Optional features include integrated credit card payment processing, dictation, fingerprint login, customized websites, encrypted email and a secure client portal for online registration, payments, scheduling and communication. A smartphone and electronic tablet app can be purchased for $9.99.

Therasoft also offers reasonably priced data transfer assistance on a contract basis to help move your practice data from your old software to Therasoft, which can be a real time-saver. A traditional billing service to take client calls, register new clients, handle insurance and manage payments is also available for an additional fee.

[... Details of review are in the full issue...]

Overall Rating: A-

Therasoft was created in 2008 by a team of counselors and technologists and it shows. This company wants to become the industry leader in mental health practice management software and appears to be well on the way to achieving this goal. The software provides a remarkable level of service, flexibility and functionality for its price. Fees vary according to services desired with generally comprehensive packages beginning at about $100 a month. (See fee breakdowns at: www.therasoftonline.com)

Erickson was a master of several therapeutic techniques, techniques he pioneered. Indirect techniques such as metaphors, anecdotes and analogies were part of his repertoire. Two of the most significant “tips” he passed along to me were utilization and tailoring.

A cornerstone to Ericksonian therapy, utilization is a posture that the therapist takes of finding virtues in perceived faults. Whatever exists in the therapy situation, including resistances, problem patterns and values can be harnessed to accomplish therapy.

Utilization was also Erickson’s way of tailoring therapy to the individual. He invented an approach for each patient.

When I first met Erickson I smoked a pipe, perhaps because I thought it fit my image of the earnest young psychotherapist. Erickson did not talk about my tobacco addiction as a way of get-ting me to quit. Rather, he told me a story that changed my perception about smoking.

“We have total chaos out there on these codes with both the providers and the payers,” said James Georgoulakis, Ph.D., APA’s representative to the AMA’s Relative Update Committee (RUC). “I think we may have underestimated the problems and the challenges. This is the first revision of the psychotherapy codes in many years. A lot of psychologists do not read the CPT manual and did not even know the codes were being changed.”

He said the American Psychiatric Association told its members there is little information available about how the new codes should be interpreted by Medicare or private insurers and to expect that each company will have its own rules and interpretations. He also noted that the Local Coverage Determinations (LCDs) have not yet been developed.

Antonio Puente, Ph.D., the only psychologist on the voting panel of the AMA’s CPT committee, said he worries that insurance companies do not under-stand the new codes. “Some companies did not load up the codes quickly enough, and there were kickbacks from some of the companies.”

In New Jersey, nearly identical bills that would prohibit psychologists and other licensed mental health professionals from counseling to change the sexual orientation of anyone under 18 have been assigned to committees.

A bill that would ban conversion therapy (or reparative therapy, as it is sometimes called) was introduced in late January by State Rep. Carl Sciortino, a Medford Democrat, in the Massachusetts legislature.

In December 2012, a three-judge panel of the Ninth District Federal Court of Appeals agreed to block the first-in-the-nation California law banning con-version therapy, which was slated to go into effect Jan. 1, until the full court could decide on the law’s constitutionality. A district court judge initially reject-ed a suit by Liberty Counsel, whose clients included a 15-year-old boy undergoing conversion therapy, and the Christian-oriented legal group appealed the decision to the Ninth Circuit.

Opponents of the California law said it would violate freedom of speech and the therapist-patient relationship.

The New Jersey legislation was introduced in the state Senate in late 2012 by Senate President Stephen M. Sweeney, a Cumberland Democrat; Democratic Majority Leader Loretta Weinberg of Teaneck and Raymond J. Lesniak, an Elizabeth Democrat.

The measure is backed by the New Jersey Psychological Association. Josephine Minardo, executive director of the association, noted the national consensus against conversion therapy. “All the major national psychological, psychiatric and counseling associations, including the APA, have found that this kind of therapy is actually very harmful,” she said.

Minardo said the association’s stand on the legislation puts it in the position of backing a bill restricting therapy that some members provide. “We have just cautioned that we have concerns about legislating specific types of treatment and we don’t want it to set a precedent.”

The bill prohibits licensed therapists from attempting to change children’s sexual orientation, including efforts to change “behaviors or gender expressions, or to reduce or eliminate sexual romantic attractions for feelings toward a person of the same gender.”

Sweeney said those who think they can change people’s sexual orientation have an outdated view. “Kids are under enormous peer pressure to start with and being a kid and being homosexual, it’s a lot of stress in the school environment to start with and the one place you look for support is your family.”

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Similar legislation was introduced in the New Jersey Assembly by Assemblymen Timothy Eustace, a Bergen County Democrat, and John Burzichelli, a Paulsboro Democrat. That bill has been assigned to the Women and Children Committee.

“If adults want to engage in processes to change their life, that’s an adult decision,” Burzichelli said.

The Jersey City-based Jews Offering New Alternative for Healing (JONAH) oppose the bill. JONAH founder Arthur Goldberg said legislators don’t understand “both sides of the equation. There are literally hundreds and hundreds of people who have successfully changed” sexual orientation through therapy.

The Southern Poverty Law Center has filed a civil action against JONAH, maintaining that the organization is committing consumer fraud by offering sexual orientation conversion therapy.

In a related matter, a bill to ban conversion therapy for minors was introduced late in the last session of the Pennsylvania legislature but never received a hearing.

The Oregon Democratic Party passed a resolution recently calling on the state legislature to ban conversion therapy for minors.

When asked for their test data, some psychologists claim paternalistically that nobody could ever understand what these mysterious numbers mean without being a licensed psychologist. They seem to ignore the fact that we ourselves have an ethical duty (Ethical Standard 9.10; APA, 2002) to provide test feedback (i.e., explaining those numbers), not to mention that most test publishers routinely sell test forms and computerized test interpretations to psychiatrists, social workers, counselors and others.

Other psychologists contend that either test copyrights or licensing agreements with test publishers prevent them from complying with these requests. They overlook the fact that the Fair Use Doctrine under the Copyright Act of 1976 (2011), the legal rights of test takers to their health care information and discovery rules governing the bases for experts’ opinions in forensic matters have consistently trumped these arguments when they have been put to the test (e.g., see Carpenter v. Yamaha, 2006).

What ethical prohibition?

The last refuge of those who struggle to conceal their raw test results as though they were subject to the same security considerations as the secret formula for Coca-Cola is to make vague declarations that releasing the data to anyone but another psychologist is ethically prohibited. But has it ever been? The basis for this notion harks back to the 1992 APA Ethics Code, which enjoined psychologists from “releasing raw test results or raw data to persons… not qualified to use such information” (APA, 1992, p. 1603).

But many failed to notice the phrase I’ve omitted in the ellipsis above, adding a critical exception: “other than to patients or clients as appropriate.” Thus, even from 1992-2002, there was no blanket prohibition on sharing such data with clients (or, presumably, their legal representatives).

Then the feds burst through the door

Of course the 1992 Ethics Code is long obsolete. In the meantime the HIPAA Privacy Rule included raw test data among the health care information to which patients must ordinarily be permitted direct access, either in the form of copies for themselves or to anyone they designate as authorized recipients. Bowing to changes in federal regulations, the current Ethics Code (APA, 2002) made it unmistakable that release of raw test data to non-psychologists is permissible.

According to Ethical Standard 9.04(a): “Pursuant to a client/patient release, psychologists provide test data to the client/patient or other persons identified in the release.” There is some additional language permitting psychologists to refrain from releasing the data in special circumstances, but not routinely and always keeping in mind legal regulations concerning the release of confidential information. One might argue that in a forensic matter, a litigant’s or defendant’s test data are neither covered by the HIPAA Privacy Rule nor are they subject to a “client/ patient” release under Standard 9.04(a), but they still are subject to court rules concerning legal discovery, and nothing in the Ethics Code or the Specialty Guidelines for Forensic Psychologists (APA, in press) suggests that forensic psychologists should not cooperate fully with applicable court rules.

We still have an ethical duty under Ethical Standard 9.11to try to resist simply turning over test materials (e.g., test manuals, items, stimuli and scoring keys) upon request or even when subpoenaed in order to protect test security. The matter becomes somewhat more complicated when test materials and clients’ test data are all mixed together on the same “hybrid” document (in which case the Ethics Code defines all of it as “test data.”)

Balancing test security with test takers’ rights

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The day is long since past when it was acceptable for psychologists to make oracular pronouncements about people based on secret knowledge to which only the initiated might have access. But it is still possible to protect test security without violating patients’ rights to their assessment and treatment records and litigants’ rights to the bases for expert testimony. Here are a few tips for how to do this:

• If possible, provide excellent, personalized feedback to test takers.

  In clinical matters, ask to provide a detailed written summary of test findings as an alternative to providing copies of the raw data. When clients demand copies of their data, provide a written notice explaining the limits to the Fair Use Doctrine under the Copyright Act of 1976.

• When possible, record test data separately from test items and stimuli.
• In forensic matters, when test materials are required for inspection, request that it be supervised.
• In forensic matters in which test materials or hybrid data are subpoenaed, ask for a protective order prohibiting misuse or redisclosure.
• Work with test publishers’ legal departments when serious threats to test security are encountered.

References available from author

Robert E. Erard, Ph.D., is a clinical and forensic psychologist in Bloomfield Hills, Mich. He is a past president of the Society for Personality Assessment and a co-developer of the Rorschach Performance Assessment System (R-PAS). Erard may be reached at robertee@umich.edu.

Norman B. Anderson, Ph.D., said that during his meeting with Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius there was agreement about the need to improve all aspects of mental health services for both children and adults. He added that there was agreement about the need to reduce stigma and educate the public about mental health treatment and to make parity a reality.

During the meeting, Anderson said one of the most important things the president could do is use his last term in office to bring mental illness out of the shadows and make it his priority to change the national dialogue about mental illness.

He added that mental health care should not be “optional” in any health plan and psychologists and other behavioral health professionals must be part of all health care teams.

There were also dead teachers, a dead principal and a dead school psychologist. All seven adults were women and my bet is that as we learn more about the psychodynamics of the disturbed young man who was the shooter, we will find out that the gender of the victims was not a coincidence, but part of his thought disturbance.

We all want to know why this thing happened and we would prefer that there be one single, clear reason. But as a clinical psychologist, I’m certain there were several contributing factors, because human beings rarely do anything for one simple reason. We are complex creatures, we humans.

Why did this happen? Part of the answer is that we live in a culture that encourages violence, and that culture is held up for worship on the altars of television screens and movie theaters each and every day. It’s in our lust for blood in boxing matches and our appreciation of helmet-cracking tackles in football and hockey.

It’s in movies from Rambo (I though V) to Brad Pitt’s Killing Them Softly. It’s on television via movie reruns and shows like “The Sopranos” and your favorite version of “CSI.” We are a culture that embraces violence.

And don’t forget our love of guns. ABC News recently reported that during the three-day Thanksgiving holiday weekend alone, more than 250,000 guns were sold in the United States.

During the next several months, you will hear the same question over and over in the news media: Does violence in the media increase violent behavior? For nearly 50 years, the American Psychological Association has issued a variety of reports answering that critical question with an emphatic “Yes!”

In psychological research, the viewing of large amounts of violence on television by young children has Stephen A. Ragusea, Psy.D. been correlated with increases in violent behavior into adulthood. Well, if TV viewing can impact our aggressive tendencies, what about the music we listen to?

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One 2003 study published in the Journal of Personality and Social Psychology suggested that listening to songs that contain violent lyrics results in aggressive thoughts and emotions. Some think that listening to powerful, violent and angry songs can provide a “venting” of these powerful feelings, but this research provides evidence that just the opposite is true.

Of course, we must also ask ourselves, “How much violence do we expose our children to?” A 2007 study found that “by the time the average U.S. child starts elementary school, he or she will have seen 8,000 murders and 100,000 acts of violence on TV.” And that doesn’t include exposure via music and movies.

Add into that mix the fact that a small percentage of our population suffers from various forms of severe mental illness and that we perpetually under fund treatment of psychological disorders. Make semi-automatic weapons available to that group and sooner or later, we will see an explosive incident such as that which occurred in Newtown, Conn. If we don’t do something to influence this course of events, we’ll see these incidents occur again and again.

Violence directly and negatively impacts our physical and mental health. Because violent content in movies, television and songs has so consistently been shown to increase violent behavior, these characteristics should be diminished in our entertainment products. Psychologists have been giving that research-based advice to American society for almost 50 years. Quite frankly, nobody seems to be listening.

We can do better. Each of us can decide to stop consuming these products. When enough people boycott media violence, producers will stop creating these violence-encouraging forms of “entertainment.”

We can do better and we’d better do that. CE

Stephen A. Ragusea, Psy.D., is a clinical psychologist in Key West, Fla., and on the medical staff of The Lower Keys Medical Center. He may be reached at ragusea@ragusea.com.

In India, this is synonymous with death, at least as far as general perception goes. And this fear is so entrenched in the mind of the common man that getting to the very root of the problem can be an uphill task.

There are many myths in India surrounding cancer. A lot of people believe that it is a form of punishment for bad karma: Bad things only happen to bad people. Some think it is contagious and this can lead to ostracizing, even by one’s own family. With public health funding accounting for only 1 percent of the total government budget, a lot of the misconceptions stem from a lack of public education and awareness schemes.

Despite spiritual beliefs of reincarnation and higher realms, the concept of dying is still very painful and frightening. Soothsayers are sought out. Sacred threads and various mantras are often invoked to forestall life’s greatest mystery: death. If only horoscopes and zodiacs were spot on. If only a single incantation was all that is required for life to have a 180-degree turn. But the truth of the matter is that there are no real cheat sheets.

Suffering from cancer doesn’t always mean support is guaranteed. With a burgeoning population, palliative care is still a relatively new concept. Why bother for one whose chances of recovery are low when there are so many more patients to attend to?

When it comes to abandonment and negligence, women and children are especially at high risk. A colleague of mine was recounting one particular incident to me. A woman was admitted into the cancer institute and her tumor was found to be at an advanced stage. While the medical protocol was being discussed, her husband took the doctor aside and asked if the cycles of chemotherapy were truly necessary, his point being that since his wife was going to die anyway, why bother pay- ing for her treatment. What is to be noted here is that the man wasn’t under any financial constraints. He was actually very well off and well educated. But his apathy is fueled both by the society’s patriarchal priorities and its dismissal of cancer patients.

The question of quantity versus quality is pertinent. It is not just about accepting the diagnosis and following the treatment. What is yet to be comprehended is the importance of providing dignity to patients, to not make them the object of ideas and procedures, but to instead give them joy, reinforcement and love. Quality of life is many times lost in the pursuit of quantity of life.

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Psycho oncology has come a long way in India. With more and more survivors playing an active public role in cancer awareness, the idea that there is life after cancer is slowly beginning to dawn. Counseling the patient and the caregivers is becoming relevant as strong family support is shown to lower relapse rates and boost survival.

Apart from diet and exercise, holistic methods such as yoga, pranayama (breathing exercises) and chanting are being implemented for mental peace and positivity. Alternative care such as ayurveda and homeopathy may be included but strictly in accordance with the consulting physician.

Cancer is not just about the best medical care, the best doctors or the best medicines. There is a lot more that goes into it, such as love, understanding, optimism and, above all, hope. No one should be subservient to life’s unpredictability. It should make us stronger, wiser and more alive.

Nritya Ramani is currently working with Sadhana Charitable Trust to promote cancer awareness and psycho oncology in India. She is in the process of applying to Ph.D. programs for fall 2013. She may be reached by email at: nvkisna@yahoo.com.

That approval clears the way for the DSM-5 to be published in May to replace the current DSM-IV-TR. Since the draft of the DSM-5 was released last year, criticism from non-psychiatrist mental health providers has been rampant, and many of the proposed changes drew fire even from Allen Frances, M.D., the psychiatrist who headed the task force that prepared the DSM-IV.

A chief complaint is the emphasis on bio-medical diagnoses criteria, which many fear will lead to greater use of pharmaceuticals that some believe are already over-prescribed. Critics also contend field tests were poorly designed and in many cases lowered diagnostic thresholds could lead to “medicalizing” normal reactions to life experiences, such as labeling grief following the death of a loved one as a major depressive disorder.

Other widely criticized disorders included in the revision include disruptive mood dysregulation disorder, which could be diagnosed based on a child’s temper tantrums; redefining addiction to include behaviors not involving chemical substances, such as gambling, and lowering the standards for autism diagnoses.

The National Alliance of Professional Practicing Psychologists (NAPPP), formed in 2006 by psychologists who felt the American Psychological Association (APA) was not active enough on behalf of practitioners, said even before details of the planned revisions were released that psychologists should abandon the DSM and use the mental disorder descriptions of the International Classification of Diseases (ICD) for diagnoses.

APA’s practitioner arm, the APA Practice Organization (APAPO), has been more circumspect in its criticism, but APA’s Division 42, Psychologists in Independent Practice, circulated a petition after the American Psychiatric Association (ApA) released a draft of revisions last year seeking the ApA to back off from many changes viewed as based on poor research and heavily weighted with presumed biologic causes for mental disorders.

The petition was endorsed by more than 50 mental health organizations and 13,000 individual mental health care providers concerned that lowered thresholds and the over-emphasis on physical causes could expand what is already viewed as over-prescribing of psychotropic drugs, but only minor changes were made before the revisions were approved Dec. 1 for final publication.