.

MembershipChair: Craig N. Shealy, Ph.D.James Madison UniversitySchool of PsychologyHarrisonburg, VA 22807-7401Ofc: (540) 568-6835 Fax: 540-568-3322 [email protected]

Student Representative to APAGS:Anna McCarthy2400 Westheimer #306-WHouston, TX [email protected]

Nominations and ElectionsChair: Linda F. Campbell, Ph.D.

Professional AwardsChair: Robert J. Resnick, Ph.D.

FinanceChair: Leon VandeCreek, Ph.D.

Education & TrainingChair: Jeffrey A. Hayes, Ph.D.Associate Professor and Director ofTraining Counseling Psychology ProgramPennsylvania State University312 Cedar BuildingUniversity Park, PA 16802Ofc: (814) [email protected]

Continuing EducationChair: Jon Perez, Ph.D.

Student DevelopmentChair: Open

Psychotherapy ResearchChair: Clara Hill, Ph.D.Dept. of PsychologyUniversity of MarylandCollege Park, MD 20742Ofc: (301) [email protected]

ProgramChair: Alex Siegel, Ph.D., J.D.915 Montgomery Ave. #300Narbeth, PA 19072Ofc: 610-668-4240 Fax: [email protected]

TASK FORCES

Task Force on Policies & ProceduresChair: Mathilda B. Canter, Ph.D.

Diversity Chair: Dan Williams, Ph.D., FAClinP,ABPP185 Central Ave- Suite 615East Orange, New Jersey 07018Ofc: 973-675-9200 Fax: [email protected] - 1-888-269-3807

Interdivisional Task Force on HealthCare PolicyChair: Jeffrey A. Younggren, [email protected]

Task Force on Children, Adolescents& FamiliesChair: Sheila Eyberg, Ph.D.Professor of Clinical & HealthPsychologyBox 100165University of FloridaGainesville, FL 32610FEDERAL EXPRESS ADDRESS1600 SW Archer [email protected] 352-265-0468Co-Chair: Beverly Funderburk, Ph.D.

Division of Psychotherapy � 2003 Governance StructureELECTED BOARD MEMBERS

APPOINTED BOARD MEMBERS

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PSYCHOTHERAPY BULLETIN

Published by theDIVISION OF

PSYCHOTHERAPYAmerican Psychological Association

6557 E. RiverdaleMesa, AZ 85215

602-363-9211e-mail: [email protected]

EDITORLinda Campbell, Ph.D.

CONTRIBUTING EDITORS

Washington ScenePatrick DeLeon, Ph.D.

Practitioner ReportRonald F. Levant, Ed.D.

Education and Training CornerJeffrey A. Hayes, Ph.D.

Professional LiabilityLeon VandeCreek, Ph.D.

FinanceJack Wiggins, Ph.D.

For The ChildrenSheila Eyberg, Ph.D.

Psychotherapy ResearchClara E. Hill, Ph.D.

Student CornerAnna McCarthy

STAFF

Central Office AdministratorTracey Martin

PSYCHOTHERAPY BULLETINOfficial Publication of Division 29 of the

American Psychological Association

Volume 38, Number 1 Spring 2003

CONTENTSPresident’s Column ................................................2

Student Column ......................................................3

Research Corner ......................................................6

Feature: The Added Value of RxP Training ......12

APA Council Report ..............................................15

Division 29 Social Hour ........................................16

Practitioner Report ................................................17

Division 29 Member Gathering ..........................20

Feature: In Conversation with Dr. Al Mahrer ......................................................21

Division 29 Mid-Winter Meeting ........................25

Feature: Clinical Coaching: A Paradigmfor Supervision ..................................................26

Candidate Statements ..........................................30

Feature: The Unseen Diagnosis:Addiction Assessment ......................................38

Call for Nominations: Editor ofPsychotherapy Bulletin ........................................43

Free Division of Psychotherapy ContinuingEducation Workshop at APA Convention ......44

Feature: Was the CompetenciesConference 2002 a CompetentConference ..........................................................45

Washington Scene ..................................................49

Call for Papers........................................................55

APA Membership Application ............................56

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I am writing this column the first week inApril, 2003. I’m in Washington, D.C. at theAPA building. There are signs of springeverywhere. The cherry blossoms are out.This is the season of growth and develop-ment. Relationships strengthen. In themidst of this seasonal rebirth we are at war.There is violence, hurt, and pain. There isalso courage and strength and a need forhealing. The need for the healing power ofpsychotherapy in all its forms is all aroundus. It is always there but the need is inten-sified in troubled times. We must be readyto meet such a need.

Several months ago Linda Campbell, ourpresident elect, and I began some long conversations about the state of the field ofpsychotherapy in terms of research, teach-ing and practice in psychology. What dowe know in each of these areas? What arepsychologist psychotherapists excited about?Where are the innovations? What are graduate students in psychology beingtaught about psychotherapy? What do thechanging demographics of our society tellus about the need for diverse models ofpsychotherapy to meet the needs ofdiverse populations? What are the externalchallenges, political, economic? Is psy-chotherapy practice for psychologists indanger of slipping away from us?

Our conversations increased in length andexcitement. At the most recent Division 29Board meeting we continued the conversa-tion with others. People commented “Wehaven’t talked this way in a long time—about the research, the teaching and prac-tice—the content, the ideas, the future.”Linda and I began to formulate whatwould be our joint presidential initiative.We would begin to gather data, informaland formal, about the state of the field ofpsychotherapy in psychology, the issues

and challengesraised by ourcontinuing con-versations. Wewould welcomeall of you into theconversat ions.The current andfuture role ofpsychotherapy inpsychology is anambitious endeavor but it is one in whichwe are already involved whether asresearchers, academics or practitioners.We can proceed in this endeavor thoughtfully and planfully. We can discover andorganize where we are and move fromthere.

I know the economic challenges of managedcare have created a depressive, pessimisticperspective in many psychologists. This isreal but I also know that when we have theconversations about substance and contentpeople are energized.

As I watched TV, read the paper, talk tostudents, patients and colleagues, here andnow in April, 2003, I know the world is adifferent place from when Linda and Istarted to talk. I cannot find a place in theworld where we as psychologists doingpsychotherapy are not sorely neededwhether it is psychotherapy in health promotion, psychotherapy to cope andprevent world crisis, psychotherapy to healand psychotherapy to live more fully. Weare needed.

Despite the challenges how can we as psychologists-psychotherapists let such avaluable tool of healing and health such aspsychotherapy slip through our hands?Please join us in saying, “we can’t and wewon’t.”

PRESIDENT’S COLUMN

Patricia M. Bricklin, Ph.D.

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Anna McCarthy is currently the GraduateStudent Liaison for Division 29, and a first yearstudent in the clinical psychology Ph.D. pro-gram at the University of Houston. Prior tomoving to Houston she graduated fromCalifornia State University, Long Beach, with amaster’s degree in psychology. Additionally, shehad spent nearly half a decade working in inpa-tient and outpatient settings with children,adolecents, and adults with a broad range ofmental health problems. Anna intends to writeher dissertation on the effects of maternal depres-sion on children of depressed mothers, and topursue a career as a clinician and researcher.

When do we stop being a student andbecome an employable being? When doesthis metamorphosis occur and what know-ledge areas, skills, and values define the“competent” professional psychologist?How do we assess the presence of suchcompetencies? What competencies are“core” to all professional psychologists? Arecent conference at APPIC, entitled“Future Directions in Education andCredentialing in Professional Psychology,”attempted to formulate answers to theseand related questions. Chaired by NadineKaslow, Ph.D., ABPP, the Competencies2002 Steering Committee assembled working groups comprised of some of thecountry’s leading psychologists—and representing a wide spectrum of relevantconstituencies—to discuss ten dimensionsthat were determined (via survey informa-tion) to be at the core of competency forprofessional psychologists. The delibera-tions of these ten working groups (listed inbold below)—and subsequent discussionsby various training councils in our field—may well shape the future of graduatetraining programs and the nature of graduatestudent evaluations. This article is a thumb-nail sketch of some of the key points to

emerge from the conference (seewww.appic.org for additional information).

1. Scientific Foundations and Researchemphasized the need for a scholarlyfoundation to the practice of psychology,while also recognizing that scienceoccurs within a specific socio-culturalcontext. I interpreted this to mean thatstudies based on white male college stu-dents won’t suffice, and that cross-cul-tural differences are being taken seri-ously. Further, the group proposed thatprofessional and scientific psycholo-gists communicate with each other. Thisis an interesting point. It seems that aca-demic psychologists view a career as aclinician as the poor relative of psycholo-gists, while clinicians frown on academicpsychologists for conducting researchthat frequently lacks clinical signifi-cance. However, the working groupwisely suggested that an exchange ofideas, reciprocity, is a necessity.

2. Ethical, Legal, Public Policy/ Advocacy,and Professional Issues concluded thattraining should be formative (ongoing)rather than summative (a single ethicsexam), and in vivo (in the “real world”)in addition to classroom-based educa-tion. Again there was emphasis on thefact that legal/ethical issues take placewithin a multicultural context, therebymaking it essential that professional psy-chologists understand their own valuesand biases. A final, most interesting, rec-ommendation from this group was forstudents to be exposed to good model-ing throughout their training pro-grams—professors, supervisors, andadvisors must practice what they preach.Although this sounds like a moot point,the reality of training programs is oftenfar removed from such an ideal. From

STUDENT COLUMN

When Are We Competent Enough to Kiss Student StatusGoodbye and Embrace the Professional World?Anna McCarthy

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false advertisement when recruiting newstudents to substandard patient care atinternship sites, it seems that the “ideal”does not always trickle down from thetextbook to the trainers.

3. Supervision grappled with issuesregarding those who supervise studentsand students who are learning to super-vise. The group decided that legal andethical issues must be of the utmostconcern, in addition to viewing supervi-sion as a life-long process whose goalmust be proficiency rather than merecompetence. This, in turn, brings up theissue of the nature of graduate training.Many graduates go on to supervise people in some form or other, yet littlefocus is paid to the development ofsupervision skills in graduate pro-grams. Just as many graduate programsassume their students spontaneouslyacquire teaching skills, so to do theyassume that their students sponta-neously acquire supervision skills.

4. Psychological Assessment proposedthat students should be competent inthe use of multiple methods of assess-ment and evaluation in a manner that issensitive to the individuals, families andgroups being tested. This requires stu-dents to have a basic understanding ofpsychometric principles; the flexibilityto assess multiple domains of humanfunctioning; an understanding of theimportance of assessing treatment out-comes; and of the interplay betweenpsychologists and clients, and assess-ments and interventions. They questionedwhether students are receiving thetraining they need during graduateschool to be viable competitors ininternship and professional realms.Undoubtedly, assessment skills areimportant, marketable, and constitutethe historical essence of psychologicalpractice. In an age of managed care, andof justifying diagnoses, the appropriateapplication of reliable and valid assess-ment tools can only be an asset.

5. Individual and Cultural Diversity considered multiple issues such as the

euro-centric bias in psychology, the ideathat culturally salient aspects of a clientcan change from situation to situation,the overarching need to demonstratenecessary and sufficient self-awareness,the importance of professional psycholo-gists recognizing their own value-ladenjudgments and fears when working withdiverse populations, and the importanceof educating oneself about specificgroups of people. Being educated in anenvironment full of diversity is a firststep to addressing many of these issues.Faculty and students with a range ofbackgrounds, abilities, histories, and eth-nicities makes for an enriched learningexperience.

6. Intervention emphasized the importanceof keeping abreast of relevant scientificliterature, the need to be familiar withinnovative and empirically supportedtreatments, the importance of self-awareness (a consistent theme through-out the conference), and the overlapbetween intervention and assessmentamong many other areas. They proposedthat treatment should stem from a theoretically solid base, and shouldencompass self- and client- evaluationsduring treatment. An interesting topicdiscussed was what constitutes asound measure of competence in thisarena. Is competence having the knowl-edge, skills and values to enableemployment as a professional psychol-ogist? Is it the amount of income andprofessional psychologist generates? Isit the number of clients retained over agiven period of time by a professionalpsychologist? Although no consensuswas reached, this question is certainlyworthy of further thought.

7. Consultation and InterdisciplinaryRelations agreed that good consultativeand inter-professional relationships(across the practice areas in psychology,and with allied disciplines) were corecomponents of professional competency.Indeed, there has been growing minorityof psychologists who hypothesize thatthe future of our field entails greater

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respect, appreciation, and exposure tothe different practice areas in our ownfield as well as professionals from otherdisciplines—so that, for example, inter-disciplinary teams of psychologists,medical doctors, psychiatrists, and socialworkers located in the same office spacewill be used to provide more integratedand holistic treatment for individuals inneed. Among other recommendations,this group suggested that graduate stu-dents engage in in-vivo experiences,role-plays and “pre-practice” pertainingto consultations.

8. Professional Development focused onissues pertaining to professional devel-opment, broadly defined to includesocial judgment and critical thinkingskills. The group acknowledged thatthere is much overlap between compe-tencies in social judgment and culturaldiversity (previously discussed by the5th working group). The group proposedthat professional development wasmost aptly conceptualized as a capacityto engage in certain behaviors, ratherthan a defined set of skills. Further,they suggested that such developmentis synonymous with “professionalsocialization” and “professional identitydevelopment”—an all-encompassingstate of “thinking, doing, and being.” Apertinent suggestion from the workinggroup on ethics and legal issues is cer-tainly applicable here: that studentsneed to be exposed to exemplary rolemodels throughout their training. Justas children are shaped by their parents’behaviors, so too are students shapedby their trainers’ behavior.

9. Specialties and Proficiencies developeda wonderfully intricate “competenciescube”—a diagrammatic representationof their summations. The height of thecube depicts stages of professionaldevelopment (i.e., education, internship,post-doctoral positions etc.), the widthdepicts “functional competencies” (i.e.,the roles professional psychologists can assume), and the length depicts“foundational competencies” (i.e., the

knowledge, skills, values, and attitudesprofessional psychologists have). Aswith many of the other groups,Specialties and Proficiencies also notedthat these core competencies would be expected of all professional psychol-ogists, and that “additional preparation”beyond the post-doctoral level “isrequired for specialty practice.” Inaddition to other recommendations,they also indicated that the three practice areas of clinical, counseling,and school psychology should be“identified as general health servicepractice in psychology.”

10. Assessment of Competence discussedthe overarching issue of how to assessthe attainment of overall competence inprofessional psychology—the afore-mentioned metamorphosis from beinga student to an employable being. Theyreiterated the need for formativeassessments (across the student andprofessional lifespan) and summativeassessments (such as licensing exams).Ethical, multicultural, and professionalvalues issues were revisited. However,the group also suggested that “personalsuitability or fitness to the profession”(both inherent and taught) is an impor-tant domain to add to an assessment ofcompetence. They also proposed thatmore research is needed on the assess-ment of professional competence in allof its multiple forms.

In conclusion, this article attempts to provide a thumbnail sketch of the manyhours of discussion that took place at the Competencies Conference (go towww.appic.org for further information). It was offered as food for thought, and atool with which to evaluate your owntraining. Obviously, many questionsremain untouched. How do you, as a consumer, evaluate someone’s level ofcompetence? What qualities, traits or elements do you admire in professionalpsychologists close to you? Lastly, andmost importantly, when you kiss studentstatus goodbye and embrace the professional world what characteristicsand competencies will you embody?

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William B. Stiles is a professor of clinical psy-chology at Miami University in Oxford, Ohio.He is a psychotherapy researcher and a psy-chotherapist. He received his Ph.D. from UCLAin 1972. He taught previously at theUniversity of North Carolina at Chapel Hill,and he has held visiting positions at theUniversities of Sheffield and Leeds in England,at Massey University in New Zealand, and atthe University of Joensuu in Finland. He is theauthor of Describing Talk: A Taxonomy ofVerbal Response Modes. He is a past presi-dent of the Society for Psychotherapy Research,and he is currently North American Editor ofPsychotherapy Research.

Author Note: I thank Meredith J. Glick,Michael A. Gray, Carol L. Humphreys,Katerine Osatuke, and Lisa M. Salvi for com-ments on drafts of this article. Correspondenceshould be addressed to William B. Stiles,Department of Psychology, Miami University,Oxford, OH 45056. Fax 1-513-529-2420.Email [email protected].

I propose this answer to the title question:When observations of the case are explicit-ly brought to bear on a theory. I will firsttry to describe briefly what I mean by sci-entific research and how case studies can fitthe description. Then, as an illustration, Iwill describe the assimilation model, a the-ory of how people change in therapy(Stiles, 2001, 2002; Stiles et al., 1990), andgive some examples of how case studieshave been brought to bear on it.

In this article, I focus on the scientific purposes of case studies. I acknowledge,however, that case studies may be interest-ing or enriching independently of theircontribution to scientific theory (Stiles, inpress).

WHAT I MEAN BY SCIENTIFIC RESEARCHScientific research compares ideas withobservations. In good research, the ideasare thereby changed. The observationsmay be said to permeate the ideas (Stiles,1993, in press): Sometimes the observationssimply confirm or disconfirm the ideas andmake them stronger or weaker. More often,the observations lead to extensions, elabo-rations, modifications, or qualifications ofthe ideas. The ideas change to better fit theobservations; in effect, aspects or qualitiesof the observations become part of theideas. Science is cumulative because obser-vations permeate ideas in this way.

Theories are ideas stated in words (or num-bers or diagrams or other signs), whichcommunicate ideas between people—between author and reader in the case ofresearch reports. To the extent that commu-nication is successful, the reader experi-ences something similar to the author’sunderstanding. Empirical truth—the goaltoward which theoretical statementsstrive—can be understood as a correspon-dence between theories and observedevents. Of course, it is a nonsense to sup-pose that the words in a theory (e.g., printon a page, spoken sounds) literally corre-spond to the concrete objects or eventsdescribed. However, both the words andthe events are experienced by people; thatis, they produce ideas and observations.Because both of these are human experi-ences—composed of the same stuff—theycan be compared and judged as similar ordifferent (Stiles, 1981).

Empirical truth is never general or perma-nent because different people experiencewords and events differently, dependingon their biological equipment, culture, lifehistory, and current circumstances.

RESEARCH CORNER

When is a Case Study Scientific Research?William B. StilesMiami University

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Nevertheless, it is often possible to distin-guish better from worse theories or decidewhich parts of theories need changing,based on their experienced correspondencewith events. As new observations permeateat theory, the theory changes to bettermatch the observations. For example, thetheory may be explained differently, usingdifferent words or perhaps using the newobservations as illustrations.

To summarize my view: Theory can be con-sidered as the principal product of science.The work of scientists can be considered asquality control, insuring that the theoriesare good ones by comparing them withobservations. Good theories are useful. Byaccurately representing the process of psy-chotherapy, for example, a good theory canhelp practitioners understand their clientsand how to be effective in helping them.

TESTING THEORIES WITH CASE STUDIESIn contrast to statistical hypothesis-testingresearch, case studies characteristicallyyield results mainly in words rather thannumbers, use empathy and personalunderstanding rather than detached obser-vation, place observations in context ratherthan in isolation, focus on good examplesrather than representative samples, andsometimes seek to empower participantsrather than merely to observe them (Stiles,1993, in press). I suggest that case studies,as well as statistical hypothesis-testingresearch, can permeate scientific theoryand contribute to quality control.

In statistical hypothesis-testing research,an investigator extracts or derives onestatement (or a few statements) from a theory and attempts to compare this state-ment with a large number of observations.If the observed events tend to match thederived statement (that is, if the scientists’experience of the observations resemblestheir experience of the statement), thenpeople’s confidence in the statement issubstantially increased, and this, in turn,yields a small increment of confidence inthe theory as a whole.

In a case study, instead of trying to assign afirm confidence level to a particularderived statement, an investigator simulta-neously compares a large number of obser-vations based on a particular individualwith a correspondingly large number oftheoretically-based statements. Each state-ment that describes some aspect of the casein theoretical terms represents a compari-son of the theory with an observation. Atissue is how well the theory describes thedetails of the case. For a variety of familiarreasons (selective sampling, low power,potential investigator biases, etc.), theincrease (or decrease) in confidence in anyone theoretical statement may be verysmall. That is, isolated descriptive state-ments drawn from a case study can’t beconfidently generalized. Nevertheless,because many statements are examined,the increase (or decrease) in confidence inthe theory may be comparable to that stem-ming from a statistical hypothesis-testingstudy. A few systematically analyzed casesthat match a theory in precise or unexpect-ed detail may give people considerableconfidence in the theory as a whole, eventhough each component assertion mayremain tentative and uncertain when considered separately. I think the most con-vincing support for the assimilation modelhas been the detailed fit between the modeland observations in a series of intensive casestudies (e.g., Honos-Webb, Stiles,Greenberg, & Goldman, 1998; Knobloch,Endres, Stiles, & Silberschatz, 2001; Stiles,1999b; Stiles, Meshot, Anderson, & Sloan,1992; Stiles et al., 1991; Varvin & Stiles, 1999).

CASE STUDY RESEARCH ON THEASSIMILATION MODELAt the core of the assimilation model is anobservational strategy: identifying prob-lems and tracking them across sessions,using tape recordings or transcripts (Stiles,2001, 2002; Stiles & Angus, 2001). Drawingcases from a variety of therapeuticapproaches, we have observed how expres-sions of a problem differ from time to time,we have inferred a process of change, and

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we have developed concepts to describethis process.

According to the model, people’s experi-ence leaves traces, which can be re-activat-ed by events that have related meanings.That is, thoughts, feelings, and actions,tend to re-emerge in related circumstances,and they then be come linked to the tracesof the new experiences. As a result, tracesof related experiences occurring at differ-ent times tend to form interlinked constel-lations, providing the experiences areunproblematic. We call the traces of experi-ence voices to emphasize that they areactive agents, which can act and speak(Honos-Webb & Stiles, 1999; Stiles, 1997,1999a, 2002). The process of interlinking iscalled assimilation. Assimilated voices serveas a repertoire of resources, drawn upon todeal with life’s demands. For example,cooking skills (traces of previous cookingexperiences) tend to emerge, appropriately,in the kitchen.

Some experiences are problematic, howev-er, for example, traumatic events ordestructive important relationships. Theproblematic traces, or voices, are notsmoothly integrated, but are treated asunwelcome or foreign. Triggering them is signaled by negative emotion. Psycho-therapy, according to the assimilationmodel, is a process of turning such problematic experiences into resources. Forexample, in one case (Debbie; Stiles,1999b), an angry, rejecting voice that wasresponsible for violent verbal and physicaloutbursts was assimilated and graduallytransformed into a capacity for appropriateassertiveness.

On their way to becoming resources in suc-cessful therapy, problematic experiencesappear to pass through a sequence ofstages or levels of assimilation, describedin the Assimilation of ProblematicExperiences Scale (APES). As shown inTable 1, the APES includes 8 levels num-bered 0 through 7. Applied to passagesfrom therapy, each APES rating character-

izes the degree of assimilation of particularproblematic content. The names of the lev-els describe the state of the problematicvoice (traces of a problematic experience)from the viewpoint of the community. Incase studies, the APES has typically beenused not by independent raters but byinvestigators who have used APES ratingsto precisely convey their context-informedassessment of each problem’s degree ofassimilation. Using assimilation analysis(Stiles & Angus, 2001; Stiles & Osatuke,2000), investigators become familiar with acase, identify a problematic voice, excerptpassages representing that voice, and thenuse the APES to help describe whether andhow it was assimilated. The APES is a sum-mary of our current understanding of thesequential process of assimilation, and thescale continues to evolve.

Although there have been some statisticalhypothesis-testing studies addressing theassimilation model (see Stiles, 2002, for areview), the model has grown mainly fromthe case studies (e.g., Honos-Webb et al.,1998; Knobloch et al., 2001; Stiles, 1999b;Stiles et al., 1990, 1991, 1992; Varvin &Stiles, 1999). The gradual development ofthe APES illustrates how the case observa-tions have permeated the model, refining,elaborating, and clarifying it:

The development of the APES began with alist of immediate therapeutic impacts(Stiles et al., 1991), which were derivedfrom clients’ open-ended descriptions ofhelpful and unhelpful events within thera-py sessions (Elliott, 1985; Elliott et al.,1985). Based on our initial case observa-tions, we listed the impacts in sequence toreflect our understanding of the assimila-tion process, and we modified and expand-ed the impact descriptions to construct theanchored eight-point scale. As an exampleof modification and expansion, althoughthe original “personal insight” impact cate-gory was characterized as a “task impact”(Elliott et al., 1985, p. 622), we observedthat therapeutic insight events wereaccompanied by intense but mixed (posi-

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tive and negative) emotion in the first caseswe studied (Elliott et al., 1994; Stiles et al.,1990). Consequently, we included affectivefeatures in our characterization of APESlevel 4, understanding/insight (see Table1). As another example, although APESlevel 2 was originally called simply “vagueawareness” (Stiles et al., 1991, p. 199), evenearly case studies showed a quality ofemergence at this level (e.g., describing thecase of Joan at APES level 2: “the intensepsychological pain signaled the emergenceof the unwanted thoughts”; Stiles, 1991, p.202). As this pattern was repeated acrosscases, the term emergence was eventuallyadded to the name and description of level2 (see Table 1).

If a case fits the theory in a great manyrespects but fails to fit it in a small and spe-cific way, this can point to something in thetheory that needs changing, as in the fol-lowing example: In the earlier versions ofthe APES (e.g., Honos-Webb et al., 1998;Stiles et al., 1991, 1992), which were basedmainly on studies of depressed but other-wise well-functioning clients, the APESlevel 0 was called simply warded off. Morerecently, in considering cases with border-line features, we observed material thatwas clearly problematic and unassimilatedbut not warded off. On the contrary, theseunassimilated voices emerged all too force-fully in state switches, in effect, taking overthe person. Despite this discrepancy, therewere many aspects of these cases that fitthe model’s account well. For example, theopposing states were at first mutually inac-cessible, encounters between them tendedto be emotionally painful, and in successfultherapy, they seemed to go through thesequence described in Table 1. Thus, theobservations did not justify abandoningthe theory, but instead led to some alterations(e.g., Osatuke & Stiles, in preparation,Stiles, 2002), such as the addition of theterm “dissociated” in the label of APESlevel 0 and rewriting of the level 0 descrip-tion (Table 1). This reformulation alsooffered an improved fit with dissociatedtraumatic experiences, which, when trig-

gered, may emerge in flashback phenome-na, such as film-like reliving of the trauma(Varvin & Stiles, 1999). Thus, the alterationbased on new case observations strength-ened the model.

SOME IMPLICATIONSIn summary, I suggest that case studiesoffer an alternative that can complementhypothesis-testing research. By simultane-ously bringing many observations to bearon a theory, case studies offer both a way totest and an opportunity to improve the the-ory. I acknowledge that other people maymean something by scientific researchbesides comparing ideas with observa-tions. My meaning implies that, for exam-ple, Freud’s case studies, such as Dora(Freud, 1905/1953) and Schreiber (Freud,1911/1958) qualify as scientific research. Inmy view, Freud’s case studies permeatedpsychoanalytic theory (that is, the theorywas altered by them), and the detailed fitbetween the theory and the cases helpedincrease confidence in the theory. In thesame way, our assimilation case studieshave both changed the assimilation modeland built our confidence in it.

An implication of my argument is that casestudy authors can make their research sci-entific by articulating their case’s detailedrelation to an explicit theory. In principle,this could be a new theory, developed fromthe case at hand, as long ago suggested inthe grounded theory approach (Glaser &Strauss, 1967). Arguably, psychoanalysisand many other theories of therapy beganas accounts of cases. Constructing a newtheory for each case, however, forgoes thebenefits of cumulative improvements, andfewer readers may be interested in a theo-ry developed for one-time use.

Of course, neither Dora, nor Schreiber, northe assimilation case studies, nor any sin-gle piece of scientific research—case studyor otherwise—can overcome all the ambi-guities and doubts in a theory. Like othertheories, the assimilation model is far froma precise or complete account; I hope and

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expect it will continue to be permeated byobservations on new cases. All good scien-tific theories, I believe, remain open-ended,stimulating new research while they accu-mulate, summarize, and convey previousobservations.

REFERENCES

Elliott, R. (1985). Helpful and nonhelpfulevents in brief counseling interviews: An empirical taxonomy. Journal ofCounseling Psychology, 32, 307-322.

Elliott, R., James, E., Reimschuessel, C.,Cislo, D., & Sack, N. (1985). Significantevents and the analysis of immediatetherapeutic impacts. Psychotherapy, 22,620-630.

Elliott, R., Shapiro, D. A., Firth-Cozens, J.,Stiles, W. B., Hardy, G. E., Llewelyn, S. P.,& Margison, F. R. (1994). Comprehensiveprocess analysis of insight events in cog-nitive-behavioral and psychodynamic-interpersonal psychotherapies. Journal ofCounseling Psychology, 41, 449-463.

Freud, S. (1905/1953). Fragment of anAnalysis of a Case of Hysteria. In J.Strachey (Ed. and Trans.), The standardedition of the complete psychological worksof Sigmund Freud, Vol. 7 (pp. 3-122).London: Hogarth Press.

Freud, S. (1911/1958). Psycho-analytic noteson an autobiographical account of a caseof paranoia. In J. Strachey (Ed. andTrans.), The standard edition of the completepsychological works of Sigmund Freud, Vol.11 (pp. 9-55). London: Hogarth Press.

Glaser, B. G., & Strauss, A. L. (1967). Thediscovery of grounded theory: Strategies forqualitative research. Chicago: Aldine.

Honos-Webb, L., & Stiles, W. B. (1998).Reformulation of assimilation analysisin terms of voices. Psychotherapy, 35, 23-33.

Honos-Webb, L., Stiles, W. B., Greenberg,L. S., & Goldman, R. (1998). Assimilationanalysis of process-experiential psycho-therapy: A comparison of two cases.Psychotherapy Research, 8, 264-286.

Knobloch, L. M., Endres, L. M., Stiles, W. B.,& Silberschatz, G. (2001). Convergenceand divergence of themes in successfulpsychotherapy: An assimilation analysis.Psychotherapy, 38, 31-39.

Osatuke, K., & Stiles, W. B. (in prepara-tion). On different kinds of problematicinternal voices: Elaboration of the assim-ilation model.

Stiles, W. B. (1981). Science, experience, andtruth: A conversation with myself.Teaching of Psychology, 8, 227-230.

Stiles, W. B. (1993). Quality control in qual-itative research. Clinical PsychologyReview, 13, 593-618.

Stiles, W. B. (1997). Signs and voices: Joininga conversation in progress. British Journalof Medical Psychology, 70, 169-176.

Stiles, W. B. (1999a). Signs and voices in psy-chotherapy. Psychotherapy Research, 9, 1-21.

Stiles, W. B. (1999b). Signs, voices, meaningbridges, and shared experience: How talkinghelps. Visiting Scholar Series No. 10 (ISSN1173-9940). Palmerston North, NewZealand: School of Psychology, MasseyUniversity.

Stiles, W. B. (2001). Assimilation of problem-atic experiences. Psychotherapy, 38, 462-465.

Stiles, W. B. (2002). Assimilation of problem-atic experiences. In J. C. Norcross (Ed.),Psychotherapy relationships that work:Therapist contributions and responsiveness topatients (pp. 357-365). New York: OxfordUniversity Press.

Stiles, W. B. (in press). Qualitative research:Evaluating the process and the product. InS. P. Llewelyn & P. Kennedy (Eds.),Handbook of Clinical Health Psychology.London: Wiley.

Stiles, W. B., & Angus, L. (2001). Qualitativeresearch on clients’ assimilation of prob-lematic experiences in psychotherapy. In J.Frommer & D. L. Rennie (Eds), Qualitativepsychotherapy research: Methods and method-ology (pp. 112-127). Lengerich, Germany:Pabst Science Publishers.

Stiles, W. B., Elliott, R., Llewelyn, S. P.,Firth-Cozens, J. A., Margison, F. R.,Shapiro, D. A., & Hardy, G. (1990).Assimilation of problematic experiencesby clients in psychotherapy. Psychotherapy,27, 411-420.

Stiles, W. B., Meshot, C. M., Anderson, T.M., & Sloan, W. W., Jr. (1992).Assimilation of problematic experiences:

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The case of John Jones. PsychotherapyResearch, 2, 81-101.

Stiles, W. B., Morrison, L. A., Haw, S. K.,Harper, H., Shapiro, D. A., & Firth-Cozens, J. (1991). Longitudinal study ofassimilation in exploratory psychothera-py. Psychotherapy, 28, 195-206.

Stiles, W. B., & Osatuke, K. (2000).

Assimilation analysis. Unpublished man-uscript. Department of Psychology,Miami University, Oxford, Ohio 45056

Varvin, S., & Stiles, W. B. (1999). Emergenceof severe traumatic experiences: Anassimilation analysis of psychoanalytictherapy with a political refugee.Psychotherapy Research, 9, 381-404.

Table 1Assimilation of Problematic Experiences Scale (APES)

0. Warded off/dissociated. Client is unaware of the problem; the problematic voice issilent or dissociated. Affect may be minimal, reflecting successful avoidance.Alternatively, problem may appear as somatic symptoms, acting out, or state switches.

1. Unwanted thoughts/active avoidance. Client prefers not to think about the experience.Problematic voices emerge in response to therapist interventions or external circum-stances and are suppressed or avoided. Affect is intensely negative but episodic andunfocused; the connection with the content may be unclear.

2. Vague awareness/emergence. Client is aware of a problematic experience but cannotformulate the problem clearly. Problematic voice emerges into sustained awareness.Affect includes intense psychological pain—fear, sadness, anger, disgust—associatedwith the problematic experience.

3. Problem statement/clarification. Content includes a clear statement of a problem—something that can be worked on. Opposing voices are differentiated and can talkabout each other. Affect is negative but manageable, not panicky.

4. Understanding/insight. The problematic experience is formulated and understood insome way. Voices reach an understanding with each other (a meaning bridge). Affectmay be mixed, with some unpleasant recognition but also some pleasant surprise.

5. Application/working through. The understanding is used to work on a problem.Voices work together to address problems of living. Affective tone is positive, opti-mistic.

6. Resourcefulness/problem solution. The formerly problematic experience is a resource,used for solving problems. Voices can be used flexibly. Affect is positive, satisfied.

7. Integration/mastery. Client automatically generalizes solutions; voices are fully inte-grated, serving as resources in new situations. Affect is positive or neutral (i.e., this isno longer something to get excited about).

Note. Assimilation is considered as a continuum, and intermediate levels are allowed, forexample, 2.5 represents a level of assimilation half way between vague awareness/emer-gence (2.0) and problem statement/clarification (3.0).

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John Caccavale, Ph.D. is a licensed, clinical neu-ropsychologist practicing in Downey, CA in aninjury practice and is the managing partner atThe California Occupational Injury Center. Hisdoctoral degree is from the University ofSouthern California and he has since completedan M.S. in clinical psychopharmacology fromAlliant University. His current projects includewriting in the area of adverse drug events andpsychotropic medications and recently publishedin the Journal of Clinical Psychology on pre-scriptive authority.

The true added value of psychopharmacol-ogy training (RxP) may be difficult toascertain at this time because training isrelatively new and the number of psychol-ogists who have completed level II trainingare relatively few. Perhaps, four to fivehundred, at best. Nevertheless, the experi-ences of individual psychologists can pro-vide a sort of template showing trends thatno doubt will be shared among those whowill complete RxP training and integratepsychopharmacology into their practices.From personal experience and those ofpsychologists similarly trained, I have con-cluded that RxP training can be the singlemost factor to benefit both practitioners,patients and psychology. I have delineatedseveral key areas where I personally haveexperienced the added value of RxP train-ing: Increased Patient Safety; EnhancedPatient Services; Professional Growth &Recognition; Enhanced Practice Revenues;and Reduced Treatment Costs. There areother factors beyond these that can also beattributed to RxP training, such as theimpact of training on mental health policy.However, I’ll leave that for another time.

INCREASED PATIENT SAFETYI am a partner in an injury practice and Iintegrated psychopharmacology into my

practice in 1995. All of my psychologypartners are trained in psychopharmacolo-gy. The physicians and other medical spe-cialties that we deal with generally have nofurther training in psychopharmacologybeyond medical school and residency.Typically, the patients I see have at leastthree other specialties providing treatment.Many times there may be in excess of sevenproviders. Invariably, all these specialtiesprescribe one or more medications andrarely know what the others have pre-scribed. Generally, my patients have noidea of even why they were prescribed anyone medication let alone several. Becauseof my RxP training and because I am theone specialty who actually sees the patienton a regular basis, I am in the unique posi-tion of being able to evaluate the drug-drug interactions and the medicationerrors of the many medications being pre-scribed for an individual patient. It is thenorm that I find potential and real harmfulside effects due to interactions. Medicationerrors are frequent. I am able to communi-cate this information to the patients and tothe other specialties. I am able to recom-mend which medications should be dis-continued or changed. The majority oftimes physicians ask me to monitor andmanage the medication regimen. WithoutRxP training both my patients and myselfwould be at a terrible disadvantage. RxPtraining has helped me to become a far bet-ter practitioner. I am sure that this experi-ence extends to many others who havecompleted psychopharmacology training.

ENHANCED PATIENT SERVICESBecause I now integrate psychopharmacol-ogy factors into my evaluations, I am ableto provide a needed and valuable serviceto my patients. My evaluations are morecomplete. I provide every patient who istaking a medication with a simple state-

FEATURE

The Added Value of RxP TrainingJohn L. Caccavale, Ph.D., M.S. Clinical Psychopharmacology

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ment showing the interactions and sideeffects of their medication regimen. I havefound that few patients read or understandthe literature given to them by pharma-cists. I am a fluent Spanish speaker andover 85% of my patients are Spanish speak-ing, I provide them with important healthinformation that they have difficulty get-ting elsewhere. I can say that many of thesepatients are prescribed medications with-out the benefit of anyone being able tocommunicate with them. I have seen jani-tors “translating” for physicians. In theworld of English speaking practitionersanyone who can read a menu can be atranslator. While all patients benefit frompsychopharmacology training, underserved populations greatly benefit fromhaving a psychologist trained in psy-chopharmacology. There are many otherexamples that I can cite with respect toincreased patient services but for nowthese should suffice.

PROFESSIONAL GROWTH & RECOGNITIONAnytime a professional can obtain anadded proficiency, professional growth isenhanced. However, with RxP trainingthere is the added value of being recog-nized by both peers and other specialties,particularly physicians. Medications is thecurrency of communication with the med-ical profession. When a non-physician cancommunicate using this currency the artifi-cial line separating the two becomes muchsmaller. In some cases it even disappears.On a daily basis, I am called upon byphysicians to evaluate and recommendpsychotropic medications. After a contact, Ialways follow up with a simple report,many times only one page, showing theparticulars of the medication discussed.

I have been requested by physicians to rec-ommend medications to their family mem-bers. Clearly, these physicians have accessto psychiatrists but my experience is thatnon-psychiatric physicians prefer to speakand deal with a psychologist trained inpsychopharmacology. This is the type of

recognition that we will need to realize ournational RxP goal. Besides the recognitionobtained from medical practitioners, psy-chologists trained in psychopharmacologycan expect being consulted by other col-leagues and new referrals from existingpatients. This is particularly true in areaslacking a diversity of other specialties. RxPtraining has also given me the opportunityto speak and write on subjects from a dif-ferent perspective. All of these have con-tributed to both my personal and profes-sional growth. My discussions with otherRxP trained psychologists indicates that allhave enjoyed what I am experiencing.

ENHANCED PRACTICE REVENUESFrom an economic perspective, I have longago recovered my investment in RxP train-ing. I calculate that my RxP trainingaccounts for an additional 35% of my over-all revenues on a yearly basis. I base this onincreased referrals, additional charges formedication recommendations, increasedfees for my forensic evaluations, increasedvisits for patients on medications, and thedevelopment of novel services, e.g., per-forming medication case reviews for insur-ance companies of patients that they sus-pect are not getting the right medications.With RxP training one can expect seeingincreased revenues from the above sourcesas well as any number of other areasdepending upon geographical location,type of practice and other training.However, no matter how one looks at theissue, RxP training will allow one to recouptheir investment. I know that there aresome critics who believe that this is themain thrust for prescriptive authority. Thefact that we can recoup our investment isgreat. There should be no shame in earninga good honest living. The fact that RxP alsopays is just another added value.

REDUCED TREATMENT COSTSOverall treatment costs, whether paid byan insurance carrier, employer or individ-ual, can be significantly reduced when apsychologists is trained in psychopharma-cology. RxP training greatly reduces over-

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all office visits to physicians because thepatient gets diagnosed appropriately andquicker. They get an appropriate recom-mendation for medications, when neces-sary. Many studies have already demon-strated that it can take a significant amountof time for general practitioners to correctlydiagnose and subsequently appropriatelytreat patients with depression and anxiety.The costs associated with this no doubt aresignificant.

If one were to factor all the costs, includingthe impact on the national economy fromabsenteeism and other down time, wecould probably fund and extend full healthinsurance coverage to the uncovered fromthese savings. RxP training has the poten-tial to significantly reduce the costs associ-ated with bad diagnoses and adverse drugevents associated with medication errors,which is estimated by the FDA to be in therange of 72 billion to 120 billion dollarsannually. RxP training can significantlyreduce costs associated with symptomsresulting from side effects from polypharma-cy and inappropriate medication regimens.

RxP training can significantly reduce over-all costs for mental health because those sotrained know when medications are appro-priate. For the year ending 2001, the com-bined costs for all medications in theUnited States exceeded 132 billion dollars.RxP trained psychologists can significantlyreduce this expenditure because experi-ence shows that we tend to recommendreducing or discontinuing overall use ofpsychotropic medications. In practice, thiscan also equate to better efficiency andeffectiveness. Its a “win-win” situation.

In conclusion, from whatever perspectiveone looks at the issue, RxP training pre-sents a lot of added value to any psycholo-gist choosing to make the relatively smallsacrifice associated with training. Thegains to patients, practitioners, psychology,and society as a whole, can be significant.Although I have addressed only a few ofthe issues associated with the value of RxPtraining, I am sure that many more willsurface as we proceed to enter into an areathat is the proper domain of psychology.The public interest is served with RxP andI strongly recommend and advocate to allpsychologists that they take the time toinvestigate the many programs now avail-able to become trained and gain a profi-ciency in an area vital to our patients andprofession

REFERENCESReducing and Preventing Adverse DrugEvents to Decrease Hospital Costs.Research in Action. Issue Number 1.Agency for Health Care Policy andResearch, Rockville, MD. Center forResearch Dissemination and Liaison.

Testimony on Medical Errors:Understanding Adverse Drug Events by Janet Woodcock Director, Center for Drug Evaluation andResearch, Food and Drug AdministrationU.S. Department of Health and HumanServices. Before the Senate Committee onHealth, Education, Labor, and Pensions.February 1, 2000.

Health Financing and Public Health IssuesU.S. General Accounting OfficeFebruary 1, 2000

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The APA Council of Representatives meton February 14 and 15, 2003 inWashington, DC. Dr. Alice Chang, Dr. JackWiggins, and myself — the Division 29team — represented the Division ofPsychotherapy.

The original plan called for a 20-hourpacked agenda across three days; however,a raging snowstorm reduced it to 16 hoursacross two days. We managed to escapethe ravages of the weather on Saturdayafternoon, but many of our colleagueswere not as fortunate. They were strandedin the District of Columbia for two addi-tional days due to airport closings.

Here are 10 highlights of Council’s agendaand actions:

• Heard President Bob Strernberg reviewhis 2003 initiatives, principally his cen-tral priority of fostering unity withinpsychology.

• Applauded Dr. Norm Anderson’sapproach to his new position as APACEO.

• Reaffirmed APA’s commitment to thedesignation of health-service psycholo-gists as primary health care providers in relevant regulations and in fundingprograms.

• Approved the final 2003 APA budgetcontaining a modest surplus, after sever-al years of serious deficits.

• Devoted several hours of discussion toAPA’s financial situation and to therecognition that the reduced number ofAPA staff will not be able to accomplishas much as in prior years.

• Approved the recognition of SportPsychology as a proficiency and theAssessment & Treatment of SeriousMental Illness as a proficiency in profes-sional psychology.

• Honored psychologist Dr. DanielKahneman for his recent receipt of theNobel prize in economics.

• Approved the impressive refinancing ofAPA’s two Washington, DC buildings atlower mortgage rates.

• Held extended discussions in Counciland in the breakout groups on the con-tinued plans for a shorter APA conven-tion and cluster programming.

• Discussed plans for the 2004 APA con-vention to be held in Hawaii. Now isthe time to prepare for this excitingopportunity in July 2004!

As always, please contact Alice, Jack, ormyself directly ([email protected]) ifyou would like to speak about the actionsand directions of the APA Council ofRepresentatives.

APA COUNCIL REPORT

Report on APA Council Meeting of February 14–15, 2003

By John C. Norcross, Ph.D.Council Representative Division 29

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DIVISION 29 SOCIAL HOUR

Jim Calhoun, Marv Goldfried, Georgia Calhoun, John Dagley, Clara Hill, Andy Horne,Linda Campbell, Louis Castonguay, and Charles Gelso

John Norcross and Don Freedheim

Larry Beer and Bob ResnickMatty Canter and Harry Wexler

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Ronald F. Levant, Ed.D., A.B.P.P., is a candi-date for APA President. He is in his secondterm as Recording Secretary of the AmericanPsychological Association. He was the Chair ofthe APA Committee for the Advancement ofProfessional Practice (CAPP) from 1993-95, amember of the Board of Directors of Division 29(1991-94), a member at large of the APA Boardof Directors (1995-97), and APA RecordingSecretary (1998-2000). He is Dean, Center forPsychological Studies, Nova SoutheasternUniversity, Fort Lauderdale, FL.

Psychologists seeking to obtain a license inanother state, whether for purpose of relocation, for a multi-state practice, or forengaging in tele-health, might find them-selves facing a real nightmare. The Boardof Psychology in the new state might askthe psychologist to jump over many hurdles,such as producing notarized supervisionforms, when some of the supervisors haveretired or passed on. As former APAPresident Pat DeLeon (2000) has observed,“few psychologists realize how difficult itis to get relicensed in a new state.”

The problem arises because each statedetermines the qualifications for profes-sional licensure. By 1977, all states hadenacted a psychology licensure law, however with a great deal of variation inthe requirements. The APA PracticeDirectorate, using the APA ModelLicensure law, has attempted to reducesome of this variation in order to promotemobility. However, many variations remain.

Other professions have addressed thisproblem. The National Council of State

Boards of Nursing has endorsed a modelbased on the driver’s license, in whichmechanisms exist for mutual recognitionand reciprocity. Licensure is recognizedacross state lines, with the nurse subject tothe laws and rules of the new state. So too,the pharmacists facilitate mobility throughuniform licensure requirements and aclearinghouse program which transfers thepharmacists license to the new state, verifying background information andscreening for disciplinary actions.

APA has been attempting to address thisproblem. The APA Council of Representa-tives at the February 2001 meeting gaveformal approval to an ongoing strategicplan developed by the Committee for theAdvancement of Professional Practice(CAPP) for helping to provide a climatewithin which existing mechanisms for pro-fessional mobility can continue to develop.

CAPP, at Council’s request, had beenimplementing a strategic plan to provide asupportive environment for giving visibilityto the existing mechanisms for professionalmobility available through the NationalRegister of Health Service Providers inPsychology (National Register), theAssociation of State and ProvincialPsychology Boards (ASPPB), and theAmerican Board of ProfessionalPsychology (ABPP). CAPP conducted pro-grams at the annual State LeadershipConference, disseminated invited articlesto state and provisional psychologicalassociation newsletters, and took otherstrategic actions. In February, Councilapproved the continuation of this plan, andas a result, additional articles on the statusof the various mobility mechanisms have

PRACTITIONER REPORT

The Problem of Licensure MobilityRonald F. Levant, Ed.D., ABPPNova Southeastern UniversityAPA Recording Secretary

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been, and will continue to be published, asappropriate, in APA and PracticeDirectorate publications (e.g., Smith, 2001,Sullivan, 2000-01), additional conferenceprograms will be arranged, and meetingsamong parties of interest will be facilitated.In addition, the author and Jay Benedict,Associate Editors of the journal,Professional Psychology: Research andPractice, are preparing a special section onthis issue.

BACKGROUND

The information in this section of the col-umn has been drawn from various APAgovernance documents. In February 2000Council suspended its rules and approveda new business item, titled “Reciprocity ofLicensure Among States”, introduced byDr’s. Carol Goodheart, Ron Levant, and 20other Council Representatives. This itemaffirmed that the attainment of reciprocityof licensure and other mechanisms for pro-fessional mobility are urgently needed. Itdirected CAPP, as the lead group, and BPAto work in collaboration with ASPPB todevelop a plan to achieve this goal.

In March, 2000, CAPP and the PracticeDirectorate made time available before thestart of the State Leadership Conference forrepresentatives of state psychology licens-ing boards and state psychological associa-tions to meet to discuss mobility, in aforum coordinated by ASPPB. This wasthe second consecutive year for this partic-ular forum.

At its meeting later in March, 2000, CAPPdiscussed the Council item and decided toconvene a conference call among represen-tatives of CAPP, BPA, and ASPPB to deter-mine what would be most helpful in pro-moting mobility. This call took place inJune, 2000. It highlighted several relevantissues, including the type of support thatAPA could provide, the potential implica-tions of technology changes and tele-healthfor licensure, and the recognition that otherorganizations have also developed initia-tives to facilitate licensure for psycholo-

gists moving to different states. Of consid-erable importance, the participants on thecall noted that there are two differentmechanisms for promoting professionalmobility: Reciprocity, which refers toagreements between jurisdictions in whichstates are willing to recognize each other’slicensees based on comparable require-ments for licensure, and Endorsement,which is a vehicle to recognize individualsas having met a high standard qualifica-tion, such as the Certificate of ProfessionalQualification (CPQ) developed by ASPPBwhich is accepted by jurisdictions as meet-ing most of the qualifications for licensure.In the past 10 years only 10 states haveentered into reciprocity agreements. Thismakes endorsement the more promisingmechanism for promoting mobility sincemore than two dozen states are in variousstages of recognizing the more recentlydeveloped CPQ.

In July, 2000, CAPP continued discussionof this issue with representatives of ASPPBand the National Register. CAPP noted thatdecisions about licensure reciprocity andmobility are not the province of APA butrather of state and provincial psychologyboards. CAPP also noted that BPA has awork group examining tele-health issues,and that these issues are clearly relevant toany consideration of reciprocity and mobil-ity. CAPP felt that it could take two addi-tional actions supportive of reciprocity andmobility at the present time: 1) provide aclimate and create an environment inwhich existing mechanisms for mobilitycan flourish, by informing members aboutthe various mechanisms for mobilityoffered by ASPPB, the National Register,and the American Board of ProfessionalPsychology (ABPP); 2) inform Council ofthe distinctions between reciprocity andendorsement, and the status of the latter asbeing the mobility mechanism more wide-ly accepted by states and provinces.

As part of providing a climate to supportexisting mechanisms for mobility, CAPPoffered to compile and disseminate to stateand provincial psychological associations

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(SPPAs) invited articles written by ABPP,ASPPB, and the National Register aboutthe various mechanisms and initiativeseach has developed to promote licensurereciprocity and mobility. Each of the organi-zations was contacted and agreed to preparea brief article suitable for publication inSPPA newsletters. These 3 articles were circulated in September, 2000, and have beenreprinted in various SPPA newsletters.

In October, 2000, CAPP reviewed theprogress made in publicizing the variousmechanisms for promoting mobility andthe increasing acceptance which thesemechanisms are receiving, and decidedthat a continuation of the current strategywould be recommended to the Board andCouncil. In December, 2000, the Board ofDirectors approved the strategic plan pre-pared by CAPP.

MECHANISMS TO MOBILITY:IMPLICATIONS FOR PRACTITIONERS

At this point in time it seems clear that theneed for mobility for psychologists willcontinue to increase. However, since we

really don’t know how events will unfoldin the future, all of the vehicles for increas-ing psychologists’ mobility should be sup-ported. We need all of our “oars in thewater,” so to speak. Readers are encour-aged to contact the sponsoring organiza-tions to learn more about each of themobility mechanisms: the NationalRegister, the ASPPB , and ABPP.

As always, I welcome your thoughts onthis column. You can most easily contactme via email: [email protected].

REFERENCES

DeLeon, P. (2000). The critical need forlicensure mobility. Monitor on Psychology,31(4), 9.

Smith, D. (2001, May). Helping psycholo-gists on the move: States and provincesmake professional mobility easier forpsychologists. Monitor on Psychology,32(5), 73.

Sullivan, M. J. (2000-2001, Winter).Directorate helps to promote mecha-nisms for mobility. Practitioner Focus, 13,4, 16.

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DIVISION 29 MEMBER GATHERING

Matty Canter and Alice Rubenstein

Larry Beer, Shirley Glass, and Leon Hoffman

Jeffrey Barnett and Cynthia Sturm

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If I were to ask you, what is it you do on aregular or irregular basis to become theperson you can become? In other words,what is it you do to helps you grow ordevelop as a person? Is there some particularthing or activity that aids you in what somemight call—personal transformation? Thenagain, maybe this question has little mean-ing to you since you do not practice orengage in any transformational activity?Whatever your reply, I invite you to read thisinterview and consider the possibilities ofa new development in understanding andenhancing personal self-transformation.Whether you are somewhat interested orgenuinely curious, I hope you at least takea moment to consider these ideas herein asjust another possibility how one canengage in a kind of self-transformation.

As you will learn from this interview, Dr. Alvin Mahrer is confident that each oneof us can learn a great deal about who andwhat we can be, by having our own thera-peutic session. The method describedbelow is based on years of his extensivework in experiential psychotherapy cumu-lating in his current work Becoming ThePerson You Can Become: The Complete GuideTo Self Transformation (Bull Publishing,2001). For Alvin Mahrer, this way of hav-ing an experiential session is just anotheroption for personal transformation. Hisencouraging confidence simply invitesothers to discover what he himself hasfound helpful.

Alvin R. Mahrer is a Professor Emeritus ofthe School of Psychology, at University ofOttawa. He is the author or 12 books andmore than 200 publications. Recently he

has been acknowledged as one of the“Living Legends in Psychotherapy” andrecipient of the American PsychologicalAssociation Division of Psychotherapy’sDistinguished Psychologist Award. Dr.Mahrer is “internationally renowned eitheras a visionary or as psychotherapy’s DonQuixote.” His endeavors in personalitytheory, psychotherapeutic training, experi-ential psychotherapy and more recent ses-sions of self-transformation are alwaysthought provoking and innovative.

(HG = Howard GontovnickAM = Dr. Alvin Mahrer)

HG: Dr. Mahrer, for the past few years youhave been working with a four stepmethod to help a person have their ownsession during which they could discoverwhat they have the capability of becom-ing? This being the case, what was yourthinking behind this idea of having one’sown therapy session alone? And could youdescribe what is involved in order for oneto do this?AM: Let me see, I have a session by myselffor two reasons. First, I think it is possiblefor me to become much more the kind ofperson I’m capable of becoming. In thisway, I would like to be a qualitatively newperson. Does this make sense to you?HG: So far, so good. AM: I want to have my own session and bythe end of that time I hope I can become alot more of this kind of person —whateverit is—that I am capable of becoming. Thatmeans I am willing to become a whole newperson if that what happens. That’s onething. The other is, there are all sorts oftimes when I feel rotten, I mean really rot-

FEATURE

In Conversation With Dr. Al Mahrer:Innovations in psychotherapy - having your own therapeutic session

Howard Gontovnick, Ph.D.

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ten, scared, depressed or something. I havelots of ways I can feel terrible. And when Iam done with a session, what I want to dois to be free of those times when I feel sorotten. If those scenes or if those times arestill in my life, like crossing a street or driving a car or something, I do not want tohave such rotten feelings in those scenes.So those are the two things I want toaccomplish in every single session. HG: Here is what I understand so far. I canpicture you teaching a group of people justhow to discover a deeper quality aboutthemselves. An important considerationand question you ask these people is—arethey ready and willing to really do this?Would they like to become a whole newperson? It also seems clear, that by havingthis kind of session, a person can learn howto eliminate an awful feeling that has beenassociated with a particular past scene?How is this done?AM: In each session or a time when youwould set aside to do this, one of the firstthings that you can do is to close your eyes,sit back and look deep down inside your-self and find qualities, things about orthings that are possible for you to experi-ence. Things you weren’t even aware ofand that’s the first maybe scary thing youdiscover something about yourself. Here isan example from a session that I’ve justhad by myself a couple weeks ago. At thattime, I came across a sense, a quality, possi-bility in me of being really alone by myself,away from people, totally isolated. Thiswas one thing that scared me and was sortof new. And that’s the first thing you do ina session. You discover something that youprobably did not know about, a feeling thatis new and different. Something you areable to undergo, to experience. It is akin toan opportunity to be different.HG: As I think about what you have justsaid, a question comes to mind that I amsure is often asked. What about the scenariowhen there is a person who is inexperi-enced or unprepared to discover somethingabout them self? Is there a sense of hesitancyor scariness to change such a situation?

AM: Your question is one that I have oftenhere when I speak in public or every nowand then it pops up at the workshops I givein other different countries. They often say,“that’s scary right?” And all I can do is saylook; if the whole idea of probing downwithin yourself and discovering somethingthat you don’t know is deep inside you isscary, then maybe you shouldn’t do it. Youdon’t have to do it. If it’s scary to you stayaway from it. I’m not forcing people to dothis, but rather it’s like as an opportunity. Ifyou are interested in discovering moreabout your self and your own abilities,then this may be something for you.HG: Very simply, what you are talkingabout is an opportunity for a person to learnhow to help them self and that’s all. Thisbeing the case, let’s talk more specifically onthe method. How does one actually goabout doing this?AM: The best place to start learning abouthaving your own session is to read my newbook: Becoming The Person You Can Become—The Complete Guide to Self Transformation(Bull Publishing, 2001). In the first step,you will use scenes of strong feelings todiscover something deeper inside you, likethe quality I discovered in my session ofbeing really alone. It was something likebeing separated or apart from everyone.Being all by your self. This is somethingthat I discovered a couple of weeks ago inme. That was the first step. In the secondstep, after discovering this new quality youtry to welcome this new feeling by puttingyour arms around this quality and saying;“my God, you’re not so bad”—“I like thisnew quality.” It is a big step to at leastadmit that there is something like that isdeeper inside you. You probably spentyour whole life hiding it, or not knowinganything about it. Well now you have achance to say, “hello, I know you, you’repretty nice, I like you.” This then becomesan opportunity for you to kind of acceptthis new quality you discovered. Now,does that make any sense?

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HG: Yes, in the first two steps you discov-er a new and deeper quality about one self,followed by a time to get to know what it islike to be this way. To welcome this newaspect as a real part of who one is and thepossibility of what can be. So let’s go on tothe third next step.AM: OK, in the next step the person havinga session is going to have do something really big. Here is where you have to let goof who you are, while you get ready toplayfully wallow in or throw yourself intobecoming what you had previously discov-ered deeper inside you. And you do that inthe context of past scenes of situations thatmay have happened yesterday, last week, oreven two years ago or earlier in your life.HG: In other words, you are looking forsome past time when you might have beenlike this or maybe a little like this newlydiscovered quality. Is that what your saying? AM: Yes, your right. You have to essentiallylet go of the kind of person you are anddrench yourself, wallow, play being, thiswhole other person that you discoveredearlier. That’s the third step. Ok?HG: Yes. Now I guess everything comestogether in the fourth and final step?AM: That’s right. The forth step is the lastone. Now at this point you’re being awhole new person and your ready toessentially face the world outside the roomthat you are in. In this step you can live inspecially created moments when you seewhat it is like to actually be this way in sit-uations more in line with your actualworld. In this step, you have an opportuni-ty to pretend and experience what it is likebeing this whole new person in a realworld. Whether it is 10 minutes after youopen your eyes or an hour after the session,the experience of what it’s like, what it canbe like to be a whole new person in a real-istic setting is a very powerful event! Forexample, to experience being this newlydiscovered quality of someone who lovesto be alone, being all by them self in thisplayful reality provides a taste of what it islike to actually be this qualitatively newperson. Being separated from everybody

or whatever you find inside you in the realworld. For a few minutes, or forever. And ifyou could do this and do it well, then bythe end of that session whatever scene youstarted with originally that may have beenscary or frightening, bothersome and madeyou feel rotten, will disappear. The badfeeling is gone—it’s out of your world, fin-ished. You’re really a totally new changedperson. Now I’m scaring myself, that reallyambitious isn’t? Its being totally trans-formed to whatever extent your ready tobe totally transformed in one session. Tobecome this way, you would playfullypractice being this new person within thecontext of some imagined situation whereyou are this way. You would create thesepossible hypothetical scenarios while havingthe opportunity to live in these circum-stances. To practice being this way and seeing what it is like to be this new person. HG: I’m intrigued, what a powerful andtransforming exercise. How would a personlearn to do something like this?AM: Right now there are several ways tolearn how to have a session by and for one-self. First and most important way, is oneshould read “Becoming The Person YouCan Become..,” this is essential. Otheroptions such as attending a workshopwhere someone will show you how to havea session or listening to audio-tapes ofsomeone having a session can be enhance-ments, once you have first read the book. HG: That sounds easy enough. Yet how doI know if I am going about having a sessionin the right manner?AM: Once you have tried having your ownsession, a nice thing that a lot of people dois to send me an audio recording of the ses-sion. I will listen to tape and then send mycomments back to you with things like youdid this pretty well. Or you didn’t do thispretty well try this. That’s what I can do tohelp you learn how to do this.HG: Looking ahead in the future at a hypothetical situation. What if this idea ofhaving a session were to become quitepopular and really take off, would the roleof the psychotherapists become obsolete?

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AM: Let me tell you what I think. I train doc-toral students and give workshops wherethere are a lot of professionals, social workers,psychologist, psychiatrist, etc. And my firstinvitation is—instead of doing therapy onyour clients or patients, how about doingsomething to make you feel better. To helpyou become what you can become. So thefirst thing I want to do, is to take all the ther-apists in the world and see how many ofthem want to learn how to have their ownexperiential sessions. That’s the first thing.More importantly, I would really like a fairproportion of psychotherapists to start hav-ing their own experiential sessions for therest of their lives. And that’s a lot of peoplelearning how to have their own experientialsessions. Look, if you don’t like the idea ofhaving your own experiential session thenmaybe something else appeals to you. Maybeyou would like to learn how to do medita-tion or something else you can do regularlyby yourself so that you can really feel betterand become whatever sort of person you arecapable of becoming. Not feeling so rotten,scared, depressed, tense or whatever it is.HG: All this considered, how did you comeabout developing this? How did it come toyou?AM: This new method didn’t just come out

of the blue, it kind of evolved over time.During my university years, when in thedoctoral program I wasn’t so concernedabout becoming a psychotherapist. I wentinto the psychology program to discoverhow to feel better. So from the beginning Ijust wanted to find some way I could learnto feel better and become whatever I amcapable of becoming. HG: If you could isolate one importantoutcome of having your own session, whatwould, should or could it be?AM: If I had to choose one goal? It wouldbe to enable the person, in each session, tobecome more of the person that the personis capable of becoming. Find a deeperpotential for experiencing, and allow it tobecome an integral part of a qualitativelynew person.HG: If a person was interested in contact-ing you with comments or questions, howcould they go about it?AM: Please write to Dr. Alvin R. Mahrer,School of Psychology, University of Ottawa,Ottawa, Ontario, K1N 6N5 Canada. Or e-mail: [email protected]: Thank you for taking the time to talkabout this and explain your current work.Now, I think I am ready and willing to goand have my own experiential session.

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

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DIVISION 29 MID-WINTER MEETING

Alice Chang, NormanAbeles, and John Norcross

Tracey Martin, JohnNorcross and Jean Carter

John Norcross, LeonVandeCreek, Wade Silverman, Pat Bricklin and Matty Canter

Kal Heller,Andy Steinbrecher,

and Bob Resnick

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Dr. Katz is a staff psychologist at the LongBeach VA Medical Center‚s, women‚s healthclinic. She is the military sexual trauma coordi-nator and specializes in treating issues of trau-ma. She is currently writing a book,"Holographic Reprocessing: A cognitive-expe-riential psychotherapy for the treatment oftrauma" which will be published by Brunner-Routledge in 2004. She may be reached at:[email protected]

Clinical coaching is a paradigm for supervi-sion designed to address evaluative aspectsof traditional supervision that can interferewith training. Eight pre-doctoral interns(seven female, one male) and twopracticum students (one female, one male)from university-based psychology trainingprograms gave verbal and written commentsabout their opinion of clinical supervision.Although this is a small sample of trainees,five of them independently voiced thatthey felt they were in a double bind asrecipients of clinical supervision. On the onehand, they needed to appear competentsince they were being evaluated, and yeton the other hand, they needed help fromtheir supervisors. This conflict promotedanxiety and a constriction of self-expres-sion. Trainees also reported feeling unsafeto personally disclose or disagree withsome supervisors.

Trainee: ”I felt that downplaying the personallydifficult aspects of being a therapist(e.g., lack of confidence and feelingsof counter-transference) was necessaryto earn positive evaluations. I feltthat I could not express my truethoughts and feelings about mywork, my patients or the quality ofthe supervision that I was receivingfor fear of being perceived negatively.”

The ten trainees have had multiple super-visors and felt that regardless of therapeuticorientation, their supervisor’s personalitywas the most important factor in makingthe experience more or less comfortable.Outcome studies on supervision concurthat the quality of the supervisory relation-ship is the most important factor to predicteffectiveness of supervision (Unger, 1996;Kilminster & Jolly, 2000; Sloan, 1999;Shanfield, Heatherly, & Matthews, 2001).There appears to be two categories ofattributes that predict positive outcomes:1) trainees feel a sense of autonomy, control,and input into their training (Unger, 1996;Kilminster & Jolly 2000), and 2) supervisorsare supportive, committed to supervision,good listeners as well as provide knowledgeand guidance (Sloan, 1996; Shanfield,Heatherly & Matthews, 2001).

The proposed paradigm of clinical coachingincorporates these positive outcome find-ings by shifting the role of passive traineeto an active participant in the trainingprocess and shifting the role of supervisorto that of a coach. Coaching as a form oftraining is not new and is traditionallythought of as a model to train athletes.Typically, the athlete engages in a sportwhile the coach advises, trains, and givesfeedback to the athlete. A coach recognizesthat athletes have different strengths andweaknesses and encourages each athlete toachieve his or her personal best. Similarly,in training psychology students, what istaught depends on the uniqueness of thetrainee. Clinical coaching allows trainees toenhance their own identity, style, andskills. This is particularly important formore advanced trainees such as pre andpost-doctoral interns who are transitioningto an independent professional role.

FEATURE

Clinical Coaching: A paradigm for supervision

Lori S. Katz, Ph.D.

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Clinical coaching can best be understood incontrast to traditional models of training,namely supervision and mentoring. Thedefinition of a supervisor in the RandomHouse College dictionary is “a person whois responsible for and oversees a process,work, or workers during a performance.”A supervisor monitors, evaluates, andmakes sure there are no difficulties orproblems. A supervisor ensures that cer-tain minimal standards or criteria are met.The goal for a supervisor is for a trainee tomeet the requirements for competency aswell as to handle clinical issues in a satis-factory manner.

A mentor is defined in the Random HouseCollege dictionary as “a wise entrustedcounselor, advisor, guide, or guru.” A men-tor cultivates a “watch me-follow me” or“be like me” relationship. This is similar toan apprentice model where a novice ispaired with a highly skilled person to learna trade. A trainee and mentor may co-lead agroup or therapy session where the traineeobserves the master and then emulates himor her. The mentor may correct the traineeby saying how he or she would have doneit differently. The goal for a mentor is oneof emulation.

It may seem that the difference betweencoaching and these other styles is merelysemantic. However, to make such anassumption denies the impact of thesewords. “Supervisor” and “mentor” assumea hierarchical relationship that can easilybe entrenched in criticism, evaluation, anddomination. These roles make traineescompliant, passive, and submissive and bythe nature of the relationship, may hinderindependent thought. In contrast, clinicalcoaching assumes a mutually accountablerelationship where both participantsactively create the experience of education.The role of coach as “educator” is wellsummarized in Paulo Freire’s “Pedagogy ofthe oppressed” (1997), “(The educator’s) effortsmust coincide with those of the students toengage in critical thinking and the quest for

mutual humanization. (The educator’s) effortsmust be imbued with a profound trust in peopleand their creative power. To achieve this, they mustbe partners of the students in their relationswith them.”

Of course, it is appropriate for a clinicalcoach to incorporate aspects of traditionalclinical supervision and mentoring.However, these can be added in a contextof mutual agreement without the addedpressures associated with the other stylesby emphasizing individual developmentand valuing the trainee’s personal experi-ence. For example, it is appropriate for acoach to supervise and ensure certain criteriaare met. As in sports, clinical trainees mustfollow certain rules and standards in orderto participate. Also, it is appropriate for acoach to model techniques for a trainee toobserve and emulate, but not demand thatthis is the only or best technique. Whitman& Jacobs (1998) stated that supervisors haveto balance the hierarchical and collaborativeaspects of the supervisory relationship. Theysuggest offering evaluations in an educa-tional framework and for supervisors toresponsibly self-examine their supervisionto foster this balance.

Coach: “Two interns were struggling to par-ticipate in a group that we co-ledbecause they felt too intimidated to“perform.” I asked them to imaginethat they hired a coach to give thempointers. I said, ‘think of me as yourclinical coach. I am here for your ben-efit, so take advantage of all that I canoffer you. I am working for you.’This simple reframe, empowered thetrainees to take a more active role intheir training.”

HOW TO BE A CLINICAL COACH, FROM THE PERSPECTIVE OFHOLOGRAPHIC REPROCESSING

Holographic Reprocessing (HR) (Katz,2001) is a cognitive-experiential psy-chotherapy, based on Epstein’s cognitiveexperiential self-theory that distinguishes

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two processing systems: the rational sys-tem (logical and linear) and the experien-tial system (imagistic, associative, andemotional) (see Epstein, 1991, 1998). InHR, information about maladaptive pat-terns is accessed and reprocessed in theexperiential system. HR supports a coach-ing approach to supervision as it focuseson the experience of the client and pro-motes individuality and creativity on thepart of the trainee. The HR clinical coachfocuses on training the following five steps:

Step 1: Teach the “Don’t Know” attitudeStep 2: Teach how to be an “Experiencing

Therapist”Step 3: Teach how to “listen instead of fix”Step 4: Teach how to “elicit information” Step 5: Encourage trainees to develop their

own techniques

1) The “Don’t Know” attitude. Novicetherapists are often afraid of beingfound out that they really do not knowwhat to do. In HR, “not knowing” isreframed as a strength. Adopting theDon’t Know attitude encourages thera-pists to focus on generating questionsrather than on producing answers (orlooking good, competent, and all-know-ing).

“Trainees are asked to imagine that they aredriving in a place where they are

not sure which direction to go. What do they do? They pay attention, ask for

directions, and explore different routes. When lost in therapy, it is the perfect

opportunity to pay attention, ask questions,and explore different routes.”

2) The Experiencing Therapist. If traineesadopt the Don’t Know attitude, then they need to rely on “road signs” along the therapy path for guidance. TheExperiencing Therapist reads thesesigns by staying in the moment andsensing, feeling, imagining, and associ-ating right along with the client. Thisfacilitates rapport and deepens the level

of communication.3) Listening instead of fixing. Instead of

quickly addressing presenting symp-toms, trainees are coached to resist theurge to fix or be helpful in the first fewsessions. Instead, trainees are taught tolisten and label the communication thatis being presented. For example, traineesare asked to discern if a client’s commu-nication is about an implicit belief, acompensation strategy, or an avoidancestrategy.

4) Eliciting information. Clients may notbe able to verbally communicate signifi-cant information that keeps themblocked or trapped in maladaptive pat-terns. HR coaching encourages thera-pists to elicit such information, byexploring emotions, images, and associ-ations experienced by the client.According to HR, therapists can focus onhere and now events or events fromchildhood as both sets of events wouldbare a similar “fingerprint” or repeatingtheme of a maladaptive pattern.

5) Techniques. Choosing which techniqueto use and when is part of developingclinical instinct as well as personal style.Trainees are encouraged to learn a varietyof clinical techniques as well as to createvariations of their own using informationthat is relevant for the client (i.e., theirown images, metaphors, and assign-ments). This encourages trainees to listenand be present, rather than focusing on“performing.”

Other Coaching Tips:1. Offer feedback on a frequent basis. A

coach offers feedback on a frequentbasis. Constructive feedback is honest,direct, and couched in a growth-orientedcontext without judgment. Positive feed-back is also valuable and a coach can begenerous with both.

2. Explore trainees’ experience of beingcoached. Ask trainees about their expe-rience of being coached. Encourage per-

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sonal reflection and ask how their train-ing can be enhanced.

3. Explore supervisors’ experience ofbeing a coach. The supervisor’s experi-ence is often overlooked, as typicallythere are no structured opportunities fordiscussion, reflection, or exchange ofideas. Ideally, training programs wouldfacilitate this. Nonetheless, clinicalcoaches have the responsibility toengage in self-reflection and seek toimprove their coaching skills.

4. Show respect for cultural contexts andpersonal differences/preferences.

Everyone has a different set of life experi-ences and someone else’s preferences orthe meaning of someone’s actions cannotbe assumed.

Trainee: “Instead of making assumptionsabout me (and my culture), and thenimposing those assumptions on mytraining, I appreciated when my(coach) made an effort to find out myperspective.”

In conclusion, clinical coaching is offeredas a paradigm that values collaborationand mutual respect. Both coach and traineeare responsible and accountable for thetraining experience. The success of thismodel depends on both participants’ will-ingness to actively participate, give andreceive feedback, seek opportunities forskill enhancement, and engage in self-examination of one’s own performance.

REFERENCESFreire, P. (1997). Pedagogy of the

oppressed. The Continuum publishingcompany, New York.

Epstein, S. (1991). Epstein, S. (1991).Cognitive-Experiential Self-theory: Anintegrative theory of personality. In R.Curtis (Ed.), The relational self:Convergences in psychoanalysis and socialpsychology (pp. 111-137). New York:Guilford Press.

Epstein, S. (1998). Cognitive-experientialself-theory: A dual-process personalitytheory with implications for diagnosisand psychotherapy. In Bornstein andMasling (Ed.), Empirical perspectives onthe psychoanalytic unconscious (pp. 99-140). Washington DC: APA.

Katz, L. (2001). Holographic reprocessing:A cognitive-experiential psychotherapy,Psychotherapy, 38(2), 186-197.

Kilminster, S.M., and Jolly, B.C. (2000).Effective supervision in clinical practicesettings: a literature review, MedicalEducation, 34(10): 827-840.

Shanfield, S.B., Hetherly, V.V., andMatthews, K.L. (2001). Excellent super-vision: the residents’ perspective,Journal of Psychotherapy Practice andResearch, 10(1): 23-27

Sloan, G. (1999). Good characteristics of aclinical supervisor: A community men-tal health nurse perspective, Journal ofAdvanced Nursing, Sep; 30(3):713-722.

Unger, D.B. (1996). Core problems in clinicalsupervision: Factors related to outcome,Dissertation Abstracts International, 56(11-B): p. 6411.

Whitman S.M. and Jacobs, E.G. (1998).Responsibilities of the psychotherapysupervisor, American Journal ofPsychotherapy, 52(2): 166-175.

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William Fishburn, Ph.D.

I am especially honored to be a president-elect nominee for Division 29. I seek yoursupport and vote in order that I may pro-vide a continuation of the outstanding pastpresident leadership. I want to promote thestrongest possible role for Division 29 inAPA and in the larger public sector inissues essential for the involvement anddevelopment of doctoral level psychologistpsychotherapists. I will promote psy-chotherapy contributions to the well beingand quality of life in health service, per-sonal growth and development experi-ences, specific problem resolution, andspecific behavioral changes. I am commit-ted to Division 29 as the primary voice forthe integration of psychotherapy practice,training, and research in APA. It is imper-ative that we are involved in a concertedpublic relations/educational effort toinform the public that psychotherapy isbetter provided by well-trained doctorallevel psychologist psychotherapists.Psychotherapy must be a covered servicein all managed care activities and propos-als. The assurance of the highest quality ofpatient care is directly related to patientfreedom of choice of doctoral psychologistpsychotherapists. We must be proactive ininforming the public, state, national, andlocal policy makers about the contributionsof professional psychologists and the man-ner in which we use our unique clinicalskills in diagnosis and treatment. Division29 leadership must be aware of andencourage an ever-expanding role for psy-chologists and psychotherapists in diverseand non-traditional settings.

It is essential that psychotherapists be sen-sitive to issues of cultural diversity. As apsychotherapist in a state known for itsdiversity, I have been involved in the pro-motion of professional psychology by fre-quent radio, TV, and print media appear-

ances focused on criticalsocietal issues and pro-fessional psychology andpsychotherapy practice.Psychotherapy as anessential foundationalbase of practice must bepreserved and enhanced.Divisional leadership must be responsiveto membership issues and concerns. Iencourage the active involvement of allmembers in asserting the strongest possi-ble role in the development and implemen-tation of member contributed proposals,ideas and visions to achieve the goals ofDivision 29. This can be optimally accom-plished through town hall meetings anddirect contact with divisional leaders.

My background and experience in leader-ship roles includes having been PastPresident and Charter Fellow in the NewMexico Psychological Association, PastPresident and Division 39 Representative ofthe New Mexico Psychoanalytic Society,Past President of the New Mexico GroupPsychotherapy Society. I have been an oralexaminer for the New Mexico Board ofPsychologist Examiners since 1973. I was afounder of and have been chief of the psy-chology section in the largest hospital com-plex in New Mexico. I have been a privatepractitioner specializing in psychotherapywith individuals, couples, families andgroups for 35 years. I have been activelyinvolved in Division 29 activities for over 20years. I have been Mid-Winter ConventionCoordinator, and served on the GoldenAnniversary Committee for Division 29. Iam a charter member of the NationalRegister. I am Professor Emeritus inCounseling Psychology at the University ofNew Mexico. I have the experience, energyand enthusiasm to provide active, involvedleadership for our Division and I respectfullyrequest your vote.

CANDIDATE STATEMENTS

PRESIDENT-ELECT

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Leon VandeCreek, Ph.D.

It is an honor to have been nominated torun for President Elect of Division 29.Psychotherapy is in the midst of a challenging struggle. On the one hand,psychotherapy offers wonderful opportu-nities for change for our patients, but onthe other hand, the reimbursement systemsin society press for ever shorter courses oftreatment and fewer options of care. TheDivision is in a good position to exerciseleadership in the training, research, andpractice of therapy.

If elected President Elect, I would work forthe following goals:

Fiscal Responsibility: For the past manyyears, the Division has spent money eachyear that should have been earmarked forthe next year. We have modified ouraccounting practices, and beginning in2004 the Division should be better able tosupport initiatives and again develop areserve fund.

Membership: The average age of our mem-bers is among the oldest of any divisions inAPA. Not surprising, we are losing mem-bers at a faster rate than we are gainingthem. We must continue the strong mem-bership drives of the last two years thathave increased the numbers of new mem-bers, especially student members.

What Do New Members Want? As weattract new and younger members, weneed to know how the Division can be ofservice to them. The needs of our agingmembership may not match well the inter-ests of newer and younger members.

Consider a Society of Psychotherapy:Many psychotherapists are not eligible formembership in Division 29. We shouldexplore shifting the Division into a societythat would permit a variety of membership

categories, includingthose who are membersof other professions, andthat would increase anddiversify our member-ship.

Theory, Research, Practice, and Training: We should increaseour attention to theory and research, andwe need to place much stronger emphasison training. Some of our members fearthat psychotherapy as we know it is losingground in training programs because oftheir needs to provide students withbroader training for the marketplace.

Sections in Division 29: Sections are per-mitted by our By-laws to create their owngovernance structures, levy assessments ontheir members, hold meetings, develop pro-gram proposals, and publish a newsletter. Iwould ask the Division to explore thedevelopment of Sections as a tool to in-crease membership and to sustain initiatives.

My experience in the Division includesMembership Chair, Board of Directors, andTreasurer. At the state and national levels, Ihave served as President (PennsylvaniaPsychological Association), Financial AffairsOfficer (Ohio Psychological Association),Member of the APA Council ofRepresentatives, Associate Member of theAPA Ethics Committee, Member of the APABoard of Educational Affairs (chair in 1999),and Member of the APA Insurance Trust(chair in 1997). I have been an author or co-author/editor of more than 90 journal arti-cles, book chapters and books and 70 profes-sional presentations. I served as Dean of theSchool of Professional Psychology at WrightState University, and I am currentlyemployed there as a Professor.

CANDIDATE STATEMENTS – PRESIDENT-ELECT, Continued

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Jan L. Culbertson, Ph.D.

Jan L. Culbertson is Professor of Pediatricsand Clinical Professor of Psychiatry &Behavioral Sciences at the University ofOklahoma Health Sciences Center(OUHSC), Oklahoma City, OK. She also isDirector of Neuropsychology Services atthe OUHSC Child Study Center. Shereceived her Ph.D. in psychology from theUniversity of Tennessee (Knoxville), andhad a faculty appointment in theDepartment of Pediatrics at VanderbiltUniversity School of Medicine prior tomoving to Oklahoma in 1982. Her leader-ship roles in APA include Secretary andPresident of Division 53 (Clinical ChildPsychology) when it was Section 1 ofDivision 12, Member-at-Large andPresident of Division 37 (Child, Youth, andFamily Services), and Secretary of Division54 (Society of Pediatric Psychology) whenit was Section V of Division 12. She wasappointed to the APA Committee onChildren, Youth, and Families 1998-2000,and served as Committee Chair in 2000.This was followed by an appointment tothe APA Working Group on Children’sMental Health in 2000-01, representing theBoard for the Advancement of Psychologyin the Public Interest. She was editor of theJournal of Clinical Child Psychology (1991-96)and the Child, Youth, and Family ServicesQuarterly (1986-90). She also served as

Program Chair ofDivision 29 in 2001. Herresearch has focused onneuropsychological func-tioning of children withcomplex learning disabil-ities, attention deficithyperactivity disorder,and pervasive developmental disorders.She is the author of numerous articles andco-editor of three books, and is an activeparticipant in presenting Division 12Postdoctoral Institutes and various othertraining seminars nationally and interna-tionally.

I am pleased to be nominated for treasurerof Division 29. My past involvement withthe Division has shown me that there aremany important initiatives and projects tobe carried out, and having a strong finan-cial base is imperative for realizing thesegoals. All APA Divisions are struggling atthis time to retain their membership, stemthe trend toward dwindling revenue, andstill maintain an active agenda of profes-sional activities. Division 29 has had strongfiscal leadership in the past and continuesto need this strong leadership in the future.I would be honored to help fulfill this rolein support of the Board and members ofDivision 29.

CANDIDATE STATEMENTS – TREASURER

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Jeffrey Younggren, Ph.D.

I very much appreciate being nominated torun for Treasurer of Division 29. As a full-time private practitioner in clinical andforensic psychology, I am committed toour profession and to the practice of psy-chotherapy. I believe I have demonstratedthat commitment in the past through mymembership on the APA EthicsCommittee, having chaired that committeein my final year, and now through mymembership on APA’s Committee onAccreditation. In addition to my clinicalpractice, I also work as a consultant to theAPA Insurance Trust where I provideworkshops throughout the country to ourcolleagues on risk management and thestandards of care. Finally, I am also on theclinical faculty of UCLA’s School ofMedicine where I supervise residents andprovide consultation services. My contri-butions to our profession have resulted inmy receiving fellow status in two divisionsof APA.

From a financial per-spective, I believe thatour Division, and APA,need to be prudent in themanagement of theirfinances. The expendi-ture of the Division’sfunds needs to be made with foresightsuch that the programs the divisionschooses to implement are those that are themost cost effective and of the greatest ben-efit to the most members. In addition, weneed to embark on a program to increasemembership and revenues in order tomake the division more effective in influ-encing APA policy. It is through member-ship and revenue growth that we can makesure that the division continues to be avibrant and effective force within our pro-fession. I believe that I am well qualified toserve as treasurer of Division 29.

CANDIDATE STATEMENTS – TREASURER, continued

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Susan Corrigan, Ph.D.

Division 29 has so much to offer psycholo-gists. From an excellent journal, local andnational presentations to excellence inteaching, research, and practice, we all participate in ensuring the future of psychotherapy. Although we are one of thelargest divisions in APA, we must continueto address challenges that could limit ourfuture growth and effectiveness.

•As psychology expands and becomesincreasingly specialized, it is critical thatwe promote the central role of psycho-therapy in the field of psychology. In addi-tion, the scope of our practice is changingwith new applications in areas such ashealth care and business. We need toendorse Division 29 as home to all thosecommitted to behavior change practicingin traditional and non-traditional settings.

•The current economic and political climatecreates many challenges. The Division hasmade great efforts to remain solvent, butthis continues to be a difficult task.

Although the Division’sinitiative to attract bothpsychologists and stu-dents has been very suc-cessful, tough economictimes affect efforts torecruit and retain mem-bers. Clearly conveyingthe value of Division 29 membership tocurrent and new members becomes evenmore crucial.

I served the Division as the program chairfor the 2001 and 2002 APA Conventions. Inthat role, I witnessed the talent in our divi-sion and the appeal that psychotherapy hasto so many in psychology. As a supervisorof psychology interns and graduate studentsas well as a provider at the University ofOklahoma Health Sciences Center, I pro-mote psychotherapy each day. I wouldwelcome the opportunity to embrace thesechallenges and advocate for our professionand Division 29 as a member-at-large.

Jean Carter, Ph.D.

Although it may sound cliché, my goals asmember at large of Division 29 are 1) toenhance the Division’s ability to supportand enhance psychotherapy — theory,research and practice; 2) to enhance theDivision’s ability to be responsiveness toneeds of members; 3) to return the Divisionto fiscally sound position that allows betterresponsiveness to the issues and to mem-bers. As member-at-large on the Board Iwould bring the perspective of a full timeindependent practitioner of psychothera-py, as well as considerable experience inDivision and APA governance.

Issues that the Division faces include 1) theimpact of empirically based treatments,which have the potential to control thepractice of psychotherapy and stifle cre-ativity; 2) maintaining influence withinAPA to ensure appropriate attention to the

role of psychotherapyand its protection in thehealthcare system.

Relevant experienceincludes service on thePublications Board forDivision 29; VicePresident for Professional Practice andPresident (1999-2000) of Division ofCounseling Psychology (Division 17);Secretary and President (2002) ofPsychologists in Independent Practice(Division 42). I am in my 2nd term onCAPP (Committee for the Advancement ofProfessional Practice). I have a history ofpublication on the psychotherapy relation-ship and on the integration of science andpractice, and I serve as an Adjunct memberof the Graduate Faculty in the counselingpsychology program at the University ofMaryland—College Park.

CANDIDATE STATEMENTS – MEMBERS-AT-LARGE

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Irene Deitch, Ph.D.

I appreciate the opportunity to serve ourdivision. My style is proactive, inclusiveand energetic. I work collaboratively topromote psychotherapy. My commitment:achieving diversity, public interest con-cerns and professional growth

INITIATIVES:•advance research in psychotherapy•outreach to academics,researchers,

practioners, and graduate students•share professional and scientific

information: bulletins journals •build and retain membership•offer continuing education programs •increased visibility divisional activities•publicize achievements of membership•expand opportunities membership

involvement•public education via print &electronic

media•establish liaison with state associations

CANDIDATE BACKGROUND

Professor at College of Staten Island, CityUniversity of NY; licensed psychologist,psychotherapist, certified in thanatology,(death, dying and bereavement.) producer/host – making connections (cable tv programfeaturing-psychological issues) fellow:divisions 29, co-edited: Counseling theAging and Their Families; chapter: Treatingthe Changing; chapter: Women Therapists

Helping Women; appoint-ed by InternationalCouncil PpsychologistsNGO delegate– UnitedNations, (Mental HealthCommittee)

APA-SERVICE•active “public education” campaign•cadre of violence experts•chair: public information committee•president: running psychologists•president: media psychologists•chair: APA membership committee•member:committee international

relations in psychology •task force ”helping psychologists work-

ing with older adults” (publication)

DIVISIONAL SERVICE•chair: interdivisional task force psy-

chotherapists working with older adults•chair: interdivisional committee- psy-

chotherapists enhancing quality of lifeissues

•organized, chaired, presented continuingeducation

•convention, mid winter programs •recipient divisional award

Support Irene Deitch — member-at-largedemonstrated commitment, service

and leadership

CANDIDATE STATEMENTS – MEMBERS-AT-LARGE, Continued

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Charles J. Gelso, Ph.D.

Throughout my career (doctorate formOhio State in 1970), I have been immersedin theory, research, practice, and trainingabout and of psychotherapy. Much of mytheoretical and research efforts havefocused on the therapeutic relationship inboth brief and longer-term therapy.Another part of my work has dealt withthe question of how to turn professionalpsychology students on to science andresearch. In this work, I have sought tounderstand the factors in the training envi-ronment that serve to facilitate or impedestudents’ interest and efficacy aroundscholarly activity.

Division 29 has been near and dear to methroughout my career. I have been a memberand fellow for 30 years and most recentlyhave served as Chair of the Education andTraining Committee, which included orga-nizing the Education and Training Corner of

the Bulletin. I believe weall understand that thefield of psychotherapy isat a crossroads. Just as sci-entific evidence has final-ly accrued that clearlypoints to the efficacy of arange of therapies, thespecter of managed care has appeared andsought to force treatments into progressivelybriefer formats that are more and morefocused on less and less. To say that this andother forces have created a crisis for the fieldof psychotherapy and Division 29 (includingits role in APA) is an understatement. Asmember-at-large I would work vigorously toprotect and enhance both the field of psy-chotherapy and its place in APA. My effortswould be aimed at each of the key aspects ofpsychotherapy that the Division has histori-cally prized—theory, practice, research, andtraining.

CANDIDATE STATEMENTS – MEMBERS-AT-LARGE, Continued

Patricia S. Hannigan-Farley, Ph.D.

It is an honor to be considered for nomina-tion for the position of Member-at-Largefor the APA Division of Psychotherapy(29). Division 29 has been my "home" inAPA since I was a student. As a studentmember I was so impressed with the workthat the Division conducted on behalf ofthe theory, research, and practice of psy-chotherapy. Since that time, I continue tobe impressed with the wealth of knowl-edge and expertise that exists within theDivision membership. Because I believedthat the Division gave so much to me, Icontributed by serving in various capaci-ties within the Division including Chair,Women's Committee, Chair of HospitalitySuite Program; Secretary, and President.

Following my tenure as Past-President ofthe Division, I took some "time off" from

governance in order topursue family and otherprofessional areas some-what removed from psy-chology. Most recently,my attention and ener-gies are turning moreand more to the basicimportant contribution of psychotherapyin the lives of so many.

As a Member-at-large, I would hope torenew my contributions to the Divisionmembership and strive to bring an updatedperspective to the activities of the Division.

Thank you for your consideration of mycandidacy. And regardless of your choices,please exercise your privilege to vote!Everyone's contribution is very important.

NO PHOTOAVAILABLE

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Alice Rubenstein, Ed.D.

In recent times the Division of Psycho-therapy, along with so many other organi-zations, has been forced to respond tothese difficult economic times by carefullyreexamining our priorities and makingcutbacks. We have had to make hard deci-sions about which projects and initiativesto support and those that must wait.However, in spite of these constraints wehave accomplished a great deal. Our stu-dent membership has soared, the BrochureProject, which I have directed for manyyears, has expanded its scope and, begin-ning this year, will offer CE programs onsome of our most popular Brochure Projecttopics, during the APA convention. Thisyear, you will be able to attend a free CEprogram on ADHD, led by one of our mostesteemed members and a national experton ADHD, Dr. Robert Resnick. Our publi-cations board, on which I have served overthe past several years, has been revitalizedand is focusing on several new initiativeswhich will offer members easier access totimely information about psychotherapyeducation, research and practice, alongwith tools to help members educate thepublic about the ways in which psy-chotherapy can help them. Looking ahead,I propose the introduction of a member ser-vices initiative, a priority that I believe islong overdue. This member services initiativewill be aimed at increasing communication

between the Board ofDirectors and the mem-bership, creating oppor-tunities for members toshare their expertisewith one another, andoffering members moretools with which to mar-ket their services to the public. To this endI have developed several proposals, includ-ing exploring the feasibility of the divisionsponsoring qualified members to offer CE intheir hometowns and states and the intro-duction of a mentorship-writing projectaimed at encouraging and supporting prac-titioners to publish in journals such as InSession: The Journal of Clinical Psychology.This journal, which is published in collabo-ration with the Division of Psychotherapy,focuses on the challenges facing practition-ers by introducing new therapeutic innova-tions and identifying treatment methods andrelationship stances that work with differentpatient populations. These are just a few ofthe proposals I have developed to betterserve you, our members. As an active mem-ber of the Division of Psychotherapy formore than twenty-five years I have beenhonored to serve as your President,Treasurer, and chair of numerous commit-tees and task forces. I ask for your vote sothat I might continue to work on your behalfas a Member-at-large.

CANDIDATE STATEMENTS – MEMBERS-AT-LARGE, Continued

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FEATURE

The Unseen Diagnosis: Addiction Assessment

Marilyn Freimuth, Ph.D.

Marilyn Freimuth is on the faculty of the FieldingGraduate Institute and has a private practice inNew York City where she works primarily withpeople in recovery from addictions. She began tostudy this topic about 14 years ago after an addic-tions counselor began referring her patients inearly recovery. Working with this populationstimulated her interest in better understandinghow to treat addictions within a private practicesetting and how the addiction treatment modeland psychotherapy can be integrated.

Signs of addiction may not be readilyapparent in those seeking mental healthtreatment. Psychotherapy patients rarelyexhibit the poor health and pervasive func-tional impairments of those entering a hos-pital for detoxification. Level of use maynot appear to be an issue for dually diag-nosed patients who use less drugs andalcohol relative to the addicted patient withno co-0ccuring psychopathology (Wolfordet al., 1999). Further complicating accuratediagnosis is the fact that the consequencesof addiction can mimic the symptoms ofpsychological disorder—especially depres-sion and anxiety.

Given that substance use and abuse isprevalent but not necessarily apparentamong those seeking psychological ser-vices, one would expect that mental healthprofessionals would routinely do a carefulassessment for potential problems. In PartOne, I argued how mistaken beliefs aboutand discomforts with addictions impedeaccurate assessment. Interviews with clini-cians who do not routinely assess for addic-tion indicate that some feel it is useless toask about substance use because any onewith a real problem will be in denial.While some patients will hide their use,most will answer questions to the best of

their knowledge. Even if a given patient isfearful about revealing the full extent of use, there is little danger in asking.However, not all psychotherapists hold thisbelief. Some are concerned that merely ask-ing about substance use will be met withhostile reactions. This and other beliefsabout who is addicted and how an addict-ed individual presents for therapy hinderaccurate recognition. For example, the typ-ical alcoholic does not fit the down and outdrunk stereotype but rather, is likely to bemarried and employed. Finally, some pro-fessionals shy away from addressing addic-tions given the ambiguity around distin-guishing recreational use from abuse anddependence. The more like oneself theclient is, the harder it seems to be to makethese distinctions.

Having argued in Part One for the impor-tance of routinely assessing for addiction,this article examines a variety of formal andinformal approaches to addiction assess-ment. There are a myriad of instruments forsuch purposes but few are used routinely. Inalcohol treatment centers, the clinical inter-view remains the most frequently usedmeans of assessment (Myerholtz &Rosenberg, 1997). Likewise, for many psy-chotherapists, information about substanceuse will evolve out of the clinical dialogue.However, knowing the major instrumentsand their usefulness in mental health set-tings gives direction about what is useful toask. After reviewing a number of standard-ized screening/assessment tools, this paperwill consider some interview-basedapproaches to addiction assessment.

STRUCTURED SCREENING QUESTIONS

The CAGE is the best known and mostoften used screening instrument in medical

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and health care settings. It consists of fourquestions directed at the use of alcohol. 1. Have you ever felt you should cut down

on your drinking?2. Have people annoyed you by criticizing

you about your drinking?3. Have you ever felt guilty about your

drinking?4. Have you ever had a drink first thing in

the morning to steady your nerves orget rid of a hangover (i.e., eye opener)?

A score of two or three is indicative of asubstance related disorder. However, inpsychiatric populations where even lowlevels of alcohol use can have adverse con-sequences (e.g., disrupt the effectiveness ofpsychotropic medications, lower compli-ance, exacerbate symptoms), a score of onemerits further assessment.

To address the CAGE’s limited focus onalcoholism, the CAGE–AID has beendeveloped and validated incorporating ref-erence to drug use into the four questions.Another alternative, the TICS, is a two-item screen for both drugs and alcohol thathas been found to have good predictiveability in medical settings (Brown,Leonard, Saunders, & Papasouliotis, 2001).A positive response to either question war-rants further investigation. 1. In the last year, have you ever drunk or

used drugs more than you meant to? 2. Have you felt you wanted or needed to

cut down on your drinking or drug usein the last year?

The CAGE, CAGE-AID, and TICS ques-tions are easily incorporated into a clinicalinterview or therapy session. They are alsoeasily modified to inquire about behavior-based addictions. Have people annoyedyou or criticized you about the way youspend money? Have you felt you wantedor needed to cut down on your use of theInternet in the last year? Although theseinstruments are not validated for otheruses, the answers still provide useful clinical information.

STRUCTURED ASSESSMENT INSTRUMENTS

For clinicians interested in self-administeredself-report instruments for alcoholism

there is the MAST (Michigan AlcoholismScreening Test) and AUDIT (Alcohol UseDisorder Identification Test). The MAST(Selzer, 1971) is composed of 25 commonbehaviors and symptoms associated withalcoholism along with the negative conse-quences of use in the areas of health, work,and social life. A score of 4-10 is consid-ered indicative of possible problematic usewhile scores greater than 10 indicate alco-holism. Shorter forms of the MAST areavailable with as few as 10 items. Somesample questions are: Have you ever got-ten into trouble at work because of yourdrinking? Have you ever gone to anyonefor help with your drinking? Have youever attended an AA meeting? This scale isnot appropriate for use with adolescentsbut a similar tool, the PEI (PersonalExperience Inventory) by K.C. Winters andG.A. Henley is available through theWestern Psychological Association.

The AUDIT (Saunders, Aasland, Babor, DeLA Fuente, & Grant, 1993), consists of 10items asking respondents to indicate theirdegree of alcohol use such as how oftenone has a drink (never, monthly, 2-4 timesa month, 2-4 times a week, 4 or more timesweek) and how much is consumed on anyone occasion. This instrument also assess-es feelings about and reactions to one’sdrinking. How often have you felt guilt orremorse? Has anyone been injured due toyour drinking? Have significant othersasked you cut down?

The value of self-report measures has beencalled into question by the belief that mostpersons with addiction problems resort todenial. Denial may be less pervasive thangenerally assumed. In Part One, it was sug-gested that many with addiction problemsfail to link the life problem, for which theyseek therapy, to addictive behaviors.When the psychotherapist makes suchconnections, most patients are open to con-sidering it. Research on the validity of self-report measures within an alcoholismtreatment context shows that alcoholicscan report accurately on their drinkingbehavior (Sobell and Sobell, 1990).Whether this accuracy applies to self

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reported drug and alcohol use in a mentalhealth context has yet to be determined.For those concerned that denial or a con-scious desire to fake will adversely affectassessment, there are several instrumentswhere the questions’ intent is less apparent.

For many years the MAC, which consistsof 49 MMPI items, has been considered agood measure that avoids the problemsassociated with high face valid instru-ments. Like the MMPI, the MAC does notyield a specific diagnosis but rather detectspatterns of responding characteristic ofalcoholics. However, the MAC needs to beused cautiously in light of recent researchshowing low predictive validity whenused in clinical settings (Myerholtz andRosenberg, 1997).

Those interested in instruments with lowface validity still can turn to the SubstanceAbuse Subtle Screening Inventory orSASSI (Miller, 1994). The first part consistsof a series of questions related to a varietyof needs, interests, values, health concerns,social interactions, and emotional stateswhich are considered “subtle” becausethey do not appear to be asking about sub-stance use. These 62 T-F items have beenfound to reliably distinguish drug andalcohol dependent persons from others.The second part consists of 26 items askingthe usual questions regarding the frequen-cy and amount of drug and alcohol use andthe consequences.

The SASSI can take as little as 15 minutes tocomplete and has good validity in identify-ing chemically dependent persons even ifthey wish to conceal their use. A specialversion of the scale has been developed foruse with adolescence, a population mostlikely to present an inaccurate picture oftheir drug and alcohol use. The only draw-back to the scale is that it must be pur-chased from the owner.

INFORMAL CLINICAL INTERVIEWAPPROACHES

Most psychotherapists, especially those inprivate practice settings, are not mandatedto do a formal screen for addiction. If

providers are attuned to addiction issues,they are likely to glean information duringthe clinical dialogue. Some may ask directquestions about addictive behaviors, oth-ers may ask indirect questions about lifestyle and social relationships and still oth-ers may not ask any questions until thepatient’s report suggests that an addictivebehavior is likely.

For those comfortable with more directquestioning, it is easy to incorporate CAGEor TICS questions into a clinical interview.These questions elicit information aboutthe consequences of substance use. Or onecan ask directly about degree of use. Asmost know, it is not recommended to ask a“yes” or “no” question such as “Do youdrink?” Given that some use is normative,ask, “How much do you drink?” or simplystate, “Tell me about your drinking.”

Many working in clinic settings arerequired to ask directly about substanceuse but regretfully do it in a perfunctorymanner without following up on ananswer such as, “Oh, just a couple ofdrinks on the weekend.” Clinical wisdomsuggests that one never stop the inquiry atthis point. For example, a couple of drinksregularly on a weekend may hide a bingedrinker. Binge drinking is defined as atleast five drinks for men and four forwomen on a single occasion within a two-week period. The importance of doing acareful inquiry is reflected in one physi-cian’s experience with a patient who unex-pectedly began to seizure post-operatively.The chart dutifully noted that the patienthad two alcoholic drinks a day. However,a follow up with family members revealedthat these two daily drinks were of vodkasipped from a beer stein. Given that alco-hol dependence is associated with lifethreatening withdrawal symptoms, anysuspicion of addiction should be followedby gathering information about the fre-quency, amount, and length of use includ-ing time between drinking episodes. Athorough inquiry will also collect informa-tion about the context of use (alone, withfriends, at home, a bar), the experience ofuse (is it always pleasurable?) and conse-

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quences (e.g., legal, health, social or workproblems).

Some psychotherapists avoid direct ques-tioning until they hear signs in the clinicalmaterial that there may be a problem.Signs that can indicate a more thoroughaddiction assessment is warranted includea family history of addictive behaviors, ahistory of trauma, evidence of sociopathy,social isolation or a peer group where sub-stance use is a common part of socializing.Evidence of borderline personality charac-teristics, anxiety or depression also war-rant further investigation given that suchcharacteristics and symptoms can be a con-sequence of substance dependence. Myresearch interviewing clinicians wellversed in addiction treatment indicatesthat they look and listen very carefullywhen the topic of substance use comes up.They are sensitive to any changes in behav-ior such as a brief acknowledgement of usefollowed by a change of topic, a suddenjoking attitude, or an increased level ofexcitement or enthusiasm when talkingabout use.

As discussed in Part One, some psy-chotherapists are uncomfortable askingdirectly about addictive behaviors out ofconcern that the patient will experiencesuch questioning as a criticism or insult.For those who are uncomfortable withdirect questions, there are a number of lesstransparent questions that can indicatewhether further inquiry into an addictivebehavior is warranted. Some possiblequestions are: What do you do after work?What do you do for pleasure? How do youhave a good time/relax? Have you everbehaved in a way that was not consistentwith your value system/that you regrettedlater? Follow a patient’s reference to a trau-ma or stressful situation with the question:How do you cope or deal with that situation?

Over and over again, treatmentproviders—even those familiar with addic-tions—can recall a time when they wishedthey had not taken a patient’s casual refer-ence to substance use at face value. Onetherapist recalled a young man with a sex-

ual addiction who was quite open abouthis activities. In the process of telling aboutthe previous week’s sexual experiences, hewould occasionally mention that he hadsmoked marijuana. No further inquiry wasmade. When, later in treatment, a referralwas made to a psychopharmacologist whodid a thorough substance use assessment,this man’s degree of use was found to beconsistent with a diagnosis of abuse.

Thus, any time a patient makes an explicitreference to some type of substance use,the topic merits further exploration by simply asking the person to say more.Quite often, I find that patients have notthought much about their use and whetherit is problematic. Continued questioningcan help the two of you decide together ifthere is a problem. One follow up questionI have found very useful is: How muchenjoyment/pleasure do you get from thesubstance? Recently, a man who came tosee me for problems achieving his profes-sional goals expressed surprise at how heresponded to this question; he had not real-ized until asked how long it had been sincehe enjoyed drinking. This led to furtherexplorations into his desire to drink and hisincreasing lack of control over alcohol. Forothers, I have found that this questionstays with them and they will come back ata later time to report how they no longerenjoy the substance and are conflictedabout continued use.

FROM ASSESSMENT TO DIAGNOSIS ANDTREATMENTIn a therapy setting, in contrast to an alco-holism treatment center, the initial out-come of an assessment need not be a for-mal diagnosis. Instead the assessment goalmay be to introduce the idea of substanceuse as a topic for discussion. For others, theintent may to understand the degree towhich drinking is enjoyable or not, prob-lematic or not, along with a determinationof risk. This material then becomes part ofthe therapy content. If the therapistbelieves that the criteria for substancedependence or abuse have been met, s/hewill want to share this information withthe patient, ensure that substance use is not

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endangering others (e.g., driving under theinfluence) and discuss implications of con-tinuing to use in this way.

In those instances where the patient dis-agrees or the therapist prefers to avoid thepossibility of arguing about the diagnosis,one can help the patient become aware ofthe negative effects of his/her substanceuse (Miller and Rollnick, 1991). One canexplore if there is any remorse by asking ifthe person has ever done something or hadsomething happen while under the influ-ence which would not have happened ifthey were not. Has anyone important inyour life ever complained about your use?Have you ever thought of slowing down?Stopping? What would that be like? Atwhat point do you think your drug or alco-hol use would be a problem?

Another simple approach that avoids thetherapist labeling the patient is to ask:Have you ever worried/thought that youmight be an alcoholic? A mere acknowl-edgement of worry helps bring the issueinto the therapy room. Even if the patientsays “no”, the therapist who is concernedabout possible abuse or dependence willremain attuned to negative consequencesof the patient’s substance use and pointthese out as they arise in treatment. Whilesome may want to make a referral for spe-cialized addiction treatment, Miller andBrown (1997) strongly argue that psycholo-gists are suited to treat addictions.

SUMMARYPsychologist may be aware of the frequencywith which those seeking mental health ser-vices have co-occurring addictive disorders.However, mistaken beliefs and uncomfort-able feelings about addictions impede accu-rate recognition. No matter what approachone takes to addiction assessment—be it for-mal or informal, direct or indirect ques-tions— it is critical that the topic beaddressed and that the assessment not bedone in a perfunctory manner.

REFERENCES

Brown, R.L., Leonard, T., Saunders, L.A. &Papasouliotis, O. (2001). A two-item con-

joint screen for alcohol and other drugproblems. Journal of the American Board ofFamily Practice, 14, 95-106.

Miller, G.A., (1994). The Substance AbuseSubtle Screening Inventory Manual: AdultSASSI-2 Manual Supplement. Spencer, IN:Spencer Evening World.

Miller, W.R. & Brown, S.A. (1997). Whypsychologists should treat alcohol anddrug problems. American Psychologist,52, 1269-1279.

Miller, W.R. & Rollnick, S. (1991).Motivational interviewing: Preparing peopleto change addictive behavior. New York:Guilford Press.

Myerholtz, L.E. & Rosenberg, H. (1977).Screening DUI offenders for alcoholproblems: Psychometrical assessment ofthe Substance Abuse Subtle ScreeningInventory. Psychotherapy of AddictiveBehaviors, 11, 155-165.

Saunders, J.B., Aasland, O.G., Babor, T.F.,De La Fuente, J.R., Grant, M. (1993).Development of the Alcohol UseDisorders Identification Test (AUDIT):WHO Collaborative Project on earlydetection of person with harmful alcoholconsumption. Addiction, 88, 791-804.

Selzer, M.L. (1971). The MichiganAlcoholism Screening Test: The quest fora new diagnostic instrument. AmericanJournal of Psychiatry, 127, 1653-1658.

Sobell, L.C. & Sobell, M.B. (1990) Self-report issues in alcohol abuse: State of theart and future directions. BehavioralAssessment, 12, 77-90.

Wolford, G.L., Rosenberg, S.D., Drake,R.E., Mueser, K.T., Exma, T.E., Hoffman,D., Vadaver, R. M., Luckoor, R., & Carrieri,K.L. (1999). Evaluation of methods fordetecting substance use disorder in per-sons with severe mental illness. Psychologyof Addictive Behaviors., 13, 313-326.

The author would like to express apprecia-tion to the Fielding Graduate Institute forresearch funds to support the collectionand analysis of the interview data onwhich this article is based.

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Call for Nominations:

Editor of Psychotherapy Bulletin

The Publication Board of the APA Division of Psychotherapy is seeking applications for the position of Editor of the Psychotherapy Bulletin. Candidates should be available to assume the titleof Incoming Editor on or before January 1, 2004.

The Psychotherapy Bulletin is an official publication of the Division of Psychotherapy. As such, itserves as the primary communication with Division 29 members and publishes archival materialand official notices from the Division of Psychotherapy. It is also designed as an outlet for timelyinformation on psychotherapy and professional psychology. Now in its 38th year of publication,the Bulletin reaches more than 4,000 psychologists and students with each issue.

Prerequisites: Be a member or fellow of the APA Division of Psychotherapy An earned doctoral degree in psychologySupport the mission of the APA Division of Psychotherapy

Responsibilities: The editor of the Psychotherapy Bulletin is responsible for its content andproduction. The editor maintains regular communication with theDivision’s Central Office, Board of Directors, and contributing editors.The editor is responsible for managing the page ceiling and for providingreports as required. The editor must be a conscientious manager, deter-mine budgets, and administer funds for his or her office. As an ex officiomember of both the Publication Board and the Executive Committee, theeditor attends the governance meetings of the Division of Psychotherapy.An editorial term is three years.

Oversight: The Editor of the Psychotherapy Bulletin reports to the Division ofPsychotherapy’s Board of Directors through the Publication Board.

Search Committee: Jean Carter, PhD, Lillian Comas-Diaz, PhD, Raymond DiGiuseppe, PhD,John C. Norcross, PhD (chair), Alice Rubinstein, EdD, and GeorgeStricker, PhD.

Nominations: To be considered for the position, please send a letter of interest and acopy of your curriculum vitae no later than July1, 2003 to: John C.Norcross, PhD, Publication Board, Department of Psychology, Universityof Scranton, Scranton, PA 18510-4596. Inquiries about the positionshould be addressed to Dr. John Norcross (570-941-7638;norcross@scranton. edu) and/or to the incumbent editor, Dr. LindaCampbell (706-542-8508; [email protected]).

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Free Division of PsychotherapyContinuing Education Workshop

at the 2003 APA Convention

Join Robert J. Resnick, Ph.D. for

An Update on Pharmacological Interventions for ADHD

Across the Life Span

Saturday, August 9th, 9:00 AM – 10:50 AM

Metro Toronto Convention CenterConstitution Hall Room 106

You must pre-register in order to receive continuing education credit. All pre-registrantswill receive 10 copies each of the Division of Psychotherapy Brochures, “Attention DeficitHyperactivity Disorder in Children and Adolescents” and “The Hidden Problem:ADD/ADHD in Adults.”

Continuing Education Policy: The number of Continuing Education credits is equal to thenumber of contact hours. Full attendance is a prerequisite for receiving CE credit.Partial credit will not be given. Sign-in for each workshop begins 20 minutes before starttime and continues 10 minutes after start time. After that, CE cannot be granted. It is theresponsibility of the attendee to determine whether these CE credits are valid in his/herstate of licensure.

Name ________________________________________ Phone (_____)___________________

Address ______________________________________________________________________

City ______________________________________ State _________ Zip _______________

Email _____________________________________

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Jack Wiggins is a Division 29 CouncilRepresentative, a Past-President of Division 29,and the Division’s representative to theCompetencies Conference.

The Association of Psychology Postdoctoraland Internship Centers (APPIC) held itsCompetencies Conference 2002: “FutureDirections in Education and Credentialing inProfessional Psychology” in Scottsdale,Arizona on November 7–9. The ten-personSteering Committee, chaired by Dr. NadineJ. Kaslow, did excellent work in planningand organizing the Conference and makingsite arrangements for the 130+ attendees’comfort and participation.

Attendees were assigned to one of theseten (10) groups:

• Scientific Foundations and Research• Ethical, Legal, Public Policy/Advocacy,

and Professional Issues• Supervision• Psychological Assessment• Individual and Cultural Diversity• Intervention• Consultation and Interdisciplinary

Relationships• Professional Development• Specialties and Proficiencies• Assessment of Competence

In addition to the attendees each grouphad a facilitator, a recorder and a memberof the Steering Committee. Division 29 waswell represented by officers: Pat Bricklin,President-Elect; and Lee VandeCreek,Treasurer. As a Council Representative forDivision 29, I was the official representa-tive for the division as a late substitute for2002 President Bob Resnick. I was assignedto the Consultation and Interdisciplinary

Relationships group. The attendees at theConference were very able, articulate indi-vidually, and collectively represented abroad spectrum of psychological interests.

Each workgroup had a written charge andthe facilitators, recorders and member of theSteering Committee were very familiar withthis charge. They worked diligently to com-plete the assigned tasks of the workgroups.Minutes of each workgroup meeting weredistributed the following day to all atten-dees. On Saturday, the final day, facilitatorsof each workgroup gave oral rather thanwritten summaries of the meetings. Thesemeetings consisted of an integration meet-ing where one member of the assignedworkgroup attended one of the other nineworkgroups. I chose last and attended theuntaken Scientific Foundations andResearch Integration group meeting. Afterlunch we reassembled back in our assignedworkgroup and reported our experiences inthe integration groups.

Following this feedback meeting of theworkgroups, there was a large group dis-cussion in which group facilitators present-ed their summaries followed by a questionand answer period. It was apparent therewas a great deal of overlap in the presenta-tion of the facilitators. There was noattempt to arrive at a consensus of theattendees as whole on any particular point.The overlap among the groups of the con-sensus reached in each assigned group willapparently be the basis of recommenda-tions coming from the conference. A draftSummary of the Conference is due inDecember.

The reader will have to make up his/hermind as to the value of the conferencebased on findings that are to be reported inDecember. Some attendees were disap-

FEATURE

Was the Competencies Conference 2002 a Competent Conference? Jack Wiggins, Ph.D.

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pointed there was no opportunity to dis-cuss and vote on salient points of the dis-cussions. I have attended both types ofconferences where the attendees attemptedto reach consensus through voting andthrough consensus building by the overlapof opinions among the various work-groups. Neither model is completely satis-factory or satisfying to attendees. Themodel used in this conference tends tohave attendees leave “feeling good”though wondering if anything was reallyaccomplished. The conferences where con-sensus is attempted through voting letattendees know what the conference did ordid not do. This latter model also causesmany to feel like winners and losers onissues. Attendees leave with hard feelingswhen their personal positions were notsupported by the conference. While theremay be a place for both types of confer-ences, it is my obligation to report on myimpressions about the CompetenciesConference 2002.

The leaders of the CompetenciesConference 2002 acknowledged at the out-set there is no consensus about what a“competency” is. It was recognized thatthe word “competency” is used in a varietyof ways in psychological circles; sometimesreferring to excellence, sometimes simplymeaning a skill set and sometimes mean-ing that something is “good enough.”These meanings are illustrative of the vari-ous connotations of the word “competen-cy” and are not intended to be exhaustive.Dr. Kaslow in her opening remarks sug-gested for purposes of this conference,“competency” would be understood as“good enough.” I cannot disagree withsuch a definition, but it does raise the ques-tion of “what is good enough in the educa-tion and training of professional psycholo-gists.” Dr. Nicholas Cummings was uniquein his remarks in the plenary session. Hesaid we must train psychologists to be ableto take advantage of new opportunities inthe market place and not be limited by tra-ditional training that may have been goodenough in the past. Dr. Belar, director of the

APA Educational Directorate, alluded tothe need to take a fresh look at trainingcompetencies but was less explicit in herremarks than was Cummings. Dr. DeraldWing Sue, the discussant of the plenarypanel, did not attempt a summary of thepanel comments. Instead, he made his ownpresentation with a plea for cultural com-petence as a core competency.

Psychology needs to determine training thatis “good enough” for specific purposes. It isnot clear that this conference addressed thatquestion directly and created some difficul-ty is reaching consensus in workgroups.Competency comes from the same rootwords meaning “to compete.” Thus, themeaning of competency will shift some-what according to where the competition istaking place. The marketplace is wherepractitioners of the discipline of psychologymust compete with other professions andother approaches to problem solving.Psychology must compete for students andits training must enhance practitioners’ abil-ity to compete in the world marketplacewith their psychological skills. As a value-adding discipline, our profession mustidentify opportunities to compete and wemust train our graduates to compete suc-cessfully. Through our advocacy, we mustcreate jobs for our graduates to contribute tosolving individual and societal problemsand be compensated sufficiently to justifytheir training in psychology. Thus, my posi-tion is closer to that of Cummings since themarketplace is the ultimate determiner ofcompetency in psychology.

It is my view that psychology as a profes-sion has continued to be based on an acad-emic economy. There, success is measuredby the numbers of students with highSAT/GRE scores that can be attracted; thenumber of publications of the faculty; thesize and number of grants that are accrued;and the success in placement of their grad-uates on highly esteemed university facul-ties. These measures have merit in acade-mia but little or no value or cachet in theglobal marketplace.

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It is time for psychology to think moreglobally and consider a market-basedeconomy for psychology as a discipline.For example, in the integration discussiongroup dealing with the ScientificFoundations and Research it becameapparent that the concept of a market-based economy for psychology had notbeen considered. One of the principle peo-ple of this workgroup let it slip that theyhad used an Aristotelian dichotomy of“researchers and technicians.” In their“future directions” it was proposed towrite a book on what a scientifically mind-ed practitioner looks like. I argue that thepractitioner of today accurately reflects thescientific training he has experienced.Psychologist practitioners are true profes-sionals and merit this recognition.Practitioners do not merely assume a “sci-entific technician role” that academiciansaspire for them.

Dr. Jane Halonen articulated eight domainsof proficiencies from the PsychologyPartnerships Project task force including:1.Descriptive Skills; 2. ConceptualizationSkills; 3. Problem Solving; 4. Ethical Reason-ing; 5. Scientific Attitudes and Values;Communication Skills; 7. CollaborationsSkills; and, 8. Self Assessment Skills.

The Scientific Foundations and Researchworkgroup recommended these eightdomains be tested to see if they make a dif-ference. They also wished to determineways that practitioners are held accountablefor the science they practice. Also, theywished to encourage the continuing educa-tion about the scientific practitioner. Theparticipants from other workgroups to thisintegration group pretty much agreed onthe eight domains of skills but questionedthe narrow one-way focus of involvingresearch for practice but not considering thefeedback of practice to science and training.

This workgroup did recommend a confer-ence that holds training programs account-able. There was a lively discussion of thisand the need to make academia more

responsive to marketplace issues. The ideaof a practice-based research network wasbrought up. The fact that doctoral level psy-chologists are required to compete withmaster’s level trained personnel was noted.The economic consequences for both thepractitioners and the discipline of psycholo-gy of this doctoral/ master’s level competi-tion were briefly discussed. The need for thediscipline of psychology to be on a market-based economy fell on deaf ears and wasnot included in the summary remarks of theScientific Foundations and Research work-group. Let us hope the critical need for ashift away from an academic-based econo-my to a market-based economy will appearsomewhere in the final text.

I did hear that some were consideringteaching “history and systems” of psychol-ogy at the undergraduate level for thoseinterested in graduate training in psychol-ogy. This could open up opportunities ofadditional competency training at thegraduate level. Perhaps we could alsoenhance our skill sets in graduate trainingby reformatting current courses. A market-ing course could simultaneously teachmarketing skill sets and statistics using thecase study approach found in MBA pro-grams. A course in intervention assessmentcould have similar utility. Training in sta-tistical outcome evaluations is essential forpsychologists to become program man-agers and directors. If the case studymethod were applied to health field, where70% of psychologists earn some portion oftheir incomes, we could find specific exam-ples of how competencies could be deter-mined and implemented in training.Graduate programs could also offer acourse in epidemiology for statistical train-ing. Then, Murray and Lopez’s GlobalBurden of Disease epidemiological datacould serve as an outline of clinical trainingfor the next 20 years. Depression, Roadtraffic accidents, Cerebrovascular disease,War and HIV (health conditions with psy-chological underpinnings) will becomefive of the 10 leading causes of disability asmeasured by Disability-Adjusted Life

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Years (DALYs). Self inflicted injuries willrise from the 33rd to the 15th cause ofDALYs. It is reasonable to ask what com-petencies (skill sets) will be useful toaddress these societal needs. This data hasbeen public for six years but we see littleevidence that this information hasenhanced psychology training programs.

The Scientific Foundations group did rec-ommend that the APA Committee onAccreditation and other regulatory bodiesnot just “count” courses in evaluating corecompetencies. Currently, the Committee onAccreditation, lacking measures of neededcompetencies, uses a “truth in advertising”or “let a thousand flowers bloom” stan-dard for accrediting academic training pro-grams. This allows any academic programto be accredited as long as it trains accord-ing to the way the faculty says they aretraining. Is this good enough?

Without market-based criteria, theCommittee on Accreditation lacks defensi-ble standards to evaluate the adequacy oftraining programs. It was pleasing to seethis workgroup endorse a “conferenceinvolving regulatory bodies to determinewhat processes and groupings of coreknowledge areas are needed to evaluatecore competencies.” They asked the rightquestions but to the wrong group. Again,as in this conference, psychologists areasked to answer market-based questionsthat are typically addressed by marketingexperts. APA has a Division of ConsumerPsychology. Perhaps, they could providesome answers from a market-based per-spective or direct us how to obtain answersto what jobs need to be done and whatskills are necessary. I doubt that anotherconference will accomplish this desiredresult. Another, potential resource wouldbe to empower the Association of State andProvincial Psychology Boards (ASPPB) tostudy where the job opportunities are forpsychologists and what training is

required to fulfill these job qualifications.Grant money could be obtained to do thissince it would be within ASPPB’s missionto protect the public. The Council ofCredentialing Organizations inProfessional Psychology (CCOPP) willpublish its evaluative work on competen-cies in January 2003. Perhaps the CCOPP’sreport will offer additional guidance andserve as another reference point.

There were many excellent discussions andvaluable contributions that were made atthe Competencies Conference 2002.Without some means to rank the valueadded by various competencies (skill sets)suggested at the conference, we will notknow how to establish priorities for imple-menting these skill sets into training pro-grams. My concern is that the excellent dis-cussions that the various workgroups hadwill become psychocentric rhetoric with-out some external criterion to judge what is“good enough.” “Good enough” can not bebased solely on the standards of an acade-mic economy. The marketplace is the finalarbiter of the ability to compete as the mea-sure of competence and competencies.Until psychological training programs rec-ognize the marketplace as the measurer oftheir value-added training, our competen-cy training may feel good but may do lessthan we desire.

The Competencies Conference 2002 contri-butions have been outlined and its limita-tions detailed. Suggestions for market mea-sures for competencies and next steps totaken were addressed. The offensiveemailed conference follow-up question-naire, which permitted only positiveanswers to the questions asked, was com-pleted. My comments are offered to serve asbenchmarks for readers when they reviewthe proceedings of this conference. It is leftto the reader of the proceedings to judgewhether the Competencies Conference 2002was a competent conference.

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Pat DeLeon is a contributing editor for thePsychotherapy Bulletin in the area of legal andlegislative issues. He is a past president ofDivision 29 and a recipient of the DistinguishedPsychologist Award, and 2000 President ofAPA.

Dedicated Individuals Can Make ADifference: Perhaps the most rewardingaspect of serving as APA President is theopportunity to interact on a face-to-facebasis with colleagues across the nation whoare genuinely excited about the future andwho are personally involved in makingsociety “just a little bit better.” And, not sur-prisingly, experiencing the growing affir-mation that the behavioral sciences, includ-ing participating in data-based program-matic decision making, truly are the key tosuccessfully addressing many of our coun-try’s most pressing public health concerns.

This Spring, although no longer in the APAgovernance, I was invited by New MexicoPsychological Association President BobEricson to attend their dinner in celebra-tion of the “Enactment into Law thePsychologists’ Authority to Prescribe.”APA’s Mike Sullivan, Past-President JackWiggins, and I had a wonderful time. Inattendance that evening were the bill’sHouse and Senate sponsors, the NewMexico Secretary of State, the psychiatristwho had met twice with the Governor onbehalf of the Association, and, of course,our heros Elaine LeVine (accompanied byher son Marshall, appropriately dressed intux and top hat) and Mario Marquez andhis lovely wife, Diana. These dedicatedand far-sighted colleagues have trulymoved professional psychology into the21st Century. My sincerest appreciation to

APA President-Elect Bob Sternberg andRay Fowler for making my attendance onbehalf of the entire Association possible. Itwas a very special evening. Mahalo.

It is interesting to reflect upon psychiatry’sobservations (Clinical Psychiatry News):“‘New Mexico should be seen as a sadanomaly, not the start of a perverse trend...There is no reason to believe that the peculiarset of factors that determined the outcome inNew Mexico will recur elsewhere...’ (The)President of the New Mexico chapter of theAmerican Psychiatric Association, saidrural access became the lobbying mantra ofpsychologists, and legislators readilypicked up on it. She and other psychia-trists met with the governor on severaloccasions, but their testimony did notappear to phase legislators, who had previ-ously granted prescribing privileges tonurse-practitioners, physician assistants,and clinical pharmacists... ‘(T)he ultimatepassage of the bill was not due to any lackof effort on the (ApA’s) part...’ But the NewMexico lobbying efforts by the (ApA) weredeemed too late by some of its own mem-bers, who called for a more intense andwidespread campaign to prevent theextension of prescribing privileges. ‘Thosepsychiatrists who are in leadership posi-tions, especially those who are leaders inthe American Psychiatric Association, arewholly to blame for this disaster...’ ‘This isa wake-up call...’ Psychiatrists need towork with primary care providers, provid-ing consultation and support. Patients donot know the differences between psychol-ogists and psychiatrists, but they do knowtheir primary care providers. The (ApA)has failed to embrace primary careproviders as essential caregivers in mentalhealth even though it is well known that

WASHINGTON SCENE

A Range of Interests and Highly Relevant ExpertisePat DeLeon, Ph.D.

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more than 80% of psychotropic medica-tions are prescribed in primary care... (I)fall the states allow psychologists to pre-scribe, nothing will distinguish them frompsychiatrists. ‘Thirty years ago, we hadpsychotherapy to distinguish ourselves;now we don’t...’ ‘This aggression has moreto do with guild economics than with realconcerns or rationalizations concerningquality or access. It has been particularlyexacerbated as the medical model of psy-chiatric disorders has become dominant,the role of psychological models hasbecome diminished, and managed care hasincreasingly disenfranchised psychologyby reimbursing psychiatrists for medica-tion management and preferred less-costlysocial workers to provide psychotherapy.Psychology has sought to cloak themotives for this territorial campaign in theself-serving and altruistic-sounding lan-guage of greater access for ‘clients,’ greatereconomy, equivalent (if not superior) qual-ity, and even, in California, a cynical buttransparent concealment within so-calledmental health parity legislation...’”

Former New Mexico PsychologicalAssociation President Julie Lockwoodnoted a full page advertisement, taken outby the ApA’s Patient Defense Fund, in theSanta Fe New Mexican: “You wouldn’t doit to your dog, So why would you do it toyour child?... Letting psychologists pre-scribe is bad medicine — a HIGH RISK ourfamilies cannot afford...”

A Broader Public Policy Perspective: Aninteresting ApA perspective. Nevertheless,as Mike continues to emphasize, thePractice Directorate’s Southern-Rural RxP-strategy nicely parallels the findings of theFordham Institute for Innovation in SocialPolicy: The Social Health of The States(2001). “As we Americans strive to protectour way of life, we need to pay sustainedattention as well to our standard of living.Issues such as health and housing, educa-tion and income, need to remain on-goingconcerns. It is our hope that this document,which assesses and compares the social

health of the fifty states on these and simi-lar social conditions, will make a small con-tribution to that important national dia-logue... By using a set of sixteen key socialindicators that represent conditions ofwell-being at critical times of life, fromchildhood to old age, we have been able toprovide an overall picture of America notpreviously available... This documentreveals that, like the nation’s geography,there is great variety in the social health ofthe states. Some states have high levels ofperformance with exceptional achievementon numerous indicators. Other states areexperiencing significant social deteriora-tion, with most indicators pointing to con-ditions requiring immediate attention...”

The report strongly urges “extensive com-munity participation in evaluating thestate’s social health performance anddeveloping ways to improve it.” It is atremendous understatement to suggestthat Elaine and Mario excelled at commu-nity participation. Never during my yearsof service within the APA governance haveI ever experienced such genuine “grass-roots support” for a psychology agenda,the way that it materialized on behalf ofthe RxP — movement in New Mexico.Vocal public support was expressed bynumerous physicians and other health careproviders (including clinical pharmacists),the President of the University of NewMexico; representatives of the legal com-munity, including the State AttorneyGeneral and various local Bar Associationrepresentatives; and even the local chapterof NAMI. Psychology’s voice was heard inpublic legislative testimony; on the radio,television and in the print media; the NewMexico Medical Society endorsed their bill;and perhaps equally impressive, was thenearly unanimous support that surfacedwithin the New Mexico PsychologicalAssociation. There can be no question thatthis inclusive and collaborate approachmade all of the difference in the world.Whereas the Fordham Institute found thetop-ranked state (e.g., the healthiest) to beIowa, the bottom ranked state was New

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Mexico. Focusing upon society’s real andpressing needs is the key to legislative suc-cess. This is a lesson we should take toheart and never forget.

Some of the report’s more graphic high-lights: the child abuse rate in Montana ismore than ten times that of Pennsylvania;teenage suicide in Alaska is nine times thatof New Jersey; the percentage of people inNew Mexico with no health insurance isnearly four times higher than in RhodeIsland; and the homicide rate in Louisianais seven times that of Iowa. Eight states areconsidered to be in “social recession”, withan overall rank in the bottom ten and poorperformance in more than five individualindicators. These include: Arizona,California, Louisiana, Mississippi,Montana, Nevada, New Mexico, andTexas. Those colleagues who have closelyfollowed the maturation of the RxP- agen-da will note that six of these states havevery active RxP- task forces. Of the bottomoverall ranked twenty-five states, psycho-logical leaders in at least 11 are currentlyaggressively pursuing RxP- action. From apublic policy perspective, we would sug-gest that perhaps New Mexico does notreally reflect a “peculiar set of factors,” aswished by our medical colleagues.

We were particularly pleased to learn fromSteve Tulkin that Elaine may be thekeynote speaker for this year’s Alliant(CSPP) University’s clinical psychophar-macology graduation ceremony. She is aninspirational role model. Undoubtedly, oneof her fundamental messages to the gradu-ates will be that in order to truly serve theirpatients well, they must have faith in them-selves and be personally and activelyinvolved in the public policy (i.e., political)process. Her insider view of the now ongo-ing discussions between New Mexico’sPsychology and Medical Boards and theirefforts to develop the specifics of the pre-scribing and supervision protocols will befascinating, to put it mildly. As the HealthPolicy Tracking Service (i.e., the literatureof state legislators and their staff) reports,Mario and Elaine have revamped the RxP-

landscape: “On May 16 or 17, the NewMexico State Medical Board expects to heara report from a recent meeting in San Diegoof the Federation of State Medical Boards,where preliminary discussions concerningprescriptive authority for psychologistswere to take place, and to appoint a com-mittee to study the prescription issue. TheBoard of Psychologist Examiners alreadyhas appointed its subcommittee, headedby Tim Strongin. The development of anational examination for ‘any mentalhealth provider prescribing psychotropicdrugs,’ may be a consideration.” We cansee Mike and Russ Newman smiling. Thisis a major development for all of profes-sional psychology.

Family Comes First: On a highly personallevel, I have always felt it was important totake the time to watch our two childrenparticipate in athletic events during theirgrammar and high school careers, regard-less of how pressing work or psychologyagendas might appear at the time. Like allinvolved parents, the sight and soundsaccompanying injuries, for example on thesoccer field, are never forgotten.Accordingly, I was intrigued by the recentInstitute of Medicine (IOM) report—IsSoccer Bad For Children’s Heads? And, Iwas proud to learn that APA colleagueswere intimately involved, serving on theIOM Board on Neuroscience andBehavioral Health (e.g., Nancy Adler,Jerome Kagan, Beverly Long, KarenMatthews, and staff Michelle Kipke).

To explore whether soccer playing putsyouths at risk for lasting brain damage, theIOM brought together experts in headinjury, sports medicine, pediatrics, and bio-engineering for a one day workshop. Theexperts presented the scientific evidencefor the possible long-term consequences ofhead injury from youth sports, possibleapproaches to reduce the risks, and policyissues raised. “(S)ports concussions are infact far more serious than most people real-ize. There are many... examples of former Astudents struggling to pass high schoolafter experiencing concussions on the soc-

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cer or football field. Many student athleteshave been forced to abandon both theirsports and their career aspirations becausethey never fully recovered from concus-sions. These disturbing examples counterthe common belief that a concussion is justa bump on the head with no lasting effects.Indeed, recent research reveals that a con-cussion unleashes a cascade of reactions inthe brain that can last for weeks, and makeit particularly vulnerable to damage froman additional concussion. There is also evi-dence that youths who experience concus-sions may be at more risk for brain damagethan adults because their brains are stilldeveloping and have unique features thatheighten their susceptibility to serious con-sequences from head injuries. Even thoughpeople generally think of soccer as a safersport than football, soccer players experi-ence concussions about as often as footballplayers... Soccer is probably the most rapid-ly growing team sport in this country, espe-cially for girls and women. Millions of chil-dren and adolescents participate in youthsoccer leagues and there are hundreds ofthousands of adolescents on high school soc-cer teams. The growing popularity of socceramong youth... has fostered concern thatchildren who play soccer may not be ade-quately protected from head injury....

“Although soccer balls can be kicked tospeeds as high as 70 miles per hour, evenmost professional players cannot kick aball that fast and most soccer playerswould not attempt to head a ball movingthat fast... (Y)ouths rarely have enoughforce to kick a ball to speeds higher than 40miles per hour... (C)alculated the impact ofa soccer ball on the head of youths of vari-ous sizes, based on the likely speed of theball, and concluded that the force of impactis well below the force that is thought to benecessary to cause a concussion in headinga soccer ball. But.... concussions do occur insoccer when the ball hits an unpreparedplayer in the head... when players acciden-tally knock their heads into other playerswhile attempting to head the ball, particu-larly if they are attempting to flick the ball

backwards... Compared to other contactsports, head injuries are common in soccer.In neuropsychologist Dr. Jill Brooks’ studyof high school soccer players, she foundthat more than one quarter of them hadexperienced one or more concussions.Neuropsychologist Dr. Ruben Echemendiareported that in his study of college ath-letes, over 40 percent of the soccer playershad at least one concussion prior to attend-ing college. By comparison, only 30 per-cent of the incoming football players.. hada concussion.. (M)any high school soccerplayers neglected to report experiencing aconcussion, because they didn’t think itwas serious or wanted to continue playingin the game...

“X-rays and other imaging of the brainoften cannot detect signs of a concussion....(M)any of the symptoms of concussionsalso occur in people without the condition,and... some of the most widely knownsymptoms, such as amnesia or loss of con-sciousness, are frequently lacking in con-cussed individuals... Loss of consciousnessfrequently lasts only seconds to minutes,so it is often not even detected because ofthe delay in stopping a game and assessingthe condition of a player following a headcollision... Some symptoms do not appearuntil days to weeks following a concus-sion.... (S)ubtle signs of a concussion thatoccur later and appear to be more persis-tent than the traditional symptoms. Twoneuropsychologists, Drs. Barth andEchemendia, reported evidence at theworkshop that brain functions areimpaired even after the obvious symptomsof concussion disappear... If people areunfortunate enough to experience a secondconcussion before they have fully recov-ered from their first, they can experience alife-threatening swelling of the brain, nomatter how minor the first or second bangto the head appeared to be...

“The notion that soccer might put youthsat risk for brain injury has circulated in thepopular media and that has led some tosuggest that soccer players wear protectiveheadgear. But.. no protective headgear cur-

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rently on the market is designed to protectagainst concussion. Today’s helmets aredesigned to meet standards for reducingthe risk of serious and fatal brain injuryand these standards are limited to reducinginjury caused by a linear acceleration, or a‘straight on’ blow to the head. But a blowthat causes concussion typically includesrotational acceleration, in which the braingets twisted. Current helmets and stan-dards are not designed to take this type ofblow into account... ‘We talk to trainers, toequipment managers, and they are verysurprised when I say that no helmet isdesigned to prevent concussions’...

“As to federal policies, safety issues in chil-dren’s sports are often covered by theConsumer Products Safety Commission(CPSC) insofar as sports equipment isinvolved. In May 2000, the Commissionheld a workshop to examine the possibleuse of helmets in youth soccer players, butdid not find that the available evidencewarranted the mandatory adoption of hel-mets. The Centers for Disease Control andPrevention (CDC) also monitors childhoodinjuries and funds research on injury pre-vention, but has not recommended againstheading in youth soccer. Finally, theNational Institutes of Health is the majorfederal supporter of medical research, butcurrently supports fewer than half a dozengrants related to head injuries in children’ssports... (W)ithout definitive data there canbe no conclusive resolution about the dan-gers of heading...”

The First Of Many Appearances: In mid-May, Karen Matthews drove down from theUniversity of Pittsburgh to testify for herfirst time, along with APA colleague DavidAbrams of Brown University, before the U.S. Senate Appropriations Committee regard-ing the “Impact of Stress Management InReversing Heart Disease.” Both were out-standing. Highlights from Karen’s testimo-ny: “My own research is on the role of stressin the development of heart disease, with anemphasis on young adults and on womenduring the menopausal transition. OurCenter is dedicated to understanding how

stress and other psychological factors trans-late into risk for diverse diseases, includingheart disease.

“Today I would like to make four points: 1. Psychological stress is typically consid-ered to be a process and not a single event.Stress management techniques can inter-vene in multiple ways in the stress process.2. Psychological stress can trigger ischemia,heart attack, and premature death. It mayalso accelerate the rate of atherosclerosisprior to the first heart attack or other clini-cal event, especially among those whoalready have high levels of ‘subclinical orsilent disease.’ Thus, effective stress man-agement techniques should theoreticallybe able to prevent a first or second heartattack. 3. Adequate tests of the impact ofstress management interventions in heartdisease patients have been few in number,but combining together the data fromsmall clinical trials shows that psychoso-cial interventions can be a useful adjunct toother therapies. (And), 4. The science ofbehavior change and practical knowledgeof how to conduct clinical trials haveadvanced sufficiently so that now is anopportune time to conduct high qualitystudies on the impact of stress reduction onpreventing or reversing heart disease....

“We know that the combination of notsmoking, having a healthy diet, higher lev-els of physical activity, moderate alcoholconsumption, and not being overweight isassociated with very low risk of heart dis-ease in the Nurses’ Health Study.Unfortunately, only 3% of the nurses werein this category. Very few people in theUnited States have adopted life styles thatare associated with very low risk for heartdisease, in part because of the difficulty inchanging well-practiced behaviors later inlife and in part because stress may interferewith altering behaviors to more health-pro-moting forms. We need a better under-standing of the role of stress in acceleratingdisease risk early in life and how stressmanagement interventions might impactearly risk trajectories. Stress managementcombined with promoting healthy life

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styles in adolescence and young adulthoodmay have long term economic and socialadvantages.” During the question-and-answer session, the witnesses stressed the

importance of health care reimbursementmechanisms (e.g., health insurance) cover-ing preventive clinical services. Aloha.

Call for Papers

The NNoorrtthh AAmmeerriiccaann SSoocciieettyy ffoorr PPssyycchhootthheerraappyy RReesseeaarrcchh ((NNAASSPPRR) is happy toinvite Division 29 regular and student members to submit a presentation at(and/or attend) its next meeting, which will be held in:

NNeewwppoorrtt RRII,, oonn NNoovveemmbbeerr 55--99 22000033

The submission deadline is April 30, 2003. For more information about submissions(posters, papers, symposia, workshop, open discussion), the conference, and stu-dent travel awards, please contact Louis Castonguay, Ph.D.(President, [email protected]), Lynne Angus, Ph.D. (Program Chair, [email protected]), or visit our website (www.naspr.org)

We hope to see you in Newport!

Louis G. Castonguay, Ph.D.Associate Professor

President,North American Society of Psychotherapy Research

308 Moore BuildingDepartment of Psychology

Penn State UniversityUniversity Park, PA 16802

Phone: 814-863-1754 / Fax: 814-863-7002

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I never spend time worrying about my malpractice insurance

because I’m with the Trust

The Trust takes the worry and guesswork out of man-aging my professional liability insurance. For morethan 30 years the APA Insurance Trust has been thesource of innovative insurance cover-age anticipating the needs ofPsychologists like you and me. Evenin this tough insurance market I cancount on them to safeguard my liveli-hood! What I get with the Trust iscomprehensive state-of-the-art cover-age that keeps pace with the con-stantly changing environment with-out having to worry about it.

Trust sponsored Professional LiabilityInsurance was the first to provide coverage for thingswe all needed and didn’t even know to ask about likelicensing board defense and employment practicesliability insurance. I never had to ask; the coverage wasmade available automatically.

My patients get 100% of my time with no distrac-tions...thanks to the Trust. All it takes is one click atwww.apait.org for the peace of mind and securitythey offer. Or call them at (800) 477-1200 for details.

My patients getall of my attention

* Underwritten by Chicago Insurance Company, rated A (Excellent) by A.M. Best Co.** Administered by Trust Risk Management Services.

The only professional

liability program sponsored by the

American Psychological Association Insurance

Trust

Jana N. Martin, Ph.D.Dr. Martin is President of the CaliforniaPsychological Association, APA's PublicEducation Campaign Coordinator forCalifornia, Past President and current Boardmember of the Los Angeles CountyPsychological Association, and Member andPast Chair of the CPA Marketing

www.apait.org(800) 477-1200

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DIVISION OF PSYCHOTHERAPY � MEMBERSHIP APPLICATION

Please return the completed application along with payment of $40 (or $29 for Student membership) by credit card or check (Payable to: APA Division 29) to:

Division 29 Central Office6557 E. RiverdaleMesa, AZ 85215

Code _____ FD _____

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Chair: John C. Norcross, Ph.D., 2002-2008Department of PsychologyUniversity of ScrantonScranton, PA 18510-4596Ofc:570-941-7638 Fax:[email protected]

Publications Board Members:Jean Carter, Ph.D., 1999-20053 Washington Circle, #205Washington, D.C. 20032Ofc: [email protected]

Lillian Comas-Dias, Ph.D., 2001-2007Transcultural Mental Health Institute908 New Hampshire Ave. N.W., #700Washington, D.C. [email protected]

Raymond A. DiGiuseppe , Ph.D., 2003-2009 Psychology Dept St John’s University 8000 Utopia Pkwy Jamaica , NY 11439 Ofc: 718-990-1955 [email protected]

Alice Rubenstein, Ed.D. , 2002-2003Monroe Psychotherapy Center20 Office Park WayPittsford, New York 14534Ofc: 585-586-0410 Fax 585-586-2029Email: [email protected]

Publications Board Members, continuedGeorge Stricker, Ph.D., 2003-2009 Institute for Advanced Psychol Studies Adelphi University Garden City , NY 11530 Ofc: 516-877-4803 Fax: 516-877-4805 [email protected]

Psychotherapy Journal EditorWade H. Silverman, Ph.D. 1998–20031390 S. Dixie Hwy, Suite 1305Coral Gables, FL 33145Ofc: 305-669-3605 Fax: [email protected]

Psychotherapy Bulletin EditorLinda F. Campbell, Ph.D., 2001-2003University of Georgia402 Aderhold HallAthens, GA 30602-7142Ofc: 706-542-8508 Fax:[email protected]

Internet EditorAbraham W. Wolf, Ph.D., 2002-2004Metro Health Medical Center2500 Metro Health DriveCleveland, OH 44109-1998Ofc: 216-778-4637 Fax: [email protected]

3

PUBLICATIONS BOARD

DIVISION OF PSYCHOTHERAPY (29)

Central Office, 6557 E. Riverdale Street, Mesa, AZ 85215Ofc: (602) 363-9211 • Fax: (480) 854-8966 • E-mail: [email protected]

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O F P S Y C H O T

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6557 E. RiverdaleMesa, AZ 85215

Non-ProfitOrganizationU.S. Postage

PaidUtica, NY

Permit No. 83