INSIGHT Magazine

W INTER 2011

V OLUME 4

IS SUE 1

THE MAGAZINE FOR ALUMNI AND FRIENDS OF THE CHICAGO SCHOOL OF PROFESSIONAL PSYCHOLOGY

MIND OVER

MEDICINE AN IN-DEPTH LOOK AT THE ROLE PSYCHOLOGY DOES— AND DOESN’T—PLAY IN AMERICAN HEALTH CARE.

W E L C O MIN G A NE W P R E S ID E N T

P S Y C H O L O G Y AT T HE E ND O F L IF E

FA R E W E L L T O D R . RU B E N S T E IN

WINTER 2011 VOLUME 4 ISSUE 1

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Mind-body science has now reached a stage where it should be accepted as the third major treatment and prevention option, standing as an equal alongside drugs and surgery, Dr. Herbert Benson, director emeritus Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital

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EDITORIAL STAFF: Judy Beaupre Lindsay Beller Nathan Jones Kelli Langdon CONTRIBUTING WRITERS: Doug McInnis Kyle Peacock DESIGN: Bates Creative Group CONTRIBUTING PHOTOGRAPHERS: Amy Braswell Aaron Brownlee Bernadette Dare George DeLoache Udi Goren Kelli Langdon Derrick Smith Nick Sokoloff

President Michele Nealon-Woods, Psy.D. ’00 President, Washington, D.C. Campus Orlando Taylor, Ph.D. INSIGHT is published twice annually by the Department of Marketing and Communications at The Chicago School of Professional Psychology.

It is mailed to alumni, faculty, staff and friends of the school.

Address changes and correspondence should be sent to: insight@thechicagoschool.edu Visit INSIGHT online at : http://insight-magazine.org

WINTER 2011 V OLUME 4 IS SUE 1 T HE M A G A Z INE FO R A L UMNI A ND F R IEND S O F T HE CHIC A G O S CHO OL OF PROFE S SION A L P S YCHOL O G Y

04 05

26 DEPARTMENTS 3 PRESIDENT’S LETTER Introducing The Chicago School’s eighth president.

4 ON CAMPUS Opening our newest campus in the nation’s capital, TCSPP takes its unique approach to psychology education coast to coast, while L.A. faculty launch a series of centers aimed at meeting community needs.

8 FACULTY Faculty debate the pros and cons of prescription privileges for psychologists, while another offers his perspective on health care reform.

26 ALUMNI An unexpected farewell to our 2010 Distinguished Alumnus, Dr. Ted Rubenstein.

20 28 GIVING BACK With funding from the Chicago Community Trust, TCSPP takes its commitment to meeting the mental health needs of Chicago’s Latino population to the next level.

29 LAST PAGE The pageantry of Commencement: Celebrating Los Angeles’ first graduating class, and Chicago’s 26th.

FEATURES 14 MIND OVER MEDICINE An in-depth look at the role psychology does—and doesn’t—play in American health care.

20 OUT OF THE SHADOWS As more light is shed on the mental health needs of the terminally ill, is there a role for psychologists to play?

yes

yes

no

no

Did you graduate from The Chicago School between 1979 and 1994?

Did you teach or work at The Chicago School between 1979 and 1994?

If you answered “yes” to either question, you are a TCSPP Pioneer!

And you’re invited to a special homecoming reception to honor you and to celebrate the early years of our alma mater.

When:

Saturday, April 16, 2010, 6-9 p.m.

Where: The Chicago School of Professional Psychology’s Chicago Campus Why:

Catch up with old friends, meet some new ones, see the campus, reconnect with your graduate school, and have some fun!

Look for your invitation in February with more details.

Questions? Contact Kathleen Pace, Associate Vice President of Institutional Advancement, at 312.379.1659 or kpace@tcsfound.org.

{president’s letter} INSIGHT MAGAZINE WINTER 2011 3

Under New Leadership, A Vision for Tomorrow

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n July 1, 2010, I became president of The Chicago School of Professional Psychology. The great excitement, the great expectations, and the sense of great responsibility with which I took on the role of president continue to lead me in every step I take with this incredible institution.

My journey with The Chicago School began more than 15 years ago. I have been a student, a member of the faculty, a department chair, a campus dean, and a campus president. The school has been a significant part of my life and will continue to be so for many years to come. I am thoroughly invested in pursuing our mission, infusing everything we do with our core values, and working tirelessly to ensure that our dynamic institution strives for excellence, prominence, and quality in all we seek to achieve.

Reflecting on how our institution has changed over the past decade and a half, I am struck by the magnitude of the achievements of our students, faculty, and alumni. Today, we are developing outstanding practitioners who are making a real difference in families, neighborhoods, and communities; we are contributing thousands of hours of service to disadvantaged and underserved populations; and we are adding valuable insight to the scholarship and discourse that make our field so dynamic and responsive to global need. We have much to be proud of, and as always, we have so much more to do.

I have a vision for our institution—one that is anchored in the unwavering commitment of our faculty and staff, the boundless energy of our

students, the wise guidance of our trustees and leadership, the involvement of our alumni, and the burgeoning needs of the people and communities we serve. My vision is that we will be the national and global model among professional schools for achieving and maintaining excellence in teaching, clinical training, research, professional practice, and service. Designed on the cutting edge of research and practice, our curricula will be delivered in a highly flexible and student-focused manner. We will strive to identify, develop, and provide the programming and services that communities, regions, and nations need to advance the well-being of their people. Our academic environment will be one in which the sophistication of our teaching and research develops relevant and predictive content. Supported by our commitment to diversity and manifested in faculty-driven centers of excellence in teaching, practice, and research, our community will thrive.

Within this issue of INSIGHT, you will read how our students, faculty, and alumni are working as integral parts of our nation’s health care system —caring for people from the beginning of life and to its end. They are the embodiment of our mission and I could not be more proud of their endeavors and accomplishments.

I am eager to keep our institution moving forward; to discover the opportunities and challenges that await us as we strive to achieve our goals. Let’s think forward with an open mind, let’s look forward with clear vision, and let’s move forward with strength of purpose.

Michele Nealon-Woods, Psy.D. President

on campus

THE CHICAGO SCHOOL HERE A ND NOW

PHOTO COURTESY OF © BERNADETTE DARE 2010

Sharing in the celebration of our newest campus as U.S. Rep. Eleanor Holmes Norton cut the ribbon were, from left: Board Chair Ricardo Grunsten, TCS ES CEO Michael Horowitz, D.C. Campus Student Association President Denise Redmon; TCSPP President Michele NealonWoods, D.C. Campus President Orlando Taylor, and TCS Foundation President Tim Shannon.

Psychology Coast to Coast THE CHICAGO SCHOOL OPENS D.C. CAMPUS

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wo years after expanding its reach to California, The Chicago School has opened a campus in the nation’s capital, making its practitioner-based, community-focused approach to psychology education available from coast to coast.

The Washington, D.C. Campus welcomed its first class of 48 students August 30, enrolling them in the school’s flagship Clinical Psy.D. program and in master’s programs in Forensic Psychology and Counseling Psychology.

“It is not accidental that we have located our campus near the center of power of the United States—the White House,” said Dr. Orlando Taylor, campus president. “We intend to make contributions to the field of psychology locally, nationally, and internationally through the distinction and dedication of our graduates, the scholarship of our faculty, and the service contributions of our institution.”

Faculty have already begun the process of developing partnerships that will provide practicum, internship, and community service opportunities for students, setting

their sites on Washington’s long list of governmental agencies and nonprofit organizations that can offer unparalleled real-world experiences for psychologists-in-training.

Building on The Chicago School’s tradition of diversity and its goal of internationalism, the D.C. Campus will be home to the Center for African Psychology. The campus and center held a joint grand opening ceremony September 22, welcoming Washington-area alumni, local dignitaries, and psychology professionals to their new space in the McPherson Square area of Washington. Rep. Eleanor Holmes Norton, now in her 10th term as the District’s congresswoman, was on hand to deliver remarks and to cut the ribbon for the new center.

“The Chicago School brings to the District of Columbia an extraordinary and unique facility,” said Congresswoman Norton. “We are especially pleased to have the Center for African Psychology, as we see its relevance both to the city and for the work of Congress. Your reach to the international community could not be more important as we see more and more people throughout the world facing disaster as a way of life.”

Part of the school’s network of Centers for International Studies, the new Center for African Psychology is the first to focus exclusively on the research, service, and policy needs of a particular continent. Activities of the center include international scholarship and community engagement through structured international programming and study abroad; development of multicultural awareness and culturally sensitive therapeutic approaches; and development of local partnerships and government support to establish a sustained TCSPP presence that will serve the needs of underserved populations in Africa.

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$2 million grant from the Illinois Board of Higher Education is being used to significantly upgrade the Chicago Campus’ educational technology infrastructure and bring students’ classroom experience into line with the innovation and quality reflected throughout the academic content.

All 13 classrooms in the Wells Street building will get a high-tech facelift, bringing them up to par with newer classrooms in the campus’ Merchandise Mart space. Multimedia teaching stations and integrated audio, video, and Internet capabilities will be installed in all classrooms, while a few will additionally be outfitted with state-of-the-art videoconferencing equipment that can support distance learning between campuses. Expanded wireless network-

INSIGHT MAGAZINE WINTER 2011 5

High-quality Content Meets High-tech Delivery

ing capability and the integration of technology that supports public safety are also part of the project, which is funded through the state’s Independent Colleges Capital Program.

“Increasing the use of technology in instruction is critical for our students,” said Dr. Breeda McGrath, associate dean of academic affairs, who serves on the project implementation committee.

“Research tells us that, by varying the range of learning options offered to students, we can significantly increase their engagement and improve their learning. And we know from our own Market Research Department that students today are looking for alternative learning options and delivery modes that can fit in with their schedules and lifestyles.”

Among the new resources that will be available to faculty is podcasting—the use of cameras and audio equipment

to capture lectures and instructional materials and repackaging them for later review through eCollege (the institution’s online learning platform) or through iTunes University. Some faculty have already begun to pilot the use of podcasting equipment in their classes.

“All classrooms will have podiums with touch-screen panels that faculty can use to control all electronics in room,” said Philip Atwood, associate vice president of IT infrastructure. “We want all teaching facilities to meet a consistent standard so that faculty can move easily from one classroom to another and always be familiar with the equipment.”

While grant funding is enabling TCSPP to move forward quickly with technological upgrades at the Chicago Campus, the institution plans to replicate the improvements at the California and Washington, D.C., campuses. The project is being

International Reflections

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illennium Park's bean sculpture was one stop on the Windy City tour for international psychology students who visited the Chicago Campus in November. Representing Peru, China, Cambodia, and the United Kingdom, students received a first-hand glimpse of psychology—Chicago School Style—during a week spent attending classes, observing students at work in the community, participating in hands-on learning experiences, and sightseeing.

The program was co-hosted by the Center for International Studies and the Center for Multicultural and Diversity Studies, and supports TCSPP's ongoing commitment to expanding the reach of psychology by exposing international students to the multiplicity of ways the discipline is applied in the United States.

on campus

THE CHICAGO SCHOOL HERE A ND NOW

implemented in phases, so that no more than a few classrooms are out of service at any one time, but Atwood projects that at least half of Chicago Campus classrooms will have been upgraded by the beginning of the fall 2011 semester.

Offering A Safe Haven

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here’s often no way out, no matter how desperate they are to leave.

Faced with violence, fear, and emotional abuse, victims of sex trafficking are usually women and girls who are coerced or forced into prostitution.

While news headlines focus largely on other countries, few realize that this happens in the United States, where an estimated 17,000 people are trafficked annually (a number that is likely much higher in what is considered to be a widely

“Through this collaboration with The Chicago School, Anne’s House will provide a different model for treating victims.” under-reported crime).

Chicago School faculty and students are addressing this need through a partnership with Anne’s House, a newly opened safe haven for some of Chicago’s most vulnerable victims— adolescent girls and young women ages 12 to 21—who receive therapy, life skills training, education, and other services designed to help them overcome the psychological trauma and have a chance at a new life. The project is run by the Salvation Army’s PROMISE (Partnership to Rescue our Minors from Sexual Exploitation) Initiative.

Initiated by TCSPP’s Child & Adolescent Coalition, a cross-disciplinary group of faculty members who pool resources to assist Chicagoland children and families,

the project is funded by a $35,000 grant from the Virginia Lee Shirley Private Foundation. Students and faculty train Anne’s House staff, and help establish and review treatment goals, interview protocols, and intake procedures.

“It hit us at our hearts,” said Dr. Bianka Hardin, associate professor of clinical psychology, who formed the coalition in fall 2009 with Dr. Tiffany Masson, assistant professor of forensic psychology; Jill Glenn, director of community partnerships; Dr. Nancy Dubrow, director of the Center for International Studies; Dr. Cynthia Langtiw, assistant professor of clinical counseling; and Dr. Breeda McGrath, associate dean of academic affairs.

Faculty members expect staff trainings to begin in January 2011. Some are already incorporating the program into their classes, which will give students critical experience in working with an organization that serves trauma survivors.

Dr. Hardin and Dr. Langtiw, for example, will assign their students to review intake forms, consult on assessment measures, and develop training presentations.

Few homes that provide long-term therapeutic trauma counseling like this exist in the country, and building the capacity of Anne’s House staff will help reduce burnout that can result from working with victims of sex trafficking, added Glenn.

Although sex trafficking is illegal, and anyone under age 18 is considered a victim under Illinois law, girls who end up in the juvenile justice system are often seen as criminals. But through this collaboration with The Chicago School, Anne’s House will provide a different model for treating victims. “We’re raising awareness too,” said Dr. Dubrow. “Not many people know this happens in Chicago.”

3 New Centers Expand L.A. Campus Reach

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arely two years old, The Chicago School’s Los Angeles Campus has

clearly come of age. With an enrollment that continues to climb and their first cohort of alumni already putting their degrees to work throughout Southern California and beyond, L.A. faculty have continued to expand the school’s impact—through new grants, powerful partnerships, and three recently launched centers aimed at meeting community needs while providing real-world training for future psychology professionals.

To accommodate the centers—each of which puts The Chicago School’s Engaged Professional Model of Education into practice—the campus acquired an additional floor in their downtown L.A. building. Occupying the new space are: • The Forensic Training Institute (FTI), through which forensic psychology students train law enforcement personnel to perform mental health screenings, offer workshops for gang intervention workers, and meet other forensic training needs in the community.

• The TEACH Center, operated by the Applied Behavior Analysis (ABA) Department, which trains caregivers to work with children with autism and other developmental disabilities.

• The ConCISE Center for Performance Management and Consulting, an arm of the Business Psychology Department established for the business community, which helps to develop leadership programs, manage change, and undertake strategic planning initiatives.

“These centers all grew out of our president’s vision for meeting needs in the community,” said Dr. Martin Harris, dean of academic affairs for the Los Angeles and Orange County campuses. “Whether it was the police department looking for a better understanding of mental health issues to use in crisis intervention or terrorism response or small businesses in need of consulting services, each of our new projects represents a direct response to a community need.”

The TEACH (which stands for Training and Education in Action for Caregivers with Hope) Center will offer ABA students the opportunity to provide workshops for professionals and caregivers who work with children with autism and other developmental disabilities.

Known for its effectiveness in treating autism, ABA is a teaching technique that breaks behavior into small discrete nuggets, allowing clients to master each task separately as a way of effecting permanent changes in behavior. In coming years, Dr. Rachel FindelPyles, lead ABA faculty in Los Angeles, hopes that the center’s activities will expand beyond training to direct service delivery.

As the consulting arm of the campus’ Business Psychology Department, the ConCISE Center gives students hands-on training in providing consultancy services to

businesses and community organizations.

When the center launched in September, Dr. Al Edwards, lead department faculty, had already established numerous partnerships with educational institutions, government and municipal organizations, businesses, and nonprofit organizations throughout the area. Students are working with A Better LA, where they are implementing a strategic planning process, and offering training in the areas of leadership, performance management, diversity, and inclusion.

“Traditionally, graduate school has been a place you go to get the tools to impact the world tomorrow,” Dr. Harris said. “But at The Chicago School, students don’t have to wait for a degree to make a difference.

They do it every day as part of their learning experience.”

ACADEMICUPDATES New Course Emphasizes the Power of One

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s internationalization takes on increased emphasis at The Chicago School, curriculum is being updated to support student travel and to incorporate international learning experiences into coursework.

The Power of One is a new course that can be adapted to any region of the world, offering students a combination of classroom instruction and a service-learning-abroad opportunity. Often open to students in any academic program, the course will include course objectives and learning outcomes that ensure an appreciation for diverse cultures and an understanding of the role psychology can play in a specific region of the world.

“The Power of One is an innovative way for students to earn credit, learn about a country or region and then travel there to participate in an impactful service opportunity,” says Emily Brinkmoeller, associate vice president of international affairs. “Our hope is that these experiences will help better prepare students to live and work in our increasingly multicultural world and that they will bring fresh perspective back to their home campus.”

Inaugural Power of One courses were being taught during the fall 2010 semester and focused on Israel and the West Bank, Rwanda, and Zambia.

The Israel- West Bank trip builds on the years of experience that Dr. Nan Dubrow, director of the Chicago Campus’ Center for International Studies, brings through her previous work and scholarship in the region.

The course focuses on the concept of “global citizenship” in the context of an international service-learning trip. Students traveled to the Middle East in December, and participated in service activities at the Palestine Red Crescent Society, a non-governmental organization that provides health, mental health and social services to the Palestinian people.

The Power of One courses on Rwanda and Zambia provide students and faculty opportunities to participate in the Global HOPE Training Initiative, developed by TCSPP. Through this program—which is open to participants from all Chicago School campuses—students learn specific techniques to train orphanage workers, teachers, and health care professionals on how to deal with effects of collective trauma. They will have the chance to utilize these skills on site in each country through a formalized train-the-trainer program.

Opportunities for alumni, staff, board members and friends to participate in these trips are currently being formalized. Interested alumni should contact studyabroad@thechicagoschool.edu.

ABOVE: Clinical Psy.D. student Melanie Spain (center) works with Rwandan teachers during a December train-the-trainer program designed to teach caregivers to help children cope with— and heal from—trauma. The eight students who traveled to Kigali represented the first group to take advantage of the Power of One course.

INSIGHT MAGAZINE WINTER 2011 7

The campus has partnered with A Better LA, a nonprofit organization dedicated to reducing violence throughout the Los Angeles area, to support the work of the FTI. A $75,000 grant will allow for the addition of a coordinator to oversee the work of faculty and students in providing training opportunities and developing a gang intervention workshop curriculum, particularly for the West Athens area of L.A. Under the direction of Dr. Debra Warner, lead faculty for the Forensic Psychology Department, the institute has also developed partnerships with the Los Angeles Police Department, the Department of Homeland Security, and the Los Angeles City Attorney’s Office to provide community-engaged training efforts that benefit students and the community.

faculty

BE YOND THE CL A S SROOM

Health Care Reform: Is it? {by Kyle Peacock} Assistant Professor, Organizational Leadership

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oments before he signed the Affordable Care Act of 2010, President Obama mentioned to Vice President Biden that this particular piece of legislation was 100 years in the making. Also referred to as the Health Care Reform Act of 2010, it is a large step in the creation of compulsory insurance coverage and just well may be the most significant health care act since the creation of Medicare and Medicaid in 1965.

As a nation, this is not our first attempt at major reform within the field of health care. We tried to pass compulsory insurance in 1911, yet World War I quickly took center stage and the reform movement was forgotten.

We tried again in 1965 and compromised with the passing

of Medicare and Medicaid. In the early 1990s, President Clinton took his reform plan to the masses until it was defeated due to last-minute deals never realized and the window for bargaining slowly closing on both sides, one side happier than the other.

As I write this essay, I realize that I could certainly spin my position a hundred different ways. However, I come back to the notion that health reform isn’t about political wins or who gets paid for what. It does however, boil down to one thing: access to care. Inevitably, we are either currently consuming health services and if not, it isn’t a question of whether we need services; rather it is simply a question of when.

This exploration of health reform is not about political wrangling, rather it is a question of what exactly are we paying for and what did we get for our $950 billion price tag? In 1911, in 1965, and in the 1990s, the premise for reform was centered on the notion that compulsory, by definition, meant coverage for everyone. The great dilemma of WIFM (what’s in it for me) was satisfied across all socio-demographic boundaries. Access was to be guaranteed to all.

The title of this piece stems from the idea that at first glance, there may be more losers than winners in this particular legislative act. Touted originally as “universal health care” (another term for compulsory—just sounds less ominous), the current piece of legislation leaves an estimated 22 million Americans without health insurance.

Health insurance normally equates to health care access.

Of particular concern is the double-edged sword that many individuals suffering from mental illness are often excluded from access to health services through the denial of health insurance.

How do we make sure that such a reform is distributed evenly across the masses and does not leave those with mental health needs out in the proverbial cold? Granted, we have passed parity mandates in the past, however, health data suggests that the mentally ill are not receiving nor have they received the care that they need.

In 2008, the government passed the Mental Health Parity and Addiction Treatment Act which prohibited private insurance from placing discriminatory limits on mental health. However, one key loophole that often prevented individuals from receiving the insurance coverage they needed was the idea of pre-existing conditions. Unlike physical diagnoses that seem to come and go, mental health diagnoses often remain on medical health records indefinitely, thus making the attainment of health insurance virtually impossible. Although health reform should prohibit insurance companies from denying coverage for pre-existing mental health conditions, my fear is that this will continue to happen. Enforcement of health care legislation and particularly that of mental health has often been lacking.

While I applaud our nation’s step in the right direction through its passing of health care reform, I am concerned that access to health services will again become too limited for those in need of mental health services.

FACULT Y IN THE NE W S Dr. Marilee Aronson, assistant professor of clinical psychology, was quoted in an Atlanta Journal Constitution article discussing how parents should talk to their children about the rapper—and student idol—T.I.’s recent drug relapse and arrest (9/3).

In an article in Youth Today, Dr. Robert Foltz, professor of clinical psychology, discussed why he believes the increasing use of anti-psychotic drugs on juvenile offenders actually interferes with the their ability to benefit from psychotherapy (10/1).

Dr. Michael Barr, assistant professor of business psychology, was interviewed in Jayplay, the magazine of the University of Kansas, for a story about consumer psychology and supermarket tactics (4/29).

A Chicago Tribune story on career opportunities in child psychology featured interviews with Dr. Bianka Hardin, associate professor of clinical psychology and Aisha Ghori, director of career services (5/6).

Dr. Michael Davison, assistant professor, forensic psychology, was quoted in a story about Colonel Russell Williams, a former Canadian air force base commander who was recently convicted for two murders, sexual assaults, and numerous counts of breaking and entering. The story appeared in newspapers throughout Canada, including the Vancouver Sun, Calgary Herald, and Montreal Gazette (10/22).

Dr. Ken Fogel, professor of clinical psychology, was interviewed on CBS 2 Chicago News for a story about why Americans seem to be increasingly rude to each other (5/7).

What is that barcode thingy?

Dr. Michael Komie, associate professor of clinical psychology, was quoted in an article in Crain’s Chicago Business on the emotional and relationship pitfalls of working in the office on weekends. (11/15) Dr. Cynthia Langtiw, assistant professor of counseling psychology, provided in-depth insight for a story in Chicago Parent Magazine about how parents can support their children through the socialization process as they learn to make friends in school (7/21).

Dr. Chris Leonhard, professor of clinical psychology, was quoted in the MSNBC blog,

“The Body Odd,” in a post about why we seek out and often crave the excitement of frightening experiences (8/24).

Dr. Linda Liang, Organizational Leadership Department chair, talked with ABC-News Chicago about how to develop negotiating skills—asking for and getting what you want (9/28).

In The Norwalk Hour, Dr. Charles Merbitz, professor of applied behavior analysis, discussed the value of applied behavior analysis and the BCBA certification in the context of a story about a local Connecticut woman who misrepresented that she held board certification to work with children with autism. (4/30).

Dr. Daniela Schreier, assistant professor of clinical counseling, commented in the Chicago Daily Herald that former Illinois governor Rod Blagojevich displays symptoms consistent with narcissistic personality disorder (7/5). The New York Daily News featured her in articles about whether spouses/partners who have secret bank accounts are “cheating” on their partners (10/11); a new test that predicts menopause may make women anxious (6/28); the psychological impact on children who grow up

with an abusive mother (5/7); and the psychological impact of facial transplants (4/26).

Dr. Debra Warner, associate professor and lead faculty for the Clinical Forensic Psychology program in Los Angeles, was interviewed on Viewpoints, a weekly public affairs radio magazine broadcast on over 370 radio stations across the country (11/3).

On the anniversary of John Lennon’s death, Dr. Nancy Zarse, associate professor of forensic psychology, was interviewed by KTRS Talk Radio St. Louis about people who stalk and kill celebrities (12/8).

The Chicago School of Professional Psychology’s L.A. Campus was mentioned in an article about Aquil Basheer, a renowned gang intervention practitioner who received a California Peace Prize from the California Wellness Foundation. The article notes that Basheer’s organization runs the Professional Community Intervention Training Institute in partnership with The Chicago School (10/20).

Just scan the codes with your smartphone to see web-exclusive content.

Visit insight-magazine.org/barcode to see recommended apps for your phone.

READ MORE ABOUT FACULTY ONLINE. thechicagoschool.edu/ inthenews

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faculty

BE YOND THE CL A S SROOM

Q&A I

n the past decade, a few states passed laws that allow psychologists to prescribe medication to treat mental illness as a declining number of psychiatrists, particularly in rural areas, raised concerns over access to mental health care. Many physicians oppose the idea, citing safety concerns and a lack of training. We gathered four Chicago School faculty and one student to discuss the issues surrounding prescription privileges for psychologists. From the Chicago Campus, Dr. Elaine Fletcher-Janzen, professor of school psychology; Dr. Lukasz Konopka, professor of clinical psychology; and Jessica Funk, clinical psychology doctoral student. From the Los Angeles Campus, Dr. David Pyles, associate professor of applied behavior analysis; Dr. Richard Sinacola, associate professor of clinical psychology and marital and family therapy. would do the actual psychotherapy or treatment. These days, managed care companies and insurance companies don’t tend to reimburse for psychiatrists doing those sorts of activities.

Now most psychiatrists are much more involved in psychopharmacology and very seldom engaged in the therapeutic process. Consequently, the continuum of treatment has changed a lot in psychiatry in the last few years.

DR. SINACOLA: We’ve also seen an interesting trend in medical education: psychiatry is becoming one of the lower-paid medical specialties.

And psychiatry training programs

DR . PY L E S

DR . FL E T C HE R -JA N Z E N

DR . KO N O P K A

INSIGHT: What are some of the differences between psychology and psychiatry?

DR. PYLES: The biggest and most obvious difference is that psychiatrists are physicians, and psychologists are psychologists.

The degree for a psychiatrist is an M.D., generally, although sometimes you get D.O.’s and other kinds of professions weighing in, whereas a psychologist tends to be a Ph.D., Psy.D., or Ed.D. degree.

DR. FLETCHER-JANZEN: When I first started in this profession, which was a long time ago, a lot of psychiatrists

now don’t have quite the robust numbers that they had at one time, which is resulting in the inability of psychiatry to provide the amount of care that’s needed in each state. This is what led to recent developments in states like New Mexico where prescription privileges were afforded to psychologists because there was an emergency situation where even psychiatry admitted that they could not keep up with the pace of med reviews. I think someday when psychologists are doing more of the prescribing, the psychiatrists will be available for consults as specialists on unusual cases. But clearly, so far, at least in states that do allow it—New Mexico, Louisiana, Guam, the Department of Defense—psychologists are prescribing, and they are doing so safely.

INSIGHT: Legislation to grant prescription privileges to psychologists has been proposed in several other states, but they have not passed laws. Why not?

DR . SIN AC O L A

PRESCRIPTION PRIVILEGES FOR PSYCHOLOGISTS?

INSIGHT MAGAZINE WINTER 2011 11

S T UD E N T J E S SI C A F U NK

FUNK: I think the main issue with other states is the opposition from the medical associations. In my research that was the main trend, that in every state the medical entity had much stronger lobbying forces, a lot more funding behind them, and they just were able to end our efforts.

DR. FLETCHER-JANZEN: I think the major concern from the American medical establishment is that psychologists don’t have the medical training to understand the complications that can occur with prescriptions. I think legislative efforts have the scare tactic of psychologists not knowing anything about comorbidity and comorbid medical disorders and side effects.

Most folks who go through training in Louisiana and other states work in conjunction with general practitioners. So, we’re not talking about psychologists going off on their own and creating high-risk conditions. It’s a very conservative approach to training and supervision.

DR. SINACOLA: If we go back to the fact of 60 to 70 percent of psycho-

“I think the major concern from the American medical establishment is that psychologists don’t have the medical training to understand the complications that can occur with prescriptions.” tropic prescriptions are written by a primary care physician, we also forget that the typical family physician has four weeks of mental health training. That’s it. That’s the extent of their medical training in psychotherapy and the art of mental health treatment, and they’ll be the first to admit that they know very little about it. But yet that onus falls on them.

INSIGHT: Then what training is necessary to prepare a psychologist to prescribe medication safely and effectively?

DR. KONOPKA: My opinion is that prescribing medications is not a huge, complicated task. Particularly today since we have electronic medical records, and pharmaceutical information is available online, and we have intelligent programs that will not allow you to prescribe medications that do not fit in terms of metabolism or other interactions. So, it’s really difficult to make an error.

FUNK: I think it is important to get that medical background training, to order a metabolic panel, to then understand what labs are coming back. We aren’t taught that in the general psychology programs.

DR. SINACOLA: I think that what APA and other professional groups have

begun to talk about is the fact that we are looking at the minimum of an equivalent of a master’s degree to cover all those topics. But, I guess what is going on now is that some psychologists have taken the back-door approach to training by going into nursing programs. Nursing has jumped on that bandwagon and thrown open the doors with wide open arms saying, “Come on board. We want to have you.” But I think we as psychologists need to look at that and say, is that an identity crisis? What do you call yourself when you are done?

Do you call yourself a nurse practitioner/ psychologist or a psychologist/ nurse practitioner? I think the time is right for educational institutions, even The Chicago School, to consider these specialty programs in pharmacology for psychologists to prescribe.

INSIGHT: Why isn’t there agreement yet?

DR. KONOPKA: I think many psychologists will argue that they are not working within the medical model.

And psychology is a separate field unrelated to the practice of medicine.

If you sell yourself as that kind of an individual, and if you present that to the public, that’s the outcome. You’re not medically trained.

faculty

BE YOND THE CL A S SROOM

“The issue is that most psychoactive medications for children are off-label.

In other words, there are no evidencebased practices associated.” become a prescribing psychologist, that you would really become an expert in psychotropic medications.

A psychiatrist who wrote an article in the National Psychologist said that he believes psychologists will prescribe more judiciously because their mainstay will still be psychotherapy.

DR. KONOPKA: I’m not sure that that behavior will stay. As with any new field initially, I think, there will be a conservative approach. But eventually, if your income will depend on the number of patients you see, and you can justify your existence by seeing patients for 10-minute medication management visit, I think humans have a tendency to go down to the lowest common denominator.

FUNK: I think there is also a fear from some psychologists that if not for prescription privileges, psychology will turn into psychiatry. That we’ll lose that aspect of biopsychosocial and we’ll just become biologically focused medication managers like psychiatrists are now.

DR. SINACOLA: I know of a study that says that if psychologists achieve prescription privileges, psychologists would only prescribe psychotropics— whereas psychiatrists can prescribe anything as a physician. So I think that it allows for psychology to really develop its specialty, if you’re going to

INSIGHT: Are there different issues to consider when thinking about children and adolescents?

DR. PYLES: Most psychiatrists that I’ve interacted with—if they are adult psychiatrists—are very hesitant to treat children at all, and consider child psychiatry to be a specialty.

Given how little we know about the developing brain and, to be honest, how little we know about how drugs actually affect the brain, there’s much more that we don’t know than we do know, and trying to pretend that we do know anything about this is, I think, a mistake. In my practice, I see people with developmental disabilities who are on medications for decades.

And in most of the drug trial studies, when they say there are no long-term effects, they’re talking about six weeks. They’re not talking about the

effects of being on an antipsychotic medication for a number of decades.

DR. FLETCHER-JANZEN: I work mostly with children in the public schools, which has a dizzying array of children with various kinds of neurodevelopmental, behavioral, social, and sometimes family disorders. And the issue is that most psychoactive medications for children are offlabel. In other words, there are no evidence-based practices associated.

Apart from that chilling fact, the other issue is differential diagnosis.

Think of the average general practitioner who has a 15-minute appointment with a family who has a child that someone has said is overactive—and during this 15-minute appointment, a perhaps unreliable and therefore questionable test like the Vanderbilt is given to checklist for ADHD. This is just differential diagnosis at its worst. And then the general practitioner says, well, I have to help these children, this family, so we’ll prescribe a stimulant. And perhaps the family go away for three months.

And then they come back for another 15-minute visit where this person with no psychiatric training whatsoever asks the family, how’s it going? This is the most unscientific way I could possibly imagine of trying to determine whether the positive and negative side effects of a psychotropic medication are present and to what degree, and therefore if the prescription should continue or not or should change.

Psychologists know the whole process. They are capable of doing good assessments, good differential

INSIGHT: Does this come up in your classrooms?

DR. KONOPKA: On my first day of classes I ask, who wants to prescribe?

It all depends on the composition of the class. There are some people who are very strong proponents of prescription and very vocal about it and others very reserved. But ultimately by the end of the course, when the question is asked again, more people will raise their hands because they generally feel that they would be more empowered to participate in helping the individual than not.

DR. FLETCHER-JANZEN: I spend a great deal of time talking about how school psychologists can help with differential diagnosis and medication

management. The obvious point comes up that school psychologists are spending a great deal of time trying to fix what is a broken system at this point. And they would very much like to have more control over what they are doing.

DR. SINACOLA: California requires that all psychologists and MFTs and LCSWs take courses in psychopharmacology. But what usually comes up is how difficult it is to find a psychiatrist for your patient. That’s often talked about a lot, which has led to us having to develop models for having collaborative relationships with primary care. There are very few students who sit on the fence with this one. They either are for it, or they don’t think it’s for them.

from those same drug companies.

So I’m not convinced that the information that we’re getting on the results of the drugs’ effectiveness are completely unbiased and don’t need a closer look by a lot of outside objective third parties.

INSIGHT: Any final comments on the issue?

DR. KONOPKA: I hope that with time the world of psychology recognizes the importance of participating in the world of medical interventions, and that we begin to engage our students in the process of learning without fear that somehow they are inferior to other disciplines and provide them training so that they can stand on

“Psychologists know the whole process.

They are capable of doing good assessments, good differential diagnosis.”

DR. PYLES: One of the things I think we also need to get out on the table is that psychosocial interventions and learning-based interventions also change the brain and do it without all the nasty side effects of the more chemical methods. I don’t hear us talking about interventions that change the brain much more safely than do the medications that are prescribed. And our outcome data are at least as good. So, I’m not denying a lot of people have been helped by medication, but I think that the effectiveness has been oversold, and if you look at a lot of who’s doing the research, it’s the drug companies that create the product in the first place, and they have the ability to affect editorial decisions in medical journals because those medical journals also accept advertising

their own two feet with heads up high and be able to say “my opinions are this and this and based on these and these articles that I recently read and so let’s have an argument based on data rather than argument based on impressions.” That’s my hope.

DR. SINACOLA: I think that we should consider training programs to educate those who prefer to be prescribing psychologists to make sure that they are using sound judgment and good research. If it is not happening in the psychology programs, where will it happen?

LISTEN TO THE COMPLETE INTERVIEW AND ADD YOUR COMMENTS ONLINE. insight-magazine.org/ QA-winter2011

INSIGHT MAGAZINE WINTER 2011 13

diagnosis. They spend more time with the child and family and can do better follow-up in terms of understanding whether negative side effects are present and if the medication effects, the desired outcomes, are eventuating.

DR. SINACOLA: We have to consider, what could psychologists do differently should they obtain prescription privileges? I think you touched on a very key thing, and that’s better assessment. I think we would all agree that a lot of psychotropics are overly prescribed. Many times we see patients in our practices who had very little assessment done by anyone, and yet they very quickly obtained a prescription from either a psychiatrist or primary care physician. So I think hopefully what will happen is that psychologists will bring that extra piece to the table where they will do a complete assessment before a child is placed on stimulants, or alpha blockers, or anything for ADHD, or medications for depression or psychotic conditions.

That’s always been the thing that’s been missing—psychiatry does not assess; they do not test.

MIND OVER

MEDICINE {by Doug McInnis and Judy Beaupre}

AN IN-DEPTH LOOK AT THE ROLE PSYCHOLOGY DOES— AND DOESN’T—PLAY IN AMERICAN HEALTH CARE.

INSIGHT MAGAZINE WINTER 2011 15

WHEN JOAN WAS DIAGNOSED with isolated

systolic hypertension—a condition that affects more than 10 million Americans over the age of 65 each year—the treatment plan seemed obvious enough. With dozens of blood pressure medications on the market, it was just a matter of finding the one that worked best for her.

The answer, however, wasn’t so simple.

On a regimen of two drugs, the 68-year-old patient found herself battling headaches,

dizziness, fatigue, and frequent coughing spells—yet her blood pressure readings still registered high. So her doctor, Herbert Benson of Harvard Medical School, tried a different approach entirely: He sent her home with a compact disc—loaded with soothing voices and sounds—and instructions to listen to it daily while visualizing calming scenes.

Eight weeks later, Joan’s blood pressure was normal. »

J “

oan became a case study in how the effective mind-body treatment of hypertension can result in the complete elimination of anti-hypertensive drugs,” Dr. Benson writes in his book, The Relaxation Revolution: Enhancing Your Personal Health Through the Science and Genetics of Mind Body Healing, published in June 2010. Dr. Benson’s research dates back more than 35 years (his first book, The Relaxation Response, was published in 1975), qualifying him as a pioneer in incorporating mind-body approaches into Western medicine.

Dr. Benson is far from alone in his thinking or research however. In 1994, Dr. Andrew Weil, a Harvard-trained physician and professor of medicine, founded the Center for Integrative Medicine at the University of Arizona, the first program that formally trained physicians in incorporating mind-body approaches into their practices. Other institutions followed his lead, including Harvard, Johns Hopkins, Duke, UCLA, and Georgetown. Today more than onefifth of U.S. medical schools are members of the Consortium of Academic Health Centers for Integrative Medicine.

“My intent in founding the center was to train physicians in a new way of thinking about medicine to cover the areas of deficiency in conventional medical education.” Dr. Weil says. In his book, Natural Health, Natural Medicine: The Complete Guide to Wellness and Self-Care for Optimum Health, he explains what he feels those deficiencies are.

“Mainstream medicine continues to be the same as it has been, but more so: more expensive, more reliant on technology, more focused on the physical body to the exclusion of mind and spirit.”

In an increasing number of treatment settings, mind-body approaches are being integrated into traditional Western medical practices. They include psychological counseling, mindfulness exercises such as meditation and yoga, nutrition management, massage therapy, and herbal

remedies. Facilities such as the Center for Mind-Body Medicine in Washington, D.C., founded by another physician—Dr. James S. Gordon—are springing up in metropolitan areas across the country.

And while a small but growing number of mainstream medical school programs are incorporating alternative approaches into their curriculum, a handful of specialized institutions such as Santa Barbara Graduate Institute (SBGI) have been established specifically to address the need for a more integrative type of health care.

“The connection between mind and body and our overall health is difficult to ignore,” says Dr. Marti Glenn, who founded SBGI a decade ago and today serves as its campus dean. “Our attitudes and emotions affect us on a cellular level, and become evident in conditions that range from ulcers and high blood pressure to chronic pain. Many research studies have compared patients who suffer from the same malady but have different psychological experiences; their outcomes are very different.”

SBGI currently offers programs in somatic, prenatal, and perinatal psychology, and has plans to infuse its

holistic philosophy into professions such as nursing, occupational therapy, and physical therapy.

“We can’t just treat the symptom, we have to treat the human being,” Dr. Glenn says. “Healing and resiliency are affected by so many factors: lifestyle, resources, values, developmental history, and emotional health.”

A Solid Research Base Research is producing mounting evidence linking physical health to mental or emotional health. Both the medical and psychological communities acknowledge that issues such as stress, anxiety, depression, and anger—once believed to impact only one’s emotional well-being—must be addressed to effectively deal with conditions ranging from diabetes to heart disease to cancer. The American Psychological Association has compiled more than 300 studies that show that stress weakens the immune system, and that proactive psychological interventions can work hand in hand with front-line medical procedures in curing or slowing disease. In just one example, women treated for breast cancer were 56 percent

MIND-BODY MILESTONES

T

he concept of a mind-body connection dates to the ancient world in both Western and Oriental traditions. The ancient Greeks held that physical fitness was necessary for mental well being, and they placed a heavy emphasis on athletic achievement, notably through the Olympic Games. Asia developed traditional Chinese medicine, Ayurvedic medicine, and yoga, which employs exercise, breathing, and meditation.

But the ancient concept of the mind-body connection was derived anecdotally. In the 20th and 21st centuries, landmark research has documented the connection.

sor at Harvard Medical School and the director emeritus of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, uses his relaxation protocols for a far wider range of illnesses than the hypertension his patient Joan experienced. His approach is used in the treatment of heart disease, cancer, HIV, depression, and diabetes.

The latter two often go hand in hand.

The University of Washington School of Medicine and Seattle’s Group Health Research Institute recently collaborated on a study of patients with diabetes and found they were more likely to suffer potentially life-threatening complications from their illness if they were depressed.

“Diabetes patients require four to five medications to control the disease, and many need more than that,” says Dr. Elizabeth Lin, a Group Health researcher who took part in the study. “When patients are depressed, they may not take their insulin on time or at all. They are also more likely to eat badly, smoke, and exercise less. These factors all contribute to what we saw in our study.”

Dr. Sandra Siegel, an addictions specialist and associate professor of clinical

counseling at The Chicago School, agrees.

“We’re seeing this huge number of people with Type 2 diabetes because of overeating,” she says. “If we just put them on a diet and don’t deal with what’s fueling the behavior, we won’t see much improvement. When I teach, I recommend looking at the patient holistically.”

The holistic approach that Dr. Siegel recommends is used at some medical centers, including Chicago’s Mount Sinai Hospital, which offers psychological counseling to ill children and teens through its pediatric and adolescent behavioral health program, Under The Rainbow.

“If a 16-year-old diabetic is seen by one of our doctors, we then work with the kid to explain that this disease is something that will be with them the rest of their life,” says Dr. Richard Macur-Brousil (Psy.D.’91), the program’s director and an alumnus of The Chicago School’s Clinical Psychology program. “But we also tell them that they can control it with diet, behavior, and insulin.”

The psychological staff works with parents as well,

1929

1968

1990

THE DAMAGE THAT

HERBERT BENSON, a young medical school graduate, noticed a peculiar and unwanted variation of fight or flight among his patients—their blood pressure rose during regular checkups.

He attributed this to the stress brought on by going to the doctor.

Benson went on to discover the link between stress and hypertension. But he also found that training the body to relax could trigger a healing response for stress-related disease.

CARDIOLOGIST DEAN ORNISH, while still

the mind can inflict on the body stems in part from the fightor-flight syndrome, a stress-response mechanism that helps keep us alive when we’re attacked. Fight or flight was identified early in the 20th century by Harvard University physiologist Walter Cannon.

a student at Baylor University’s College of Medicine, discovered that it was possible to unclog blocked arteries and increase blood flow to the heart without surgery through a holistic program of diet, exercise, stress reduction, and anger management.

2008 NEW TECHNOLOGY HAS

enabled researchers to document what happens when the mind-body approach is used. Scientists have identified genes that are linked to disease and others that are linked to good health. The bad genes can be switched on and the good ones switched off by negative emotions.

Dealing with stress can reverse that, and Dr. Benson has documented the changes with microarray technology, which produces a readout of genetic activity.

INSIGHT MAGAZINE WINTER 2011 17

less likely to die from the disease if they participated in group therapy sessions than if they did not.

In September 2010, researchers attending a heart-brain conference organized by the Cleveland Clinic reported on more than 100 studies linking depression and stress to cardiovascular disease. Dr. Marc Penn, a cardiologist at the Cleveland Clinic and director of the clinic’s HeartBrain Institute explains the connection.

Depression is believed to impact the operation of the body’s vagus nerve in ways that increase inflammation that can damage the heart, he says, adding that the situation is made even worse by the fact that depressed patients often ignore treatment protocols and lead sedentary lifestyles.

Acknowledging that depression treatment is an inexact science, Dr. Penn points to a wide range of treatment options that include psychological counseling, drugs, exercise, and relaxation therapy. While all approaches work, he says, they don’t all work for everyone.

“It all comes down to whatever works for the patient,” he says.

Dr. Benson, who is an associate profes-

he adds, because coping with diabetes is a family affair. Parents are encouraged to change family menus to conform to their child’s dietary restrictions. For the diabetic, eating the wrong food can lead to diabetic comas, or to the chronic diseases the diabetes can cause—heart disease and kidney failure among them.

“If the family eats the same meal, it’s very helpful,” says Dr. Macur-Brousil.

“But if the family eats one thing and the kid eats something else, then he will fall off the wagon.”

Despite the efforts of believers like Drs. Benson and Weil and the example set by the doctors at Mount Sinai, however, prescription drugs and the surgeon’s scalpel still dominate American medicine.

Much of the reason lies with the patients themselves, who often prefer a quick fix.

“Whatever the problem, the first intervention in Western medicine is a pill,” says The Chicago School’s Dr. Siegel.

“Western medicine doesn’t stop to look at the whole person and what’s fueling the problem.”

Why do so many doctors take the single-minded

approach that Dr. Siegel describes?

Because physicians are trained primarily in medical interventions—surgery and prescription drugs—many don’t have the experience that psychology and counseling professionals have in incorporating behavioral interventions. Even when they are aware of the benefits of a holistic approach, doctors lack both the training and time to diagnose psychological issues or help their patients reverse unhealthy lifestyles. Studies show that doctors spend an average of 20 minutes with a patient per visit—hardly time to unravel the emotional tangles that often underlie the patient’s physical complaints. Nor are they equipped to deal with hurdles faced when trying to treat a patient who is in denial about his disease.

“A doctor may say ‘You’re not taking your medicine. Take it!’” says Dr. Cynthia Langtiw (Psy.D.’05), a former Mount Sinai psychologist and an assistant professor of clinical counseling at The Chicago School. “And the kid says ‘sure’ and then goes back to what he’s doing.

Doctors just don’t have time to deal with this. It would involve assessing the patient and finding ways to motivate him to deal with a disease that doesn’t go away.”

A Long Way To Go Despite the growing evidence that many patients can benefit from—and often require—a treatment regimen that goes beyond conventional medicine, health care that targets both mind and body remains the exception rather than the rule.

“Mind-body science has now reached a stage where it should be accepted as the third major treatment and prevention option, standing as an equal alongside drugs and surgery,” says Dr. Benson. “If we could lower the incidence of disease through effective preventive medicine and also cut costs with less expensive mind-body approaches, we might save hundreds of billions of dollars now spent or lost through excessive medications, stress-related diseases, and lost work days.”

Among psychologists, the holistic approach has gained traction. It is mental health practitioners, after all, who are frequently called in to pick up the pieces of shattered lives, and what they find is a web of physical and emotional ills that feed on one another.

If addressed earlier in a primary health setting, psychology and counseling professionals argue, the human and financial savings could be huge.

HOLISTIC APPROACHES ACROSS THE COUNTRY. A small but growing

number of medical practices are integrating mind-body approaches in innovative ways.

A FEW EXAMPLES INCLUDE: • In the Twin Cities, Children’s Hospitals of Minnesota uses psychologists in the treatment of asthma, diabetes, and cancer.

• In Cambridge, Mass., Mount Auburn Hospital mental health professionals work with doctors to treat alcoholism, chemical dependency, heart disease, and Parkinson’s disease.

• In Palo Alto, Calif., the Stanford Center for Integrative Medicine uses psychotherapy to help patients deal with stresses that cause anxiety, depression, fatigue, and uncomfortable physical symptoms.

• In Chicago, TCSPP Associate Professor Gale Sargent works with HIV-infected patients, using her counseling skills to help patients with decisions surrounding their medical care.

• In Portland, Ore., the Center for Women’s Health provides its preconception patients with mental health counseling, which has produced positive effects on fertility.

• In Pennsylvania, the University of Pittsburgh Center for Integrative Medicine uses hypnosis to treat fibromyalgia and chronic pain.

• In Delmar, N.Y., the Center for Integrative Health and Healing uses guided imagery—which it describes as deliberate daydreaming—to speed the recovery of post-operative patients, to enhance immune function, and to treat Irritable Bowel Syndrome.

Sinai, which treats indigent patients, Dr. Macur-Brousil explains; many hospitals charge significantly more).

“We can avert these hospitalizations with weekly cognitive-behavioral therapy for two or three months at a monthly cost of about $280,” he adds.

The potential savings goes far beyond dollars and cents though—they also can be counted in terms of avoiding complications such as blindness and heart disease.

But before any savings materialize, chronically ill patients must first have access to mental health care.

Congress moved to increase access in 2008 when it voted to require parity between medical and mental health coverage in health insurance plans. Yet, even with this legislation now enacted, psychological care is still elusive for many Americans, 50 million of whom are without health insurance. Millions more are underinsured; although they may have insurance, large deductibles and co-pays limit their willingness and/or ability to seek treatment for any but the most pressing—usually physical—problems. Still others may avoid seeking help, even when it’s both available and affordable, because they believe psychological counseling carries a stigma.

In the meantime, vast sums are spent on treatments that cost too much and may not work. “We spend at least $15 billion per year on medications for insomnia alone, which do not work well over the long term and which can often be replaced by mind-body interventions,” says Benson.

“The huge amounts of money at stake in medical care must not be minimized,” he contends. “(It’s) a sum that represents almost one-fifth of the American economy. Imagine the savings that we may achieve as we begin to take the mind-body option more seriously.”

BY THE NUMBERS 1 OUT OF 5 pyschologists with a Psy.D. takes an integrative approach to their work.

3 FACTORS driving the integrative medicine movement: 1. Research 2. Health Care Costs 3. Demand by the Public An explosion of research linking disease to stress, depression, and other mental health issues; the hope that mind-body medicine will help rein in fastrising health care costs; and a demand by the public for a new approach to healing.

OVER 35 MILLION U.S. adults now use mind-body approaches to achieve better health.

9% IN 1998 TO 37% IN 2008 The jump in the number of U.S. hospitals that offered alternative therapies.

MORE THAN QUADRUPLED SINCE 2002 (11 TO 46 TODAY).

The increase in swelling membership rolls of the Consortium of Academic Health Centers for Integrative Medicine.

Members include Harvard, Yale, Stanford, Michigan, Johns Hopkins, University of California – San Francisco, and University of Arizona.

INSIGHT MAGAZINE WINTER 2011 19

But changing the existing system would be a tall order. Government data show that, in its current form, American medicine is a $2 trilliona-year industry that supports more than 14 million jobs. An integrated care model could shake up this system by substituting inexpensive alternative care for more costly traditional drugs and procedures.

“When a patient has learned the basic techniques for applying mind-body approaches in medical treatment and prevention, the techniques cost nothing to administer,” Dr. Benson says in his book. “The use of mind-body medicine will decrease the overall use of medical services, and, concomitantly, reduce medical costs.”

As an example, he cites one study showing a 43 percent reduction in doctor visits by arthritis patients who participated in a self-management program, and a 20 to 36 percent decline in costs for patients who underwent brief psychotherapy treatments for six to 12 months.

“Those Medicaid patients who spent the most time in counseling tended to have the highest percentage reduction in their medical costs,” Dr. Benson writes.

Because most health care in the United States is not approached holistically, the burden of balancing medical treatment with psychological counseling often falls to the patient.

Mental health intervention adds another entire layer—of appointments, cost, and insurance considerations.

In the long term, psychological intervention saves money by heading off medical crises, says Dr. MacurBrousil. For instance, when a young diabetic crashes, he will typically go to the emergency room, where the average charge is $400. Then he will be hospitalized for three to six days at an average cost of $500 a day. (These costs reflect typical charges at Mount

OUT OF THE

SHADOWS As more light is shed on the mental health needs of the terminally ill, is there a role for psychologists to play? {By Lindsay Beller}

INSIGHT MAGAZINE WINTER 2011 21

OUT OF THE

SHADOWS

An elderly hospice patient was so close to death that her team of health care providers, on hand to address all needs related to her mind, body, and spirit, could not understand why she was still alive. From a biological standpoint death should have come, but in what seemed like defiance of her physical condition, she held on tight to life.

When Dr. Todd DuBose stepped in her room, he found her awake and riddled with anxiety. During their conversation, the woman tearfully revealed that she was afraid to die because of a deepseated fear that her mother—with whom she had a falling out with decades earlier—would meet her at the gates of heaven and keep her out. Her talk with Dr. DuBose likely brought her the measure of peace she needed to let go because later that afternoon, the woman passed away.

By his own account, Dr. DuBose has had thousands of similar conversations, underscoring how common it is for terminally ill patients to experience mental anguish when they know the end is near. “There are often issues related to guilt, regret, resentment, feeling

a lack of worth or mattering of one’s life, worrying about those left behind. I’ve seen people hang on because they are concerned about the well-being of those who survive them,” he said. “Psychologists could move into those spaces.”

They could, but for the most part, they have not. Dr. DuBose, an associate professor of clinical psychology at The Chicago School who focuses on sudden and traumatic loss, and previously worked with AIDS patients as a hospital chaplain, is more the exception than the rule. In the four decades since noted psychiatrist Elizabeth Kübler-Ross’ seminal book On Death and Dying brought the taboo subject of death into the open and legitimized the emotional issues that terminally ill patients experience through the

five stages of grief, psychology has not had a clearly defined role in end-of-life care.

But current trends suggest a growing awareness that mental health providers in this area are needed. In the U.S. nearly 50 million more people will join the 65-and-over crowd by 2050, while an increasing body of research finds patients want to have a “good death,” but instead die in pain, in psychological distress, and with family members or caregivers who may not have fully understood the prognosis and expected to have more time with their loved one.

Stemming from this is more widespread integration of palliative care units in hospitals, where an interdisciplinary team of health care providers, including a mental

INSIGHT MAGAZINE WINTER 2011 23

health specialist, focus on quality-of-life improvements over curative treatment for sick patients, regardless of their life expectancy. Under the umbrella of palliative care is hospice, which offers a similarly holistic approach to terminally ill patients, typically in a home or longterm care setting. From 2000 to 2008, the number of palliative care programs in hospitals increased by almost 126 percent, while last year, nearly 42 percent of all deaths in the United States occurred in the approximately 5,000 hospices in the country. Despite increasing integration of such programs in recent years, they still lag far behind what is needed.

The expertise that psychologists have in assessment, research, evaluation, and counseling; their considerable involvement with chronically ill patients; and a general acceptance of the holistic and integrated health care philosophy suggest that they could bring useful skills to the end-of-life arena. But a lack of educational opportunities, few financial incentives, a complex health care system, and, for some, a general discomfort with death and treating patients at the end of their lives have all explain why psychologists rarely occupy this niche. “It’s almost as if when you’re ready to die, people feel the work of the psychologist is over when in fact it’s just the beginning,” Dr. DuBose said.

Outside the System One could argue that historically, psychologists have demonstrated little

5 STAGES OF

GRIEF 1.

2.

3.

4.

5.

I

Denial Anger Bargaining Depression Acceptance

n 1969, psychiatrist Elisabeth Kübler-Ross’ book On Death and Dying introduced the five stages of grief that a terminally ill patient experiences after receiving the diagnosis.

Although these stages have been both adopted and criticized, they were considered groundbreaking for providing insight into what the dying went through, and for ushering in a new era of openness that guided families, physicians, and mental health professionals in discussing a previously taboo subject with patients.

interest in working in end-of-life care.

The field was just beginning to advocate for more training in clinical settings after the endorsement of the Vail Practitioner-Scholar model when the first hospice opened in 1974 in Connecticut, introducing a more holistic approach to treating terminally ill patients.

“Historically speaking, that’s not where psychologists were,” said Dr. James L. Werth Jr., professor of psychology at Radford University. “They were in group or private practice in the early years.”

Meanwhile medical advancements had begun to extend life, and the notion of caring for the whole person, that is, the physical, emotional, social, and spiritual needs of the patient, was catching on.

In 1983, Congress created the Medicare benefit for hospice care, which established several guidelines that needed to be met in order to cover the cost, including the requirement that every patient have a health care team that consisted of doctors, nurses, counselors, a social worker, speech-language pathologists, hospice aides, homemakers, and volunteers. The counselor was often a member of the clergy, and the social worker provided psychological support for patients and their families. “There’s a difference in opinion in how interested psychologists were in being a part of government programs,” Werth said.

“Social workers were more a part of the system. By not advocating for ourselves, we therefore got written out.”

Social workers, on the other hand,

OUT OF THE

SHADOWS

received training in such areas as case management and discharge planning that served them well in this role. “It’s a natural fit for them to be included in these teams in hospitals and hospices,” Werth said. “They have courses on hospice and health care built in whereas it’s an elective to take these in any health psychology programs. Psychologists are playing catch up.”

Although the field of psychology has since expanded into different settings and embraces a

occasionally brought in to consult, the perceived lack of reimbursement is a key reason why psychologists do not often provide services in these settings.

But a push toward more integrated care could bring more psychologists into the fold. In recent years the field has begun to champion the idea that a more collaborative and streamlined approach toward treating patients could reduce medical costs and improve care, and research has supported this belief.

One of three goals in the American

“There’s a difference in opinion in how interested psychologists were in being a part of government programs. Social workers were more a part of the system.

By not advocating for ourselves, we therefore got written out.” more integrated approach to health care (see cover story), the hospice benefit has not changed since its inception nearly 30 years ago. The team is defined in the same way, and the small per diem— which remains the same regardless of where the patient is in his or her illness—only covers services provided by the team. Additional costs incurred by a psychologist that are related to the patient’s illness would need to be covered by the hospice or the patient (psychologists can be reimbursed for providing services for concerns not directly related to terminal illness, although there is a common misconception that they cannot). While psychologists are

Psychological Association’s new strategic plan is to expand psychology’s role in advancing health. “The big piece is integrated care.” said Werth, who chairs of the APA Committee on Rural Health. “The organization realizes that we need to move in this direction to stay viable in the field.”

Some psychologists who work with terminally ill patients have faced challenges in trying to accomplish this.

Dr. Merla Arnold, a registered nurse and geropsychologist who works in long-term care settings with aging adults, receives little response when she reaches out to her patients’ physicians to discuss the impact of medications on their mental health.

“The nature of our health care system as a whole is hierarchical,” she said. “The physicians are at the top, and everyone else is under them. That has to collapse for a truly integrated approach. It has to be less hierarchical and more cyclical.”

Doctors may also have a different mindset in treating the terminally ill, said Marsha Nelson, vice president of American Hospice Foundation. “This can be an uncomfortable topic for physicians.

They’ve been trained to save people, and death may be perceived as a failure.”

Psychologists are not immune to this thinking either, said Dr. DuBose. “I think we (psychologists) are still impacted by medical modeling that sees the job to be fixing, curing, making better. If you have that operating, it’s hard not to understand death as a threat,” he said.

A Greater Role There are signs that the field not only wants to define a greater role for psychologists in end-of-life care, but has made inroads too. The American Psychological Association has initiated various efforts in the past decade.

In 2000, a report from the APA Working Group on Assisted Suicide and End-of-Life Decisions found evidence that neither the discipline of psychology nor other professions that care for terminally ill patients saw end-of-life care as an important area for psychologists. A year later, the APA convened an Ad Hoc Committee on End-of-Life Issues and identified four areas in which psychologists could be useful: before illness occurs, after the diagnosis and treatment begins, during the advanced

stages of the illness, and after the death of the patient during the grieving process.

Psychologists could have numerous roles, reported a 2003 article published by committee members in Professional Psychology: Research and Practice: helping patients make decisions about end-of-life care, developing community education programs, counseling patients who experience depression or anxiety, supporting caregivers, and providing bereavement counseling for survivors, to name a few.

The article also cited the growing field of geropsychology—which addresses the needs of the aging—as well-positioned to provide mental health services and manage symptoms of older adults in nursing homes. This summer after more than 20 years of efforts to bring the field to the forefront, APA formally recognized geropsychology as a specialty of psychology, a move that brings more credibility to the field and paves the way for more educational opportunities. The APA also listed geropsychology as one of the top 10 growth areas for psychologists in its magazine, The Monitor.

In Europe, the newly formed European Association for Palliative Care’s Task Force on Education for Psychologists in Palliative Care is seeking to define a role for psychologists in these settings and establish specialty postdoctoral curricula.

Psychologists have also led research efforts in the growing interdisciplinary field of thanatology, which is the study of dying and death.

But ultimately there is a need for psychologists to want to be more involved in end-of-life care.

Dr. Arthur Kovacs, a psychologist who works with older adults and occasionally treats clients who become terminally ill, was frank in explaining his reservations in working patients at the end of their lives. “We find it upsetting and we avoid it,” he said.

“We don’t get much training. Some of my colleagues make a living of rising nobly to the challenge. I don’t know how they do it. It’s terribly lacerating.

It’s demanding. It’s terrifying.”

A cultural shift is necessary for this to change, said Dr. DuBose.

“We have to shift our thinking away from the avoidance of death,” he said. “We have to embrace death and think about it as a part of life.”

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INSIGHT MAGAZINE WINTER 2011 25

“We find it upsetting and we avoid it. We don’t get much training. Some of my colleagues make a living of rising nobly to the challenge. I don’t know how they do it. It’s terribly lacerating. It’s demanding. It’s terrifying.”

WORKING WITH A DYING PATIENT

1. CONCERN: Empathy, compassion, and involvement are essential.

2. COMPETENCE: Skill and knowledge can be as reassuring as warmth and concern.

3. COMMUNICATION: Allow patients to speak their minds and get to know them.

4. CHILDREN: They can bring consolation to dying patients.

5. COHESION: The clinician who gets to know the family maximizes patient support and is prepared to help the family through bereavement.

6. CHEERFULNESS: A gentle, appropriate sense of humor can be palliative.

7. CONSISTENCY: Continuing, persistent attention is highly valued by patients who often fear that they are a burden and will be abandoned.

Source: Cassem NH. The dying patient.

In: Cassem NH, editor. The handbook of general hospital psychiatry. St. Louis: Mosby; 1991.

alumni news

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TED RUBENSTEIN (PSY.D. ‘04)

Dr. Ted Rubenstein, Distinguished Alumnus, A Heartfelt Farewell

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Dr. Rubenstein addressed graduates as the 2010 Distinguished Alumnus.

he Chicago School lost a revered alumnus and faculty member when Dr. Ted Rubenstein (Psy.D. ’04) died September 11. His unexpected death came just three months after he was honored at the Chicago Campus’ 2010 Commencement Ceremony as the Distinguished Alumnus of the Year.

and students shared the memories of the difference he had made in the school and in the department.

“When I think of Ted, I think of the purest kind of energy, and of love, laughter, compassion, and creativity,” said Dr. Barbara Kelly, former chair of the Clinical Psychology Department.

“I think of his seemingly inexhaustible

A member of the Clinical Psychology Department faculty since 2005, Dr. Rubenstein was known for the passion with which he blended his areas of expertise—psychology and the expressive arts—and the enthusiasm with which he mentored students. His influence, inspiration, and energy were described repeatedly at an on-campus memorial service and in a memorial blog that was launched the week after his death. Dozens of colleagues, friends,

willingness to take on more, as if life would not be long enough to do all he needed and wanted to do to repair broken lives, heal wounded hearts, and make this world a better place.”

Among Dr. Rubenstein’s most visible accomplishments was the Home Again Family Reintegration Project, which he and his students developed in partnership with the Illinois National Guard. The project uses art, drama, and music therapy to help the children of returning soldiers cope

with the feelings of anxiety, fear, and confusion that accompany a parent’s deployment. In the past year, Home Again has been implemented in towns throughout Illinois. Its success has drawn the attention of the U.S. Department of Defense, which has asked that the project be expanded to other states and with other groups of military families. New versions are currently in development and will be implemented with families of fallen soldiers and those who are facing imminent deployment.

Dr. Rubenstein was the 20th graduate to be honored with the Distinguished Alumnus Award.

Presented by Alumni Council Chair Susanne Francis-Thornton (Psy.D. ’03), the plaque recognized his scholarly and humanitarian efforts to broaden the school’s impact through the Home Again project.

“I’ve had the great honor to build this program,” Dr. Rubenstein said in accepting the award. “Through the use of art and storytelling, we invited these children to someway express their feelings, convey their fear, to play again, to breathe again, and if necessary, get angry again. In short, it was time for kids to be kids again.”

Dr. Rubenstein also cited fellow faculty members who had been an inspiration to him during his days as Chicago School student.

“He talked about the professor who inspired calm in the middle of turmoil, but Dr. Rubenstein was that professor to me,” Clinical Psy.D. student Heidi Schilling wrote on the memorial blog, “I feel the world has been robbed of so much more he had to offer.”

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PATRICIA A. PIMENTAL (PSY.D. ’87)

Treating the Whole Person

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hen the patient continued to experience pain after an anesthesiologist performed a surgical block on the spinal cord injury, doctors called in Dr. Patricia A. Pimental, a consulting neuropsychologist. Through hypnosis, she uncovered a deep-seated trauma in the patient, who had saved someone’s life but become injured in the process. The patient’s pain score dropped as a result of the hypnosis treatment, amazing her doctors. “In a lot of cases, the location or type of physical injury represents a traumatic emotional loss or injury,” Dr. Pimental says. “Until the neuropsychological underpinnings can be released, they can’t completely get rid of the pain.”

The case—in addition to bringing her together with her future husband, who was an impressed anesthesiology resident in the room—illustrates the mantra she coined after graduating from The Chicago School in 1987: All pain is in your head because your brain is in your head. “I use a biopsychosocial approach,” she says. “In the nervous system, there is a noxious component to pain. There’s also an emotional component and a learned component. I treat the whole person for pain.”

Dr. Pimental’s focus on treating the mind, body, and spirit of each patient is a cornerstone of her Carol Stream, Ill., practice, Neurobehavioral Medicine Consultants, Ltd., which has specialized in neuropsychology, behavioral medicine, multidisciplinary pain management, and rehabilitation psychology since 1991, a year after U.S. Congress dubbed the forthcoming decade as “The Decade of the

Brain.” Research had begun to yield major insights into diagnosing and treating brain disorders and head injuries.

The idea of collaborating with multiple practitioners to treat patients—of using an integrated approach—was also catching on. As patients sought Dr. Pimental’s treatment of their sports injuries, behavioral issues, stress, post-injury rehabilitation, and more, she often worked with a team of specialists to treat them.

“A multidisciplinary team can make a huge difference in treating any disorder,” she says. “It’s like a pie. Each piece of the pie helps you in a different way, but we’re all working together to make this pie and no one is more important than the other.

When done correctly, patients feel like they have a team.”

In her 23-year career, Dr. Pimental has pursued several other neuropsychologyrelated interests. The same year that she started her practice, she launched a neurobehavioral medicine program at nearby Glen Oaks Hospital. A passion for political issues led to her presidencies at the Illinois Psychological Association and

WIN A

American Board of Professional Neuropsychology, and she continues to serve on committees of several professional organizations. She is also a published researcher, writer, and editor, and delivers lectures at conferences.

Throughout her career she has taught and mentored numerous externs and for the past eight years, taken post-doctoral fellows from The Chicago School, fostering such a close-knit group that many return for an annual holiday reunion at a local crepe restaurant near her practice.

To her students, she makes a point of passing on advice that Dr. Nancy Newton, professor of clinical psychology, gave her when she was a student at The Chicago School: “In order to be a good specialist, you have to be a good generalist.”

“Don’t put all your eggs in one basket,” Dr. Pimental says. “Discover your talents, gifts, and passions. If you do that, the patients, doctors, professionals, parents, and consumers who you’re working with will see that spiritual energy emanating from you, and that’s who they will want to be around for treatment.”

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giving back

TH A NK S & RECOGNITION, OPP ORTUNITIES TO GI V E

Un Punto de Encuentro (Gathering Place)

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or three years, clinical social worker Arturo Carrillo has provided free counseling services to uninsured adults on Chicago’s West Side. As the only bilingual clinician in the Saint Anthony Hospital Community Behavioral Program, he has helped a growing number of Latino immigrants cope with depression, anxiety, marital problems, and other mental health issues.

Despite working in a city with a large Latino population, Carrillo knew few other mental health providers who spoke Spanish and understood the culture, which compromised his ability to connect clients with other services available in the community.

When Carrillo joined the Latina/o Mental Health Providers Network (LMHPN)—an initiative started by The Chicago School’s Center for Latino Mental Health (CLMH) to train more mental health professionals to serve the growing Latino community—he met Carlos Lopez, who runs domestic violence groups for couples less than two miles away.

“We’ve been able to talk about the services we provide,” Carrillo said. “I feel more comfortable referring clients to the program because I know him personally.”

This type of connection exemplifies what Dr. Hector Torres, assistant professor of clinical counseling and CLMH coordinator, had in mind when the network launched in 2009 with a $130,000 grant from the Chicago Community Trust. In September, the Trust renewed the grant with an additional $140,000 following a successful first year, in which the network recruited 75 members—more than twice as many as projected.

“We connect with the community through the network,” Dr. Torres said. “We have two goals: to allow current providers to know and refer each other; and to increase the number of providers who are culturally competent.”

The network has worked to achieve this in a variety of ways, particularly as a poor economic climate has led to statewide cuts in mental health services and added urgency to connecting agencies and practitioners with each other.

Bimonthly meetings allow members to network and take continuing education workshops designed to increase understanding of Latino culture and knowledge of effective mental health interventions, new research, and other relevant topics. After the network launched last year, staff made nearly 40 site visits at community-based agencies to assess needs for providers and services and launched a website (lmhpn.tcscenters.org) that enables members to interact with each other and share resources.

The LMHPN has also given students like Ana Sierra the opportunity to participate. During an internship at The Counseling Center of Lakeview, where Sierra counseled victims of domestic violence, she held a workshop for mental health providers on Latin American

FACTS 1. Latinos comprise 26 percent of Chicago’s population 2. 1 in 11 Latinos with mental disorders contact mental health care specialists 3. Fewer than one in 20 Latino immigrants with mental disorders contact mental health specialists for care. When Latinos do access services, 70 percent never return after the first visit.

4. There are only 29 Latino mental health providers per 100,000 Latinos

gender roles. When she realized the group knew more about male (machismo) than female (marianismo) gender roles, she conducted an exercise that put the practitioners in the shoes of a Latina woman. “We need to know what these terms mean to work successfully with Latinos in therapy,” she said.

In all, 10 Chicago School students who are earning master’s in clinical counseling degrees with a concentration in Latino mental health

CHICAGO

ILLINOIS Network members work throughout Chicago’s North, South, and West sides, and in numerous suburbs.

developed a project for the network, including taking additional case loads, conducting outreach, and running culturally focused workshops on topics like positive parenting, suicide awareness, and supporting Latino adolescents. The Chicago School’s Department of Community Partnerships also placed 56 students in member agencies, providing nearly 7,000 hours of service.

With the grant renewal, LMHPN activities are already well underway. In October the network sponsored the 2010 Latino/a Behavioral Health Conference along with the Illinois Department of Human Services and The Chicago School of Professional Psychology and brought more than 200 behavioral health professionals together to address how to improve mental health services for the Latino community.

The network also plans to expand focus on advocacy, professional development, and promotion of mental health careers for Latino students, and launch a local media campaign to raise awareness about Latino mental health issues.

Ultimately the network fosters a deeper commitment to address the long underserved mental health needs of the Latino/a community.

“Bringing people together who have the same interest in working with the Latino community creates an energy to better provide and advocate for the need for services,” Carrillo says.

LEARN MORE ABOUT LMHPN online. http://lmhpn.tcs centers.org/

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Principal Ross greets children and parents as GPPA opened its doors.

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4 POMP AND CIRCUMSTANCE

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As the Los Angeles and Orange County Campuses celebrated their inaugural Commencement in October (photos 3 and 4), graduates in Chicago observed the campus’ 26th, taking the traditional Oath of Affirmation (photo 2) and exchanging hugs and congratulations (photos 1 and 5).

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