During this 10-year period, many notables in the field of psychology died, as well as the founder, publisher and editor, Henry Saeman, who passed away at the age of 76 on May 13, 2003.

Psychology were able to claim victory over the medical profession when two states enacted prescriptive authority to appropriately trained psychologists and legislators in two additional states enacted similar legislation only to see the bills vetoed by the states’ governors. Victory was also hailed when Congress finally passed a national mental health care parity act, which prohibits insurance companies from treating mental health treatment differently from physical illnesses.

Enough psychologists were upset by the refusal of the American Psychological Association (APA) Council of Representatives to limit psychologists’ involvement in national security issues that they took the issue to an unprecedented referendum and overturned the council’s earlier policies. The referendum called for the end of psychologists’ involvement in interrogations at the nation’s military and CIA prisons and limited their activities to humanitarian and health care issues.

Alleging that the APA’s Practice Organization was not sufficiently representing the interests of practicing psychologists, several past leaders of the APA founded a new organization, the National Association of Professional Practicing Psychologists to advance an ambitious agenda.

The National Psychologist covered the activities of psychologists working in New York City and elsewhere in the aftermath of the Sept. 11, 2001, terrorist attack, kept an eye on developments within APA and reported on the growing presence of psychologists in Congress

The Task Force on Psychological Ethics and National Security (PENS)

The APA managed to get involved in one of the most contentious issues of the decade when the Board of Directors in February 2005 named a 10-member task force to propose adequate ethical guidelines for psychologists involved in national-security related investigations. The Task Force on Psychological Ethics and Nationaly Security (PENS) was created, among other things, to look at how the profession has responded to reports of torture at the Abu Ghraib Prison in Iraq and the Guantanamo Bay Detention Center in Cuba. The task force was charged with examining ethical dimensions of psychology’s involvement in national security investigations. The report that the PENS task force released in mid-2005 was quickly condemned in many quarters, including medicine and psychology.

Writing in the September/October issue, Gary Kaufmann, Psy.D., whose background is in police behavioral science, said the task force “did not fulfill its responsibility to think through and provide guidance on the complex ethical challenges that face psychologists who apply their training, skills and expertise in our nation’s service.” He faulted the task force’s conclusion that when psychologists serve in any position by virtue of their training, experience and expertise, the APA code of ethics applies, but when psychologist act in roles outside traditional health-service provider relationships, psychologists are not acting in a professional capacity as psychologists and are therefore not bound by the APA ethics code.

Indeed, the Council of Representatives at its August 2005 meeting attempted to strengthen the report by amending it to make it clearer that when there is a conflict between laws and the APA Code of Ethics, the latter always prevails. Another amendment said there is never an excuse to inflict torture under any circumstance and the third strengthened a requirement that psychologists be required to report violations of the APA Code of ethics to the APA.

In the same issue that Kaufmann’s critique appeared Stephen Behnke, Ph.D., J.D., director of the APA’s Ethics Office, defended the report and said that additional comments would be solicited before a final version is published. He admitted that “much work remains to be done by APA and its members.”
At the August 2006 Council of Representatives meeting, Steven Reisner, Ph.D., called the entire U.S. operation in Guantanamo “immoral” and psychologists should be precluded from any participation. He noted that the American Psychiatric Association had acted to prohibit its medical doctor members from participating in military activities in the Guantanamo prisons.

A letter to the editor in the March/April issue signed by Ghislaine Boulanger, Ph.D., and 46 other psychologists announced they would withhold their 2007 and 2008 dues to protest the APA’s failure to take action prohibiting psychologists from being employed in government facilities that do not subscribe to the Geneva Conventions. The signers said APA’s policies regarding psychologists employed in various detention facilities is tied to the U.S. government policy, which provides wide discretionary power for the president to interpret and apply the Geneva Conventions.

At the 2007 APA convention in San Francisco, around 400 demonstrators urging the Council of Representatives to ban psychologists from participating in interrogations of prisoners at Guantanamo Bay and other prisons failed to convince the delegates to change its 2004 resolution against cruel, inhuman or degrading treatment of prisoners. The Council of Representatives re-affirmed its support of the 3-year-old policy and turned back a resolution that would have limited psychologists at prisons to be responsible only for inmate health care.

Noted author Mary Pipher, Ph.D., of Lincoln, Neb., returned her 2006 Presidential Citation from the APA in protest of the organization’s reaffirmation that psychologists have a proper role in CIA detention centers. In a 2007 letter to APA President Sharon Brehm, Ph.D., Pipher called the reaffirmation “a terrible mistake.” She said as a matter of conscience she cannot keep an award from an organization that takes a stand on human rights “at odds with the United Nations, the Red Cross, the American Psychiatric Association and the American Medical Association.”

Articles and letters to the editor protesting the APA position of psychologists and national security continued to pour into The National Psychologist. In the January/February issues, Brad Olson, Ph.D., a research and consulting psychologist at Northwestern University, and Martha Davis, Ph.D., a visiting scholar at John Jay College of Criminal Law, said three of the reasons the APA advances for allowing psychologists to work in Guantanamo and other military and CIA prisons are based on myths. The first myth, they wrote, is that “if psychologists are restricted from involvement in detainee interrogations, they can be restricted from other work.” The defeated 2007 amendment would have prohibited unethical work in settings that violate the Geneva Conventions and international law, not ethical practice in legal settings, they wrote. Myth No. 2 is that the “presence of psychologists will prevent detainees from abuse.” “There is not evidence from independent observers that Behavioral Science Consultation Teams (BSCTs) protect detainees any more than other military officers,” Olson and Davis said. Thirdly, the pair said, is the myth that members of the APA Council of Representatives arrived at its 2007 interrogation policy after extensive deliberations with a wide range of experts and had given these issues a fair hearing. “In 2005, the APA council members sped through deliberations with a PENS Task Force that was heavily weighted with psychologists affiliated with the U.S. military and the procurement of Department of Defense contracts,” they explained.

In the same issue, a letter signed by more than 220 psychologists noted they were withholding 2008 APA membership dues because APA “continues to give institutional support to the U.S. military and other government agencies that operate detainee sites in which international standards of human rights are violated.”

At the February 2008 meeting, the APA Council of Representatives, in an effort to silence critics of a resolution passed a year earlier on the involvement of psychologists in U.S. Detention centers, replaced a paragraph of the resolution to better define what psychologists can and cannot do at such sites. Delegates voted to include wording that emphasizes an “unequivocal condemnation” of all techniques considered torture or cruel, inhuman or degrading treatment of prisoners. The action followed what some saw as a ambiguity that could be interpreted as allowing direct or indirect participation of psychologists in questioning of prisoners at Guantanamo and other detention centers.

In a September 2008 membership mail vote, the APA was directed to forbid psychologists to work in Guantanamo or other national security centers except in humanitarian roles. The vote was 8,702 votes in favor of a ban, 6,157 against and 15 abstentions. The membership vote was spearheaded by a cadre of psychologists led by Stephen J. Reisner, Ph.D., of New York over outrage that the APA Council of Representatives decline to pass bans similar to those adopted by other healthcare associations, following news reports of abuses at Guantanamo, Abu Ghraib and other military detention centers and “blacksites” operated by the CIA.

The mail referendum marked the first time it was used to overturn a council action. Reisner said the vote tells him that the APA is ripe for a change of leadership to restore the association as a voice with the “moral authority” to speak out against violations of human rights throughout the world and to be a champion of bringing mental health care to the underserved.

The ban was adopted in February 2009 by the APA Council of Representatives by a vote of 141-12, with six abstentions.

In a related matter, retired Army Col. Larry James, Ph.D., denied charges that he taught torture techniques to military interrogators while stationed at Guantanamo and Abu Ghraib. He has published a book, Fixing Hell, in which he explains his experiences at the two prisons. In the January/February 2009 issue, Col. Kathy Platoni, Psy.D, defended James and other military psychologists. “Though we have been witnesses of the personification of true evil and the most heinous of all transgression and offenses, there simply is no evidence to support the commission of crimes by military psychologists,” wrote Platoni, who served in war zones and Guantanamo. She added that the referendum approved by the APA membership forbidding psychologists from being involved in anything but humanitarian work at military and CIA detention centers “borders on lunacy.”

Stephen Soldz, Ph.D., of the Coalition for an Ethical Psychology, however, questioned James’s contention that all torture and prisoner abuse stopped under his watch. Soldz cited reports compiled by the Red Cross, FBI and nongovernmental organizations (NGOs) documenting abuses far into 2004, at least.

Meanwhile, in the July/August 2009 issue, The National Psychologist reported the Toledo, Ohio psychologist Trudy Bond, Ed.D., had sued the Louisiana State Board of Examiners of Psychologists claiming the board had refused to investigate James for alleged professional and ethical violations at two prison camps. The board had turned down her 2008 request for an investigation, claiming the statute of limitations had expired. A Louisiana district court judge dismissed the suit, upholding the board’s statute of limitations argument. On June 11, 2010 a unanimous Louisiana 1st Circuit Court decision held that Bond did not have legal standing to pursue court review of the Louisiana State Board of Examiners of Psychologists lack on action on the complaint she had filed against James.

In a June 18, 2009 letter to its membership, the APA board of directors conceded that psychologists were involved in designing and advising on torture techniques employed at national security centers such as Guantanamo and Abu Ghraib. At the same time, the board wrote that “some of our members continue to be disappointed and other angered” that the association did not take stronger action earlier to condemn the interrogation methods. “Although there are countless psychologists in the military and intelligence community who acted ethically and responsibly during the post 9/11era, it is now clear that some psychologists did not abide by their ethical obligations to never engage in torture or other forms of cruel, inhuman or degrading treatment,” the board wrote.

In a Viewpoint essay in the November/December 2009 issue, Bryant Welch, J.D., traced the history of the involvement of the military in APA affairs. He said the undue influence of the military began in the 1990s and into the early 2000s. “I saw APA shift into a regressed organizational state characterized by excessive fawning, limited creativity and ineffective interactions with the outside world. The lack of dissent by most was praised as evidence of ‘working together.’ Rational disagreements, in contrast, were quickly responded to with ad hominem attacks, some of them quite sadistic, against dissenters.” He said that since the APA had implemented the recent referendum passed by the membership, “it appears that the current leadership at APA has decided to batten down the hatches and wait until the storm has passed.”

Stephen E. Handwerker, Ph.D., a founder and chair of the Advancement of Human Welfare, Inc. and a member of APA Division 48 (peace psychology) called for the APA to implement the language of the 2008 referendum into the APA Code of Ethics in an essay in the January/February 2010 edition. He also called for an investigation by an independent body to pursue accountability for psychologists who participated in or otherwise contributed to torture or cruel or degrading treatment at military prisons. He also urged that the June 2005 PENS report be annulled or rescinded due to “severe and multiple conflicts of interest.

RxP

New Mexico became the first state on Feb. 14, 2002, to enact legislation granting psychologists prescribing authority. It passed the state senate by a 29-9 vote and the New Mexico House 56-11, both veto-proof margins. It was signed by Gov. Gary Johnson, who had earlier summoned representatives from psychology and psychiatry to see if an agreement could be worked out. Psychiatry fought the measure to the bitter end, but an agreement between psychologists and the New Mexico Medical Society became the cornerstone of the new law, which requires psychologists to complete 450 hours of classroom training and spend 400 hours treating no fewer than 100 patients under a physician’s supervision.
Buoyed by psychology’ success in winning prescribing authority in New Mexico in 2002, a record number of state psychological associations sought similar legislation in 2003-2004, including five new states and seven states that have attempted to gain such authority in years past .New states include Arizona, Oklahoma, Oregon, Wyoming and New Hampshire. State associations that will again seek RxP include Connecticut, Georgia, Illinois, Louisiana, Tennessee, Texas and Hawaii.

On May 6, 2004, Louisiana Gov. Kathleen Babineaux signed a bill granting the state’s medical psychologists the authority to prescribe psychotropic medications, ending a decade-long battle in that state’s legislature.

At the August 2004 APA convention in Hawaii, David O. Antonuccio, Ph.D., of the University of Nevada School of Medicine warned psychologists gaining prescribing authority to be on guard against the siren song of drug manufactures and urged psychology publications not to accept advertising from drug companies. He said the American Psychiatric Association (ApA) receives more money, around $13 million annually, from drug companies than it does from membership dues and that the American Medical Association receives $20 million annually from selling drug companies its mailing list of medical doctors.

Morgan Sammons, Ph.D., then a Navy commander, echoed Antonuccio’s remarks, saying it was up to psychologists to insure direct drug company to consumer advertising didn’t distract from the profession’s primary responsibility, therapy. “It has to be us,” Sammons said, noting that the Federal Drug Administration is not going to crack down on exaggerated claims by drug companies. “No one else is going to do it; no one else is going to make sure our patients see the other side.”

Unsuccessful in stopping RxP legislation in New Mexico and Louisiana, the ApA created a seven-person presidential task force to “put an end to psychologists’ bid to win prescription privileges throughout the United States.”

In August 2005, George W. Albee, Ph.D., told a workshop at the APA convention that prescriptive authority for psychologists would doom the organization for abandoning its long history of research and clinical experience. He said that “poorly prepared professionals steadily gained control of APA’s governing council and board of directors” at the expense of researchers who continue to hold to non-medical theories about the nature of mental illness. “APA,” he said, “is firmly in the hands of the medical model/drug prescribing practice group that is killing the organization.”

The California Society of Clinical Psychopharmacologists filed suit in early 2006 in the U.S. District Court seeking the right to prescribe psychotropic drugs. The court denied the state’s request to dismiss the case and warned state attorneys not to file further “frivolous” motions to delay the case.

In the May/June 2006 edition of The National Psychologist, Glenn Ally, Ph.D., reported that 30 medical psychologists in Louisiana had written more than 10,000 prescriptions in the year since that state granted psychologists prescribing authority. And in New Mexico, Elaine S. LeVine, Ph.D., training director for the Southwestern Institute for the Advancement of Psychotherapy wrote that 30 psychologists had graduated from the program granting an advanced degree in psychopharmacology and another 20 were enrolled in the program.

Both chambers of the Hawaii Legislature approved a bill in mid-2007 to allow psychologists to prescribe in federally designated health centers, but it was vetoed by Gov. Linda Lingle.

A major push for prescriptive authority legislation in 2008 in California and Missouri went down to defeat, while the Tennessee Board of Examiners in Psychology approved rules allowing appropriately trained psychologists to consult with physicians on medication, an growing trend among the states. Tennessee joins California, Florida, Maine, Missouri, Vermont and the District of Columbia where psychologists are permitted to consult with physicians on medication. The practice is common in other states, as well, even when the law or regulations are silent on the subject of psychologist-physician collaboration.

The Louisiana Legislature in 2009 backed legislation that transferred licensure of medical psychologists from the Louisiana State Board of Examiners of Psychologists to the Louisiana State Board of Medical Examiners in recognition of the implicit medical components of the practice of medical psychology.

Both houses of the Oregon Legislature approved legislation in February 2010 giving properly trained psychologists the right to prescribe psychotropic medications. The prescription authority would not go into effect until July 1, 2011 to allow a task force to determine the level of training that would be required and the formulary contents. However, Oregon Gov. Ted Kulongoski vetoed the bill, but left the door slightly ajar for a pilot RxP program in 2011.

Psychologists Respond to Terrorists’ Attacks

Noemi Balinth,, Ph.D., June Feder, PH.D., Sandra Haber, Ph.D., were among hundreds of New York psychologists involved in helping victims of the Sept. 11, 2001 terrorist attack. Balinth worked eight days for the Red Cross that were filled with indelible remembrances, not least being “therapeutic” poker games in which no money changed hands with city firefighters as a way of distracting them and to help them think about counseling.

Ohio psychologist James Rodger, of the University of Akron, drove to New York to help, worked at ground zero wearing a hard hat and gas mask. Another Ohio psychologist, Kathy Platoni, Psy.D., accompanied three Dayton area police officers to New York City as part of a International Critical Incident Stress Foundation team to help restore many of the city’s 41,000 police officers to physical and mental health.

Norma Steuerle, PH.D., of Alexandria, Va., was killed in the plane that crashed into the Pentagon. U.S. Navy commander Robert Schlegel, husband of Dawn Schlegel, Psy.D., of Portsmouth, Va., was killed in the Pentagon.

Haber kept a moving diary of her work and shared it with readers of The National Psychologist.
Gary DeNelsky, Ph.D., and Philip G. Zimbardo, Ph.D., wrote Viewpoint articles. In “The day the psychology of America changed forever, DeNelsky wrote, “What happened that terrible Tuesday changed our lives a great deal, changed them immensely and probably changed them irreversibly. We will bounce back because the human spirit is if nothing else highly resilient and times does have a tendency to heal.”

Zimbardo, president elect of APA at the time of the attack, wrote on “good, evil and terrorism”, warning “We must individually and collectively refuse to adopt the terrorists devaluation of human life or they will win the next battle by giving into the kind of negative sentiments that their evil deeds have generated in us all.”

In March 2002, Leon J. Hoffman, Ph.D., of Chicago, warned against becoming over-saturated by media presentations of the 9/11 attack. He urged readers to absorb just enough news from print and electronic media “to stay informed.” He urged therapist to get plenty of sleep, eat well and don’t depend on drugs and alcohol to get through the day. “Few people are likely to be trauma experts. Don’t try, yourself, to become expert at what is impossible or irrelevant, such as memorizing the personal profiles of 50 Arab terrorists.”

U.S. Rep. Brian Baird, then a Washington State Democrat, who witnessed the hijacked American Airlines jet crash into the Pentagon from his seventh-floor congressional office, submitted a proposed constitutional amendment, dubbed the “doomsday” amendment that would allow governors to make temporary 90-day appointments to replace House members if disaster struck the capital building instead of waiting for special election as required by law. The proposal received one hearing, but failed to attract much support and died.

At its February 2003 session, meeting under an orange alert, a flight canceling snow storm and gathering war clouds, the APA Council of Representatives created a task force to study the psychological effects of efforts to prevent terrorism. The task force considered psychological processes that provoke terrorism, such as stereotyping, compartmentalization, enemy images, attribution error, self-fulfilling prophecies and group think.

The National Alliance of Professional Psychology Providers

A respected group of practicing psychologists on July 1, 2006, unveiled a new organization to counteract what it sees as inaction by the (APA) and the professional community as a whole on issues to importance to practitioners. The National Alliance of Professional Psychology Providers (NAPPP) includes such luminaries and former APA officers as Nicholas Cummings, Ph.D., Sc.D., Jack Wiggins, Ph.D., Psy.D., and Stephen E. Berger, Ph.D., on its board of directors. Other board members include Michael A. Baer, Ph.D., James Childerston, Ph.D., Howard Rubin, Ph.D., John Caccavale, Ph.D., Matt Nessetti, Ph.D., Lenore Walker, Ed.D., and Stanley Graham, Ph.D., another past president of APA. Noting that it wanted the new organization that unifies practicing psychologists, the board said, “We are averse to slow, encompassing bureaucracies that can take years or never to produce results.”

Not all psychologists agreed that such a new organization was needed. Pat DeLeon, Ph.D., J.D., a former APA president, branded NAPPP as a divisive movement that will breed unnecessary disgruntlement in the psychology community. “It’s a waste of time and a waste of energy,” DeLeon said, adding that he resents former APA presidents using their prestige to criticize the association. Russ Newman, Ph.D., J.D., then-executive director of the APA Practice Organization, said the need for advocating for practicing psychologists is great enough to warrant any help NAPPP can provide and hoped the two organizations can work together.

By October, NAPPP launched a practitioner-owned provider network modeled on the Kaiser Healthcare plan. The initial target client base was the 2.5 million members of the Service Employees International Union, which with dependents totals 8 million potential behavioral health clients.

In the may/June issue, Graham wrote in a Viewpoint column, “As past president of APA and a current executive board member of NAPPP, I do not accept that the organizations cannot work together in common cause. I see no reason why cooperation should not be seamless in areas that concern the practicing psychologist.”

NAPPP announced a national media campaign to educate physicians and their patients on the value of the mental health services of doctoral psychologists. Part of the message will be to educate the public that primary care physicians are not trained mental health professionals and have only drugs at their disposal to help patients. Insurers like the arrangement with primary care doctors prescribing psychotropics because drug treatment costs less than therapy.

APA News

Ray Fowler, Ph.D., for 13 years the APA CEO announced he would retire at the end of 2002. Fowler is credited with invigorating a financially and administratively broke group into the principal psychology organization in the United States. The fallout from 9/11 contributed to a $5.5 million hit when subscriptions from foreign governments were stopped and that money diverted to their internal security. Low turnover and the recession were other factors. The loss nearly matched the $6 million loss the APA suffered in the late 1980s during the last year it published Psychology Today.

It was later revealed that Fowler had received $2.2 million on his retirement during a period when the APA was running a $1.3 million deficit. By the strangest of coincidences, the fact that Fowler had received what many thought to be an outrageous amount of money appeared in a gossip column in The Washington Post on the first day of the APA winter Council of Representatives in February 2004.

In mid-2002, Norman Anderson, Ph.D., was named the new APA CEO. He became the first African-American to head the organization. The only addiction Anderson has, he told the TNP, is a sometimes irresistible urge to eat Krispy Kream donuts.

APA borrows $120 million to get its financial house in order following 10 years of accumulated operating debt.

The APA Council or representatives expanded its members from 144 to 162, giving each state, Canadian provinces and American territories with psychological association voting privileges. Arkansas, Wet Virginia, Delaware, Idaho, South Dakota, Wyoming, Montana, Nebraska and Nevada were states gaining votes, as well as the District of Columbia. Canadian provinces gaining seat include British Columbia, Manitoba, Nova Scotia and Quebec. Ontario previously had a seat on council. Guam, Puerto Rico and the Virgin Islands also gained one seat each. As a result, California and New York representation went from three to two, while Illinois, New Jersey, Massachusetts, Ohio and Washington went from being represented by two members to one psychologist.

In 2003, the APA created a task force to take a look at its practice of not accepting military advertising in its publications, a policy adopted in 1990 in response to the-then policy that prohibited gays and lesbians from joining the military.

Meeting in Honolulu in August 2004, the APA Council of Representatives approved the most sweeping endorsement of gay rights by any mental health association in a pair of resolutions opposing any legal restriction on the rights of gays, lesbians or bisexuals to marry or rear children.

In 2007, Russ Newman, Ph.D., J.D., executive director of the APA Practice Directorate since 1993, resigned to become provost and vice president of academic Affairs for Alliant International University in California. Jack McKay, the long-time chief financial officer retired.

Katherine C. Nordal, Ph.D., a managing partner of an independent practice group in Vicksburg, Miss., was named executive director of the APA Practice Directorate in April 2008.

At the February 2010 Council of Representative meeting, delegates defeated a motion to exempt industrial/organizational psychologists from licensure.

A flap over whether the “required” practice assessment was mandatory for practitioners to maintain APA membership broke out in early 2010. After some stonewalling and considerable doubletalk, the APA and the Practice Organization finally agreed that the “required” assessment was not mandatory to maintain APA membership.

Mental Health Parity

Mental health parity legislation was approved by the Senate Health, Labor and Pension Committee by a vote of 21-0 in mid-1991, but was sidetracked as Congress dealt with the aftermath of 9-11 and the rash of mail containing anthrax. In December, the House of Representatives, at the urging of employer groups and insurance companies, killed the bill. In early 2002, Sen. Paul Wellstone, a Minnesota Democrat, and Pete Domenici, a New Mexico Republican, vowed a new effort to pass parity legislation, despite no support from the White House and continuing Republican opposition in the U.S. House.
Wellstone, his wife, daughter and five staff members are killed in a plane crash in northern Minnesota on Oct. 25, 2003.

An early 2006 report in The New England Journal of Medicine concluding that providing mental health coverage equal to medical coverage would save workers money without increasing employers’ insurance premiums gives new hope that a national parity law might be enacted soon.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was approved in October 2008.

In the May/June 2009 issue, Bryant L. Welch, J.D., Ph.D., warned that mental health parity will remain an illusion as long as health maintenance organizations use the “medically necessary” standard for reimbursement. “One can have all the mental health care that is “medically necessary” under an 80-20 payment plan with no maximum limit on visits and still wind up with exactly zero mental health treatment if the insurance company determines the care is not medically necessary. In short, parity closes the barn door after the horse has already been stolen.”

In April 2010 a group of mental health carve outs filed suit seeking to block rules adopted to enforce the federal parity law. A judge denied a temporary restraining order.

Evidence-Based Practice in Psychology

At the 2005 APA convention, the Council of Representatives approved a proposal backing the use of Evidence-Based Practice in Psychology (EBPP) to promote effective psychological practice and enhance public health by applying empirical supported principles of psychological evidence in therapeutic relationships and interventions.

The action created considerable controversy. In the September/October issue, Thomas A. Habib, Ph.D., of San Juan Capistrano, Calif., said the decision gave health maintenance organizations one more reason to deny payment for psychological treatment. He wrote that psychology isn’t ready “for the strait jacket imposed by evidenced-based treatment. We are a young profession that is very much evolving. Our scope of treatment, the human condition, is much broader and more dynamic. He added that research shows that “it isn’t what we do that affects treatment outcome but qualities within the patient-therapist relationship.”

Habib blamed the influence of academics for the development of evidence-based treatment and charged that they had hijacked the APA by “tapping into psychology’s obsessive search for legitimacy and our collective professional doubt.”

In the same issue, Frank M. Dattilio, Ph.D., a faculty member of the Department of Psychiatry at Harvard Medical School, wrote that, with the advent of evidence-based treatment, there has come some reluctance on the part of many, evened seasoned therapists, to do what comes naturally. Instead, many feel compelled to follow a step-by-step procedure that almost appears “mechanized” or “wooden” at times.

More comments questioning the wisdom of relying on evidence-based therapy appeared in Letters to the Editor column in the November/December issues. Ken Harwood, Ph.D., of Jacksonville, Fla., wrote that a new generation of therapists can do therapy the “right” way , and feel secure (if not smug) in their performances, while often bringing no more than superficial change for the complex human being sitting across from them. This is a sad time for psychology!”

David H. Barlow, Ph.D., of Boston, Mass., wrote, “Let’s join together to vigorously advocate for the fundamental right of licensed psychologists to treat patients based on their judgments of what is best for patients, rather than having this decided by low-level bureaucrats. The problem is not the existence of new sophisticated psychological treatments; it is bureaucrats attempting to tell us how to practice.”

Passages

Paul Meehl, PH.D., 82, of Minneapolis died on Feb. 14, 2003. He was an early clinical psychologist and president of APA. Feb 14, 2003.

Ted Blau, Ph.D.,of Tampa, former president of the APA, the first practitioner on the APA board of directors and president of the APA, died Jan 28, 2003. He was a member of the Dirty Dozen.

John W. Gardner, Ph.D., of Palo Alto, Calif., the only psychologist to serve in a President’s cabinet and founder of Common Cause, died on Feb 18, 2002.

Neil Miller, Ph.D., of New Haven, Conn., died on March 23, 2002. He was a recipient of the nation’s highest scientific honor, the National Medal of Science. He was a president of APA in 1960.

Charles Kiesler, Ph.D., of San Diego, died on Oct. 11, 2002. He was the CEO of APA, 1975-1979.

Magda B. Arnold, Ph.D., of Tucson, died in October 2002. She was the author of Emotion and Personalty.
Erika Fromm, Ph.D., 93, of Chicago, who as a youth was mesmerized by a speech by Adolph Hitler, went on to become widely known in the application of hypnosis to help people work through issues. She died in June 2003.

Jerry Clark, Ph.D., was running for president of the APA when he died in September 2003 at the age of 90. He was the oldest member of the APA Council of Representatives and had twice served as president of the California Psychological Association.

Henry Saeman, founder and managing editor of The National Psychologist in 1991, died May 13, 2003, at the age of 76. He suffered from Myelofibrosis, a rare blood disorder. He was for 18 years the executive director of the Ohio Psychological Association, following a career as a newspaper reporter. He was honored by the APA’s Division 31 as the first-ever award as Outstanding Executive Director of a state psychological association.

In 2002, he was inducted into the Psychology Academy of the National Academies of Practice, the first non-psychologist ever elected to this elite group. Born in Regensburg, Germany in 1927, Henry was a passenger on one of the last ships to cross the Atlantic from Germany before the United States entered World War II. His mother died in the Holocaust. He is survived by his wife, Mitzi, and their son Marty, who is now managing editor of The National Psychologist.

Ira Polonsky, Ph.D., 64, was murdered on Nov. 1, 2005, in his Vallejo, Calif., office. He was a long-time and respected columnist for The National Psychologist. His killer has never been caught.

George Albee, Ph.D., 84, of Longboat Key, Fla., died July 8, 2006. He was influential and recognized for his early advocacy of prevention and other proactive approaches to mental health. He died July 8, 2006.
Jay Haley, widely acclaimed as a pioneer of strategic family therapy, master teacher and an advocate for hypnosis in 1960s, died in February 2007 at the age of 83.

Jacqueline C. Bouhoutsos, Ph.D., of Los Angeles, whose pioneering studies of therapist-patient sex culminated in legislation making the practice illegal, died on May 22, 2008 at age 83, following a 15-year battle with Alzheimer’s disease.

Army Maj. Eduardo Caraveo, Ph.D., was killed on Nov. 5, 2009 in the shooting rampage at Fort Hood in Texas.

Reginald Jones, Ph.D., 74, professor emeritus of the African American Studies Department at the University of California-Berkley, died Sept. 24, 2005. Jones was often called “the father of African American psychology. He was a recipient of the APA’s Award for Distinguished Career Contributions to Education and Training in 2003.

Albert Ellis, Ph.D., 92, the founder of Rational Emotive Behavior Therapy, died July 24, 2007. He was considered one of the most important psychologists of all time, coming in second only to Carl Rogers and ahead of Sigmund Freud.

Politics

Pat Gardner, Georgia pa executive director of the Georgia Psychological Association for 25 years announced her bid to run for that state’s House of Representatives. She handily won the election.
Two-term U.S. Rep. Brian Baird, Ph.D., a Washington State Democrat, caught a lucky break when a well-funded Republican challenger dropped out of the race in 2002.

Ted Strickland, Ph.D., the first psychologist elected to Congress, is gerrymandered out of his Ohio Sixth District, forcing him to run in a new district that follows the Ohio River from Youngstown to Portsmouth. The new district is shaped like a banana and appears yellow on redistricting maps. It is referred to as the “banana republic.”

With the 2002 election of Tim Murphy, Ph.D., a Pennsylvania Republican, and Diane Watson Ed.D.,, a California Democrat, the ranks of psychologist increased to five. Ted Strickland, Ph.D., and Brian Baird, Ph.D. and Tom Osborne, Ph.D., a Nebraska Republican were reelected. Strickland, Baird and Murphy created Congressional Mental health Caucus that claimed 72 members.

All five congressional psychologists were handily returned to Washington in the November 20204 elections.

Ted Strickland, Ph.D., and Tom Osborne, Ph.D., announced in mid-2005 that they would not seek re-election in 2006, instead opting to run for governor in their respective states. Strickland was handily nominated in the 2006 primary as the Democratic candidate for Ohio, governor, but Osborne was defeated.

Strickland was swept to office in the November 2006 election. But, the departure of Strickland and Osborne reduced the number of psychologists serving in Congress from five to three. In 2010, Baird announced he would not seek a seventh term in Congress, further reducing that number to two.

Names in the News

Albert Ellis, Ph.D., 92, one of the leading clinical practitioners, was dismissed from the New York City institute bearing his name in the fall of 2005. The father of Rational Emotive Behavior Therapy founded the institute in 1959 to promote his then-revolutionary form of therapy. The board of the institute said Ellis was dismissed when his nursing care costs amounted to an alleged improper “excess benefit” under tax laws, jeopardizing the institute’s nonprofit status. Ellis filed suit seeking reinstatement.

Elizabeth Loftus, Ph.D., the nation’s most controversial repressed memory skeptics, learned in mid-2005 that the California Supreme Court would hear her appeal to determine if she could be sued for invasion of privacy and defamation. In a complicated and drawn-out case, Loftus was charged by Nicole Taus for invading her privacy by identifying her in court documents, depositions and in other ways during the psychologist’s attempt to prove that Taus’s recovered memory of early childhood sexual abuse was false.

The case had dogged Loftus for many years and was responsible for her decision to leave the University of Washington in the fall of 2002 to move to the University of California at Irvine.

In February 2007, the California Supreme Court said that actions Loftus took to discredit a case study article describing repressed memories may be “considered beyond the pale” and ordered a trial court to consider whether those actions constituted an invasion of privacy. The invasion of privacy was the only issue upheld by the court. It threw out other claims, including public disclosure of private facts, defamation and intrusion into confidential juvenile court records.

Loftus was accused of misrepresenting herself during interviews with Taus’s former foster mother by claiming she was an associate and supervisor of the psychiatrist that had reported the recovery of the alleged repressed memory. Later, Loftus’s insurance company agreed to pay Taus $7,500 in exchange for dropping the invasion of privacy allegation.

Comparing the state of psychology today to a dysfunctional family that can’t take a vacation because they can’t agree on which airline to take, Ron Fox, Ph.D., challenged delegates to an APA convention to get over their fascination with disciplinary navel lint, and tackle the real problems of the world. Fox called psychology’s failure to develop into a strong, relevant and robust profession “one of the tragedies of our times.

He said that failure was not caused by disagreement with science, effectiveness of treatments or charlatans and sham psychologists. Rather, he explained, “Our tragedy and great failure is that we know so little about how to help our fellow man and are poorly positioned to apply what we do know.” He listed prevention of war, how to deal with poverty, how to cope with racism and the reduction of human misery as areas psychology should be taking the lead instead of “clogging the channels of too much of our scholarly discourse.”

Michael F. Hogan, director of the Ohio Department of Mental Health, was named chair of the President’s New Freedom Commission on Mental Health, created by President George W. Bush. It was the first presidential initiative in the mental health arena in 25 years, when Rosalynn Carter headed a similar study group.

“Services have to be made more available at all levels – at the individual consumer level, at the state level and at the national level,” Hogan told The National Psychologist.

He and commission members logged thousands of miles to Washington, D.C., Los Angeles, Chicago and Oregon during the year-long study. “If I had been able to collect frequent flier miles, I could go a long way, but when you work for t he government, you don’t get them.”

In its final report, the commission said the nation’s mental health system is in a shambles, with the quality of care varying greatly from one state to another. The commission called on Congress to pass a meaningful parity bill, and said the solution to the nation’s mental health delivery system is not necessarily more money, but imposing greater flexibility in using existing resources.

Wars, Soldiers, Veterans and Psychology

As the United States entered into a two-front war in Afghanistan and Iraq, reports of serious mental health issues among the troops began to emerge. One of the first reports was in an article in January/February 2004 issue about a psychologist who had served for 184 straight days in a remote field hospital in Turkistan on the Afghanistan border.

Air Force Maj. Steven J. Byrnes, Psy.D, told the annual convention of the Ohio Psychological Association of his experiences in working in sub-freezing temperatures at 6,000 feet identifying troops brought to the hospital with signs of stress and behavioral problems following the daily fire fights as part of the United States’ effort to eradicate elements of the Taliban in Afghanistan.

In addition to attending to the mental health needs of soldiers brought to the hospital, Byrnes said he also had to be alert to the needs of fellow officers in the medical corps and military officials when they showed signs of stress brought on by too much work in an area that offered no television, radio or other diversions.

A year later, the Department of Defense, noticing the high rate of soldiers reporting mental health problems months after leaving the Middle East war fronts, announced a new program that would provide evaluations for troops returning from Iraq and other hot spots to include follow-up assessments two to four months after leaving a combat zone. The program was started following research showed that troops were more likely to show signs of mental stress months after leaving rather than immediately leaving combat situations.

In the November/December 2005 issue, Kenneth Reich, Ed.D., and Jaine Darwin, Psy.D., both of Boston, announced a mission to provide free mental health services to families of military personnel assigned to the wars in Iraq and Afghanistan. The aim of the project, known as SOFAR (Strategic Outreach to Families of all Reservists), is to head off a massive amount of trauma because of the vulnerability of family members.

“These families are incredibly dispirited and unlike regular Army family members they’re incredibly isolated, Darwin told The National Psychologist.

SOFAR has assembled a group of experts to publish a pamphlet that will help teachers, parents and pediatricians identify trauma in children and a model workshop to educate teachers in dealing with trauma.

In November 2006, Barbara Romberg, Ph.D., of Washington, D.C., founder and executive director of Give An Hour, put out a plea for therapists to volunteer one hour a week to provide free mental health counseling to returning soldiers and their families.

In May 22007, Retired Col. Will Wilson, Ph.D., said there is a strong initiative by the military to enlist the aid of civilian psychologists to help military psychologists that are overwhelmed and understaffed from constant rotation in and out of war zones.

Wilson said it was undecided if civilian psychologists would be sent to the front lines or would serve only on bases in the United States and elsewhere.

“We’ve got people in Guantanamo, people on aircraft carriers, people all over the world and they’re getting worn out. They’re not getting a chance to stabilize of time to get their lives in order before they go back into situations that are very demanding,” Wilson told The National Psychologist. There is also a danger that many military psychologists will leave the service when their enlistments are up rather than consider making the military a career, he said.

In July 2007, a leader of the Veterans for America (VFA) said his organization and the Army have agreed to establish the Warrior Transition Brigade in a program that will train officers to recognize mental health problems among the troops they lead. The training, said Steve Robinson of the VFA will be introduced in all aspects and stages of military life starting in basic training and throughout the soldier’s professional development. He said the concept is important for those faced with wartime trauma on the battlefield and finally to personnel assisting soldiers returning home.

In the September/October 2007 issue, then-Navy Capt. Morgan T. Sammons, Ph.D., wrote a lengthy article about his experiences as a psychologist in Fallujah, Iraq, in 2006 and 2007.

“I treat a great deal of acute and chronic stress in theatre, using a basic cognitive framework that relies heavily on reducing affective response to distressing recollections and re-interpreting emotional and physical reactions to traumatic recollections,” Sammons wrote.

In the January/February 2008 issue, five psychologists talked and wrote about the intricacies of psychological treatment of soldiers and veterans. Greg M. Reger, Ph.D., a clinical psychologist at Madigan Army Medical Center; Col. Gregory A. Gahm, Ph.D., an Army psychologist, and the late Art Aaronson, Ph.D., a psychologist at the Veterans Affairs hospital in Dayton, told of their work using virtual reality to treat post traumatic stress disorder (PTSD) and other conditions affecting veterans and soldiers.
All agreed that using virtual reality to treat PTSD and other war-related mental health issues offered additional valuable tools in treating soldiers and veterans.

“In addition, virtual reality may help undercut a significant barrier to care, namely stigma, by providing a non-traditional treatment that may be a preferable option for service members who are reluctant to go to mental health facilities and ‘talk to a shrink,’” Reger and Gahm wrote.

In the same issue was an article about President Bush signing the Joshua Omvig suicide prevention bill that provides improved screening and treatment for at-risk veterans. The law was named after a 22-year-old soldier from Grundy Center, Iowa, who committed suicide in December 2005 after he returned from Iraq.

Other articles in the special section dealt with he need for more Navy psychologists and the need for psychologists to be alert to the possibility of signs of sexual abuse by female veterans of Middle Eastern wars.

In May 2008, retired Army Col. Will Wilson, Ph.D., spoke of both the importance and the difficulty in convincing soldiers leaving the service of the many resources available to them to address any mental health or other issues.

“How do you inform returning veterans about the whole process, the whole system put in place to help them? How do you get people in touch with resources that are in place to serve their needs? I’ll be damned if I know,” Wilson said.

Wilson explained that most returning veterans are coming from a high intensity environment and “they’re decompressing. Some of that energy can manifest itself not only in initial joy and enthusiasm but a certain amount of post-combat reaction, or as it is better known, depression, he added.

Many veterans will turn to drink or other harmful substances to treat mental health issues if they are not aware of the many resources available to them to confront their issues, Wilson said.

At the 2008 APA convention, Heidi Squire Kraft, Ph.D., told a workshop of her experiences as a Navy psychologist in Iraq. What she encountered, she explained, was beyond the traditional boundaries of psychology, including Marines dying in her arms, trying to keep a Marine sitting on a toilet with a rifle under his chin from committing suicide, facing mentally ill Marines who were armed with weapons and bombings going off all around.

At the same convention, Morgan Sammons, Ph.D., reported that there was a movement underway in Congress to allow the Veterans Administration offer mental health services to families of veterans at the same level now provided former military personnel. He said the largely volunteer corps of psychologist offering free care to veterans’ families was welcome, but that it was too uncoordinated and scattered to insure that duplication did not occur and that appropriate treatment was being delivered.

In a November 2008 update, Give an Hour Executive Director Barbara Romberg, Ph.D., reported that in a year the organization had grown to nearly 2,000 professional volunteers and a steadily growing number of private individuals who donate an hour a week to provide mental health services to veterans and their families. Around 6,500 hours of mental health services were provided in the last year and Romberg expects 5,000 members by summer 20209.

She also reported that the Eli Lilly had awarded the organization a $1 million grant to help increase its reach.

Squire Kraft would later write in a column for The National Psychologist that military personnel are not afraid of most things that would terrify the average person. “They define the word ‘brave’ in 15 different ways. But many are truly afraid to seek mental health care. The culture in which they were trained has had zero tolerance for mental health perfection and the popular belief is that their careers will be harmed with evidence of treatment on their records.”

Wilson, too, would later write about a survey that Cappella University conducted and its unexpected findings. He said that the veterans in the survey reported the therapy and help they were receiving in a variety of mental health settings was beneficial, while those providing the therapy and help thought they might not have helped at all.

In May 2009, The National Psychologist reported on the ongoing study in Western Pennsylvania conducted by Washington and Jefferson College’s Combat Stress Intervention Program (CSIP) in Washington, Pa. The program hopes to develop a plan that could be used nationally to address barriers to health care and provide valuable resources for veterans.

Michael Crabtree, Ph.D., a professor of psychology at the college, said 750 National Guard and reserve troops have completed an extensive 60-question survey as part of the CSIP. Results of the survey show that the average military experience of those surveyed was nearly 15 years. Forty-three percent were at least 40 years old, reflecting a mature population and the same percentage that reported mild to severe stress, emotional issues, drug and alcohol or family problems.

In the same issue, Penny F. Pierce, Ph.D., RN, a retired Air Force reserve officer with 33 years of military experience, wrote in a Viewpoint article about the increasing number of women serving in the nation’s wars. Since the end of the Persian Gulf War in 1991, she has been part of a University of Michigan study researching the wartime experiences and outcomes of women in the air Force and female solders in the Army serving in Iraq and Afghanistan.

“Our studies,” she wrote, “have found that women who are younger, in the junior ranks or deployed to the theater are more likely to report sexual harassment or assault, suggesting the work environment and the male-dominated hierarchical structure of military organizations present unique challenges.”
She noted that highlighting gender-related issues and problems is not to say that women are uniquely vulnerable, weak or otherwise unsuitable to carry out their duties. “It is plausible, and there is some evidence to suggest, that women may fare well in these challenging situations in part because they are extraordinarily adept at establishing new social networks and more freely disclose emotions.

The Army announced in late 2009 that it was collaborating with the National Institute of Mental Health in a five-year $50 million study of suicide and mental health among military personnel. The first part of the study looked at the records of soldiers who committed suicide between 2004 and 2009, compared to a control group of soldiers from the same period who did not, but have other characteristics that would be important for purposes of comparison.

The survey will be conducted with several thousand soldiers every month over three consecutive years, covering about 90,000 service members. Investigators will also survey 100,000 new recruits a year over a three-year period and continue to follow them over time.

In hopes of reducing the level of PTSD, the Army said it would train soldiers to be as fit mentally as they are physically before being sent into wars or other dangerous assignments. Adopting research into “emotional resilience” conducted by Martin Seligman, PH.D., of the University of Pennsylvania, the Army is training 150 sergeants a month at Penn in an intensive course in positive resilience. “I believe the Army is moving in the right direction,” Seligman told The National Psychologist. “I’d call it foresighted, training never given before in history. They (soldiers) can come out of the Army both physically and psychologically fit.”

Psychologists Respond to Hurricane Katrina

Psychologists from around the nation responded massively to the victims of Hurricane Katrina in Louisiana and Mississippi, although the APA was slow in offering aid to gulf area psychologists displaced by the storm. The American Board of Pediatric Neuropsychology (ABPdN) aided those psychologists with a web-based clearinghouse to connect those separated from their homes and practices with other willing to provide them with help.

Two weeks after the Aug. 29 hurricane made landfall, the APA was still working to set up a similar clearinghouse, but realizing the enormity of the situation and how far behind the organization was in its response reluctantly agreed a link to add the pediatric board’s website. John Courtney, Ph.D., executive director of APBdN, said the size of his organization made it easier to set up a website with pertinent information and that the huge size of the APA probably prevented it from doing a quicker job of responding.

He urged psychologists who had threatened to resign from the APA to protest its slowness in responding to its members’ concerns not to resign, but to realize that few organizations are able to put together an effective program in the face of such wide-spread devastation.

Sherrie Bourg Carter, Psy.D., in a letter to the editor, lambasted the APA for its failure to respond quickly to the needs of the psychologists living in the areas affected by Katrina. She noted that both the American Bar Association and the National Association of Criminal Defense Lawyers had responded within a couple of days to help their members. She called the lack of a quick response to the needs of affect psychologists “shameful.”

Michael Gerber, Ph.D., a San Luis Obispo County (Calif.) Behavioral Health Services psychologist, was docked two days pay for ignoring his employer’s order that he provide no services other than financial to the Katrina victims. “There was nothing I could do for the county (by staying) that would equal providing services to those people in need,” said Gerber, who spent two weeks in the New Orleans area.

Jim Quillen, Ph.D., president of the Louisiana Psychological Association, reported in mid-October 2005 that as many as 500 licenses psychologists remained unaccounted for since Katrina hit. He said it was hoped that the missing psychologists had simply dispersed to other states and had lost touch with the association.

In an interview with The National Psychologist, John Caccavale, Ph.D., told of his two-week experience working in the Cajundome, the University of Louisiana’s 13,000–seat sports and concert arena in Lafayette. He said the most common problem among evacuees was post-traumatic stress disorder.
“You have people who lost everything and they knew it, then they’re locked away in these facilities. You can imagine living in a structure with no natural light and martial law with the National Guard in uniform,” Caccavale said.

Several months after Katrina, and Hurricane Rita by then, three gulf area psychologists wrote of their experiences during and after the storms.

Janet R. Matthews, Ph.D., and her husband Lee H. Matthews, Ph.D., for the first time in living for 20-plus years in New Orleans, fled the hurricane in their car with two medically needy cats and lived in Arkansas for nine days before being allowed to return. They found their house under water and rented a fishing camp about an hour south of New Orleans to live in while clean-up activities progressed in the city,
“It was built half way into a bayou and they felt its rocking and flooding during Rita,” they recall.

The couple found a small apartment to rent while their home was gutted and renovated, but Lee H. Matthews was pretty much out of a job since the agencies he had worked for previously had been wiped out. Janet had her job as a professor at Loyola University, which didn’t reopen until January 2006.

“My 22 years on the faculty have given me a good sense of the students,” Janet recalled. “These students are working hard and are dedicated to the university but they show various PTSD symptoms. They do not concentrate as well as before, often look dazed and are concerned about the upcoming hurricane season.”

Mardi Allen, Ph.D., of Mississippi, a former president of the Association of State and Provincial Psychology Boards, recalled driving back into New Orleans following the evacuation.

“Hoping that it was a horrible nightmare that would seen vanish, but confronted with reality, the sight of mile-long lines of people waiting for the next gasoline truck to bring a delivery to one of the very few open gas stations created a feeling of extreme pain. In the more than 90 degree heat, high humidity and constant roar of helicopters overhead, visions of third world emergencies were evoked as families had to separate to stand in different lines to get ice and a hot meal,” Allen wrote.

She noted that more than 80 percent of the state’s psychologists were in Katrina’s path. “Some lost their homes and practices; others felt lucky with only severe roof and structural damage to homes or practices.

Joanne Steuer, Ph.D., of Los Angeles, joined with about 20 other therapists and drove through the rural south, “maps in hand, hoping gasoline would be available, seeking shelters and administrative centers with v ague addresses and gathering supplies from local the local Walmart. Katrina was a test of our resiliency, flexibility, and, yes, our training. No one was prepared for the chaos, the crowds, the physical devastation or the emotional impact.”

She wrote that the team worked in shelters, on the steps of the Astrodome, in a jail in New Orleans, in administrative centers and in parking lots surrounded by bugs, noise and heat.
“We did not do psychotherapy,” Steuer wrote.

Armed with a map, a rental car, a phone and an expense card with deployment instructions, Kathy Sexton-Radek, Ph.D., of professor of psychology at Elmhurst College, wrote of her experiences as a first responder throughout the New Orleans area.

“The crisis/triage work involved helping victims to relax to reduce their physical arousal and to provide support,” she wrote. “I found that useful interventions varied from the individual level of mediation of disagreements among residents at a shelter to the system level of attendance and consultation at administrative meetings for rescue workers.”

Managed care

“Managed care” was largely a theoretical term when the first issue of The National Psychologist was published carrying a debate on the topic between Nicholas Cummings, Ph.D., and Rogers Wright, Ph.D.

Cummings wrote that health care was leaving its status as a “cottage industry” and becoming industrialized. Wright countered that “Managed care is not really a solution but a delaying action.”

The following spring, the paper carried an article in which Cummings asserted that “APA has essentially been saying managed care will be dead in two years,” a prediction he found faulty. But he noted that there might be signs of “a willingness to change” because there had been several meetings between APA’s Practice Directorate and a number of Fortune 500 companies.

In July of 1992, however, The National Psychologist reported that “No accord (was) seen in an APA summit meeting with top officials of several managed care companies.” Bryant Welch, J.D., Ph.d., then head of the Practice Directorate, proposed an alternative to managed care, “integrated care.”

Psychologists remained divided on whether managed care would inevitably engulf the mental health field with some suggesting adapting to it and others shunning it entirely. In the March/April 1994 edition it was reported that a group of psychologists interested in forming a new division in APA to deal with managed care issues met all the required formalities but the APA Council of Representatives rejected the proposal.

In 1995, Cummings wrote that he expected by the year 2000 the “physician equity model” would be dominant and urged psychologists to be shareholders in the new model. Some who were previously opposed to managed care began urging cooperation. Jerry Morris, Ph.D., noted, “Psychologists will not survive by stubbornly rejecting 20 years of changes.”

Throughout the next decade, managed care continued to draw fire, including lawsuits contending that the profit motive dominated over concern for patients. State legislatures wrote bills trying to manage managed care and Congress weighed in at least in principle. In a 1998 article, then-U.S. Rep. Ted Strickland, D-Ohio, predicted that managed care reform would be high on Congress’s agenda.

In 2001 in California, the Department of Managed Care debuted and a Princeton economist predicted that the nation would not solve its health care delivery system problems “in the foreseeable future.”

Prescription privileges

The push by some psychologists for prescription authority was the second most reported on issue of the decade. In 1992 the Department of Defense (DOD) enrolled its second class of military psychologists for training to prescribe psychoactive medications.

A detailed debate on the pros and cons of prescribing authority was presented in the newspaper. Pat DeLeon, Ph.D., J.D., who would become known as the father of the RxP movement for psychologists, presented the argument for RxP, and Gary DeNelsky, Ph.D., gave the opposing view.

Psychiatry attempted to derail the DOD program in 1994 but Congress rebuffed the effort. The November/December 1994 edition carried a two-page advertisement announcing the founding of the Prescribing Psychologists’ Register, and in the March/April edition of 1995 the front page headline read: “Psychiatrists declare war on prescription rights.”

The APA Council of Representatives voted to endorse psychologists seeking RxP in 1995. The following year the DOD announced the RxP training would continue until 1997 but no new classes would be enrolled after that. Psychiatry claimed a victory but the DOD decision actually was based more on budget concerns.

Courses on prescription training for psychologists were expanded, especially at professional schools, and enrollments grew, although as many as half those applying indicated they would not personally seek prescription authority, apparently desiring the training primarily to advise medical doctors and to understand patients who were being prescribed such medications by physicians.

By the end of the newspaper’s first 10 years of existence, the American Society for the Advancement of Pharmacotherapy, APA Division 55, was in place, but the only jurisdiction that had approved RxP for psychologists was the Territory of Guam.

APA

In 1992, the APA allocated $500,000 to help practicing psychologists establish a better position in the health care marketplace, and sensing that health care reform was coming, the Practice Directorate launched an aggressive “$100 for 100 days” fundraising campaign from psychologists designed for use in gaining status for psychology in the health plan designed by President and Hillary Clinton.

A few months later, Bryant Welch, J.D., Ph.D., left his post as executive director of the Practice Directorate and became APA’s “health care reform consultant.” Russ Newman, Ph.D., J.D., became acting interim director executive director of the Practice Directorate and was later promoted to executive director.

Tensions between Welch and Raymond Fowler, Ph.D., APA’s CEO, reportedly were factors leading to Welch’s resignation and to a “brouhaha” surrounding renewal of Fowler’s contract. Ultimately, Fowler was re-confirmed by an overwhelming 87 percent vote of the APA Council of Representatives.

Criticism of APA’s stand against managed care continued with Nicolas Cummings, Ph.D., remarking in 1994 that APA’s direction was “off course and low on the reality scale” and “increasingly irrelevant” by contending that managed care under any circumstances is “antithetical to the treatment process.”
Cummings founded Biodyne, the first large managed care organization providing mental health services, and became a millionaire.

In 1999 The National Psychologist carried a feature story crediting then-Finance Officer Jack McKay with bringing APA back from the brink of ruin after its disastrous purchase of Psychology Today.

In 2000, APA reorganized in an effort to insure compliance with IRS regulations. APA retained its 501(c)(3) status but established the Practice Directorate as a 501(c)(6) organization with greater flexibility to lobby and provide advocacy services for practitioners.

There was one note of humor in chronicling APA’s operations. At one point, the APA inadvertently gave out the wrong phone number for CE credits. Unsuspecting CE seekers who called the number were connected instead to a sex hotline.

Licensing

Many issues relating to licensing in the first decade of the newspaper’s existence continued to arise periodically in the second decade, including efforts to protect the doctoral standard for licensing as a psychologist and the concern of many psychologists that licensing boards regularly deny due process to psychologists accused of ethical infractions.

The North American Association of Masters in Psychology (NAMP) made a concerted but largely ineffective effort to gain the right for those with masters training in psychology to practice independently while the APA Council voted overwhelmingly that the doctoral level should continue as the entry level for the practice of psychology.

The doctoral requirement remained the predominant model, but there were exceptions, including West Virginia and Vermont, which licensed masters-level practitioners as psychologists, and Kentucky which passed a law enabling those with master’s degrees to practice independently using the title “licensed psychological practitioner.”

The issue of whether licensing boards were unfairly punitive in hearing complaints against psychologists continued to relate back to the ultimate role of the boards, which is generally viewed as weighted toward protecting consumers rather than grooming professionalism among practitioners. One offshoot has been an expansion in the availability of insurance to cover expenses incurred in board proceedings under malpractice insurance contracts.

Hospital privileges

CAPP v. Rank, was the lead story in the inaugural issue of The National Psychologist and was viewed as a landmark decision in which the California Supreme Court ruled in favor of psychologists wishing to provide inpatient services.

It was believed that ruling would end hospital discrimination against psychologists, and hospital privileges for psychologists were subsequently established by law in Louisiana. In 1993, a new psychiatric hospital in Georgia granted full privileges to psychologists.

But the advent of managed care reduced inpatient utilization and many MCOs eliminated reimbursement for inpatient psychotherapy and assessment. The current health care reform is still being shaped, making it difficult to assess whether it will change matters in that area, but the emphasis on cost containment seems to make it unlikely.

In short, psychological practice expanded in many areas but psychiatric hospitals have not shown a major gain for psychologists.

As a psychologist, you understand that maintaining confidentiality between patient and therapist is core to your ability to practice. Suffering a data breach could not only cost you time and resources but could cost your professional reputation.

While federal and state laws vary, generally a data breach can occur when sensitive protected health information (PHI), including mental health records and personally identifiable information (PII), is accessed without authorization, which can occur through intentional or unintentional means.

According to a recent U.S. Department of Health and Human Services report, roughly 7.9 million people’s medical records have been exposed in 30,750 cases of health care-related data breaches since 2009 — a trend that is expected to continue.

The U.S. Congress first addressed individual privacy infringements in 1996 when they enacted the Health Insurance Portability and Accountability Act’s (HIPAA) Privacy and Security Rules, which sought to set a national legislative standard for protecting electronic individual health information. The issue was revisited in 2009 with the signing into law of the Health Information Technology for Economic and Clinical Health Act (HITECH) — a piece of legislation that was introduced as part of the Patient Protection and Affordable Care Act (the “health reform” law) that amended HIPAA — giving it “teeth” for the first time in the form of potential civil monetary fines and penalties.

While HIPAA/HITECH now provides that fines and penalties may be incurred by a health care organization in the event of a breach (on a sliding scale ranging from $50,000 up to $1.5 million per violation for the most egregious breaches), whether and to what extent these fines and penalties may be levied is always a subjective assessment by the government. An organization’s preparedness to prevent a data breach and its timely and appropriate response to a breach are factors taken into account by the federal government in determining whether and to what extent fines and penalties will be assessed under HITECH.

In addition to lost and/or stolen laptops and other portable electronic devices, one of the largest causes of health care-related data breaches is employee negligence. For instance, in 2010 NewYork-Presbyterian Hospital at Columbia University Medical Center reported a data breach which resulted in 6,800 patients’ PHI, including 10 social security numbers, being accidentally posted on the internet by an employee.

Additionally, allowing access to information by third party vendors and service providers may add another layer of vulnerability that is often overlooked when identifying cyber security weak spots. From 2010 to 2011, the personal PHI pertaining to 20,000 patients who visited the emergency room at Stanford Hospital in Palo Alto, Calif., remained publicly accessible on an online homework help site following an incident with the hospital’s third party billing contractor.

In the event that a cyber-related data breach occurs, there are often far-reaching repercussions including reputational harm and financial burdens due to potential fines and penalties and civil and class action lawsuits. There may also be expenses related to privacy notification, credit monitoring, health records resolution services, crisis management and forensic investigation.

The first step to protecting against a cyber-related data breach is through education. Learn about the federal and state laws that could apply to your organization and understand the reporting and notification requirements that may apply in the event of a data breach. Utilizing best practices both in advance of and at the point of discovering a data breach may also position your organization to be viewed more favorably by a federal or state reviewing authority post breach.

With most health care organizations only allocating 2 percent to 3 percent of their IT budgets to cyber security, an all-inclusive plan will probably be a distant reality at first for most practices. However, being caught unaware and unprepared when a breach occurs could have catastrophic consequences that an organization may not be able to weather. Therefore, in addition to consulting with a trusted advisor such as a specialized privacy/data breach attorney or risk management consultant, following these few simple guidelines may help reduce the impact of a cyber-related data breach:

• All portable/mobile electronic devices should be encrypted with data encryption software.
• When outsourcing work, do your due diligence by researching the third party vendor or service provider’s data breach policies, whether and to what extent they have errors and omissions liability and/or cyber liability insurance in place, and seek to put in place a written indemnification agreement with all vendors and service providers.
• Draft an internal incident response plan for data breaches and make it part of your organization’s culture. A clear plan outlining how to respond to a data breach within your internal organizational structure should help reduce the time between when a breach occurs and when it is appropriately responded to – all of which may place your organization in a more favorable light with an after-the-fact government audit or review of the data breach.
• Consider the purchase of a cyber liability insurance policy to help weather the financial burden of the “when” not “if” of a data breach occurring.

Complete peace of mind concerning the subject of data breaches and cyber security is not something most organizations can enjoy these days. But, you may be more confident regarding the safeguarding of your patients’ protected health information against a data breach if you have put an appropriate response plan in place to help mitigate the potentially devastating financial and reputational impact a data breach can bring upon your organization.

Kim Holmes, an assistant vice president and specialty insurance deputy worldwide product manager for health care at the Chubb Group of Insurance Companies, may be reached at kholmes@chubb.com

 

Barry Fonarow, a senior vice president for the insurance agency of Haughn and Associates Inc. He may be reached at bfonarow@haughn.com.

The psychologist found himself in the middle of their legal dispute and, without input from the psychologist, the judge ordered him to provide a custody recommendation to the court. It was the judge’s opinion that the psychologist in question was most qualified because he had been treating the family for more than a year and, to quote the judge, “He knew the family the best.”

While fully aware of the role conflicts that exist between providing therapy to clients and concurrently providing forensic opinions in a legal matter, the psychologist thought that since the judge had ordered it, he had no choice but to comply. So, he went ahead and rendered a custody recommendation to the court, an act that resulted in a complaint being filed about his conduct with the state licensing board.

In another consult, a judge ordered a psychologist to turn all the psychotherapy records of a client over to the attorneys involved in a legal matter. The psychologist was very concerned that the information contained in the records was private and violated the confidentiality rights of his client. Consequently, she simply refused to comply with the court order. Because of this refusal, the judge sanctioned her and ordered her to pay a significant fine along with the costs incurred by the attorneys in trying to obtain these materials.

The words “court ordered” can be quite daunting and confusing to practicing psychologists, most of whom are unfamiliar with the power and respective authority of those who are involved in the legal system. In addition, most psychologists do not understand what their rights are when they find themselves working in the forensic arena in one fashion or another.

The courtroom is a confusing arena of decision-making to be sure, but the seriousness of this level of confusion is only enhanced by the reality that it is also “foreign turf” to most practicing clinicians. This confusion frequently involves a misunderstanding of the concept of judicial authority within the legal system.

When something is “court ordered” the order generally establishes the courts authority over the matter at hand. While in some circumstances it will requires compliance, in others it does not. For example, should a psychologist be ordered to provide a professional service under the auspices of the court, it does not necessarily mean that the psychologist must provide those services.

What it does mean is that the judge has given the request the judicial stamp of approval, if you will. What it does not mean is that psychologists who are so ordered by the court are required to comply with the order even if the request violates the standards of professional practice. Simply put a court cannot order a psychologist to violate professional standards.

While psychologists who have been ordered to do something for the court must take some type of action when so ordered, they do not necessarily have to provide the service identified in the order. What they should do is notify the court of why the order cannot be complied with and the ethical and professional standards foundation for this.

What is important to remember is that while psychologists can educate the court on professional matters, such as what service a psychologist can or cannot provide, they cannot educate the court on legal matters. That is simply out of their area of expertise. The two examples that appear at the outset of this article are great examples of these types of differences.

While in the first example, the psychologist had a professional responsibility and duty to educate the court on how the order violated the standard of care and of ethical practice, the second dealt with a legal determination made by the court. While a psychologist surely should feel free to contact the court regarding these issues, a lack of compliance with a legal determination, is truly risky.

To make matters more serious, an inability to understand the differences between these two issues could expose treating psychologists to potential civil lawsuits and licensing board complaints. For example, if a treating psychologist is ordered to render an opinion as to the best suited parent to have custody of a child, the disgruntled parent could argue that such a decision constituted malpractice because the psychologist had a conflict of interest in the matter.

The argument for the psychologist would be that such a recommendation was court ordered. While this would likely constitute a successful defense, the psychologist would still be faced with potential hefty legal costs and time spent defending against the allegations.

So, what is the psychologist supposed to do when these types of things occur?

First, if you do not know what to do, do not do anything until you get guidance. This is very important. Most psychologists are not lawyers and until you are able to get legal advice, decisions about what to do in legal matters can be quite dangerous. So, seeking out answers from an attorney, an ethics committee or another type of legal resource is in order.

Second, psychologists should not be afraid to communicate with the court regarding questions and concerns they have about court orders. If a professional believes an order is a violation of the standards of professional practice, this should be expressed in correspondence to the court and/or to the attorneys involved in the matter. Remember, judges and lawyers are usually not psychologists and may be unfamiliar with the significant role conflicts that exist when a treating psychotherapist is required to render a forensic opinion to the court.

If neither of these provides a solution to the dilemma at hand, then it is in the best interests of the psychologist dealing with this dilemma to retain legal representation in the matter. When this is necessary, contacting your malpractice carrier is in order since such representation might be covered by your professional liability policy.

Jeffrey N. Younggren, Ph.D., is a clinical and forensic psychologist in Rolling Hills Estates, Calif. He is also an associate professor at the UCLA School of Medicine. His email is: jeffyounggren@earthlink.net

 

Elizabeth A. Younggren, J.D., is an attorney at Reback, McAndrews and Kjar, a firm that specializes in medical malpractice defense. She graduated from UCLA with honors and earned her law degree at Loyola Law School (JD, 2004). She is a member of the bar of California; US District Court, Central District of California. Her email is: byounggren@rmklawyers.com

When it is treated, it is usually with traditional therapy models that don’t address practical matters where adults with ADHD need help the most. Therapists have not sufficiently addressed these needs and the field of ADHD coaching was born and people without clinical training are providing these services. Some therapists have responded by adding coaching to their repertoire.

I have written extensively about a four-part treatment model for adults with ADHD that includes education, medication, coaching and therapy (Integrative Treatment for Adult ADHD: A Practical, Easy-to-Use Guide for Clinicians, 2007).

Because ADHD is fundamentally a disorder of information-processing and self-regulation, these clients need practical strategies to help them manage responsibilities and therapy to address the fallout from a lifetime of struggle and setbacks. Therapy alone will not suffice if clients continue to have the same struggles that drive their low self-esteem, anxiety, depression, maladaptive coping mechanisms, etc. I liken it to trying to fill a bucket with a hole in the bottom.

Therapy vs. Coaching

Coaching, like therapy, has no single definition of what it entails or how it differs from therapy. One distinction often made is that coaching addresses the present and future whereas therapy focuses on the past, but this mostly seems to apply to psychoanalytic therapy. Others say coaching focuses on strengths whereas therapy focuses on diagnosable pathologies, but positive psychology would disagree.

“There is a great deal of overlap between coaching and some types of therapy,” says Michelle Novotni, Ph.D., of Wayne, Pa.

“Cognitive behavioral therapy and behavioral therapy are most closely aligned with coaching. There are elements of a number of other counseling theories.” When asked about the differences, Alan Graham, Ph.D., of Park Ridge, Ill, said, “This may be heretical to say but the answer is, not much.”

I make a rather over-simplified distinction that coaching involves helping clients more effectively manage practical matters that adults with ADHD invariably struggle with, such as time management, organization, priorities, etc. Therapy helps with the commonly comorbid anxiety and depression, etc.

Coaching and therapy can achieve similar goals from opposite directions, as Deborah Rowley, MSW, of Madison, Wisc., knows. “Therapy involves working on the ‘stuff’ on the inside to gain strength, insight and awareness in preparation for participating more fully and effectively when interacting with the outside environment. And at the same time, effective coaching efforts usually result in desired and improved internal experiences (relief, pride, etc.).”

David Giwerc, MCC, has trained more ADHD coaches than anyone else through his ADD Coach Academy. He says coaches “empower adults with ADHD to look at their strengths and successes first and then notice what is getting in the way of their ability to create consistent progress in their lives.” Some logistics may be different.

“Therapy is almost always done face to face,” says Marjorie Johnson, LCSW, of West Chester, Pa. “Coaching can be done either face to face or virtually on the phone or through Skype. The fees are different, the frequency of sessions may be different.”

Coaches will also often have more contact with clients between sessions. For example, Novotni recently had a client call her every morning for a week to ensure the client got out of bed on time – a common problem for adults with ADHD and one that almost cost this client her job. Few therapists would make such an arrangement and many might interpret it as dependent.

Explaining her rationale, Rowley says, “The foundational component in coaching is accountability. Traditional therapy does not go outside the treatment hour unless there is an emergency, so any accountability strategy utilized between sessions wouldn’t be used. With a pure therapy client, there might be homework to report something back during the next session. With coaching, the same client might email me a few sentences about her experience between sessions.”

Integrating coaching into therapy About half of those interviewed said they don’t mix therapy and coaching with the same client – it’s one or the other. The other half feel comfortable doing a combination.

Johnson keeps them separate based on the client. “In general, if a client is new to ADHD (recently diagnosed) or under the age of 16 or so I will use a counseling model to help them understand and cope with their diagnosis and learn how it affects their whole functioning. Once the client has been diagnosed for a while and is older they often have specific goals they want to pursue (e.g.., college or a job advancement or career change.) Then, coaching is the model I use.”

In my integrative model, I go both ways. I have therapy clients who also see an ADHD coach. But I also tend to mix in some coaching with my therapy clients, especially those with ADHD. Any therapy model that can tolerate an active and sometimes directive therapist can be adapted to more fully meet the unique needs of ADHD clients.

One reason I like to blend the two is that coaching often reveals important matters for therapy when coaching strategies that “should” work, don’t. When working with a client on getting to work on time, you may discover that the problem involves practical matters like getting to bed too late and getting distracted by having the TV on when getting ready. You may find that the client feels trapped in a hopeless job and avoids the pain temporarily by showing up late, even though it contributes to job problems.

Coach training

Because coaches are not licensed by the states – yet, there are no formal training requirements. If you want to get into coaching, Alan Graham recommends, “Complete coach training. There is a different mindset that a coach uses.” However, there is a lot of variability in the quality and intensity of the programs. The International Coach Federation (ICF) accredits coaching programs of all sorts, whereas the Institute for the Advancement of ADHD Coaching (IAAC) and the Professional Association of ADHD Coaches (PAAC) focus on ADHD coaching. These accreditations aren’t required, but they are preferred.

You can include elements of coaching in your practice without making it official. Some clients may not need this, but clients with ADHD most likely will – and they will likely terminate prematurely if you don’t provide it.

Final Thoughts

It’s worth noting that although you may distinguish between coaching and therapy, if you are a licensed mental health practitioner, your licensing board probably won’t – coaching services will likely be seen as falling within the purview of your license. For example, coaching is often done by phone, making it easy to work with clients who live out of state.

This puts licensed clinicians at risk if the licensing board from a client’s state believes they are practicing in that state without a license. This is a relatively small risk, but some caution is warranted.

That said, coaching can be a helpful addition to your practice.

References available from the author.

Ari Tuckman, Psy.D., MBA, is the author of three books: Integrative Treatment for Adult ADHD; More Attention, Less Deficit; and Understand Your Brain, Get More Done. Information about his books and podcast can be found at adultADHDbook.com. His email address is: Ari@TuchmanPsych.com

The first modern systematic use of groups to promote healing is generally cred- ted to Joseph Pratt who, at the turn of the 20th Century, incorporated groups into his efforts to treat patients with tuberculosis. Evidence of the effectiveness and efficacy of group psychotherapy has continued to accumulate since then and is well documented.

A summary of the relevant literature can be found in the brochure published by the American Group Psychotherapy Association aptly entitled, “Group Works!” Group psychotherapy with adults, adolescents and children when used alone or in combination with other treatment interventions (e.g., psychotropic medications) has been found to be useful in treating a broad variety of problems, including depression, anxiety, serious medical illness, loss and addictive disorders (AGPA, 2003).

Just as there is no single form of individual psychotherapy, there is no single form of group psychotherapy. Groups come in different sizes and shapes. Different purposes and goals lead to the articulation of different group contracts.

Thus, the size of the group may vary, as well as the length of time and number of sessions, whether the group membership is open or closed, its composition, the format hat is followed, the ground rules that are adopted and how leader and member roles and responsibilities are defined and developed. Similarly, different theoretical orientations guide the group psychotherapy that is practiced, including psychodynamic, general systems, interpersonal and cognitive/behavioral approaches.

Since it is the job of the psychotherapist to treat individuals not groups who are seek- ing help, some group leaders, especially those who are psychodynamically oriented, pay careful attention to the process of the group, while others make only limited use of group process and dynamics.

Among those who advocate for the importance of examining the group process, some emphasize an examination of the intrapsychic level of the group process, that is, individual members’ internal lives, their character formations, typical defenses, internal objects, etc. Others prefer to focus more on the interpersonal level of the process, exploring relational styles of members and how their internalized conflicts are reenacted in the interpersonal field of the group. Still others systematically examine the group-as-a-whole level of the process, attempting to highlight developmentally early relationships of members with persons in positions of authority.

Since no single form of group psychotherapy has been proven to be more effective than any other, what common ingredients might underscore the efficacy of all these different group approaches? This question has led to a body of research that has attempted to identify the “therapeutic factors” in group therapy. Among those identified have been: the instillation of hope, universality, imparting of information, altruism, the corrective recapitulation of the primary family, development of socializing techniques, imitative behavior, interpersonal learning, group cohesiveness, catharsis and existential factors (Yalom and Leszcz, 2008). Of these, high levels of cohesiveness and interpersonal learning have been consistently linked with successful outcome (Burlingame and Fuhriman, 2003).

One recent application of group psychotherapy has involved the use of group interventions in the treatment of trauma. A growing body of empirical data supports their effectiveness (Schein, 2006). Several aspects of groups appear to make them particularly well suited to working with trauma and disaster victims.

To begin with, groups can provide a safe, nurturing, non-judgmental environment where participants can feel accepted and emotionally supported. Relief from the aloneness, isolation and disconnectedness that trauma survivors frequently feel can be especially valuable. Meeting together with others who have endured similar frightening, overwhelming and deeply disturbing experiences provides an opportunity for group members to put into words those very experiences that have been so difficult to talk about with others.

Establishing a holding container enables group members to find their voices, share their experiences, disclose painful feelings and begin to speak the unspeakable. The dreadful nature of such experiences, along with the accompanying feelings of shame, loss, rage and anguish, often are kept secret. Frequently, these reactions interfere with and sometimes preclude survivors from broaching their concerns with others.

Participating in a group with other survivors rather than seeking individual attention can relieve the social stigma and cultural barriers that often impede help-seeking and enable emotionally isolated survivors to recognize that they are not alone.

Furthermore, the presence of other people in the group generates opportunities to reveal, validate and to bear witness to what has happened. In the process of so doing, members begin to restore their disrupted external connections with others as well as begin to repair the often profound rifts in their internal assumptive worlds about themselves, relationships, life and the way the world usually works.

The very act of sharing information about what happened can quell misinformation and upsetting rumors. The group can provide a context for education and the proper dispersal of information, especially with regard to needed available resources and how to secure them. The courage, strength, compassion and resilience displayed by group members often serve to inspire participants and to stimulate a renewed sense of hope about the future. By helping other group members, individual participants can both augment their own damaged sense of self-esteem and relieve the collective sense of helplessness survivors experience.

In addition, groups enable members to share and learn new ways of self-care and new strategies for coping. The acquisition of such tools can promote healing and restore more effective levels of functioning.

Finally, by providing opportunities for sharing, emotional support and new learning in a safe environment, groups can help disaster survivors to begin to repair their disrupted sense of trust in their leaders, the world around them and other people (Klein and Schermer, 2000; Klein and Phillips, 2008; Buchele & Spitz; 2005).

References available from author.

Robert H. Klein, Ph.D., is a senior clinician, teacher and supervisor, who has been a faculty member at the Yale School of Medicine for more than 30 years and a Distinguished Life Fellow and past president of the American Group Psychotherapy Association. He may be reached at drrklein@aol.com.

Let’s take a look at Dr. John Q. Public’s foray into a court appearance and see how he fares.

Dr. Public is a licensed psychologist who primarily does psychotherapy with adults and children and some assessment with children. Dr. Public has been seeing a child for several months for his difficulties in school both in academics and behavior.

The child’s parents divorced several years ago and the boy does see his father occasionally, but the focus in therapy has been on the boy’s life at school and home. Out of the blue, Dr. Public received a notice to appear in court for a proceeding brought by the father to reconsider custody. Dr. Public was well aware that he was a treating psychologist and thought he would be able to enact his role competently in court. The mother was informed of the court notice and agreed to his testimony as the treating psychologist.

When Dr. Public took the stand, he made observations about the boy’s progress as well as difficulties in school. Dr. Public soon found himself thrown rapid fire questions by the opposing counsel about the mother’s fitness for custody and being given challenges to produce reasons the father should not have custody. Dr. Public steadied himself and responded that as the treating psychologist, he could not make custody judgments because he had not done a custody evaluation.

Then, just as he was feeling confident about his answer, the judge asked, “Dr. Public, now surely after seeing this boy for these months, you have some opinion about the parents. You’re not being asked to make a custody evaluation, and I would really value your general opinion here. Think of yourself as just a member of the public, not a psychologist, and tell me your overall viewpoint.”

The rephrasing of the question and the fact that the judge was pressuring him, threw Dr. Public out of the decision tree he had carefully prepared for his response. He thought, in the intensity of the moment, that he not only could but should answer. The judge was sounding as if Dr. Public wasn’t competent if he couldn’t answer these questions. Dr. Public responded that “if he were giving an opinion and not an evaluation and if his comments were to be regarded strictly as a member of the public” that he could give his thoughts about both parents given what the boy had told him.

How did Dr. Public do? We might want to give him an “A” for effort but his report card performance then begins to slip:

• Informed Consent: When Dr. Public began seeing the boy for treatment, he had no idea that custody or any court engagement would be in the picture. He had informed the boy at the outset of therapy that he might have to disclose material to his mother and gave the risk conditions under which he would do so but he did not include this circumstance. He now has to deal with the great potential of a rupture in his relationship with the boy, having revealed what the boy thought was confidential.
• Opinion versus Evaluation: Perhaps in his interest to cooperate, Dr. Public accepted the judge’s distinction between opinion and evaluation. The APA Child Custody Guidelines and the APA Ethics Code treat the terms opinion and evaluation equivalently in that an opinion is an evaluative statement. Further, even though Dr. Public had firsthand knowledge of the mother’s parenting style, insomuch as Dr. Public did consult with and include the mother in quite a few sessions, he had not conducted interviews, administered instruments or sought other critical data that would be necessary to ren- der an opinion on custody.
• Private or Public Conduct versus Professional Conduct: A litmus test that can assist psychologists in making the public versus professional distinction is this. Is it really likely that the judge would ask the bailiff to go outside the courthouse and select the fifth person to walk by, bring that person into court, and ask an opinion that would be utilized in the court’s decision? If the answer is “no” then the psychologist is not acting as a member of the public. As unlikely as this scenario may sound to the reader, there are many cases in which this very trick has been played on psychologists in several venues.

Dr. John Q. Public has had his turn in the proverbial washing machine wringer. On the bright side, the case of a well-meaning psychologist getting caught in the wringer can be educational and corrective more readily than those few cases of intentional unethical conduct of which we hear more often.

Linda Campbell, Ph.D., is a professor at the University of Georgia and director of the Doctoral Training Clinic that serves northeast Georgia. She is past chair of the ethics committees of both the APA and the Georgia Psychological Association. She is an APA Council Representative for Division 29 and vice president of the Georgia Board of Examiners of Psychologists. She may be reached by email at: lcampbel@uga.edu.

The revised DSM is scheduled to be published in May 2013, and for most of the more than 10 years the mental health “bible” has been under review by the ApA the major complaint was the secrecy surrounding the work.

Then as information started becoming available, especially last year after the task force launched an information website – www.DSM5.org – that outlines many revisions being considered, the furor changed from “why are you hiding what you’re doing” to “why in hell would you do that?” Divisions of the American Psychological Association (APA) are leading the charge to rein in changes they believe will lower the threshold of mental disorders to the point that sadness at the loss of a loved one could be diagnosed as major depressive disorder and all mental disorders could be viewed as biological phenomena calling for prescribing psychoactive drugs.

A petition was launched in October by Division 32, the Society for Humanistic Psychology, with input and backing from several APA practice divisions as a critical open letter to the DSM-5 Task Force. It is gaining thousands of signers every month from all fields of mental health providers, including counselors, social workers and many psychiatrists.

One psychiatrist highly critical of the proposed revisions is Allen Frances, M.D., who was chairman of the DSM-IV Task Force and is a professor emeritus of the Department of Psychiatry at the Duke University School of Medicine.

In an interview with Psychiatric Times, an independent publication that like The National Psychologist is not affiliated with or beholden to any professional association, Frances recommended the petition as “an extremely detailed, thoughtful and well written statement that deserves your attention and support.”

Frances said the letter

“summarizes the grave dangers of DSM-5 that for some time have seemed patently apparent to everyone except those who are actually working on DSM-5. The short list of the most compelling problems includes: reckless expansion of the diagnostic system (through the inclusion of untested new diagnoses and reduced thresholds for old ones); the lack of scientific rigor and independent review; and dimensional proposals that are too impossibly complex ever to be used by clinicians.”

The complete text of the letter, which can be signed online, is located at www.ipetitons.com/petition/dsm5.

The opposition has become international. In December, the British Psychological Society with almost 50,000 members endorsed the petition, joining 36 other mental health organizations, including 14 APA divisions. Groups in Europe, South American and Australia also were organizing signers and one group in Barcelona reported gathering more than 5,000 signatures on its petition website.

Heavy in detail, empirical evidence and professional logic, the APA’s position echoes many complaints voiced earlier last year by the British Psychological Society, which issued a statement saying in part:

“The Society is concerned that clients and the general public are negatively affected by the continued and continuous medicalisation (sic) of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation. … We believe that classifying these problems as ‘illnesses’ misses the relational context of problems and the undeniable social causation of many such problems. For psychologists, our well- being and mental health stem from our frameworks of understanding of the world, frameworks which are themselves the product of the experiences and learning through our lives.”

Many complain that the proposals so pathologize normal human actions that an unruly child’s temper tantrum could be labeled “disruptive mood dysregulation disorder” or a mother’s attempt to turn a child against the father in a custody dispute could be found to be suffering “parental alienation disorder.”

However exaggerated some of that hyperbole might be, the overriding concern is that too many people will be prescribed unnecessary and potentially harmful medications.

Opposition to such broadening of mental disorder definitions is not limited to those in the health field. The majority of psychologists and often the entire field of psychology are viewed as liberal, but revelations about the proposed revisions are drawing fire across the political spectrum, including the CATO Institute, a conservative think tank headquartered in Washington, D.C. CATO is concerned that lowering the diagnostic threshold for many mental disorders could create an avalanche of claims against employers under the Americans with Disabilities Act, the Family Medical Leave Act and workers’ compensation laws.

CATO pointed to behavioral liabilities employers already face, including a trucking company that was sued for not hiring drivers with a history of drinking problems. The online comments did not specifically recommend that employers or management personnel consider signing the APA petition, but it included an active link to go to the petition site.

This statement is in contrast to the APA’s code of ethics, (Section 3.05), which clearly states that:

“A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence or effectiveness in performing his or her functions as a psychologist or otherwise risks exploitation or harm to the person with whom the professional relationship exists.”

Multiple relationships not reasonably expected to cause impairment or risk exploitation or harm are not unethical.

Zuckerman’s statement and discussion of multiple relationships are not only incorrect, unsupported and outdated, but also are in clear contrast to the standard of care of psychotherapy and counseling. For example, multiple relationships are mandated in military settings where psychologists often have primary loyalty to the Department of Defense and only a secondary loyalty to the person they are treating in the consulting room. Multiple relationships are inherent in some correctional settings, such as prisons, where psychologists have a responsibility to the security of the institution, as well as to the mental health of actual patients.

Zuckerman, who to the best of my knowledge, lives in Pennsylvania, should be aware that multiple relationships are unavoidable in small communities and rural areas, which are quiet prevalent in his state. In fact they are a normal and healthy part of such interconnected communities (Zur, 2007). Familiarity and multiple relationships between all members of small communities, including health care providers, is how such communities survive and thrive.

Not all multiple relationships are created equal.

There are different types of multiple relationships (Zur, 2007):

• A social multiple relationship is one in which a therapist and client are also friends, acquaintances or have some other type of social relationship within their community.
• A professional multiple relationship is where a psychotherapist/counselor and client, are also professional colleagues in colleges or training institutions, presenters in professional conferences, co-authors of a book, or other situations that create professional multiple relationships.
• Institutional multiple relationships take place in the military, prisons, some police departments and mental hospitals where multiple relationships are an inherent part of the institutional settings.
• Forensic multiple relationships involve clinicians who serve as treating therapists, evaluators and witnesses in trials or hearings.
• Supervisory relationships inherently involve multiple relationships and multiple loyalties. A supervisor has a professional relationship and duty to the supervisee and to the client, as well as to the profession.
• A sexual multiple relationship is where a therapist and client are also involved in a sexual relationship.

Sexual multiple relationships with current clients are always unethical. A business multiple relationship is generally ill-advised. These are relationships, in which a therapist and client are business partners or have an employer-employee relationship.

Multiple relationships can be ethical or unethical, legal or illegal, and can be avoid- able, unavoidable or mandated. They can also be planned and anticipated or unexpected. Then they can be concurrent or sequential and can also very with different levels of involvement, from low/minimal to intense.

In summary:

• Non-sexual multiple relationships are not necessarily unethical or illegal.
• Multiple relationships can’t be avoided in many settings and are mandated in others.
• Multiple relationships are a healthy part of small and rural communities.
• Sexual multiple relationships with current clients are always unethical.

Non-sexual multiple relationships do not necessarily lead to exploitation, sex or harm. The opposite can be true. Multiple relationships can reduce isolation and prevent exploitation rather than lead to it. Almost all professional association codes of ethics do not mandate a blanket avoidance of multiple relationships.

Ofer Zur, Ph.D., is a fellow of APA (Division 42). He is co-author of Multiple Relation-ships in Psychotherapy, author of Boundaries in Psychotherapy, and director of the Zur Institute, LLC, which offers numerous free resources and online CE courses on multiple relationships, boundaries and other topics at www.zurinstitute.com. He may be reached at droferzur@zurinstitute.com.

In a recent study, Betsy Sparrow, a professor at Columbia University, demonstrated that we have begun to use our computer (and the Internet) as a robust external memory. In her studies, Sparrow found that if someone were presented a list of obscure facts they would remember where they stored that information better than the information itself, even down to computer folder where it was deposited. In other words, if someone knows that information will be available online or on their computer they seemingly choose to remember where the information is opposed to simply remembering it.