Fall 2005 Texas Psychologist

VOLUME 56, ISSUE 3

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New Frontiers in Psychology

Donna S. Davenport, PhD Brian Stagner, PhD Co-Editors David White, CAE Executive Director Sherry Reisman Director of Convention & Non-Dues Bob McPherson, PhD Director of Professional Affairs FALL 2005

Lynda Keen Executive Assistant

VOLUME 56, ISSUE 3

Candy D. Graves Communications Specialist Lindell Brown Membership Director TPA BOARD OF TRUSTEES Paul Burney, PhD President CAPP Representative

Features 8

Melba J.T. Vasquez, PhD President-Elect M. David Rudd, PhD President-Elect Designate

Robert J. Reese, PhD

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C. Alan Hopewell, PhD Past President Board Members Tim F. Branaman, PhD Mary Alice Conroy, PhD Donna Davenport, PhD Alan T. Fisher, PhD Richard Fulbright, PhD Robert McPherson, PhD Randy Noblitt, PhD Roberta L. Nutt, PhD Lane Ogden, PhD Dean Paret, PhD Alison Wilson, PhD

Meeting People Where They Are: The Promise of Telephone Therapy The Great State of Texas: a Psychopharmacology Update Pat DeLeon, PhD

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Reaching Out to Rural Adolescents: Online Counseling Donna S. Davenport, PhD

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Innovative Behavior Medicine at UT Tom Marrs, PhD

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PSYCHOLOGY IN THE PUBLIC INTEREST:

The Proposed Constitutional Amendment Banning Same-Sex Marriage in Texas and How Psychology can Contribute to the Dialogue

EX-OFFICIO BOARD MEMBERS Catherine Matthews, PhD Texas Psychological Foundation President

Nathan Grant Smith, PhD

Patrick J. Ellis, PhD PSY-PAC President Bonnie Gardner, PhD; Andrew Griffin PhD Aging Division Co-Chairs Lane Ogden, PhD Psychopharmacology Division Chair Robbie Sharp, PhD, Selia Servin-Lopez, PsyD Psychology of Women Division Co-Chairs Lane Ogden, PhD, Sherry Reisman Federal Advocacy Coordinators Amy O’Neill, BS Student Division Chair Richard M. McGraw, PhD Business of Practice Network Representative The Texas Psychological Association is located at 1005 Congress Avenue, Suite 410, Austin, Texas 78701. Texas Psychologist (ISSN 0749-3185) is the official publication of TPA and is published quarterly. www.texaspsyc.org

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Departments 4

FROM THE EDITOR Donna S. Davenport, PhD

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FROM THE PRESIDENT Paul Burney, PhD

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FROM TPA HEADQUARTERS David White, CAE

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IT’S THE LAW:

New Technology — Same Legal Issues Sam Houston, JD

28 30 30

New Members and Contributors Inside TPA Classified Advertising

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TEXAS PSYCHOLOGIST

FROM THE EDITOR

Donna S. Davenport, PhD

Donna S. Davenport, PhD Co-Editor

Brian Stagner, PhD Co-Editor

W

hen I was at the APA conference several weeks ago, I heard a term tossed about on several different occasions: Culture Shift. Some psychologists were wondering if the field was changing so much that it could lose its identity. Have we allowed ourselves to be defined too much by others, they asked in one way or another, as we struggle with sometimes quite discouraging political and academic and economic realities? I heard professors bemoan the emphasis on grant-writing, therapists upset about both the progress and lack of progress in obtaining prescription privileges, students worried that the programs they had entered were being redefined under their feet.

At a personal level, I am less fond of change than I used to be. I tell my students about the Human Potential Movement (really, now, exactly how is the current emphasis on Positive Psychology all that different?) and feel nostalgic about the T-groups I used to go to at Elliot Aronson’s house. Accordingly, I had mixed

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feelings at the notion of editing an issue featuring treatment innovations.

Happily, these articles about telephone counseling, online counseling, and a new Behavior Health focus at the UTAustin Counseling Center are about innovations solidly within my identity boundaries! As the profession struggles to find ways to serve individuals in rural areas, as well as to be more generally cost-effective, these three articles reflect ways to remain true to our ethics and roots, while at the same time making use of technology and collaboration with other disciplines in new exciting ways.

Additionally, we were happy to take former APA President Pat DeLeon up on his offer to describe where Texas is regarding the prescription privilege issue.

Please see on page 22 a call for papers on specific themes we have planned.

Contribute if you are interested, or feel free to suggest a theme of your own if you feel especially strongly about some aspect of psychology. We look forward to hearing from you! Donna

The Editors is an Associate Professor in the Counseling Psychology program at Texas A&M, where her research areas include ethics and multicultural issues. In addition to her teaching and independent practice, she is the founding director of the Lifelong Learning Institute at Texas A&M. Contact her at ddavenport@coe.tamu.edu.

Donna S. Davenport, PhD

is a Clinical Associate Professor in the Psychology Department at Texas A&M and is the founder and co-director of Associates for Applied Psychology, a multispecialty group practice in Bryan/College Station.

He is a former member and chair of the TSBEP and former Ethics Chair for TPA. His email address is bhs@psyc.tamu.edu.

B r i a n S t a g n e r, P h D

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FROM THE PRESIDENT

I

thank co-editors Drs. Donna S. Davenport and Brian Stagner for the excellent first 2005 Spring-Summer issue of Texas Psychologist. Texas Psychologist is an important publication providing information to all TPA members and psychologists in Texas.

A special thanks to the State of Texas and Texas psychologists for their extraordinary and continuing efforts during the aftermath of Hurricane Katrina. American Psychological Association partners with the American Red Cross through our DRN (Disaster Response Network) to provide psychological services to those in need, and we were onsite immediately providing our services. Our state and our psychologists achieved national recognition for their efforts and I am proud to be a Texan, a psychologist, a member of APA, and especially a member of TPA. Judith Andrews, PhD and Rita Justice, PhD, TPA’s DRN Coordinators, have done an outstanding job and deserve special recognition. A special thanks also goes to David White, TPA’s Executive Director, and to Sherry Reisman, TPA’s Director of Conventions, for coordinating the massive number of calls and emails, directing inquiries to the proper resources, and for

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Paul Burney, PhD providing timely and informative updates and links on TPA’s website.

Glenn Ally, PhD, presented “RxP Louisiana Style” at the Sam Houston Area Psychological Association’s (SHAPA) September 6, 2005 monthly meeting at Sam Houston State University. Approximately 100 psychology students and members of the faculty attended the presentation. The presentation was very well received and there were excellent questions.

This is a must-see presentation for all who are interested in RxP. The presentation details the exceptional committed effort of LAMP (Louisiana Association of Medical Psychologists) in time, legislation, and money to accomplish their RxP law. This presentation is relevant to any state interested in passing RxP legislation. Dr. Ally is a Louisiana RxP trained psychologists, a founding member of LAMP, a member of Louisiana’s legislative team instrumental in passing Louisiana’s RxP law, the Louisiana APA Council of Representative member, and a member of APA’s Committee for the Advancement of Professional Practice (CAPP). Dr. Ally deserves a special thanks for presenting during the aftermath of Hurricane Katrina as it took precious time away from his family and his psychological responsibilities.

You are receiving this issue of the Texas Psychologist prior to TPA’s Annual Convention to be held in Houston, Texas (November 3-5). I urge you to make a special effort to attend this year’s convention.

It is especially relevant that the convention will be held in Houston which, like many other cities in Texas, has done a magnificent job of reaching out to our neighbors so drastically affected by Hurricane Katrina. Make this convention a special celebration of psychology at work. The 2005 Convention Program Committee, chaired by Dr. Pat Ellis, has worked dili-

gently to present an absolutely superb list of continuing education opportunities and poster sessions. This year’s theme is “New Horizons for Texas Psychology.” Dr. Joseph Parent will serve as our Keynote Speaker. A dynamic and engaging public speaker, Dr. Parent’s keynote address for the 58th annual TPA convention is entitled “Stealth Psychology-Under the Radar” and will serve to underscore the conference theme of “New Horizons for Texas Psychology.” In addition to his keynote presentation, Dr. Parent will also serve as a special speaker at the Texas Psychological Association fundraising dinner to be held at Houston City Club.

Finally, he will offer a special two day postconvention seminar to be held at the in the Woodlands. He is dynamic, enlightening, and entertaining.

I thank everyone who has been so instrumental for TPA’s accomplishments during this presidential year. Every TPA president who has preceded me and those who will follow know this is a team effort.

The Board of Trustees, Executive Committee, Ex-officio Officers, the committee members, and especially David White, TPA’s Executive Director and his superb staff are to be commended for their exceptional commitment, work, and accomplishments. I send a special thanks to APA’s Practice Directorate and CAPP for the tremendous support and encouragement they provide to state associations, practitioners, and advocacy. Their State Leadership Conference is the premier training vehicle for leadership and advocacy. CAPP, through its grant program, has provided TPA with $94,000 the past years to help our legislative advocacy for Texas psychologists.

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FROM TPA HEADQUARTERS

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any of you might be aware of the recent CPT codes that are available to psychologists, but I think it is worth reminding you of them.

As of January, 2003, psychologists are now able to use the six reimbursement codes under the Current Procedural Terminology (CPT) coding system. These codes address behavioral, social, and psychophysiological conditions in the treatment or management of patients diagnosed with physical health problems.

These codes are: 96150 – the initial assessment of the patient to determine the biological, psychological, and social factors affecting the patient’s physical health and any treatment problems.

96151 – a re-assessment of the patient to evaluate the patient’s condition and determine the need for further treatment. A re-assessment may be performed by a clinician other than the one who conducted the patient’s initial assessment.

96152 – the intervention service provided to an individual to modify the psychological, behavioral, cognitive, and social factors affecting the patient’s physical health and well being. Examples include increasing the patient’s awareness about his or her disease and using cognitive and behavioral approaches to initiate physician prescribed diet and exercise regimens.

96153 – the intervention service provided to a group. An example is a smoking cessation program that includes educational information, cognitive-behavioral treatment and social support. Group sessions typically last for 90 minutes and involve eight to ten patients.

96154 – the intervention service provided to a family with the patient present.

For example, a psychologist could use relaxation techniques with both a diabetic child and his or her parents to reduce the child’s fear of receiving injections and the parents’ tension when administering the injections.

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David White, CAE

96155 – the intervention service provided to a family without the patient present. An example would be working with parents and siblings to shape the diabetic child’s behavior, such as praising successful diabetes management behaviors and ignoring disruptive tactics.

Until recently all intervention codes used by psychologists required a mental health diagnosis under the DSM-IV. These codes focus on patients whose primary diagnoses are physical in nature and therefore must have a physician’s ICD-9-CM diagnosis. As a result, psychologists are prohibited from diagnosing a physical health problem, but must use the physicians ICD-9-CM code when reporting their services captured under these codes.

As far as we know, all Texas Medicare providers are reimbursing for these codes. The assigned value for these codes are listed in the physician fee schedule issued by the Centers for Medicare and Medicaid Services (CMS). The chart below illustrates the estimated Medicare reimbursement amount for the six health and behavior codes:

CPT Code S e r v i c e ( A p p r o x . P a y m e n t ( 1 5 m i n : 1 u n i t 1 h r : 4 u n i t s )

96150 Assessment: initial $26 * $106 * 96151 Re-assessment $26 * $103 * 96152 Intervention: individual $25 $98 96153 Intervention: group (per person) $5 ** $22 ** 96154 Intervention: family w/ patient $24 $96 96155 Intervention: family w/o patient $23 $93 NOTE: Although Medicare has assigned a payment rate, the program is not presently covering services billed under 96155. * Multiple-unit differences compared to one-unit amounts are due to rounding. ** Total group fee equals amount times number of persons in the group.

From 2002 to 2003 the number of Health and Behavior claims submitted by psychologists increased almost 400%. The following chart depicts the increase of claims submitted by psychologists from 2002 to 2003.

CODE

2002

2003

Incre a s e

96150 - Assessment 12,952 49,944 386% 96151 - Re-Assess 21,089 52,058 247% 96152 - Individual 24,833 134,468 541% 91653 – Group 3,073 9,209 300% 96154 – Family* 2,070 6,043 292% Convert these claims to dollars reimbursed by Medicare to psychologists and you get:

CODE

96150 - Assess 96151 - Re-assess 96152 - Individual 96153 - Group 96154 - Family (w pt) TOTALS

2002

$342, 321 $541,987 $611,388 $16,686 $49,452 $1,561,834

2003

Incre a s e

$1,324,015 $981,694 $779,765 $1,321,752 $3,263,538 $2,652,150 $51,570 $34,684 $144,427 $94,975 $6,105,302 $4,543,468 Continued on page 23

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Meeting People Where They Are: The Promise of Telephone Therapy

by Robert J. Reese, PhD Abilene Christian University

The Use and Perceptions of Telephone-Based Psychotherapy

U

sing the telephone to provide mental health assistance is not a new idea. The 1950s saw the genesis of crisis lines in London (Hornblow, 1986). These types of services are very much alive and well today.

In the 1970s it was suggested that the telephone might serve as an adjunct to face-to-face therapy (Miller, 1973). In the last couple of decades, there has been support for using the telephone as the primary medium for providing psychotherapy (Shepard, 1987). Since this time telephone psychotherapy has begun to receive more attention with the proliferation of telephone-based providers and emphasis on time-limited, less expensive treatment.

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Advances in communication technology have changed how we interact with the world, from how we connect with others to how we seek information. These changes have been extended to look at how psychological services can be provided using these exciting technologies.

While newer technologies such as the Internet or real-time videoconferencing are decidedly sexier and may ultimately hold more promise, the telephone should not be overlooked for providing psychological services. Given the ubiquity and relative low-cost in comparison to other communication technologies, the popularity of the telephone is unlikely to diminish anytime soon. Among psychologists, the telephone is still the most popular telehealth medium for providing services (VandenBos & Williams, 2000).

Telephone-based services can be a simple referral or providing consultation.

However, the use of the telephone to render psychotherapy has been touted to hold much promise for increasing the accessibility of services for underserved populations, individuals in rural areas, those unable to physically go to an office (e.g., physically disabled persons, house-bound agoraphobics), or for those whose job requires frequent travel. With all of its promise, however, the profession of psychology has not rushed to publicly embrace the use of the telephone as an acceptable alternative for rendering clinical services. This reluctance is likely rooted in the lack of a solid empirical base demonstrating its effectiveness (although this is changing) and the debate over legal and ethical concerns. Also, perhaps, conducting psychotherapy over the phone may be perceived as inferior to face-to-face therapy because of its historical connections with crisis lines managed by laypersons or that the current training of therapists emphasizes visual cues. Nevertheless, the use of the telephone for providing psy-

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chological services is increasing in certain settings. Many large corporations (including the largest private employer in the U.S.) as well as the federal government now offer telephone-based counseling programs for their employees (Stephenson et al., 2003).

The purpose of this article is threefold: to provide an overview of the current empirical literature on telephone psychotherapy, the legal and ethical concerns for providing such services, and the promise that the telephone medium has in proliferating the delivery of psychological services.

D o e s Te l e p h o n e T h e r a p y Wo r k ?

Some have opined that telephone psychotherapy is, at best, an inferior alternative to face-to-face therapy and, at worst, an unethical form of practice (Haas, Benedict, & Kobos, 1996).

However, such reactions are not empirically based but rather on supposition and intuition. To address the question of whether telephone therapy is an effective alternative, one needs to back up and ask why psychotherapy works. Psychotherapy outcome researchers have found that the therapeutic relationship is a consistent predictor in outcome (Wampold, 2001) and, as a whole; other variables ranging from type of treatment to client and therapist variables have yielded equivocal results. Another pattern identified by outcome researchers is that more therapy tends to be better, although there is an impact of “diminished return� with much of the improvement occurring early in the therapy process. If psychotherapy can be effective with different treatments, with different clients, and different therapists, is it possible that it can be effective when it is provided in a different medium?

Studies that measure outcome for telephone therapy have tended to be problem or population focused. Examples of these include: smoking cessation (Zhu,

Tedeschi, Anderson, & Pierce, 1996), combined treatment with antidepressant medication for depressed persons (Simon et al., 2004), group counseling for the disabled elderly (Evans, Smith, Werkhoven, Fox, & Pritz, 1986), and treatment for housebound agoraphobics (McNamee, O’Sullivan, Lelliott, & Marks, 1989).

These studies have tended to report favorable results. Of these, smoking cessation is one area that has numerous studies (e.g., Mermelstein, Hedecker, & Wong, 2003; Zhu et al., 2002) documenting favorable results with the reduction or cessation of smoking being found superior for telephone counseling compared to other treatments.

Evidence that mirrors what is more likely found in a general therapy practice is still limited. However, a study by Reese, Conoley, & Brossart (2002) found evidence for the effectiveness of telephone psychotherapy for a variety of presenting issues. They replicated the Consumer Reports (1995) study that measured outcome as function of satisfaction, general well-being, and improvement for the specific problem that led to seeking help. The results of a telephone sample were compared to the Consumer Reports sample and the outcome scores were similarly favorable. Also, the processes underlying the effectiveness of psychotherapy appeared to be similar for the telephone therapy sample. The dose-effect response was similar to what is typically found in the outcome literature, more therapy resulted in better outcomes along with more improvement occurring early in the process. A measure of the working alliance found scores that were just as strong as those found in the literature. While this was not a controlled study, it provides evidence that telephone therapy appears to be generally effective and appears to parallel some of the processes of traditional, faceto-face psychotherapy.

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Legal and Ethical Concer ns of Te l e p h o n e T h e r a p y

Much of the discussion concerning the use of the telephone, as well as other communication technologies, has centered on legal and ethical concerns of their use.

The Ethics Committee of the American Psychological Association (1997) weighed in on this issuing a statement that the “Ethical Principles of Psychologists and Code of Conduct” is not specific to such services and thus has no rules prohibiting the use of telehealth media. However, they add that psychologists should stay within the bounds of their competence in such new areas. While not definitive, this statement is not exactly supportive of such mediums as a stand-alone service.

The research literature, albeit limited, is supportive of using the telephone for psychotherapy. If psychotherapy by telephone is demonstrated to be helpful, how can it be unethical to provide such services? On a broader level this is true, but the issues surrounding the logistics and scope of providing telephone-based services are far from resolved. Logistical issues range from legal issues (e.g., licensure, providing services across state lines, liability insurance, getting reimbursed by third-party insurers) to the mechanics of providing such services in a competent and ethical manner (e.g., establishing clear informed consent, addressing the limits of privacy when using cellular or cordless phones, and simply establishing an environment with the client that is conducive to talk therapy). Scope issues include identifying the limits of telephone therapy and establishing the parameters for rendering services.

Logistical Issues. Most states, including Texas, have not caught up with technology from a legal standpoint. While Texas law provides some clarification for physicians, referred to as “telemedicine,” there is little direction provided for psy-

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chologists. Koocher & Morray (2000) surveyed state attorneys general regarding legal and regulatory issues and found that states were far from consistent. Texas had no statutes specific to psychotherapy or mental health service provided by telephone or other telecommunication mediums. However, Texas was also listed as a state that “claimed regulatory authority over mental health practitioners residing outside of the state who offer psychotherapy and counseling to residents of that state via the telephone…” (p. 505). Over half (55%) of the other states polled said they did not. Texas psychologists conducting phone therapy with a client in a different state may be subject to the other state’s laws. While a practitioner might rationalize that a client is coming to them for services, therefore, the client is receiving services in the practitioner’s state, many states see it as just the opposite. This brings into play licensure issues as well as having an understanding of state laws. For example, is the duty to warn and protect for New Jersey different from Texas?

Nickelson (1998) pointed out the malpractice issues that need to be considered. He recommended that psychologists check with their liability insurance carrier about providing telehealth services since such services may not be covered. Interestingly, Nickelson also pointed out that psychologists are eligible for Medicare reimbursement for telehealth services, including the telephone, across all states in areas listed as a “Health Provider Shortage Area.” This demonstrates support for telehealth services at the federal level. Leslie reported (as cited in Bischoff, 2002), however, that California law states that telephone counseling is not acceptable for providing services. Needless to say, legal and regulatory issues are not resolved.

Even if a practitioner successfully navigates the legal issues, she must make sure that the services being provided meet ethical and professional standards. One diffi-

culty is assuring privacy and confidentiality on the telephone given the popularity of wireless technology. Creating a behavioral setting conducive to having a session via the phone can also be challenging. An informed consent that covers these areas and others by specifying the nature of the relationship, fees, the scope, and the possible benefits and limits of therapy via the telephone is necessary and consistent with the standards for practice whether it is on the phone or in person.

Scope of Treatment Issues. Issues involving the scope of practice include identifying presenting issues or diagnoses that may not be feasible to treat over the telephone, severity of an issue where physical proximity might be more important for assessment or referral purposes (e.g., intent to harm self or others, other crisis situations), and identifying treatments and processes that are conducive to treatment via the telephone. For example, Reese et al. (2002) found that those who reported more severe problems reported less improvement on the telephone. Simply being intuitive about the issues involving scope of treatment are not enough.

Research has contradicted statements that telephone therapy is not effective. For example, not being able to identify visual cues may be considered an integral part of training, but perhaps visual cues can also be a distraction and doing therapy on the telephone may remove biases and actually promote better listening. After all, there are no restrictions for sight impaired individuals becoming licensed psychologists.

Why

Bother

Wit h

Te l e p h o n e

Therapy?

Given the lack of clarity on legal and ethical issues, why go to all the trouble?

For one, telephone therapy holds the promise of providing services to underserved populations. Seligman (1995) stated that the majority of psychotherapy clients are educated and from the middle

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class. Traditional psychological services simply are not available to everyone; individuals of low socioeconomic status have been underserved (Mays & Albee, 1992).

The proliferation of telephone-based services is mainly due to its lower cost (i.e., excluding pay-per-call services). Community mental health services funding continues to shrink with services only available for the more severe psychiatric disorders. A model that follows employee assistance programs that contract with private employers or those associated with federal services could be adapted to work with existing state agencies and community mental health centers. Such a model would be more cost effective and increase access to both rural and urban underserved areas and help realize the promise of providing services at a lower cost.

In addition to the promise of reaching underserved populations, clients simply appear to value the service. Reese, Conoley, and Brossart (in press) found that convenience, accessibility and feeling more in control over the process were the characteristics most valued by clients. Not being able to see the therapist was perceived as increasing the client’s perception of control and helped decrease their fear of receiving counseling. It seems clients are more comfortable than we are with not seeing the other party.

Psychotherapy is typically effective with a variety of clients, provided by a variety of therapists who use a variety of treatments. We know that a strong working alliance is central to good outcome as is the ability to instill hope in our clients. There is evidence that psychotherapy via the telephone can do the same. Practi-tioners seem to understand this, given the increase in such services provided. Clients seem to understand this as well, evidenced by their positive outcomes in the literature.

Successfully navigating the issues surrounding telephone therapy as well as

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other telecommunication technologies will require different solutions, but the solutions are interrelated. Whether a legal or scope of practice issue, having empirically-based literature that addresses both outcome and process for such technologies is imperative to making decisions buttressed by evidence (Nickelson, 1998). Research funding opportunities in this area do exist. The NIMH in January 2005 announced that it was encouraging research proposals specifically in this area and encouraging researchers and practitioners of telehealth to collaborate (Kersting, 2005). High-quality research in this area may serve to promote social justice and enhance the likelihood of telehealth programs being funded to provide assistance to those who would not otherwise receive it. Psychologists have long been taught to meet people where they are. The telephone is a potentially powerful way to do this.

R ef er ences American Psychological Association Ethics Committee (1997). Services by telephone, teleconferencing, and Internet. Washington, DC: Author. Retrieved July 26, 2005 from the World Wide Web: http://www.apa.org/ ethics/stmnt01.html.

Bischoff, R.J. (2004). Consideration in the use of telecommunications as a primary treatment medium: The application of behavioral telehealth to marriage and family therapy. The American Journal of Family Therapy, 32, 173-187.

Consumer Reports (1995, November).

Mental health: Does therapy help? 734-739.

Evans, R.L., Smith, K.M., Werhoven, W.S., Fox, H.R., & Pritzl, D.O. (1986).

Cognitive telephone group therapy with physically disabled person.

The Gerontologist, 26, 8-11.

Haas, L.J., Benedict, J.G., & Kobos, J.C. (1996). Psychotherapy by telephone: Risks and benefits for psychologists and consumers. Professional Psychology: Research and Practice, 27, 154-160.

Hornblow, A.R. (1986). The evolution and effectiveness of telephone counseling servic-

es. Hospital and Community Psychiatry, 37, 731-733.

Kersting, K. (2005). NIMH seeks telehealth research proposals. APA Monitor, 36(1), 18.

Koocher, G.P., & Morray, E.M. (2000).

Regulation of telepsychology: A survey of State Attorneys General. Professional Psychology: Research and Practice, 31, 503-508.

Mays, V.M., & Albee, G.W. (1992).

Psychotherapy and ethnic minorities. In Donald K. Freedheim (Ed.), History of psychotherapy: A century of change (pp. 552-570).

McNamee, G., O’Sullivan, G., Lelliott, P., & Marks, I. (1989). Telephone-guided treatment for housebound agoraphobics with panic disorder: Exposure vs. relaxation. Behavior Therapy, 20, 491-497.

Mermelstein, R., Hedecker, D., & Wong, S.C. (2003). Extended telephone counseling for smoking cessation: Does content matter?

Journal of Consulting and Clinical Psychology, 71, 565-574.

Miller, W.B. (1973). The telephone in outpatient psychotherapy. American Journal of Psychotherapy, 27, 15-26.

Nickelson, D.W. (1998). Telehealth and the evolving health care system: Strategic opportunities for professional psychology. Professional Psychology: Research and Practice, 527-535.

Reese, R.J., Conoley, C.W., & Brossart, D.F. (2002). Effectiveness of telephone counseling: A field-based investigation. Journal of Counseling Psychology, 49, 233-242.

Reese, R.J.., Conoley, C.W., & Brossart, D.F. (in press). The appeal of telephone counseling: An empirical investigation of client perceptions. Journal of Counseling and Development.

Shepard, P. (1987). Telephone therapy: An alternative to isolation. Clinical Social Work Journal, 15, 56-65.

Simon, G.E., Ludman, E.J., & Tutty, S. (2004). Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: A randomized controlled trial. JAMA: Journal of the American Medical Association, 292, 935942.

Stephenson, D., Bingaman, D., Plaza, C., Selvik, R., Sudgen, B., & Ross, C. (2003).

Implementation and evaluation of a formal telephone counseling protocol in an employee assistance program. Employee Assistance Quarterly, 19, 19-33.

Continued on page 19

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The Great State of Texas: a Psychoparmacology Update

by Pat DeLeon, PhD

H

aving been intimately involved in psychology’s prescriptive authority (RxP) quest since its inception, when U.S. Senator Daniel K. Inouye addressed the Hawaii Psycho-logical Association annual convention on November 30, 1984, I have been extremely gratified by our profession’s efforts over the years and particularly, by the growing enthusiasm evident at the Practice Organization’s State Leadership conferences and our annual conventions.

Over two decades ago, the Senator proffered: “Finally, I would like to suggest an entirely new legislative agenda which I think fits very nicely into the theme of your convention: ‘Psychology in the 80’s: Transcending Traditional Boundaries.’ As a United States Senator, I have also been working closely during the past decade with a number of your ‘natural allies.’ I am particularly thinking of our nation’s nurse practitioners, nurse midwives, and optometrists. The members of these professions have been successful to differing degrees in amending their state practice acts to allow them to independently utilize drugs where appropriate.... “In my judgment, when you have obtained this statutory authority, you will have really made the big time. Then, you truly will be an autonomous profession and your clients will be well-served.” At the August, 1995 APA convention in New York City, the Council of Representatives formally endorsed prescriptive privileges for appropriately trained psychologists and called for the development of model legislation and a model training curriculum. RxP became APA policy and, we would suggest, is infinitely consistent with your theme — “Innovations In Treatment.”

This spring, at the Practice Organization’s 22nd annual State Leadership conference, Russ Newman informed a highly enthusiastic audience: “The prescription privileges agenda continues to see great strides accomplished. Everyone, I hope, knows by now that last May, Louisiana became the second state joining New Mexico and the territory of Guam to enact a prescriptive authority law. What everyone may not know is that just this past January, both Louisiana and New Mexico successfully completed implementation of these laws, with final rules and regulations becoming effective. Psychologists in these states are now becoming certified to prescribe, and just recently, Louisiana medical psychologist Dr. John Bolter was caught on film being the first to write a prescription under the new law. Congratulations to all in New Mexico and Louisiana who participated in these

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hard fought victories. Of course, our work is far from over....” Texas’s Randy Phelps serves as Russ’ Deputy Executive Director.

When one becomes personally involved in the public policy (i.e., political) process, certain seemingly fundamental “rules,” reflecting its unique culture, soon become evident. Perhaps foremost in my mind is the importance of the “learned professions” (i.e., psychology) becoming involved in addressing society’s most pressing needs. Without question, psychology and the behavioral sciences have much to offer to our nation’s elected officials at both the state and federal level. Yet, in the last Session of Congress (2003-2004) the dominant profession of the elected officials was law, followed by business. Fiftynine members of the U.S. Senate were lawyers. Members of these professions think differently about health or education than do clinicians, educators, or researchers. They are not knowledgeable about the nuances of our profession or of our potential contributions. They, of necessity, rely heavily upon the popular media for information and new ideas, and within the legislative arena, they particularly rely upon the public hearing process, during which witnesses of various persuasions effectively “make their best case.”

Simply stated, if we are not present, we will not be heard no matter how meritorious our case may be.

Over the years, we have come to appreciate that to be ultimately successful in public policy deliberations, it is extraordinarily important to possess long-term vision for where one wants to channel one’s energy. Change is always unsettling, far more than one might initially appreciate.

And change is often slow and incremental.

One must expect individual and institutional resistance, especially from one’s own

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colleagues. And, for truly meaningful change to evolve, one’s efforts must be fundamentally consistent with trends occurring within the broader context of societyat-large. Waiting on an invitation to present professional needs to legislators is not an option, all health care professionals (and we are healthcare professionals) have an inherent responsibility to drive changes that will demand improved patient safety and access to care. My sincerest appreciation to your Past President Dee Yates for ensuring that psychology’s voice was effectively “heard” during the deliberations of the President’s New Freedom Commission on Mental Health. In reflecting, I realized that I have had the opportunity of personally addressing Texas audiences approximately 15 times, undoubtedly the most memorable being during my APA Presidency at your joint Texas-Oklahoma annual meeting. Change takes time. Yet, it is evident we are being heard.

APA President Ron Levant noted at our recent Washington, DC convention, that Institute of Medicine (IOM) reports have concluded that: “The American health care system is confronting a crisis....

The health care delivery system is incapable of meeting the present, let alone the future needs of the American public.”

And, “Substantial investments have been made in clinical research and development over the last 30 years, resulting in an enormous increase in the medical knowledge base and the availability of many more drugs and devices. Unfortunately, Americans are not reaping the full benefit of these investments. The lag between the discovery of more efficacious forms of treatment and their incorporation into routine patient care is unnecessarily long, in the range of about 15 to 20 years. Even then, adherence of clinical practice to the

evidence is highly uneven.”

In his Presidential address, Ron passionately proclaimed: “A broken health care system is bankrupting families across the country. These problems are clearly so serious that they demand a complete reexamination of the U.S. health care system. One core assumption that requires re-thinking is the idea of the separation of mind from body, the notion pervading our concepts of health and illness that there are some illnesses that are physical and others that are mental... As we all know, mind and body are not separate, but rather they are inseparable. By assuming that mind and body are separate, and further, assuming that the only role that the mind plays in health and illness is in mental health and illness, we have maintained a healthcare system that is unable to deal with the many varied roles that mind and behavior play in so-called physical illness.

This system, further, does not even deal with mental health and illness, per se, effectively. Descarte’s 17th century metaphysical philosophy, which separated mind from body, has had an enormous negative impact on our health care system.... The current system virtually ignores the psychosocial pathways that lead to unnecessary utilization of medical and surgical services, as well as poorer health .... Mind-Body dualism, is, in a word, bankrupt.” Thus, the extreme importance of Ron’s Presidential Initiative: “Health Care For The Whole Person.” I enjoyed the realization that throughout the impressive RxP presentations, new faces and new voices were being heard no longer solely those like Betty Richeson’s who was there from the beginning. Bruce Bennett, CEO of the APA Insurance Trust, once again made it clear that prescribing psychologists would be covered, given that

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RxP was APA policy.

This year the IOM released its report Quality Through Collaboration: The Future Of Rural Health which essentially places psychology’s RxP agenda in a larger public policy context, and should be particularly poignant for Texas. “Rural communities are a vital, diverse component of the United States, representing nearly 20 percent of the nation’s population.... Rural America reflects the multiethnicity of the nation as a whole.... Rural communities are heterogeneous, differing in population density, remoteness from urban areas, and the cultural norms of the regions of which they are part. As a result, they vary in their demographic, environmental, economic, and social characteristics. These differences influence the magnitude and types of health problems communities face....

Many rural communities continue to struggle to sustain viable health care delivery systems. In recent years, it has also become apparent that rural communities confront serious quality of care challenges as well....”

“Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.... This strategy is based on the use of states or ‘market areas’ as laboratories for the design, implementation, and testing of alternative strategies, leading ultimately to the creation of a set of model 21st -century community health systems over the coming years....” “Patients likely have different preferences for settings and providers, and there may well be differences in the quality, accessibility, and cost of services by type of setting and provider....”

The RxP agenda is fundamentally

14

about ensuring that all Americans have access to the highest possible quality of care no more, no less. Texas is extraordinarily fortunate that former USAF Prescribing Psychologist Jim Meredith has left Hawaii to reside in your state. As Jim and each of his DoD colleagues have reported, psychology has much to offer to those patients who are on (or perhaps need) psychotropic medications. Psychology views the judicious use of medication dramatically differently than those trained in the traditional medical model. Rural America provides the opportunity to demonstrate the cost-effectiveness and efficacy of psychology prescribing.

A personal view: Jim Quillin, President of the Louisiana Psychological Association: “Louisiana’s Medical Psychology statute was signed into law on May 6, 2004, and the rules governing this landmark statute were finalized on January 20th of this year clearing the way for the certification of medical psychologists (MPs) under state law. This represented the culmination of a decade of hard work by a small group of extremely dedicated psychologists who believed in themselves and in their ability to effect progressive health care change through the political process. With the unfailing support of the APA Practice Directorate and CAPP, LPA and its sister organization, the Louisiana Academy of Medical Psychologists (LAMP), forged a partnership that brought to fruition, after four legislative sessions, the country’s second statute. In all, it was an exhilarating ride and one which all of us will forever remember not only for its outcome but also for the process.

“We are now embarked upon the implementation of this historical statute.

A total of 23 medical psychologists are

now authorized to prescribe here in Louisiana, and by Summer’s end, no less than 25 MPs will likely be practicing in Louisiana, and it is my hope that by the end of the year the remainder of those who have completed their training thus far will be doing so as well. A new class of psychologists is underway and being trained, and the next wave of MPs, will follow in due time. I also hope to be able to report to you in the near future another groundbreaking first, the credentialing of an MP to prescribe as part of the medical staff of a hospital. We have also been working with the insurance industry and I believe that I will soon have the pleasure of announcing an important breakthrough in the reimbursement of services provided

by MPs, one that may well extend to other states for qualifying psychologists.

“To date, we are successfully feeling our way through the logistics required to fully realize the potential of our law.

Louisiana is one of a number of states that require a state Controlled and Dangerous Substance Permit before application can be made for a DEA number. This process has gone very smoothly and, with our DEA numbers in hand, we are now authorized to prescribe any drug, Schedule II through V, that has a recognized use (including off-label) in the management of any psychiatric disorder listed under either DSM or ICD. “To a person, all current MPs have enjoyed excellent relationships with pharmacists, all of whom, across the state, received a memo from the Pharmacy Board earlier this year advising them of MPs as a new class of prescribers in Louisiana. Taking a tip from the Executive Director of that Board, I contacted many of the pharmacies in my area and provide them all the information necessary for

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them to put me into their systems. Several of them now fax or call my clinic to remind me of expiring prescriptions so that I can discontinue, change or refill as needed. It has also been gratifying to see that nonpsychiatric physicians appear to accept and even welcome MPs as partners in the delivery of health care. Whereas organized medicine has been obliged to oppose psychology in this movement, partly in deference to their psychiatric colleagues and partly out of a sense that medicine’s monopoly on health care is waning, rank and file MDs, in my experience, are concerned not with turf issues but rather with providing quality care to their patients. We are not a threat; we are their allies and are being increasingly accepted as such. Patients appear absolutely thrilled with the ability of MPs to prescribe their psychotropic medications. It has freed them of the onerous requirement of seeing two doctors each time a prescription is needed while the close coordination of care between their MP and MD helps ensure optimized outcomes. As of this writing, MPs here in Louisiana have written over 2,000 prescriptions representing nearly 50,000 treatment days, all without incident. We are prescribing all classes of psychotropic medications.

“As for myself, this implementation period has been interesting. I find that I am conservative in my prescribing habits, adhering to the age old admonition to ‘start low and go slow’ when treating patients psychopharmacologically. I have prescribed for all classes of psychotropic medications across all relevant schedules.

Still, all in all, patients have a better than 50-60% chance of leaving my clinic without a prescription so far, as psychotherapeutic/behavioral management was indicated and sufficed. Those for whom med-

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ication is necessary report that they find it refreshing that the doctor who prescribes for them also takes the time to listen to them and to approach their care in a more holistic manner. I understand that this is similar to the experience of the DoD graduates. It will be interesting to track this over the longer term.

“As I’ve started prescribing, I’ve found myself pondering afresh the concern of some that we are ‘medicalizing’ psychology. To be brief, such concerns, while certainly understandable, appear to be unnecessary. While some of our new professional activities are unmistakably medical in character (i.e., vital signs, evaluation of drug-drug and disease-drug interactions, etc.), the ‘medical’ in medical psychology is an adjective that modifies rather than defines who and what we are psychologists. The opportunity to provide a broader range of therapeutic options to

Coming in 2006

Join us in

Scotland

TPA invites you and your family to a Family Getaway in Scotland in late Spring 2006! Watch for more information in the Winter 2006 Texas Psychologist.

my patients certainly has not seemed to diminish my sense of professional identity.

It is clearer to me now more than ever that the core of the healing arts, the therapeutic ‘g-factor’ if you would, is still to be found in that somewhat mysterious, elusive bond of the doctor-patient relationship. I don’t find that I am abandoning my psychological roots I think I’m discovering them anew.”

A final thought: as I requested during my Presidential address, please join me in urging Melba Vasquez to seek the APA Presidency. All of us will truly be well served by her vision and compassion.

Aloha,

It’s not too early to plan for the

2006 Annual Convention

November 16 - 18, 2006

Westin Galleria Dallas, TX

Pat DeLeon, PhD Former APA President

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Reaching Out to Rural Adolescents: Online Counseling

by Donna S. Davenport, PhD Texas A&M University

T

he following information was obtained from an interview with Linda Castillo, assistant professor in Counseling Psychology at Texas A&M University, supplemented by professional papers she authored for publication and presentation.

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Tell me about your online counseling project.

We have a couple of projects going, all under the umbrella of GEAR UP—which stand for Gaining Early Awareness and Readiness for Undergraduate Pro-grams.

The gist of it is that we’re following a group of students from their 7th through the 12th year in school, trying to prepare them for college. My projects are focusing on helping them with psychological aspects, specifically a support group for Latinas and career counseling.

Why go online? Why not just provide direct intervention?

For several reasons, really. These students are located in three small rural towns—Sinton, Odem, and Aransas Pass.

Typically, most students are Latino and many are from families who know little about college or how to get into college.

Although their school counselors try, they are often in primarily administrative roles and don’t have the time to connect with each student as much as they would like.

We wanted to reach out to these students, but it was too far to drive! Besides, I’ve had a good deal of experience providing online counseling and I’ve seen first-hand how some people open up quickly that way, so we were eager to try a couple of approaches that haven’t been tried before.

This is through a grant, right?

Yes, through the US Department of Education. The whole project reaches about 400 students, and we want to compare how students who received various interventions compare to students who don’t receive them.

Okay. So talk to me about what you’ve found exciting about these projects?

The one closest to my heart is probably the online 10-week support group for Latinas. We knew from other research that FALL 2005

success for Latino students is often related to experiencing expressions of warmth, caring, and personal regards from teachers and counselors. We hoped that we could be part of that team of supporters.

How did you manage to gain access to them? Did you go through the school counselors?

Oh, yes, that was a very important part of the plan. We absolutely needed their collaboration. They identified for us Latina students who were having problems with school performance, and they obtained the parental consent for students to participate in the online support group.

They also gave the students the screennames and passwords we provided.

So this was Messaging?

through

Instant

Yes. American On-line (AOL) Instant Messaging is free, so we created an account through them. We knew it could be made easily accessible to the schools.

You did the facilitation of the groups yourself?

No, I trained and supervised six graduate counseling students. We called them Aggie Partners and each of them created a private chat room that was available only by invitation. Each Aggie Partner worked with a group of five Latina students. To enter the chat room, you had to be invited, and that invitation went out to the assigned students, the school counselor, and me.

You mentioned training the Aggie Partners. What kind of training did you provide?

Primarily they were taught not to write like graduate students! They needed to be very informal, very supportive, to self-disclose when appropriate, and to facilitate the discussion if too many ideas were thrown out at once by the group members.

Sometimes the Aggie Partner introduced a topic for discussion, but often students brought up their own concerns.

A lot of it, discussed almost every session, was about relationships with peers and boys. The group members came to trust each other and talked a lot about pressure to have sex at a young age. Many of them had older boyfriends. Same-sex relationships were also very important to them. They wanted help dealing with peer pressure and sometimes raised issues like needing to figure out how to handle a situation in which a friend betrayed them or started giving them the cold shoulder.

Family conflicts was also another very common topic.

So was it all support? No confrontation?

Confrontation from Aggie Partners was challenging their group members’ perspectives of a problem. Their main role, however, was to offer that warmth and acceptance we talked about earlier. It was interesting, though, that although the group members tended to share openly and be encouraging of each other, they did sometimes critique other members or show them another way to see something.

How do you think this helped prepare them for college?

Well, although a lot of the discussions were about their present circumstances, in almost every session concerns about college were brought up. This was where the Aggie Partners could really be helpful.

For example. . .?

One group was talking about their fears of going to college and being alone and away from family and friends. They worried about how they could support themselves and still keep up with their studies. One student asked her Aggie Partner, Debra, directly if she had been scared to go to college. Debra wrote back,

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“OH YES! I still remember what I felt when I drove away from home. I must have called my mom at least twice a day every day at first!” She asked if the group member was worried about things like that, and was told yes, that was it. At that point Debra responded, “The good thing to remember is that most of the people around you will be feeling the same way.”

So the Aggie Partners really became role models and mentors, right?

Yes, exactly.

What advice would you have for others trying to set up such an online support group? What have you learned the hard way?

First, it’s crucial to get support from the school administration. For us, this was simpler, because our grant provided funding for computer equipment and technology support. Without support from the administrative body and the school counselors, this wouldn’t have worked.

Anything else?

One of the problems we encountered was that the Aggie Partners sometimes had a little difficulty managing the group because the students were sitting next to each other in the computer lab, so side conversations occurred that were not part of the group discussion. If the students had been from different schools, or if there had been a monitor in the lab, it would have worked better.

The other thing I want to say is that I know how crowded a school counselor’s schedule is; they often just don’t have time to facilitate such groups. That’s why we think letting graduate students in training get practicum credit for something like this as they work to become counselors or psychologists is such a win/win proposition.

Let’s switch gears for a minute. Tell me about the career

18

counseling component you’ve introduced. Is that with the same students?

Yes and no. It was from the same school districts, but none of the students in the Latina support groups were in the career counseling program. I set this one up through the Career Counseling course I teach. I trained them, and then they had two or three Latino students to work with.

This was set up the same way, through instant messaging?

We used the WebCT software program that allowed us to use password protected email and discussion boards. Like the other group, each middle school student was given a personal login account and password; that way we could maintain confidentiality. The school counselor and I were the only ones with access to students’ accounts.

Was this just open-ended counseling, or did you use a specific model?

We used the Career Zone. Once a student was logged into WebCT, a discussion board with the student’s name and a link to the Career Zone was visible. It’s a free online career guidance program for middle and high school students and has a lot of career activities to help explore students’ talents, skills, and interests. One great thing about this program is that school counselors can keep track of a student’s career development by using the online portfolio feature.

What training did you offer your graduate students?

To begin with, they learned how to introduce themselves – informally again – and how to explain confidentiality. I gave them specific Career Zone activities to work on with their students and was able to provide individual supervision by reading each counseling student’s postings.

Give me an example. How might the first interaction go?

I told them ahead of time the trick would be to establish a working alliance, to create a presence, without actually being physically present. I gave them examples of the kind of messages that worked—informal, enthusiastic, some self-disclosure—as well as a very formal example of what wouldn’t work. So in their first message they would give their names and say how excited they were to be the student’s career counselors for the next several weeks. It was very informal—using exclamation points, contractions, ellipses, incomplete sentences.

The goal was just to establish rapport with the middle school student. They modeled self-disclosure by talking about their own interest, for example windsurfing, shopping for bargains, things like that. Then they asked the student to tell them what the student wanted them to know. There was a P.S. at the end of that first communication, explaining again, very informally, the limits of confidentiality, but explaining that before it was broken, the career counselor would definitely talk to them about it first so they could make a plan on how to deal with it.

In addition to going through the Career Zone activities, were students trained to offer other kinds of comments?

Oh, yes. In each posting, they reflected back on the middle school students’ previous message, praising them for their good work and participation and offering encouragement to continue the process. They also incorporated some of their own personal thoughts and experiences in order to cultivate a personal communication. Then at the end of each message, they would summarize the topics that they hoped the students would respond to next.

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How did you supervise your graduate students?

Well, as I said before, I read each student’s postings. My career counseling students also had to keep case notes, using the SOAP format, for every two e-communications. These were kept on disk and turned in at the end of the semester. When they finished the process, they wrote a treatment summary.

Were there special ethical issues you had to deal with in either of these projects?

The main one was figuring out how to make online counseling confidential.

We did that by creating private chat rooms and students had to be invited in order to participate. Parental consent had already been obtained through GEAR UP, but we made sure they had their own informed consent. We needed to feel that, in an emergency, we could contact their school counselors. Students knew the counselors had access to their messages. These school counselors served as our safety net, and that made the whole process less anxiety provoking for me. In online counseling with adolescents, it can be worrisome if a student suddenly quit dialoguing. This way, we didn’t have to worry; someone was on site who could check up on them.

I imagine you’re collecting data on this?

Yes, I’m collecting some process data.

GEAR UP will be doing the analyses of these 400 students. But that won’t be available for two more years—we’re now in the 4th year of the project.

Telephone Counseling - cont. from page 11

Thanks so much, Linda! This is a really great example of collaboration between a graduate program and a public school. Everyone wins!

Wampold, B.E. (2001). The great psychotherapy debate: Methods, models, and findings.

Mahwah, NJ: Lawrence Erlbaum Associates.

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VandenBos, G.R., & Williams, S. (2000). The internet versus the telephone: What is telehealth anyway? Professional Psychology: Research and Practice, 31, 490-492.

Zhu, S.-H., Tedeschi, G.J., Anderson, C.M., & Pierce, J.P. (1996). Telephone counseling for smoking cessation: What’s in a call? Journal of Counseling and Development, 75, 93-102.

Zhu, S.-H., Tedeschi, G.J., Anderson, C.M., Rosbrook, G., Byrd, M., Johnson, C.E., et al.

(2002). Telephone counseling as adjuvant treatment for nicotine replacement therapy in a “real-world” setting. Preventing Medicine: An Internal Journal Devoted to Practice and Theory, 31, 357-363.

Correspondence concer ning this ar ticle should be addressed to Rober t J. Re e s e , Box 28180, Abile ne C hri st i a n Unive rs it y, Abile ne , T X 7969 9 - 8 1 8 0

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Integrated Health Care at UT Austin

U

niversity counseling centers are

by Tom Marrs, PhD Texas A&M University

being forced to take a difficult look at how and to whom they provide

service. As a member of the 2004 intern cohort, I had the opportunity to attend the annual Counseling Center Internship Conference held at the University of Houston. Outside the formal presentations, one of the most discussed topics among training directors and counseling center staff seemed to be the unanimous agreement that college and university counseling centers are experiencing across-the-board increases in service requests and in the severity of presenting issues. Although there is some empirical support for the increase in severity, it seems that speculated factors that might be contributing to the felt increase are as numerous as the people experiencing it.

University counseling centers constantly strive toward providing ever-higher quality services to students within the everyday realities in which their counseling centers exist. One way to accomplish the goal of providing better service to students is to increase availability and awareness, including the integration of different student services offered within the institution. A program that can integrate multiple resources so that more students can be served more efficiently and effectively would certainly mesh exceptionally well with the goals of a counseling center. The best of these ideas are sure to rise to the top and become the benchmark in services that student mental health can provide, and in fact, one of the more progressive ideas about student services and mental health care came about in 2002.

At that time, David Drum, PhD, ABPP, Director of the Counseling and Mental Health Center and Associate Vice President of Student Health at the University of Texas at Austin, set into motion a long-time vision he has had about student health. With the creation of what has come to be called the Integrated Healthcare Program, Dr. Drum sought to create a system of service delivery that treated the whole person, both mind and body, with a particular emphasis on the interplay between the two.

In fact, while mind-body approaches to health have certainly been around for a very long time, both the American Psychological Association and the American Medical Association recognize the validity in development of programs that focus on it. In 2002, as the UT program was getting started, the Journal of the American Medical Association covered an APA meeting on what they called “Mind-Body Medicine,” stating “Every day, primary care clinicians face patients whose primary disease is psychiatric or is complicated by psychiatric issues. Recent findings, including brain imaging studies, deepen appreciation that mind and body are one.” (Lamburg, 2002). In fact, 3 years later, the APA Practice Directorate’s public education initiative named September of 2005 “Mind/Body Health Month”, and includes “more materials than any previous public education campaign effort,” according to Helen Mitternight, Assistant Executive Director of Public Relations in APA’s Practice Directorate (Karen

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Kersting, 2005). It appears that both sides of health care begun making moves to incorporate treatment from an overall mind-body approach.

In UT’s integrated healthcare program, psychologists and social workers practice collaboratively with medical providers in the University Health Services clinic and offer a wide range of psychological services to students referred by medical providers. According to Chris Brownson, PhD, Assistant Director of Integrated Healthcare and Research and leader of the University of Texas program, “Integrated healthcare at its core is seamless, integrated, and collaborative. It is seamless in that mental health services and behavioral or other psychological interventions occur within the primary care clinic.

Medical providers and behavioral health providers give treatment that reinforces the fact that the mind and body are not separate from one another.” Clinicians in the integrated care program present holistic care to patients initially seeking treatment from medical providers. They refer to the work as primary care psychology, with a particular emphasis on the mindbody interventions and mindfulness. In the three years since the start of the program, medical providers have responded positively and the program has flourished.

The integrated approach to healthcare provides effective treatment reaching patients at the primary care level. Dr. Brownson cites that lifestyle factors, emotional and cognitive issues, and personal and interpersonal factors are often ignored or de-emphasized during treatment because medical providers often don’t have the time or the expertise to address such issues. However, if these issues are addressed in the context of physical health, patients learn about the ways their mind and body influence one another.

Dr. Brownson went on to say “A sig-

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nificant portion of mental health issues surface in primary care, so providing these services where the patients present is important.” As a result of this immediacy effect, the program has experienced a significant increase in patient follow through and compliance, as well as reaching segments of the student population who present less frequently at counseling, particularly men and international students.

Through the integrated program, the behavioral health providers see students with more typical counseling center concerns such as depression, anxiety, eating disorders, and relationship issues. Ad-ditionally, however, they see students for more physical health concerns, such as irritable bowel syndrome, chronic pain, GI problems, insomnia, and chronic illnesses.

Services are provided for any medical condition in which stress, lifestyle, or personal or interpersonal issues have an impact on the cause, course, severity, or duration of physical complaints. Dr. Brownson says that they respond to all mental health crises within University Health Services as well, especially the urgent care clinic – including recent suicide attempts, suicidal ideation, panic attacks, or psychotic symptoms. In this way, when a student is in crisis and comes to see a doctor, she or he can be seen by someone with training in mental health immediately, without the need for a referral or a possible delay in getting the student to the counseling center.

In addition to the synergistic affects of this level of integration of mental health services into primary care, Dr. Drum sanctioned the Integrated Health-care Program to construct a Mind-Body Lab that would make Jon Kabat-Zinn very happy. In the lab, put in place in early 2005, students can learn relaxation skills with the aid of biofeedback. Students can go to the lab without the usual appointment needed in counseling services or health services, and choose one of three stations containing a

recliner, a wall mounted LCD monitor, headphones, and simple biofeedback equipment. The student can then select and listen to various audio tracks which teach how to use the equipment.

Relaxation and mindfulness exercises are also offered with multiple tracks on breathing, progressive muscle relaxation, mindfulness meditation, guided imagery, and self-hypnosis; additionally, individual Galvanic Skin Response units are provided for each station that the student can use in conjunction with the audio tracks. Both the counseling service and the health service can refer students to the Mind-Body Lab, with the counseling center staff often integrating it into treatment plans. This encourages students to take a more proactive role in their own treatment, thus allowing staff to use their direct service delivery hours with students that require other approaches.

Dr. Brownson suggested that providing some open counseling slots in the health center and offering ready consultation helps to improve referral follow through as well as relationships with health center colleagues. He stated that, “Throughout the 3 years that this program has been in existence, we have done satisfaction surveys of the medical providers and recently completed a program evaluation of our services. Our feedback has been overwhelmingly positive and this is best seen by the growth of the program.

After our pilot project in 2002, we provided services to the patients of only four of our 25 medical providers. We only had one full time behavioral health counselor.

In the past three years the demand for our services has grown to where there are now four full-time counselors providing services to the patients of all 25 of our medical providers.”

The integrated healthcare program has helped students in more ways than just providing services. In 2004, the program,

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which within the UT system is known as the “Behavioral Health Program,” received funding for two psychology interns from the national APPIC match. Interns received training in the integrated system, and had the advantage of participating in activities and training in both the counseling center as well as the University Health Services department. Like the Integrated Healthcare Program staff, this internship appointment also included offices in both departments and provided the ability to lead groups that were accessible to clients at the Counseling and Mental Health Center as well as to patients at University Health Services.

For most psychologists or center directors reading this right now, the next thought might be “This sounds like a great program, but how might I be able to start making changes toward more integrated healthcare service delivery within the practical constraints of our system?” Dr. Brownson stated. “There are many ways to begin to develop more integrated healthcare initiatives. We do a lot of consultation with our medical providers, and have been providing some joint continuing education for providers from our health centers and counseling centers. These types of activities tend to improve relationships with very little expense. Simply providing some open counseling slots in the health center can help to improve referral followthrough as well as collaboration with health center colleagues, resulting in more students getting the help they need.”

Another way in which integrated care might be feasible through existing budget and staff constraints is through group services programming. Dr. Brownson reported that one of the most successful integrated interventions has been through a group led by interns and Integrated Healthcare Program staff members Mary Vance, PhD and Cary Tucker, LCSW, RN, that is as avant-guard as the program itself.

22

Optimizing Your Potential: The MindBody Connection “is a time-limited intensive intervention for students with physical or psychological symptoms which they suspect are exacerbated by stress or lifestyle factors. At the core of the group is mindfulness meditation, but facilitators work collaboratively with other healthcare professionals to teach yoga, mindful eating, the benefits of physical activity for health, emotional expression, and a cadre of relaxation skills.” The program also offers a mindfulness meditation group which meets weekly and is open to students and University employees as well, which has proven to be a great way to generate enthusiasm and referrals from faculty and staff.

The integrated program piloted at the University of Texas since 2002 has a positive track record and appears to have bridged the gap in university mental and physical healthcare. The program has been well received by all segments of the university population thus far. Counselors report that their jobs are professionally rewarding because they feel the students being seen in health services are often young and new to mental health treatment, and are prone to

be less entrenched in their symptoms, thus making rapid change possible. The crosstraining that occurs between the two worlds also appears to be bringing them together for the common goal of helping students in the most complete and efficient manner, insuring valuation of mental health services by the university system, and giving medical providers on campus greater options and resources. The program also insures adequate usage of services to secure a future for mental health services through retention of funding and maintaining a training ground for the future of mental health.

R e f e r ences

Kirsting, K. (2005) A showcase for the mindbody connection. Monitor on Psychology, 36(8), 42.

Lamburg, L (2002). Mind-body medicine explored at APA meeting. Journal of The American Medical Association, 288(4), 435439.

CALL FOR ARTICLES! SPECIAL UPCOMING THEMES!

Ethical Dilemmas and Resolutions – due 12/1/05 This issue will address dilemmas that occur in both standard and non-traditional situations. The articles should include a description of the dilemma, a review of relevant literature, a discussion of the issues involved, and suggested ethical guidelines or procedures. An example might be: Confidentiality Issues for Military Psychologists.

T h e o r et i ca l A pp r o a c h e s i n M u l t i c u l t u r a l C o u n s e l i n g – due 3/1/06

This issue will address the use of specific theories of counseling and psychotherapy with clientele representing various diverse groups. Articles explaining the adaptations of a theory, or the integration of two theories, are also acceptable. An example might be: The Use of Cognitive/Behavioral Approaches with ChineseAmerican Clients.

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IT’S THE LAW

Sam Houston, JD

New Technology – Same Legal Issues

2.

N

ew technology is changing the practice of psychology.

The Internet and improved voice and telecommunications make long-distance counseling a much more viable solution to the practice of psychology. However, the same requirements regarding Confidentiality, Consent and Recordkeeping bind you both legally and ethically.

Therefore, if you are embarking on a new “tech” counseling career, keep in mind the following legal points: 1. Informed Consent. 465.11 of the Texas Administrative Code requires that all licensees obtain and document in writing infor med consent concerning all services they intend to provide to the patient. To the extent you are providing new or different services, you should prepare a detailed consent page to inform the client that counseling will be provided via either the telephone or the Internet. Be sure to address the limitations of the technology, as well as the possibility of any potential security or confidentiality leaks. You should have the client sign the consent forms in your office, even if the services are offered online.

If not, make certain there is someFALL 2005

3.

thing mailed to the client, at least identifying that informed consent was given.

Recordkeeping. Even if the client is not personally seen, recordkeeping is important. Be sure and keep such records in a legible form. Remember to document voicemail and print all E-mails.

If you are shifting your practice to keep all records electronically, the same rules apply with regard to maintenance. Under 465.22 of the Texas Administrative Code, you are required to keep and maintain accurate and current records of all psychological services. The records and data should be maintained and stored in a way that permits review and duplication. Also, remember that pursuant to both the state law and the Administrative Code, clients are entitled to access to their records regardless of whether the records are kept electronically or in paper form, or whether or not the client is seen in person.

Confidentiality. The duties of confidentiality apply when there is a psychological patient relationship – whether the patient is seen in the office or in some other way. If you are giving psychological advice or treatment, there is such a duty. Be sure that the system you design to communicate with your patients is secure and trustworthy. If the sessions are recorded in some form, make certain that the recordings are kept in a proper fashion.

4.

Billing. It would be a good idea to check with all insurance carriers and to check on the requirements for Medicare and/or Medicaid billing to make certain that the format and procedures that you utilize for therapy meet the billing requirements.

These are only a very few of the legal questions that you need to consider when adapting your practice to available technology. You should consult an attorney with regard to all of the ethical prohibitions and reviews.

At a minimum, I would review the ethical rules that you either have in your office or that can be found online on the The Texas State Board of Examiners of Psychologists web page which is www.tsbep.state.tx.us/.

If you have any detailed questions about such issues, you can also join the telephone consultation service by calling me at my office at 713-650-6600.

CPT Codes - cont. from page 7 The American Psychological Association Practice Organization and several of APA’s Divisions have worked tirelessly not only to get these codes approved for psychologists but also to educate psychologists on the proper use of these codes for billing. TPA will be holding workshops in early 2006 to educate and train our members on how to get reimbursed from Medicare and private insurance for these codes.

For more information on these codes, visit the Texas Psychological Association’s website at www.texaspsyc.org.

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TEXAS PSYCHOLOGIST

PSYCHOLOGY IN THE PUBLIC INTEREST

The Proposed Constitutional Amendment Banning Same-Sex Marriage in Texas and How Psychology can Contribute to the Dialogue

By Nathan Grant Smith, PhD Texas Woman’s University This is the first of various articles entitled, “Psychology in

Table 1 for the full text of the resolution). On November 8,

the Public Interest.” This column has been developed in order

2005, the proposed constitutional amendment will be sub-

to communicate psychological research and knowledge that

mitted to voters to determine whether the amendment will

informs us about issues relevant to marginalized groups in soci-

become part of the state constitution.

ety. Doing so allows for us to convey key information to the

Wh at ef f e c t w i l l t h i s a m e n d m e n t , i f p a s s e d , h a v e on t he l iv es o f le sb ia n, g ay , and b is ex u al Te x a n s and their families?

membership as a means of promoting human welfare, an important part of TPA’s mission. Because this, as well as other of the topics may be controversial in nature, it is important to note the following disclaimer:

Many Texas families will be affected. According to 2000 US Census data, Texas has 21,740 cohabitating same-sex couples,

The information in the following article is provided by the author, with

ranking fourth in number behind California, New York, and Florida

consensus of the Social Justice Task Force, to facilitate analysis and discussion

(Simmons & O’Connell, 2003). Texas also has a high number of same-

of the issues presented. It is not intended to represent official policy of the Texas

sex couples who are raising children. Indeed, according to 2000 Census

Psychological Association or the opinions of its membership. The Texas

data, Harris and Dallas counties are in the top ten in the nation in terms

Psychological Association has not taken a position for or against the proposed

of number of same-sex couples raising children. Bexar, Tarrant, Travis,

constitutional amendment on marriage. It is recognized that there are many

and Hidalgo counties are also in the top 50 counties in the US in num-

differences among our perspectives, and comments are invited.

ber of same-sex couples raising children (Bennett & Gates, 2004). It is

Richard M. McGraw, PhD, TPA Social Justice TF Chair, and

I

important to note that these figures are likely underestimates, as the data

Melba J.T. Vasquez, PhD, TPA President Elect

were compiled only for individuals who indicated that they lived with a “husband /wife” or “unmarried partner.” Some same-sex couples may not

n recent years, the issue of same-sex marriage has come under

identify as such on Census surveys.

increasing scrutiny by the courts, legislative bodies, the media, and

The Government Accounting Office (2004) has identified 1,138

the general public. In June of 2003, the United States Supreme

federal protections afforded by marriage. Opposite-sex married couples

Court struck down sodomy laws as unconstitutional in their Lawrence v.

are granted hospital visitation, social security benefits, family medical

Texas decision. In May of 2004, after the Commonwealth of

leave, and tax benefits, to name a few. Though some of the protections

Massachusetts Supreme Judicial Court ruled that the ban on same-sex

of marriage can be obtained through legal contracts, not all can be guar-

marriage was unconstitutional, that state began issuing marriage licenses

anteed. Moreover, resources are needed in order to attempt to put these

to partners of the same sex. In the 2004 elections, measures banning

protections in place. This inequity puts an unfair burden on same-sex

same-sex marriage passed in all 11 states that had them on the ballot. This

couples and their families and many may not have access to the needed

year, the Texas legislature passed a proposed constitutional amendment

resources.

banning same-sex marriage, which will go to voters in November.

Lesbian, gay, and bisexual individuals and their families are nega-

On April 25, 2005 the Texas House of Representatives passed House

tively affected by legislation such as constitutional amendments. Not only

Joint Resolution 6 (HJR6) by a vote of 101 to 29, with eight members

are they denied equal rights, but anti-gay politics have a negative effect on

voting “present.” Subsequently, on May 25, 2005, the Texas Senate passed

the well-being of lesbian, gay, and bisexual individuals (Russell, 2004a).

the resolution by a vote of 21 to 8. HJR6 would amend the Texas consti-

The dialogue concerning same-sex marriage often calls into question the

tution to define marriage as the union of one man and one woman (see

mental stability of lesbian, gay, and bisexual persons, their effectiveness as parents, and the validity of their identities. The debate around same-sex

24

FALL 2005

TEXAS PSYCHOLOGIST

marriage and the often hostile rhetoric involved opens old wounds and

be explained by the stress of living in a stigmatizing environment.

contributes to divisions within communities (Bullis & Bach, 1996).

Moreover, studies that have examined the direct effects of anti-gay dis-

What does the psychological re s e a rc h have t o say abo ut th e issue of same-sex marriage?

crimination have found positive correlations between discrimination and a number of negative psychological outcomes. For example, experiences of

Research on same-sex relationships shows many similarities between

anti-gay discrimination have been linked to depression, anxiety, psycho-

heterosexual and same-sex relationships. Many gay men and lesbians are

logical distress, suicidal ideation and behavior, and somatic symptom (e.g.,

currently in committed relationships and a substantial number have been

Diaz, Ayala, Bein, Henne, & Marin, 2001; Meyer, 1995; Ross, 1990;

in relationships over 10 years (e.g., Kurdek, 2003; Peplau & Spalding,

Smith & Ingram, 2004; Waldo, 1999). The experience of anti-gay dis-

2000). Lesbian and gay couples report levels of relationship satisfaction

crimination is common among lesbian, gay, and bisexual individuals.

and commitment that are similar to those of heterosexual couples (e.g.,

National surveys have revealed that the majority of lesbian, gay, and bisex-

Peplau & Beals, 2004). Likewise many of the challenges facing hetero-

ual individuals have been the victim of sexual-orientation-related verbal

sexual couples (such as intimacy, stability, etc.) are the same

and physical attacks, stalking, and/or vandalism (Kaiser

challenges facing same-sex couples (e.g., Kurdek, 2004).

Family Foundation, 2001; National Gay and Lesbian Task

Similarly, research on the children of lesbian, gay, and

Force, 1984).

bisexual parents indicates comparable levels of adjustment

To summarize, research on lesbian, gay, and bisexual

between children raised in opposite-sex and same-sex fami-

individuals and their families indicates that this group tends

lies. Research has demonstrated no differences between the

to be as healthy and well-adjusted as their heterosexual

effectiveness of lesbian, gay, and bisexual parents and their

counterparts. However, discrimination can lead to psycho-

heterosexual counterparts (e.g., Armesto, 2002; Patterson,

logical problems; and lack of legal recognition can put fam-

2000; Perrin, 2002; Tasker & Golombok, 1997). Claims

ilies at risk. Moreover, discriminatory laws contribute to the

that the optimal environment for raising children is a heterosexual house-

stigmatizing environment faced by lesbian, gay, and bisexual individuals,

hold have not been supported by empirical research. Moreover, research

and perpetuate the societal status quo of oppression.

on development of factors such as gender identity, sexual orientation,

Psychology as a field can contribute significantly to the dialogue on

personality, and self-concept reveals that children raised by lesbian, gay,

same-sex marriage and the civil rights of lesbian, gay, and bisexual indi-

and bisexual parents are similar to children raised by heterosexual parents

viduals. Our expertise in mental health and our ethical commitments to

(though most research is focused on lesbian mothers; Patterson, 2004;

justice and respect for people’s rights (American Psychological

Perrin, 2002; Stacey & Biblarz, 2001; Tasker, 1999). Given the large

Association, 2002) equip us with the tools to effect pro-social change.

numbers of children who are being raised in same-sex households (some

Concrete ways to effect change have been discussed by several writers

estimates are that there are over 1 million children in the nation being

(see, for example, Russell, 2004b and Stevenson & Cogan, 2003). By

raised by same-sex parents; Patterson & Friel, 2000; Perrin, 2002), deny-

using our skills as psychologists and working together to share our expert-

ing legal rights to their parents will put many children at a disadvantage.

ise, we can help to ensure the health of all Texans and their families.

Despite the many similarities between same-sex and opposite-sex couples and their children, there is growing consensus that discrimination against lesbian, gay, and bisexual individuals is linked to negative behavioral and mental health outcomes. The term “minority stress� has been used to describe the stigmatizing and hostile environment lesbian, gay, and bisexual individuals encounter on a daily basis (e.g., DiPlacido, 1998; Meyer, 1995). Because of the stressful societal context of widespread discrimination at the interpersonal, institutional, and socio-cultural levels, lesbian, gay, and bisexual individuals are at increased risk for stress-related psychological disorder. A recent meta-analysis found that lesbian, gay, and bisexual individuals report higher levels of psychological disorder than do their heterosexual counterparts (Meyer, 2003). However, there is widespread agreement that these differences in psychological adjustment are not attributable to homosexuality, per se (note that homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders in 1973; American Psychiatric Association, 1973). These differences can

FALL 2005

25

TEXAS PSYCHOLOGIST

R e f e r ence s

American Psychiatric Association (1973). Diagnostic and statistical manual of mental disorders (2nd ed.). Washington, DC: Author.

American Psychological Association (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073.

Armesto, J. C. (2002). Developmental and contextual factors that influence gay fathers’ parental competence: A review of the literature. Psychology of Men and Masculinity, 3, 67-78.

Bennett, L., & Gates, G. J. (2004). The cost of marriage inequality to children and their same-sex parents. Washington, DC: Human Rights Campaign.

Bullis, C., & Bach, B. W. (1996). Feminism and the disenfranchised: Listening beyond the “other.” In E. B. Ray (Ed.), Communication and disenfranchisement: Social health issues and implications (pp. 3-28). Mahwah, NJ: Lawrence Erlbaum.

Diaz, R. M., Ayala, G., Bein, E., Henne, J., & Marin, B. V. (2001). The impact on homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: Findings from 3 US cities. American Journal of Public Health, 91, 927–932.

DiPlacido, J. (1998). Minority stress among lesbians, gay men, and bisexuals: A consequence of heterosexism, homophobia, and stigmatization. In G. M. Herek (Ed.), Stigma and sexual orientation (pp. 138-159). Thousand Oaks, CA: Sage.

Government Accounting Office (2004). Defense of marriage act: An update to prior report. Washington, DC: Author.

Kaiser Family Foundation. (2001). Inside-OUT: A report on the experiences of lesbians, gays, and bisexuals in America and the public’s views on issues and policies related to sexual orientation. Menlo Park, CA: Author.

Kurdek, L. A. (2004). Are gay and lesbian cohabitating couples really different from heterosexual married couples? Journal of Marriage & Family, 66, 880-900.

Kurdek, L. A. (2003). Differences between gay and lesbian cohabitating couples. Journal of Social Personal Relationships, 20, 411-436.

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence.

Psychological Bulletin, 129, 674-697.

Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health Sciences and Social Behavior, 36, 38–56.

National Gay Task Force. (1984). Anti-gay/lesbian: A study by the National Gay Task Force in cooperation with lesbian organizations in eight U. S. cities.

Washington, DC: Author.

Patterson, C. J. (2000). Family relationships of lesbians and gay men. Journal of Marriage and Family, 62, 1052-1069.

Patterson, C. J. (2004). Gay fathers. In M. E. Lamb (Ed.), The role of the father in child development (4th Ed.). New York: John Wiley.

Patterson, C. J., & Friel, L. V. (2000). Sexual orientation and fertility. In G. Bentley & N. Mascie-Taylor (Eds.), Infertility in the modern world: Biosocial perspectives (pp. 238 - 260). Cambridge: Cambridge University Press.

Peplau, L. A., & Beals, K. P. (2004). The family lives of lesbians and gay men.

In A. L. Vangelisti (Ed.), Handbook of family communication (pp. 233248). Mahway, NJ: Erlbaum.

Peplau, L. A., & Spalding, L. R. (2000). The close relationships of lesbians, gay men, and bisexuals. In C. Hendrick & S. S. Hendrick (Eds.), Close relationships: A sourcebook (pp. 111-123). Thousand Oaks: Sage.

Perrin, E. C., & the Committee on Psychosocial Aspects of Child and Family Health (2002). Technical Report: Coparent or second-parent adoption by same-sex parents. Pediatrics, 109, 341-344.

Ross, M. W. (1990). The relationship between life events and mental health

26

in homosexual men. Journal of Clinical Psychology, 46, 402–411.

Russell, G. M. (2004a). The dangers of a same-sex marriage referendum for community and individual well-being: A summary of research findings.

Angles: The Policy Journal of the Institute for Gay and Lesbian Strategic Studies, 7 (1), 1-4.

Russell, G. M. (2004b). Surviving and thriving in the midst of anti-gay politics. Angles: The Policy Journal of the Institute for Gay and Lesbian Strategic Studies, 7 (2), 1-7.

Simmons, T., & O’Connell, M. (2003). Married-couple and unmarried partner households: 2000. Retrieved August 15, 2005, from US Census Bureau Web site: census.gov/prod/2003pubs /censr-5.pdf.

Smith, N. G., & Ingram, K. M. (2004). Workplace heterosexism and adjustment among lesbian, gay, and bisexual individuals: The role of unsupportive social interactions. Journal of Counseling Psychology, 51, 57-67.

Stacey, J., & Biblarz, T. J. (2001). (How) does sexual orientation of parents matter? American Sociological Review, 65, 159-183.

Stevenson, M. R., & Cogan, J. C. (Eds.) (2003). Everyday activism: A handbook for lesbian, gay, and bisexual people, and their allies. New York: Routledge.

Tasker, F. (1999). Children in lesbian-led families: A review. Clinical Child Psychology and Psychiatry, 4, 153-166.

Tasker, F., & Golombok, S. (1997). Growing up in a lesbian family. New York: Guilford Press.

Waldo, C. R. (1999). Working in a majority context: A structural model of heterosexism as minority stress in the workplace. Journal of Counseling Psychology, 46, 218–232.

Ta b l e 1 : Te x t o f Te x a s H o u s e J o i n t R e s o l u t i o n 6

(Retrieved August 15, 2005 from http://www.capitol.state.tx.us)

A JOINT RESOLUTION proposing a constitutional amendment providing that marriage in this state consists only of the union of one man and one woman.

BE IT RESOLVED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Article I, Texas Constitution, is amended by adding Section 32 to read as follows: Sec. 32. (a) Marriage in this state shall consist only of the union of one man and one woman. (b) This state or a political subdivision of this state may not create or recognize any legal status identical or similar to marriage.

SECTION 2. This state recognizes that through the designation of guardians, the appointment of agents, and the use of private contracts, persons may adequately and properly appoint guardians and arrange rights relating to hospital visitation, property, and the entitlement to proceeds of life insurance policies without the existence of any legal status identical or similar to marriage.

SECTION 3. This proposed constitutional amendment shall be submitted to the voters at an election to be held November 8, 2005. The ballot shall be printed to permit voting for or against the proposition: “The constitutional amendment providing that marriage in this state consists only of the union of one man and one woman and prohibiting this state or a political subdivision of this state from creating or recognizing any legal status identical or similar to marriage.”

FALL 2005

MEMBERSHIP APPLICATION Please fill this out and send it immediately!

Send to: Texas Psychological Association

Fax # 512-476-7297

1005 Congress Ave., Ste 410 Austin, TX 78701

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TEXAS PSYCHOLOGIST

2005 NEW MEMBERS

2005 PSY-PAC CONTRIBUTORS

May 31 through September 1, 2005 Doctoral Members Mike Brooks, PhD Vera Gill, PhD Arthur Joyce, PhD Ginger Kinsey, PhD Rose McDonald, PsyD James McLaughlin, PhD Mary Powell, PhD Robyn Reed, PhD Russel Thompson, PhD Associate Members Leah Getz, MA Charlotte Jensen, MA Student Members Ruben Aguirre James Bolton Michelle Cearley Sonya Cornwell Grace Dean, BA Tamara DeHay, BA Jared Dempsey, MA Neetha Devdas Clare Duffy Steven Gonzalez, ABD Debbie Gram, MA Elisabeth Hyland Charlotte Johnson, MS Lisa Kan Joanna Malach Ryon McDermott, BA Jennifer McGinty Elizabeth Otenaike Kim Roaten, MS Kelly Robinson Robert Seals Richard Sechrest Anna Thomison, BA Christina Torti, MA

28

$1000 or more Paul Burney, PhD

$300-999 Richard Fulbright, PhD Dean Paret, PhD Michael C. Pelfrey, PhD

$100-299 Barbara Alford, PhD Mary Alvarez-del-Pino, PhD Judith Norwood Andrews, PhD Larry Aniol, PhD Howard Atkins, PhD Kyle Babick, PhD Margaret Berton, PhD Nicole Bodor, PhD Malcolm Bonnheim, PhD Bonnie Brookshire, PhD King Buchanan, PhD Sam Buser, PhD Javier Carrillo, PhD Betty Cartmell, PhD Frankie Clark, PhD P. Andrew Clifford, PhD Ron Cohorn, PhD Jim Cox, PhD Mary Cox, PhD Walter Cubberly, PhD Caryl Dalton, PhD Mary De Ferreire, PhD Michael Duffy, PhD, ABPP Anette T. Edens, PhD Wayne Ehrisman, PhD Patrick J. Ellis, PhD John V. Elwood, PsyD Richard Ermalinski, PhD Ronald Garber, PhD Adrienne (Ann) Gardner, PhD Bonny Gardner, PhD Uri Gonik, PhD Cheryl L. Hall, PhD T. Walter Harrell, PhD James Ray Harrison, PhD David B. Hensley, PhD Robert M. Hochschild, PhD Jerry Hutton, PhD Sheila Jenkins, PhD Ronald J. Jereb, PhD Morton L. Katz, PhD Martha J. Kennedy, PhD Burton A. Kittay, PhD Christopher L. Klaas, PhD Kenneth Kopel, PhD

Franklin D. Lewis, PhD Marcia Lindsey, PsyD Arthur Linskey, PhD Stephen Loughhead, PhD Ann Matt Maddrey, PhD Dwayne D. Marrott, PhD Rebecca Marsh, PsyD Raul Martinez, PhD Sam Marullo, PhD Catherine Matthews, PhD Elizabeth Maynard, PhD Stephen P. McCary, PhD, JD Richard M. McGraw, PhD Sherry McKinney, PhD Brenda S. Meeks, PhD Robert W. Mims, PhD Lee L. Morrison, PhD Lane Ogden, PhD Sherry L. Payne, PhD Francisco I. Perez, PhD Randy E. Phelps, PhD Robin Reamer, PhD Elizabeth L. Richeson, PhD David M. Sabine, PhD Katie D. Salas, PhD Leigh S. Scott, PhD Ollie Seay, PhD Robbie Sharp, PhD Brian Stagner, PhD Constance J Turner, PhD Melba Vasquez, PhD David Wachtel, PhD Colleen A. Walter, PhD David J. Welsh, PhD M. Wright Williams, PhD Connie S. Wilson, PhD John W. Worsham, PhD Mimi Wright, PhD

Less than $100 Brian Carr, PhD Peter Cousins, PhD Sylvia Gearing, PhD Guillermo E. Gonzalez, Jr., PhD B. Thomas Gray, PhD Charles Kluge, PhD Charles McDonald, PhD Kermit Parker, PhD Verlis L. Setne, PhD Laura Spiller, PhD David R. Steinman, PhD Patricia D. Weger, PhD

FALL 2005

TEXAS PSYCHOLOGIST

2005 SUNRISE CONTRIBUTORS

2005 TPF CONTRIBUTORS

$100 or more

Less than $100

$100 or more

Judith Norwood Andrews, PhD Anthony Arden, PhD Jana Assenheimer, PhD James Berkshire, Ed.D. Corwin Boake, III, PhD Paul Burney, PhD Gloria Chriss, PhD Alexandria H. Doyle, PhD Wayne Ehrisman, PhD David B. Hensley, PhD Carola Hundrich-Souris, PhD Stephen P. McCary, PhD, JD Manuel Ramirez, PhD Elizabeth L. Richeson, PhD Brian Stagner, PhD Richard Wheatley, PhD Kenneth F. Wise, PsyD John W. Worsham, PhD Sean Connolly, PhD

Dorothy C. Pettigrew, PsyD William Randy Frazier, PhD Richard Fulbright, PhD Laura Spiller, PhD William M. Erwin, PhD Carol Grothues, PhD Dwayne D. Marrott, PhD Leigh S. Scott, PhD Neil B. Holliman, PhD Michelle Lurie, PsyD Robin Binnig, PhD Sam Buser, PhD Daniel Corley, PhD Richard E. Eckert, PhD Robert M. Hochschild, PhD Ronald J. Jereb, PhD Morton L. Katz, PhD Burton A. Kittay, PhD Richard M. McGraw, PhD Lee L. Morrison, PhD Gary Neal, PhD Deborah Rabeck, PhD Robbie Sharp, PhD Jeffrey C. Siegel, PhD Edward Silverman, PhD Jules Weiss, EdD Burton J. Zung, PhD Thomas Johnson, PhD Mary Burnside, PhD Marcia Lindsey, PsyD Patricia Perrin, PhD

Caryl Dalton, PhD Patrick J. Ellis, PhD Ronald Garber, PhD Jerry Hutton, PhD Catherine Matthews, PhD Elizabeth D. Richardson, PhD Robbie Sharp, PhD David Wachtel, PhD Manuel Ramirez, PhD Sam Buser, PhD

* * * * *

* * *

G

Less than $100 Peter Cousins, PhD, ABPP Wayne Ehrisman, PhD B. Thomas Gray, PhD Ronald J. Jereb, PhD Laura Spiller, PhD

Out TPA’s Member Benefits!

Are you in the market for pr o f e s s i o n a l l i a b i l i t y i n s u r a n c e ? Call TPA's preferred vendor, American Professional Agency, 800-421-6694. Renewal reduction when you attend one of Eric Marine's workshops at the Annual Convention!

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FALL 2005

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TEXAS PSYCHOLOGIST

e d i Ins The APA recognized J a m e s H . B r a y , P h D with several awards at their Annual Convention: Fellow of the Division of State Psychological Association Affairs for his outstanding contributions to psychology, Presidential Citation from the Division of Media Psychology for invaluable service and dedication to the growth and success of the division, and Certificate of Appreciation from the Division of Family Psychology for contributions as Council representative 2000-2005. In addition, he received the Faculty Teaching Award for 2004-2005 from the Department of Family and Community Medicine, Baylor College of Medicine, in Houston.

Je nnifer Imming , Ph D is excited to announce the opening of her private practice! You may find her new contact information at www.drjenniferimming.com.

Charlotte M. Kimmel, PhD is being promoted to Fellow Status with the American Association on Mental Retardation (AAMR) at their annual conference in Washington DC on September 21. AAMR Fellows must have made a meritorious contribution to the field of mental retardation through their employment, research, or years of service to persons with mental retardation. Dr. Kimmel has worked in the field of mental retardation for 30 years and has made numerous presentations at local, regional, state, national, and international conferences. In addition, she has several research papers that have been published in related journals. Dr. Kimmel currently is the Director of

TPA

Psychology Services at Mexia State School which serves juvenile and adult offenders with mental retardation who have been determined incompetent to proceed to trial.

TPA member S t e p h e n L o u g h h e a d , P h D co-produced with Christina McGhee, MSW a video for children of divorce.

Released in January 2005, Lemons 2 Lemonade has already gained the respect of parents and divorce professionals everywhere.

Lemons 2 Lemonade was recently honored with both a Bronze Telly Award in the 26th Annual Telly Awards competition and an iParenting Media Award in their 2005 Outstanding Products Call.

Scott Poland, PhD has retired from many years as the Director of Psychological Services for Cy-Fair ISD and has moved to Florida. Scott accepted a position as the School Psychology Program Administrator at NOVA Southeastern University in Fort Lauderdale.

Kimberly L. van Wa l s u m , P h D (Texas A&M - College Station, 2005) has taken the position of Educational Director of Clinical Simulation at Scott & White Memorial Hospital/Texas A&M University System Health Science Center/College of Medicine in Temple, Texas. She will be involved in designing medical education and research using high fidelity human simulators and standardized patients, in collaboration with physician and other health professional colleagues.

Classified Advertising Austin group looking for a colleague! Come join an existing group of solo practitioners with a minimum of 10 years each in private practice. Very nice office in central Austin available October 2005, complete with support staff.

Pleasant atmosphere with well-established professionals. This is a wonderful opportunity to establish or expand a practice in Austin with the possibility for referrals. 512-454-3685 ext 21.

North Texas State Hospital is recruiting highly skilled and motivated Doctoral Psychologists for its General Psychiatric programs, Wichita Falls campus, and Forensic programs, Vernon campus. Responsibilities: assessment, treatment and consultation services. Competitive salary and great benefits. Proximity to DFW; cutting-edge psychiatric hospital practice. An Equal Opportunity/Drug Free Workplace. For additional information, contact Michael Jumes, PhD 940-552-4140 or michael.jumes@dshs.state.tx.us or visit http://jobs.hhsc.state.tx.us.

Expanding interdisciplinary private group practice seeks a Texas licensed Psychologist, must have experience in working with children school age to adolescents. Located in a prominent part of Houston, the office has a very attractive setting. Very little managed care/emergency work. Forward resumes by fax: 713-621-7015 or email: john@tarnowcenter.com.

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FALL 2005

New Horizons

for Texas Psychology 2005 TPA Annual Convention November 3-5, 2005 Hyatt Regency Hotel Houston, Texas Imagine getting all of your CE Credits in one place in just a few days! With the many choices available to you, you can catch up on the latest research in your field, find out what regulations and laws will change the way you do business, and receive the Continuing Education you need for your professional excellence, including many options for Ethics CE credits. In addition, you will enjoy stimulating exchanges with your peers, make new contacts and renew your commitment to your profession. The TPA Convention is the only way to accomplish all this at one time, in one place, right here in Texas.

Take a look at www.texaspsyc.org for all the workshop listings. Then register for the convention right online and make your hotel reservation at the same time. The 2005 TPA Annual Convention will be hosted by the elegant Hyatt Regency Hotel in Houston. Just click the hotel link on our website to receive the convention rate of $139, or call 713-654-1234 and mention that you will be attending the TPA Convention.

With more than 140 workshops, research papers, posters and more, this is an event you can’t afford to miss.

See you in Houston!

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