In the latter half of 2011, psychologists in Florida detected the scent of an unholy witches’ brew wafting out of Jacksonville. The malodorous signs were obvious. First there were rumors of a carve-out for mental health services. Then the letters started.

First, each participating mental health provider for Blue Cross Blue Shield of Florida (BCBSF) received an odd letter in the mail, announcing that all providers were to have their contracts terminated in 90 days because “BCBSF has partnered with New Directions for the management of all aspects of behavioral health services including provider network contracting…. You will receive an application from New Directions for network participation.”

Oddly enough, BCBSF put the burden of patient notification on the doctors. “Please notify your patients… that you will not be a participating provider as of Jan. 1, 2012.”

Of course, we all immediately went on the web to investigate this New Directions outfit and discovered that it was a small managed care company in Kansas run by a psychologist I’d met briefly some years earlier. I vividly remembered him talking about how a community with 68 active psychologists only really needed 12 and he coolly described to me how he would go into such a community, take over mental health services and then slash the panel to reduce utilization and increase profits.

It was a chilling conversation that I often recounted to others over the years as an example of the underlying profit motive behind the managed care industry. Little did I know this guy would ultimately be implementing his strategy in my own state. Soon, providers received another letter from New Directions laden with distasteful and mysterious ingredients.

The letter and accompanying complex contract was approximately 20 pages long and requested a response “within 15 days” although the letter itself was undated. Included was a new reimbursement rate schedule that reduced existing BCBSF rates, already discounted by 30 percent to 50 percent below Medicare’s reimbursement levels.

There were also a variety of surprising elements that seemed to be illegal, unethical and/or inappropriate. The Florida Psychological Association (FPA) formally sought the assistance of the Florida Office of Insurance Regulation. They intervened and, soon thereafter, New Direction revised the contracts and made a new mailing to providers, but there were still many problems.

We learned that BCBSF had actually become a co-owner of New Directions and, therefore, this carve-out was more like a modified carve-in. We also learned that BCBSF was beginning to partner with other states to spread this new version of the gospel of mental health cost containment.

Individual psychologists began reporting inconsistent information received from New Directions and BCBSF. Confusing and disturbing misinformation was also apparently being given to patients increasing stress and interfering with good treatment. The FPA and the APAPO contacted a variety of regulatory agencies and elected officials; expressing great concern about the new direction mental health coverage had taken in Florida.

On Aug. 25, 2011, the Parity Implementation Coalition (http://parityispersonal.org/) wrote a letter to three federal departments: Health and Human Services, Labor and the Treasury.

Why was the Parity Implementation Coalition involved? Why would an organization “formed to help ensure that the Mental Health Parity and Addiction Equality Act of 2008…is properly enforced” be interested in Florida’s little problem? I don’t know for sure, but I’m guessing that they think the same way I do about this mess.

I think that this move by BCBSF is really the initiation of a national movement to circumvent the Mental Health Parity legislation we all worked decades to pass. I think that by reducing reimbursement rates to levels lower than the hourly rate plumbers, auto body shops workers and electricians charge, BCBSF hopes to drive doctors out of its panel, making it much more difficult or impossible for patients to find doctors willing to accept BCBSF health insurance.

Obviously, that process cuts utilization, drives costs down and pushes profits up. That undermines the intent of the 2008 parity legislation, making it more difficult for patients to get expert treatment.

Although Florida happens to be the state where the model is being given a trial run, it appears that this unholy witches’ brew is destined to be served nationally. That makes this assault on mental health care terribly important and that’s why so many organizations are working hard to challenge this initiative.

The APAPO, the American Psychiatric Association, the National Alliance for the Mentally Ill, and the FPA have all been working cooperatively to bring the facts to the attention of regulatory agencies who should take action. They should block this destructive maneuver destined to set back the treatment of mental health problems in America by decades. What can you do to help?

First, be aware of what’s going on and tell others. Second, join your state’s psychological association and pay the APAPO assessment so that we can add more power to our own brew to break the spell cast by managed care. Third, contact your legislators and let them know about this plot to subvert legislative intent and to assault the rights of patients and the professionals who work so hard to serve them.

Throw these good ingredients into the pot and help neutralize the witches’ corrupt cauldron concoction. The fire is burning and the mix is bubbling.

Your support is badly needed. Our professional futures and the futures of our patients may depend on it.

Stephen A. Ragusea, Psy.D., ABPP, is in private practice in Key West, Fla. He is a past-president of the Pennsylvania Psychological Association and currently chair of the Florida Psychological Association’s ethics advisory committee. His email address is Ragusea@Raguesea.com

He also stated that the most likely cause was ineffective parenting.

Predictably, the article attracted some negative comment. In the January/February issue there were two critical replies — one from Myles Cooley Ph.D.; the other from Jan Nix, Ph.D.

The letters are very similar. Both castigate Paterno in scathing terms and pour censure on The National Psychologist for daring to print such material! What’s interesting is that Cooley’s and Nix’s letters read more like dogmatic refutations of heresy than a scientific discussion.

In addition, Cooley cites the 2002 International Consensus Statement on ADHD (PDF). I took a look at this, expecting to find something learned and scholarly.

Instead, it is little more than dogmatic condemnation of “heresy” signed by 86 mental health professionals. A spurious document signed by 86 individuals is still a spurious document. Cooley makes no mention that the so-called Consensus Statement has been criticized at least twice in the peer- reviewed literature by a total of 36 authors at least as eminent as the 86 Consensus authors. (A critique of the International Consensus Statement on ADHD, Timimi, S., Moncrieff, J., et al, 2004, and Does the International Consensus Statement on ADHD Leave Room for Healthy Skepticism? by Jureidini, J., Taylor, D.C., 2002). It has also attracted negative comment from David Cohen, Ph.D., (professor of Social Work at Florida International University, Miami) and D.B. Double, a British psychiatrist (consultant psychiatrist Norfolk and Suffolk NHS Foundation Trust and honorary senior lecturer Norwich Medical School, University of East Anglia).

Even a cursory reading of the so-called Consensus Statement suggests not only that the authors are blatantly partial to the bio-pharma viewpoint, but also — and more importantly — missed the central issue. They labor the point that ADHD “exists.” Nobody is arguing that ADHD does not exist. Of course children misbehave in these ways. The question is: How do we conceptualize this misbehavior?

People of an evangelical persuasion conceptualize it as sin: Moral laxness in the family has allowed the devil to enter and the child lacks the moral stamina to resist temp- tation, which leads to this kind of misbehavior.

People who accept the ontological status of the APA’s so-called diagnoses conceptualize the misbehavior as an illness — not an ordinary illness, mind you — but rather a mental illness. Within this group there exists a growing subgroup that conceptualizes the misbehavior specifically as an illness of the brain.

And, of course, there are behaviorists, like myself, who conceptualize this misbehavior as behavior — pure and simple. We seek explanations within the framework of stimulus, response, reinforcement, etc. — the same framework that helps us conceptualize and understand behavior generally.

I’m not suggesting that one way of conceptualizing this misbehavior is as good as another. Far from it. In my view the behaviorist perspective is the most parsimonious, the most elucidative and the most supported by the evidence.

The “mental-illness-that-morphed-into- a-vaguely-defined-neurological-illness” explanation has in fact no explanatory value. Consider the following hypothetical conversation:

Parent: “Why is my child so restless and inattentive?”

Psychiatrist: “Because he has an illness called ADHD.”

Parent: “How do you know he has this illness?”

Psychiatrist: “Because he is so restless and inattentive.”

The reasoning is entirely circular. The only evidence for the “diagnosis” is the very behavior it purports to explain. The posited neurological deficits would, of course, break the circularity, but in order for us to take this seriously, advocates of the neurological illness theory need to come up with a neurologically-based diagnostic procedure. So far, there is none.

Another flaw is highlighted by the question of faking. If I wanted to fake pneumonia, I might read up on the symptoms, then go to an emergency room and report these symptoms, perhaps cough a little, etc… and the staff there would probably take me very seriously. But they would also order some lab tests, monitor my vital signs, etc., and after a while they would come back to me and tell me that I didn’t have pneumonia.

Contrast this with ADHD. If a parent coaches a young child to emit the items on the APA’s checklist, and the child emits these behaviors on a fairly regular basis — then the child has ADHD. All of the criteria for ADHD are behaviors. There is no deeper etiology that can distinguish “genuine” cases from fakes. In fact, the distinction is meaningless. Here again, a definitive neurological test would resolve this problem, but despite active promotion of the neurological illness concept for the last 30 years, there is still no test. As long as all the criteria for this so- called diagnosis are behavioral, the most reasonable place to seek its cause is in the behavioral dynamics of the child and his significant others.

One could critique the illness concept, indeed the entire spurious DSM nosology, at length. But the point I wish to make is that Paterno’s ideas are perfectly reasonable — more reasonable than the illness theory — and The National Psychologist should be commended — not censured — for printing them. Indeed, there is widespread and growing opposition to the American Psychiatric Association’s (ApA) medicalization of virtually all human problems.

A front page story in the January/February issue of The National Psychologist reported significant opposition among the American Psychological Association and the British Psychological Society to the proposed DSM-5 changes, opposition aimed directly at the medicalization question.

What’s particularly interesting is that it has taken the APA and the BPS so long to identify and engage this issue. The spurious and increasing medicalization of ordinary human problems has been going on since DSM-II and received its major acceleration from the ApA’s definition of a mental disorder in DSM-III: “…a clinically significant behavioral or psychological syndrome or pattern that occurs in a person and that is associated with present distress … or disability … or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom.” (DSM-III; xxii)

If you read it carefully, what this actually says is: any significant human problem. The ApA has been building its sandcastle on this spurious foundation ever since, and the APA and the BPS have been walking lock-step. I’m glad to see the development of some opposition, however belated. But the issue is not DSM-5. The issue is DSM, with its bogus diagnoses, the only purpose of which is to legitimize the drugging of an ever-increasing segment of the population.

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A check on ProPublica (http://projects.propublica.org/docdollars/) reveals that Russell Barkley, Ph.D., lead author of the so- called Consensus Statement, received just under $80,000 in consulting and speaking fees from Eli Lilly in 2009 and that at least 11 other authors were receiving significant sums from pharmaceutical companies between 2009 and 2011.

Dogma and vituperative condemnation are the true enemies of genuine understanding. We are fortunate to have a newspaper that prints opposing positions. DSM, with its medicalization of all human problems, has become a destructive Juggernaut in our society and owes its success in large part to the blind obedience of its adherents and their willingness to stifle voices that refuse to sing along.

Philip Hickey, Ph.D., is a retired psychologist. He has worked in prisons, addiction units and community mental health centers. He may be reached by email at phil.hickey1@gmail.com. He blogs at: http://behaviorismandmentalhealth.com.

This includes the notion that Catholic clergy are much more likely to be sex offenders than men from other groups as well as that the cause of the abuse crisis has to do with celibacy requirements for Catholic priests or due to homosexual men. Many believe the church continues to be a safe haven for sex offenders and abuse continues to be rampant.

Psychologists and other mental health professionals who may conduct evaluations or treat clergy abuse victims, clergy offenders or even just rank-and-file Catholics must be updated on what we know about the problem in order to provide ethical and competent services. Good quality research data and best clinical practice guidelines are available but infrequently used. Hysteria seems to be more common than reasoned discourse when it comes to this topic even among professionals.

As a psychologist and professor who treats and evaluates clergy abuse victims and offenders, consults with many church dioceses and religious orders, as well as conducts research on this topic now for 25 years, I’ve been amazed at how often knowledgeable and thoughtful mental health professionals as well as the public can be misled by news reports and intense emotional reactions to this issue.

Quality research data published in 2004 (the Nature and Scope Study) and 2011 (the Causes and Context Study) conducted by researchers at the John Jay College of Criminal Justice dispel many of these myths and offer state-of-the-art research findings on sexual abuse of minors in the church and throughout society.

These studies (among others) find that during the past 60 years 4 percent of Catholic priests and religious brothers had credible allegations of sexual misconduct with minors in America, peaking during the 1970s with significant and dramatic declines starting to occur in the early 1980s. In fact, 94 percent of known cases occurred before 1990.

No empirical evidence exists that indicates that these figures are lower among other clerical or other types of groups with men having regular access to and control over children (e.g., non-Catholic clergy, coaches, school teachers, boy scout leaders). Recent news from college athletics at Penn State and Syracuse universities underscore that child sexual abuse is not confined to the Catholic Church or to any church organization but can occur wherever adult men have power, control and unsupervised access to youth.

It is startling that research finds that about 15 percent of men and 30 percent of women in America report that they were sexually violated as a child by an adult male with about 80 percent of the offenders being relatives such as step-fathers, uncles, older brothers and cousins. Although horrific, Catholic priests are not more likely to violate children than other men. Therefore, blaming mandatory celibacy as a root cause is misguided.

Many wish to blame clergy abuse on the high number of homosexual men in ministry (with best research-based estimates to be between 25 percent and 40 percent in the Catholic priesthood). Psychologists and other mental health professionals are well aware that sexual orientation by itself is not a risk factor for crimes against children.

In fact, the American Psychological Association, the American Psychiatric Association and the American Academy of Pediatrics all offer position statements after carefully reviewing the research evidence making clear that homosexuality is not a risk factor for sex crimes against children.

Research also finds that 80 percent of the victims of clergy sexual abuse are teens and not pre-pubescent children. Therefore, most offenders in the Church are not pedophiles at all. The often heard phrase “pedophile priest” is misleading.

The number of new cases of sexual abuse by priest in the United States during the past decade averages about 10 per year with decreasing numbers in most recent years. Most of the recent offenders are international priests who often did not have the same training and screening as those trained and ordained in the United States.

We have learned in the past decade that when institutions are confronted with allegations of child sexual abuse perpetrated by valued organizational members they typically respond with denial, cover up and efforts to protect the institution from accountability, lawsuits, embarrassment and scandal rather than making their top priority the well being of victims. This has been true in the Catholic Church as well as in other institutions.

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A decade after The Boston Globe’s report, there is much to be hopeful about in keeping children safe in 2012 and beyond. Mandated reporting laws, intense media attention, victim advocacy, scrutiny and many new policies and procedures employed by the Catholic Church articulated in what is referred to as the Dallas Charter, such as zero tolerance policies, annual audits of dioceses, educational efforts such as safe environment training programs for all employees, volunteers and members of the Church who are involved with youth, criminal background checks and mandated psychological and behavioral screening of clergy applicants or new international priests and other efforts all work together to keep children safer in the presence of adults.

While much has been done in the past decade, more still needs to happen to make the system of child protection in the church and elsewhere air tight. Problems still exist in trying to get everyone to follow well conceived and articulated policies and procedures as well as the law (such as the recent challenges in the dioceses of both Kansas City and Philadelphia).

So, there is still plenty of work that needs to be done. Using the best available research and clinical data without affect and agendas is the best way for psychologists and other professionals to keep children safe both in and outside of the Catholic Church.

Thomas G. Plante, Ph.D., ABPP, is professor of psychology at Santa Clara University and author of several books on clergy abuse including the just-released Sexual Abuse in the Catholic Church: A Decade of Crisis, 2002-2012 . Learn more at www.scu.edu/tplante. He may be reached at tplante@scu.edu .

Since high school, people who knew my father was a psychologist have often expressed sympathy, as in, “It must be so hard to have a parent that is always analyzing you or wanting you to talk about your feelings.”

The therapist-parent archetype they seem be referencing feels akin to Richard Dreyfuss in What About Bob? Sometimes what was implied was a belief that therapists are more “crazy” than the typical parent, and that I am fortunate to be so well-adjusted. Far be it from me to disagree with such a characterization of myself, but I do disagree that having a psychologist for a dad has been a burden. In fact, aside from working most evenings at home or occasional phone calls from clients, there were very few ways I noticed his profession influencing daily fam- ily life.

My dad never pressured me to pursue any particular career path, including psychology, and didn’t initially think I was serious when I decided to pursue a Psy.D. I remember trying to explain that this was something I had always wanted to be, which may not have been completely true.

At some point in my life I think I had archaeologist, architect, writer, teacher and filmmaker on the list as well. I believe that my dad’s influence on my career path was largely subtle and indirect, more the result of shared personality characteristics, such as psychological mindedness, high verbal ability and an interest in helping others.

Once I started graduate school, our conversations about psychology helped to validate a sense of “fitness” for the profession. Grad school is not the real world (fortunately), and because our discussions on psychological issues typically made sense to me and felt comfortable, it boosted my confidence that I would also feel comfortable with real world colleagues. Perhaps this is why I never felt the urge to find a “mentor” in grad school, because that’s the role my dad has always occupied for me.

For those of you who have children but don’t have a psychologist parent, remember not to raise your child in a Skinner Box or otherwise treat them like a psychological experiment. The best influence you can have is being yourself, even if you cannot always demonstrate unconditional positive regard. Try to use what you’ve learned about psychology, but be sure to watch What About Bob — as a cautionary tale.

And don’t feel bad if your child doesn’t follow in your footsteps, because Congress will eventually approve the Medicare SGR cuts in reimbursement.

Anthony S. Ragusea, Psy.D., is a licensed psychologist in private practice with his father (Stephen A. Ragusea, Psy.D.) in Key West, Fla. Anthony may be reached at dr.tony@ragusea.com

To his patients, he’s Dr. Fox, to his col- leagues he’s Ron and to the general public he’s Ronald Fox, Ph.D., but to me he’s always been just Dad.

Every once in a great while, his work life would bump into our home life – a client obsessively calling the house hoping to speak to him, meetings with his intern group, a random word about the types of patients that he saw.

Being a psychologist did not seem like too difficult a job or a very interesting one for that matter.

Dad never pushed it as a career choice although he was adamant that we (my broth- ers and I) attend college and appeared to be fairly certain that we would attend graduate school in some field or another. That I would become a psychologist did not really cross my mind for many years.

I do remember from a very young age feeling that Dad is the very best listener in the world. I felt like he could listen forever and I believe that even now. Whether it was about receiving a D in fifth grade math, deal- ing with a boyfriend’s abrupt rejection, worrying about getting into graduate school or finding employment, he was simply the most attentive and supportive listener I have ever known.

He almost never had the answer I was hoping to find but the process of being listened to, taken seriously and respected never failed to have a calming effect on me. He was a genius at putting a problem in perspective and finding a reason to feel hopeful. In addition, Dad has a very good sense of humor and could almost always get me to smile and on occasion laugh at myself. To this day, I believe that if I can offer nothing else to clients, supervisees or colleagues, I can offer them the experience being listened to.

My father believes that most of his clients are doing the best that they can at a given time and that particularly applied to families. He understands that all families have eccentricities and can be maddening – that’s just what they do.

Regardless of their behaviors, he believes in giving his clients the utmost respect and truly lives the principle of “dislike the behavior, not the person.” This was not an ongoing topic of discussion; it just came up from time to time.

This way of thinking about families was particularly helpful to me in my work with abusive parents. Many times it was tempting to feel nothing but contempt for those parents but understanding that they were people deserving of respect and doing the best they could at the time helped me make it through more than one grueling interview or assessment session.

After finally choosing psychology as a career, Dad became more of a role model. Dad was and is immensely proud to be a psychologist. On the other hand, he could be exceedingly humble about his accomplishments. On one occasion he told me that no one (outside of psychology) would ever be as impressed by my degree as much as I was. And so the challenge: how to remain proud yet humble in my chosen profession. I think this awareness helps me to be accessible to my clients (for the most part) and to appear genuine. However, I have to admit that I am very biased toward psychology as a helping profession.

It doesn’t seem possible that my decision to become a psychologist was not more colorful or overtly influenced by my father. At various times in my college career I wanted to be a bartender, a dancer or a business owner. I didn’t major in psychology as an undergraduate and was completing a master’s in counseling when I decided to apply to doctoral programs. Dad didn’t set me on this career path by telling me what to do.

Once on it, he never tried to influence my professional course. He models professionalism and is unfailingly respectful, fair and kind to those who need it most. Without doing much of anything, my father strongly influenced me to want to help others through psychology and became my greatest mentor.

Kelley Fox Callahan, Psy.D., received her doctorate from Wright State University School of Professional Psychology in 1990. She has spent her career working with chil- dren, adolescents and their families as a therapist, consultant and educator in med- ical, child protective and private practice settings. She is currently clinical director of Family Solutions Center, the youth division of TCN, a community mental health center. She is married to a psychologist and they have a teenage daughter – who is not planning on becoming a psychologist. Her email address is: kfcallahan@sbcglobal.net

Soon Spanish will be the predominant language in Texas with 42 percent of the state’s population using it as the primary language, and the Hispanic group is rapidly expanding. Similar trends are occurring in Arizona, California, and New Mexico (http://www.statehealthfacts.org/).

I have been pointing out for years that poverty is also a major problem for the future psychologist, but especially in the emerging future of practice and for those practicing in certain parts of this country. In most states one in four to one in three individuals will live below the 139 percent of poverty level (about $19,000 per year for a family of three), which is the 2014 level for mandatory state minimum qualifications for coverage in Medicaid (without the current categorical limits) in order to get health care.

Members voted 124 to 28 with seven abstentions to allow members of the CPA to retain full membership in APA with a 50 percent dues discount. APA members who join the CPA also receive a 50 percent discount.