Fall 2006 Texas Psychologist

Volume 57 Issue 3 FALL 2006

psychologist A SS TT EE XX A

Positive Psychology

APA President Candidate Statements www.texaspsyc.org

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Donna Davenport, PhD Brian H. Stagner, PhD Co-Editors

David White, CAE Executive Director

Sherry Reisman Assistant Executive Director

George Arredondo Marketing / CE Coordinator

Lindell Brown Membership Manager

Lynda Keen Bookkeeper

FEATURES 8

Amber Frausto

Bonny Gardner, PhD, MPH

Administrative

Bryan White Intern

TPA Board of Trustees

Where the Rubber Hits the Road: Local Advocacy in Austin-Travis County for Psychiatric Emergency Services

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APA President Candidate Statements

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Positive Psychology in Clinical Practice and in Non-Clinical Professional Groups

Melba Vasquez, PhD President

Michael B. Frisch, PhD

M. David Rudd, PhD President-Elect

Ron Cohorn, PhD

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President-Elect Designate

Psychological Assessment and Treatment of Patients with Chronic Pain Jeff Baker, PhD, ABPP

Paul Burney, PhD Past President; CAPP Representative

Board Members Tim Branaman, PhD, ABPP Mary Alice Conroy, PhD Donna Davenport, PhD Alan Fisher, PhD Robert McPherson, PhD Randy Noblitt, PhD Lane Ogden, PhD Verlis Setne, PhD Brian Stagner, PhD Thomas Van Hoose, PhD Alison Wilson, PhD

Ex-Officio Board Members Mimi Wright, PhD PSY-PAC President

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The Positive Psychology of Humility Relative to Arrogance Wade C. Rowatt, PhD

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Uncovering the Elepant in the Living Room Elizabeth L. Richeson, PhD, M.S. PsyPharm

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The Great Local Area Society Challenge Rob Mehl, PhD, PSY-PAC President

DEPARTMENTS 4

From the Editor Donna Davenport, PhD

Elizabeth Richeson, PhD Texas Psychological Foundation

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Business of Practice Network Rep.

Deborah Horn

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Ollie Seay, PhD Sherry Reisman 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.

From the President Melba J. T. Vasquez, PhD, ABPP

Student Division Director

Federal Advocacy Coordinators

From TPA Headquarters David White, CAE

Jerry Grammer, PhD

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PSY-PAC Contributors Legislative Champions 2006 TPF Contributors

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Welcome, New Members

www.texaspsyc.org FALL 2006

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Texas Psychologist

FROM THE EDITOR

Donna Davenport, PhD

Welcome to the pre-Convention issue of Texas Psychologist!

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s usual, you’ll find articles here discussing approaches that are on the cutting edge of the practice of psychology, articles which we hope will instruct, inspire, and perhaps provoke you into sharing your own approaches. Texas is filled with psychologists who are pushing the boundaries, reshaping old stereotypes of what psychologists do. Please consider

submitting an article describing your emerging thoughts and practices!

We look forward to seeing many of you in Dallas, and to participating again in the exciting interchanges that routinely take place at TPA conventions. If you have not yet registered, please consider doing so. Presentations will cover topics similar to those described in these articles, as well

as issues ranging from neuropsychology to religion to gender issues. It’s hard to imagine a comparable place where you could count on renewing your old connections and forging new ones with such bright, energetic, genuinely nice people--and at the same time accumulating valuable continuing education hours.

See you in November!

CONFIDENTIAL AND EXPERIENCED

LEGAL REPRESENTATION FOR

TEXAS PHYSICIANS

Representation before The Texas State Board of Examiners of Psychologists, Texas Medical Board, The Texas Medical Foundation, and Medical Staff Peer Review.

• Personal Counsel in Medical Liability Cases • Non-Profit Certification / Recertification • Probation Modification / Termination • Managed Care Exclusions • Licensure • Reinstatement • Medico-legal Issues • Expert Review • Telemedicine • Medical Ethics Opinions • Physician Assistants.

MICHAEL SHARP*

COURTNEY NEWTON**

TONY COBOS**

SHARP & COBOS, P.C. ATTORNEYS AT LAW 4705 SPICEWOOD SPRINGS ROAD • SUITE 100• AUSTIN, TEXAS 78759 • 512 473 2265 • FAX: 512 473 8525 • www.sharpcobos.com * Board Certified in Administrative Law by the Texas Board of Legal Specialization. ** Not Board Certified by the Texas Board of Legal Specialization.

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FALL 2006

Texas Psychologist

FROM TPA HEADQUARTERS

David White, CAE

Connections…milestones…reunions

Faces fade with time as we move past our secondary school years, but the lessons learned remain. Especially when the lessons help build the foundation for our values.

I

had one such teacher who set a high standard for integrity, honesty, and leadership. Thirty-five years later this teacher entered my life again in an unexpected way to inspire me in my professional career.

As TPA’s 2006 President, Dr. Melba Vasquez impacted my life first as my 6th grade teacher and today she continues to be a role model in my position as Executive Director for TPA. She has taught me how

in my family, friends, TPA board members and long time high school friends.

At that time Dr. Vasquez was currently serving on TPA Board of Trustees and it was the reconnection with the some of my high school friends that this past relationship actually surfaced. As the story goes, prior to my arrival at this party, the invited guest were visiting and getting to know each other. It was at this time when my

one of the most memorable birthday parties I have ever had.

Just as she did 35 years ago, Dr. Vasquez continues to teach me integrity, honesty, professionalism, leadership and one of the best qualities anyone could ever have, a caring and loving heart. She continues to lead the Texas Psychological Association and has become a leader at the American Psychological Association. Her work on

Just as she did 35 years ago, Dr. Vasquez continues to teach me integrity, honesty, professionalism, leadership and one of the best qualities anyone could ever have, a caring and loving heart. to be a leader in all areas of life. To realize that different perspectives are vital to making important decisions, whether in running an organization or making a strategic political move. To remember that leaders must represent various constituents and take into consideration the viewpoints of individuals who might not be represented at the same level as other groups.

The unusual part of this story is that I didn’t make the connection of our past until a surprise birthday party I had several years ago. This special occasion brought FALL 2006

high school friends recognized her as our long ago 6th grade teacher. The name was different because she was in her first marriage but her warm personality, her sincere friendship and her care for her students reminded us that Ms. Garza was in our presence. After a brief search the year book was found and the stories began about the type of students we were and whether our grades in 6th grade English had any correlation with our behavior and professions in our adult life. The laughter lasted well into the evening and needless to say it was

the APA Council of Representatives along with her recent election to the APA Board of Directors, has made her one of the profession’s strongest advocate.

It has been one of my greatest honors to work with and for my 6th grade teacher this year. She continues to encourage me to grow professionally and personally. She is a true leader; a mentor to me and a leader in your profession at the state and national level.

Connections…milestones…reunions – they all intertwine.

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Texas Psychologist

FROM THE PRESIDENT

Melba J. T. Vasquez, PhD, ABPP

Join, Participate, Contribute

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am sometimes asked why I stay so politically active and involved in psychology organizations and activities. The answer is complex, of course, but the simplest answer is because I passionately and sincerely believe in psychology and its power to improve people’s lives. I learned from my parents that involvement at various political levels could make a difference. That belief influenced my pro-activity about concerns in which I believe. So I would like to devote this column to encouraging involvement of all kinds from all of you.

We all make contributions to society through our work, whether we conduct and publish research, teach, or practice. But I would like to suggest that involvement in organized psychological associations provides additional avenues for implementation of our work for the good of society.

In turn, we benefit from opportunities for learning through continuing education, as well as to network, and promote leadership, career, and professional identity. David Rudd eloquently articulated the reasons that Academic psychologists should join (or stay with) TPA in the last issue of the Texas Psychologist. Within TPA there are many structures to support and promote the human welfare portion of our mission. TPA indeed works to support psychologists regardless of area of concentration.

Join This Texas Psychologist goes to all 3561 licensed psychologists in Texas. Of those, 1185 of you are members of TPA, and 266 members are other membership types for a 6

total of 1451 members. I want to invite each and every one of you to become a member of TPA if you are not; you can join online at www.texaspsyc.org or call the Central Office to have a form sent to you (888) 872-3435.

If you paid a consultant to do a small portion of what this organization does on your behalf, it would be many times the cost of membership. The same is true for APA. Join TPA and/or APA today! I know that most of us are members of other important specialty organizations, but these two are the primary workhorse organizations on our behalf.

Our careers and lives are significantly and regularly impacted by the work of legislators.

The staff and volunteers involved in TPA (and other state organizations) and APA (and other national organizations) work very hard to address difficulties impinging on our work.

My colleague Jeff Barnett, past president of Division 42, Psychologists in Independent Practice, pointed out how they fight: against destructive managed care policies; for parity of all mental health services; to include psychology in Medicare/Medicaid funding; for funding of post-graduate training; for debt relief programs; for prescriptive authority; for hospital privileges; against challenges to our licensure laws and the efforts of other groups with more limited training seeking to be licensed to do all the same things psychologists do professionally, as we recently did in Texas.

Most of these concerns are addressed in state legislatures.

We know from our successful efforts at the national level to block the Health Insurance Marketplace Modernization and Affordability ACT (HIMMA) that legislators

are responsive when thousands of constituents speak to them and provide them with needed information. The APA Practice Directorate activated more than 18,000 messages from psychologists to their legislators to prevent creation of association health plans exempt from state consumer protection laws, including mental health parity, psychology “freedom of choice,” mental health benefit mandates, and mandated offering laws. The Practice Directorate collaborated with 224 healthcare and patient advocacy organizations, which generated media coverage and intense public pressure to defeat the destructive legislation. TPA is also working to build coalitions at the state level to support our initiatives. But we need more involvement from more psychologists to be members of our organizations, to participate in activities, and to engage in political giving.

Particpate Run for office, engage in projects and activities through task forces, committees, divisions, special interest groups. I am pleased and impressed with the involvement of members this year. We had more people nominated for Board of Trustees than ever before. Fifteen people were nominated for six slots on the ballot from which we will elect three members. My hope is that each and every one of the fine candidates perseveres until they have the opportunity to serve on the TPA BOT. Most Local Area Society (LAS) presidents or representatives attended our first spring retreat, and many LAS members attended the Texas State Board of Examiners of Psychologists meeting to testify against independent FALL 2006

Texas Psychologist practice of Psychological Associates.

Vote! I invited the APA Presidential candidates to introduce themselves to Texas Psychologists through this issue of TP. The vast majority of APA members do not vote; ten years ago, 25 percent of the membership voted. Since then voting has ranged from the low 20’s to a low of 16.8% in 2005. Let us increase that percentage in Texas this year, by informing ourselves and voting for the candidates of our choice. Of 108 APA presidents, through 2007, only 11 women have been elected President. Two outstanding women are running now, including an African American woman for the first time. Our very talented native Texan James Bray is also running! Also, vote for one of the outstanding candidates for your TPA President-Elect Designate, and for members of the Board of Trustees.

Attend our TPA Convention, to be held at the Dallas Westin Galleria November 16-18, 2006. We believe that we have a fabulous set of programs and events to meet the learning needs of the diverse membership of our association. TPA has Divisions and Special Interest Groups to serve a wide variety of interests.

Go to our website to see the wide variety of specialties represented by these groups, most of whom hold meetings at convention.

Contribute I know that you are asked to contribute to a wide variety of great causes. Our Texas Psychological Association and our Political Action Committee (PSY-PAC) work tirelessly with legislators both during and between legislative sessions advocating for the causes mentioned above, as well as during our recent Sunset Review of our licensing board. We are gearing up for a very important and exciting session.

The Texas Psychological Foundation raises money to promote educational and research awards in very important areas. TPF Chair Betty Richeson has started a new fund for research against violence; her motivation is poignantly fueled by the murder of her 18year-old granddaughter this year.

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The Association for the Advancement of Psychology is the national psychology PAC. Chair Ron Fox is trying very hard to make us aware that psychologists’ per capita political giving is far less than physicians’ and dentists’, less than half that of nurses, and below that social workers, or of any health care profession. He suggests that if each licensed psychologist gave a mere $5 to $10 per year, we could be the second largest health care PAC in the United States. The American Psychological Foundation, the APA Practice Directorate and other APA Directorates request contributions via assessments or otherwise. Giving of our time and money, in whatever ways we are able, are contributions well spent. Political giving should be seen as a contribution to our own collective and personal futures.

I sincerely believe that we can make a difference, and that each and every one of you counts in those efforts. Please get involved and be an advocate on your behalf.

I wish all of you the very best!

Addendum: I am delighted that David White has shared, in this issue, the fact that we discovered a few years ago, after working together for several years, that I was his 6th grade teacher in 1973-74! When I taught school, I was in my first marriage, had the name “Ms. Garza”, and Da-

vid went by another first name. We did not recognize each other until his 40th birthday party, when his childhood friends also recognized me (and Jim Miller, my partner, who was also a teacher at the school, where we met!). I want to take the opportunity to say that I have very much enjoyed and appreciated observing David’s evolution as one of the most experienced and effective state executive directors in the country. He is very popular at the national level (state leadership conference) for his creative fund raising and successful conferences. He has also developed very sophisticated networking and lobbying skills, and we are truly getting quite a bang for our buck with David as our Executive Director. We have a fabulous staff, and he is responsible for recruiting such loyal and effective staff members!

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Texas Psychologist

Where the Rubber Hits the Road: Local Advocacy in Austin-Travis County for Psychiatric Emergency Services Bonny Gardner, PhD, M.P.H.

CATALYSTS FOR ACTION In June 2002, the death of Sophia King, an East Austin resident with a history of chronic, relapsing mental illness, helped highlight the deterioration of our publicly funded mental health system. This deterioration was due, in part, to local population growth, increased demand for service, and budget constraints at the federal, state, and local levels. The police shooting of Ms .King, who decompensated and apparently threatened the manager of a public housing complex , drew the attention of the press and the public. Ms. King in the past had benefited from a variety of supportive services from MH-MR, including case management, but appeared to have lost access to some of these services and gradually deteriorated in the weeks prior to the incident. The police had been called to the complex many times. The coverage of the incident focused attention on the local public mental health system and raised many questions about the wisdom of cuts in health and human services budgets, given their potential consequences. Since mental health issues are very personal and carry some stigma, there is often silence, and little scrutiny of problems, until a tragedy occurs.

Texas now ranks 47th relative to other states in per capita spending on mental health. In 2003, under House Bill 2292, in efforts to ration care, public funding for treatment of mental illness was limited to fewer diagnoses and those designated by the state as official priorities for treatment: schizophrenia, bipolar disorder, and major depression. A “disease management” approach was taken, rather than an approach focusing on prevention, early intervention, and provision of a comprehensive array of services. Persons with other diagnoses were to be referred outside the MHMR system to other local non-profit agencies unless a crisis were to develop. Also, under H.B. 2292 8

outpatient psychotherapy benefits for adults under Medicaid were eliminated, although these benefits were restored in 2005 through the combined efforts of state and local advocacy groups and Health Commissioner Dr. Eduardo Sanchez. Limitations in funds for earlier intervention, ie. outpatient community mental health and case management, have led to deferred treatment seeking and an increased need for more expensive services: ie. psychiatry emergency services and hospitalization for stabilization. Yet these emergency services have become increasingly inaccessible to the public. Austin State Hospital is overburdened in that it serves many central Texas counties and is strictly limiting new admissions and the only local private ,non profit inpatient mental health facility, Seton Shoal Creek is often full, with those with insurance sometimes turned away as well as low income persons. Austin Travis County MH-MR operates Psychiatry Emergency Services but is overwhelmed by local demand and holds patients only briefly before referring them on to inpatient or outpatient treatment. According to an Austin American Statesman article on mental health issues by Andrea Ball, dated July 2, 2006, from September 1, 2003 to August 31, 2005, there was an 84.8% increase in visits to Austin’s PES Center. There is now a six to eight months waiting list for patients who need outpatient follow up care through MH-MR., whereas two years ago there was not waiting list. Currently, the regional trauma center and partially publicly funded Brackenridge Hospital does not offer psychiatric emergency services or detoxification services. The contract between the City of Austin and Brackenridge did not include any provisions for these services. Yet many persons in a state of crisis present with complicated mental health, substance abuse, and physical health problems, and for their own safety, require the full range of medical diag-

nostic and treatment services best offered in an acute care setting like Brackenridge.

The problems within the mental health system are now impacting other systems as well. By default, in Austin-Travis County, the local jails have become holding environments and de facto detox centers for many individuals with serious mental illness or substance abuse problems, particularly low income persons without insurance. Travis County recently reached a settlement with the family of a woman who died in the Travis County jail in early 2004. The woman was withdrawing from heroin at the time of her death in jail and was dehydrated. According to data from the Travis County jail system provided to the American Statesman, twenty-six percent of the inmates in the jail system are on psychotropic medications, in contrast to only 15% in September 2004. Law enforcement officers with the City of Austin and Travis County are often using their time inappropriately in attempting to handle mental health crises, securing resources, and transporting persons in need of emergency hospitalization to state hospitals hundreds of miles from Austin. In 2004, the Gray Panthers of Austin, an advocacy group for health and human services and social justice, met with Chief Stan Knee of the Austin Police Department, to discuss training of police officers in handling mental health emergencies. Chief Knee commented that about 30% of police time was then being devoted to issues involving persons with mental illness and that improved training for officers was imperative, as well as funding for more mental health services in Austin-Travis County. A disturbing statistic is that the number of suicides in Austin-Travis County for the years from 1999 to 2003 is over two and a half times the number of homicides, according to data from the Texas State Department of Health Services. A shortage of resources poses a public health and safety FALL 2006

Texas Psychologist risk and has been frightening to all of us who deliver mental health services, as well as to patients and their families.

In a recent development in 2006, Travis County received a $500,000 grant from the Texas Task Force on Indigent Defense to establish the nation’s first stand alone public defender office whose mission is to provide persons with mental illness with legal aid and the assistance of social workers and other caseworkers to connect defendants with resources in the community to divert them from recycling through the jail system. However, the question remains: how can these defendants be diverted if so few community resources are available?

The situation in Austin-Travis County is probably not atypical of other areas of Texas, although larger cities with well-funded hospital districts and university medical centers are probably a step ahead in provision of psychiatry emergency services and detoxification. The Legislative Budget Board and Governor Rick Perry’s current proposal that state health and human services agencies plan to operate on a 10% budget reduction for next year further endangers our mental health system. There is a need for systematic, coordinated advocacy for mental health funding by all stakeholders. Proof that advocacy can work was the restoration of funding for Medicaid outpatient psychotherapy and also, in February 2006, the state approved 13.4 million dollars for extra beds at its psychiatric hospitals.

LOCAL RESPONSES/ LOCAL ADVOCACY In Summer 2004, Austin Mayor Will Wynn established a Mayor’s Mental Health Task Force which included representatives from city and county government, the state and local MH-MR system, the courts and law enforcement, public and private human service agencies serving persons with mental illness, state and local advocacy groups, ie. NAMI and the Texas Mental Health Association, and the Hogg Foundation. Some private sector representatives and representaFALL 2006

tives from local colleges were also included in the group which totaled over 80 persons.

The Task Force was charged with identifying strengths and gaps in the system, developing criteria defining a mentally healthy community, and creating an action plan to close gaps. TPA members Ollie Seay Ph.D., TPA Public Policy Chair, Joe White Ph.D., Director of Catholic Family Counseling and Family Life, Diocese of Austin, and I (representing Gray Panthers and Capital Area Psychological Association) participated in the deliberations which spanned five months.

There was a clear consensus on local needs and problems and necessity for more funding. However, at the outset, the facilitators of the Task Force meetings reminded us that more funding might not be feasible and we should focus on how we might improve the system otherwise. To many of us who have worked in human services over the years, this was a disheartening and familiar caveat.

Still, the meetings were great opportunities for all stakeholders to begin collaborating on advocacy. Remarkably, there was less rivalry based on agency self-interest than might be expected. While the Task Force final report in January 2005 was weakened by not highlighting the critical need for more funding, worthwhile recommendations included: 1) establishment of policies consistent with Task Force criteria and close coordination of local planning initiatives and funding, with one entity taking the lead, 2) ongoing monitoring of implementation through a Mental Health Task Force Monitoring Committee, 3)ensuring relevancy of services, given cultural and linguistic differences, 4) improving education and training of human service providers and law enforcement as well as the public in regard to issues of mental health; 5) adherence to evidence-based best practices in service delivery, and 6) collection of data for needs assessment, for determination of service utilization, and for evaluation of process and outcome.

While there is no disagreement that prevention, and early intervention in mental health problems, enhanced community

awareness of mental health issues, better interagency coordination, better data and evidence based practices are needed, the critical lack of psychiatric emergency services has still not been resolved. The Mayor’s Mental Health Task Force Monitoring Committee has continued to meet, as a subcommittee of the Board of Directors of Austin-Travis County MHMR, which is the lead agency for implementation. Ollie Seay Ph.D. represents TPA within this group and now three TPA Social Justice Task Force members, Dr. Seay, Sylvia Servin-Lopez Ph.D. and I are also serving on the Monitoring Committee Community Awareness subcommittee.

Wisely, the Monitoring Committee’s 2005 report has now made a focus on psychiatry emergency services and suicide prevention a priority.

In January of 2005, representing TPA and Capital Area Psychological Association, I continued networking with a number of individuals and groups, ie. Gray Panthers of Austin, Austin Area Human Services Association, West Austin Democrats, Merily Keller, Director of the Texas Suicide Prevention Network, Austin Child Guidance Center, MHMR Representatives, and the Central Texas Labor Council, to underscore the need for funding for psychiatry emergency services. Additionally, District Judge Guy Herman of Austin was an invaluable ally in this effort, as was Constable Bruce Elfant and Travis County Commissioner Karen Sonleitner, and Austin City Councilman Lee Leffingwell. In a meeting of the Gray Panthers with Toby Futrell, Austin City Manager, we were encouraged to continue this type of collaborative advocacy to build the public will for funding increases. The City Manager expressed her own frustration with the local situation and indicated that while the City cannot directly fund mental health services, the city is willing to provide increased funding for supportive housing with attached services for persons with mental illness, once they are stabilized. In February 2006, representing Gray Panthers, CAPA, and TPA, I testified at a public hearing sponsored by the Texas 9

Texas Psychologist Department of State Health Services on redesign of the state and local mental health crisis system and the need for funding for mental health services in general, to avert crises. Capital Area Psychological Association is also involved in local advocacy efforts: Bruce Mansbridge Ph.D., CAPA President, Kay Allensworth, CAPA President Elect, and I indicated our concerns to the newly formed Austin-Travis County Hospital District CEO, Patricia Young. The Hospital District is a viable source of funding for local psychiatry emergency services and very recently decided to allocate $500,000 to underwrite the cost of inpatient crisis stabilization beds at Seton Shoal Creek for low income and indigent persons with mental illness for the first time.

However, there is no guarantee that funding will continue beyond the first year. According to Ms.Young, in an era of cutbacks there are many competing and legitimate needs for funding, and balancing them is difficult. For

this reason, sustained, multi-group advocacy is the key to success.

In May 2006, CAPA President Bruce Mansbridge Ph.D, Kay Allensworth Ph.D, and I arranged for a joint letter from CAPA and William Holcomb M.D., President of the Austin Psychiatric Society, explaining the urgent need for funding for emergency mental health services locally. Copies were sent to the City Manager, the Mayor, the County Commissioners, and the Hospital District CEO. Two of our local state representatives Elliot Naishtat (D) District 49 and Donna Howard (D) District 48 are champions of mental health and have indicated support for our efforts, despite the realities of state fiscal conservatism in human services. The recent resignation of the very capable and progressive Eduardo Sanchez M.D., head of the Texas Sate Dept. of Health, is yet another setback for health services in Texas.

In an adverse funding climate, when change occurs slowly, when processes are cumbersome, and when it is often difficult to determine who the real decision-makers are, it is easy to become discouraged. The very complexities of the health service system make it difficult to see where opportunities for change may exist. However, given state and federal agencies with mandates to limit spending on human services, advocacy at the local level becomes more important than ever in shaping outcomes. This work has been exciting and inspiring and I have been surprised at how well-received our efforts have been. Coalition-building seems to be the key.

It now appears that law enforcement and the mental health system may be joining forces to address problems which affect all segments of the community. I welcome suggestions and participation from all psychologists here in Central Texas and across the state who want to improve our public mental health system.

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Texas Psychologist

Texas Law and the Practice of Psychology A Sourcebook

By TPA Editors Code: XB-205 ISBN: 1886298203 Pages 256 $35.00

The Single Resource for the Legal Guidelines Shaping the Practice of Psychology in Texas.

T Texas Law and the Practice of Psychology provides licensed psychologists, psycchology students, interns, and professors with the key legal and policy issues specific to the state of Texas today. Issues directly affecting all these practitios ners and their students have been carefully selected from statutes, case laws, n official archives of the Attorney General Opinions and Open Records Opinions o as well as synopses of the opinion letters of the Texas State Board of Examina ers of Psychologists. No other compilation of such critical, up-to-date material e exists for the state of Texas. e Quickly and easily find information that would usually take hours to track down.

Practitioners and students alike will find comprehensive codes related to: • Civil Practice and Remedies • Human Resources • Education • Insurance • Family • Penal • Occupation • Health and Safety • HIPAA

For more information or to order, go to www.bayoupublishing.com and click on the books link or email orders@bayoupublishing.com or call 800-340-2034

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APA PRESIDENT CANDIDATE STATEMENT To follow are the American Psychological Association President candidate statements. TPA does not endorse any candidate. The statements are for your reference/information if you are participating in the APA elections.

Rosie Phillips Bingham, PhD, ABPP Inclusion is Power!

APA is a 150,000 member organization of some of the most able minds in the world. We have the power to lead the world toward peace and humanity through the science, education, and practice of psychology. I want us to realize that power through drawing a circle that includes all of our practitioners, all of our scientists, all people of color, all international psychologists, all state and regional associations, all genders, all religions, all with disabilities, all gays, lesbians, bisexuals, all orientations, all ages, all ethnicitiesall psychologists.

We must solve problems of managed care and prescription privileges. We can use our science community to bring power to the fight that practitioners are having with insurance companies and legislators who do not understand what it takes to bring quality care to the mental health needs of our society. Further, we need those same bright minds to support necessary changes in the current reciprocity/mobility efforts by ASPPB, the National Register, and ABPP as licensing laws change. We need scientific data to substantiate the practicality and rationality of license portability so that we can support our case to those who have questions.

We must bring together the best minds from our practice, education, and science communities to implement the Science Directorate agenda, PSY 21, a plan to set scientific priorities in APA. We need help with Institutional Review Boards. Practitioners must be in the science circle so that practice can strengthen scientific research and help those in influential places understand the essential place of psychological science in the building and flour-

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ishing of society.

We must include in the circle the best minds from education, science, and practice so that we can solve pipeline issues. Who will be the next generations of psychologists? We are aging and need more psychologists who care about issues that matter.

We must include practitioners, scientists, and educators who can help us implement the diversity guidelines and implement the recommendations from the Presidential Task Force on Enhancing Diversity within APA. Within APA we have too many factions and fractures and far too many groups and individuals feel disenfranchised. When we have factions and fractures, our power is diluted and we do not have the energy TO take on the major issues. I will establish a task force charged to bring action-based solutions for strengthening the science-practice collaboration. WE can host a summit that is structured as a practice/science collaboration that is problem-based and solution focused. The problem could be “Managing Managed Care: Insuring that Psychologists Can Earn a Living” or it could be “Funding the Science of Psychology.” The team of psychologists would determine the problem. It is the duty of the President to present the larger picture and then ask colleagues to bring their time and talent as practitioners, educators, and scientists to help specify the problems and find the methods that direct us toward solutions.

I want to be your President.

Please give me your number 1 vote. http://saweb.memphis.edu/binghamforapapresident/

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APA PRESIDENT CANDIDATE STATEMENT

James H. Bray, PhD As a member of TPA (1986) and APA governance for over 15 years, I will work tirelessly to enhance psychology through expanding opportunities in science, practice, education and public interest for all psychologists. This broad experience earned strong endorsements by science and practice divisions, APA caucuses, and state psychological associations.

APA is a strong and powerful organization, much better than when I ran for president in 2002. However, in discussions with hundreds of psychologists; practitioners, scientists and educators, many are deeply concerned about their future in psychology.

should work together for the mutual beneďŹ t of all psychologists.

Education Issues Educators are also struggling with funding cutbacks. Our young psychologists are leaving graduate school with record levels of debt, making it difďŹ cult for them to make a reasonable living.

Students considering a career in psychology are re-thinking their decisions because of economic limitations within the profession and this disproportionately impacts students from disadvantaged backgrounds.

Practice Issues Practitioners are besieged with threats to scope of practice from other professions. Managed care continues to ravage our profession, as they over-regulate and withhold psychological services from our clients/patients. We cannot let an overly rigid evidence-based practice perspective interfere with long held practices in psychology. Primary care providers treat over 60% of mental health problems, without assistance from psychologists. Minority, underserved, and elderly patients suffer even more from these systems of care. Psychologists can provide solutions to effectively prevent and treat the major health and mental health problems of our nation because we are the profession that knows the most about human behavior and how to change it. We need to use our psychological science to enhance our practice and expand into primary care and gain prescriptive authority.

A Culturally Expanded Profession We require more psychologists who are culturally and linguistically competent and to get more minority students we need to start earlier in the educational pipeline. The president has the power to keep a focus on issues and diversity and problems related to socioeconomic status will be priorities.

We need to work together to support all psychologists. Through my extensive experience and established working relationships within APA, we can do this and much more.

I thank the Texas Psychological Association for the opportunity to address our members. I look forward to working with TPA as APA President.

Science Issues Over 50% of health problems are caused by psychosocial factors, yet less than 7% of the NIH budget is spent to research them.

Although NIH budgets are at record high levels, many scientists cannot get their research funded. It is time for APA to join with other behavioral science groups to increase the percentage of the NIH and NSF budgets for psychological science, which will provide incentives for young scientists to join APA. Furthermore, APA and APS

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James H. Bray, PhD is Associate Professor of Family and Community Medicine and Psychiatry, Baylor College of Medicine. He teaches psychology students, resident physicians, and medical students. He conducts research on divorce, remarriage, adolescent substance use, and applied methodology. He has a clinical practice in family psychology and behavioral medicine. Please visit my web page: http://www.bcm.tmc.edu/ familymed/jbray for more information.

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APA PRESIDENT CANDIDATE STATEMENT

Alan E. Kazdin, PhD, ABPP My Priorities

My Background

• Clinical Practice and Service. For many of us employment depends on overcoming impediments to practice. Suitable reimbursement for services, license portability, expanded services (e.g., prescription authority), and greater participation in health care more broadly are essential priorities. My own clinic is on the ropes because of the reimbursement issues alone. I will lobby vigorously for our clinical agenda and convey to our colleagues that all of our profession must be involved.

• I am licensed psychologist in two states and a Diplomate (ABPP). I direct an outpatient service and see children and families everyday. I work with managed care agencies and the state legislature to lobby (effectively) for improved services and reimbursement.

My clinical and research experience with medication (e.g., published medication trials and work with pharmaceutical companies) will help me lobby strongly for prescription authority.

• Diversity, Culture, and Identity. I intend to move diversity, culture, and identity to center stage of APA in training, service, and science. Most programs have insufficient training, mentoring, and research opportunities. We need to understand how identity operates so we can to provide more sensitive and informed clinical services and educational programs and extend our service and science worldwide.

• Children and Families. Children and families are a focal point for many aspects of service, practice, science and have been my career focus. Child and family issues also unite many of our professional concerns (e.g., day-care, education, family leaves, addiction, exposure to advertising) and APA Divisions.

• International Focus. Globalization is critical to us, and we should become a more effective international force and partner with other countries and organizations. There is an opportunity to strengthen our global reach to help people and expand the impact of our profession.

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• I have chaired two departments (at Yale and Yale Medical School) and have increased the proportion of senior and junior women, minority, and lesbian/gay faculty. I have also obtained NIMH grants to train minority students in clinical-research.

• In my administrative positions, I have overseen programs in all 50 states of the US, including of course the Great State of Texas, and in 57 countries (e.g., on terrorism or trauma from natural disasters).

• My clinical research with children and families focuses on process and outcome of child and family therapy, therapeutic alliance, barriers to treatment among underserved families, child violence and aggression, parent stress, and family relations. The 600+ publications from this work will help me be a credible advocate for our practice as well as our science.

Your Vote and Support I am Alan E. Kazdin, John M. Musser Professor of Psychology and Child Psychiatry at Yale University and Director of the Yale Parenting Center and Child Conduct Clinic. I ask for your support and your vote. I will be a strong and vibrant voice for all of psychology. I am eager to work with you to improve the conditions of our country and advance our profession and practice (please see http://votekazdinapa.yale.edu). Thank you!

FALL 2006

APA PRESIDENT CANDIDATE STATEMENT

Nora S. Newcombe, PhD The existence of a discipline called psychology is widely taken for granted. At some level, most of us assume that the organization of the world of knowledge will remain as we have always known it.

We also believe, without too much reflection, that the relation of practice and science will continue in the traditional way, a strained yet long-term marriage that both partners have doubts about. But actually there is good reason to believe that revolutionary changes are underway. Managing these changes represents an exciting challenge that APA is uniquely well-situated to address.

• First, in an era of translational research, scientists must clarify the relation of their work to questions that concern policy makers and the public. The best way to accomplish this goal is by forging dynamic new connections between science and practice.

APA must provide the contexts in which dialogue can occur and productive partnerships can be formed.

• Second, knowledge is simultaneously becoming more specialized and more interdisciplinary. Therefore, many scientists’ allegiance is no longer to the traditional discipline of psychology, and therefore not to APA. APA must seek new ways to connect to its science constituency, leading the way to a transformed psychology by organizing the “big picture” activities that only an over-arching organization can offer.

• Third, in an increasingly evidence-based environment, for both practice and education, APA must build on what it has done recently, to delineate the most appropriate ways in which to generate new kinds of evidence and evidence on uncharted areas, as

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well as addressing what is best done when evidence is unavailable yet decisions must nevertheless be made.

The major reason I am running for the APA Presidency is my passionate commitment to the unity of psychology. However, in addition, I would want to focus on certain specific initiatives.

• The public face of psychology. The public is not clear about what psychology is. The science-practice split has created a fuzzy “brand” for our discipline.

Are we quasi-shrinks or quasi-scientists? If we are quasi-shrinks, are we second-class ones? If we are quasiscientists, where are our test tubes, or do we just discover what Grandma already knew? The key to influence begins with healing the science-practice split.

• Work and family. Childcare is often seen as a “women’s issue”, rather than a family-work issue. These different framings have important consequences. I want to focus on how to best pose problems so that women and men, families and children, all get the support they need for healthy development.

• Psychology and education. The science of learning is an interdisciplinary enterprise whose time has arrived. Various sub-disciplines of psychology (e.g., cognitive, developmental, educational and school psychology) have important roles to play in a science of learning, and yet communication among these sub-disciplines has not been optimal. APA needs to take initiatives to strengthen cross-talk both within psychology and with other disciplines (e.g., mathematics and science education, computer science) to support the emergence of a dynamic science of learning.

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APA PRESIDENT CANDIDATE STATEMENT

Stephen A. Ragusea, PsyD, ABPP Dear Colleague, My name is Steve Ragusea and I’m running for the position of President of APA. Some folks have asked me why I’m running. Here’s the answer.

This is now the fifth time I’ve been asked to run for the presidency of the American Psychological Association and it’s always an honor to be asked. I never refuse the profession that has given me so much.

This time, more than others, I very much want to win and, if I can win at all, it’s going to be because I have the support of all the practitioners in APA. And, that means I need the support of the membership of the state psychological associations.

I am past president of the Pennsylvania Psychological Association and currently on the Board of Directors of the Florida Psychological Association. For virtually my entire career, I have contributed time and effort to my state psychological association. No other organization is more dedicated to the support of psychological practice.

This year, four of the five presidential candidates are primarily academic psychologists. I am the only candidate who derives my primary income from providing services to patients. Indeed, 100% of my income comes from practice, as it has for almost all of my 26-year career. It has been many years since a full time practitioner was elected president of APA. There are lots of reasons for that piece of hard reality.

What will it mean if another academic is elected president of APA? It means that once more, the point of view of the average

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practicing psychologist will not be expressed at the highest level of APA governance. Once again, there will be nobody to focus APA’s attention on the major income loss suffered in recent years by tens of thousands of practicing psychologists. Once again, there will be nobody at the top who really understands the managed care dilemma. Once again, nobody on top will represent the average member of APA, who is a practitioner.

This year, the practice community has an opportunity to elect somebody who has been in practice for a quarter century, somebody who understands practice and the need to expand the market for our services, somebody who understands the need for relevant psychological research and relevant psychological organizations at the state and national levels.

My name is Steve Ragusea and I’d like your support. I need your #1 vote and I need you to tell your friends. I’m willing to serve you at APA, but I need you to help me get elected. Practitioners have run in the past but the practice community has not given them the necessary support. Will you help me win this year?

This time can be different.

This time we can do better.

This time, a practitioner for a change.

That’s why I’m running for president of APA. If you’d like to know more about my background, please explore my website: www.raguseaforapa.com

FALL 2006

Texas Psychologist

Join one of TPA’s Special Interest Groups (SIG) or Divisions.

Contact Amber Frausto at membership@texaspsyc.org to let her know if you wish to join.

You must be a TPA member in order to participate.

Binational Issues SIG

Aging Division

Child/Adolescent Issues SIG

Forensic Practice Division

Gay/Lesbian/Bisexual/

Psychopharmacology Division ($10 dues required)

Transgender Issues SIG Mental Retardation/

Women in Psychology Division ($10 dues required)

Developmental Disabilities SIG Diversity SIG

Psychologists in Schools Division ($10 dues required)

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FALL 2006

17

Positive Psychology

Positive Psychology in Clinical Practice and in Non-Clinical Professional Groups Michael B. Frisch, PhD Professor Department of Psychology and Neuroscience Baylor University PO Box 97334 • Waco, TX 76798

A Million Ain’t Enough and Rationale for Positive Psychology Intervention.

According to a client, “A Million Ain’t Enough”, a million dollars is no longer a secure nest egg for business people. Indeed at least fifty million is necessary. “Million” was a software tycoon from Dallas who, while unhappy in some respects, did not have a bone fide DSM clinical disorder per se (In keeping with the APA Ethics Code this case is disguised enough to make it impossible to identify the client). An initial quality of life assessment, using the author’s QOLI or Quality of Life Inventory (Frisch et al., 2005; Frisch 1994) indicated a rather impoverished existence dominated by work. Million’s overall QOLI score was low enough to put him at risk for a clinical disorder in the future, especially clinical depression (Frisch et al., 2005). In terms of Million’s valued areas of life that made up his “happiness pie, salad, or stew,” he was satisfied with the areas of Goals-and-Values and Spiritual Life, Self-Esteem, Health, Relationships with friends, relatives, and co-workers, Learning, Creativity, and Surroundings— Home, Neighborhood, Community. Million was dissatisfied, however, with the highly prized areas of Love Relationship, Helping, Play, Work, and Money.

Million was quite lonely and longed to have a family life. As a Conservative Jew, he insisted on marrying another Jew rather than the many shiksas in his acquaintance. Million admired the noblesse oblige spirit of wealthy entrepreneurs like Bill Gates who (prior to retirement) set aside part of their wealth and time to run charitable foundations. After hearing about the powerful effects of service work or Helping activities on quality of life, Million decided to pursue this area along with Love Relationship as the initial foci of his counseling or coaching, the latter term denoting work with non-clinical populations.

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Million created a non-profit foundation aimed at educating the poorest people of color in Dallas through innovative programs that brought indigenous counselors into the home from infancy to school-aged. Parents were empowered to teach and raise their children in a way that might make their children’s lives more fulfilling and less difficult than their own. Million sought out Board members for his non-profit corporation. The added life focus of a charitable foundation did nothing directly for Million’s business. Rather. it constituted a “frivolous flow” that was nevertheless highly engaging and fulfilling both through the cause it served and through the myriad social contacts it engendered (Frisch 2006). Finding a like-minded Conservative Jew for a mate proved daunting. After meeting women from around the country, Million fell in love with a woman from Mexico. Her origin became a counseling issue as a result of prejudice on the part of Million, his family, and associates; interestingly, his love interest, although born in Mexico, was from a Russian Jewish family as was Million. After some multicultural counseling and positive psychology relationship interventions, Million proceeded to marry his love interest who was a business person herself.

In terms of outcome, Million’s overall quality of life score moved to within the average range at his post-intervention assessment.

This overall improvement seemed traceable to greater fulfillment in Million’s pre-intervention areas of dissatisfaction, that is, Love Relationship, Helping, Play, Work, and Money. Million now reported satisfaction in each of these areas. Million also reported the empirically supported (although largely correlational) “holy trinity of happiness benefits” (Frisch 2006) , including improved health and fitness, more rewarding relationships in general, that is, beyond his love relationship which was a target of treatment, and greater

success in life and work. According to the positive psychology literature, while money can’t buy you happiness, happiness can buy you money. For example, happier people seem to have more initiative and productivity at work, their customers are more satisfied with them, and they enjoy greater annual incomes than less contented people (see Diener and Seligman, 2004, for review). This may explain Million’s increased income and greater satisfaction with Money after counseling/coaching even though Money per se was not a target of intervention.

The holy trinity of happiness benefits is a major rationale for positive psychology interventions in the first place. Interestingly, Million reported greater satisfaction with and income from Work, even though this was not a focus of his counseling. Indeed there is a “Get Happy In General” intervention strategy(Frisch 2006) that seems to impact multiple areas of life and not just one. This strategy is versatile, simple and appealing to therapist/coaches and clients alike. The goal of this strategy is for clients to become happier or more satisfied in general. The strategy may be operationalized as simply following a comprehensive positive psychology approach such as that offered by Seligman (2002) or the present author (Frisch 2006).

Quality of Life Therapy/Coaching(QOLT/ C; Frisch 2006), which was used in the Million case, attempts to incorporate the most current theory and research with respect to positive psychology, quality of life, social indicators, life satisfaction, happiness, and the management of negative affect along with insights from the author’s clinical and positive psychology practice. Diener (2006, p. vii) asserts that these attempts have been successful in his foreword to the book or intervention manual for QOLT/C (Frisch 2006), stating that QOLT/C “presents state-of-the-art findings in positive psychology, brought to life FALL 2006

Positive Psychology with practical exercises that make the research findings accessible to readers.” Ben Dean, founder of MentorCoach and Robert BiswasDiener say that QOLC/T is “by far the best and most comprehensive approach to positive psychology intervention currently available” (personal communication, March 31, 2006). Similar evaluations of QOLC/T have been made by Christopher Peterson (2006), C.R. Snyder (2006), Kenneth Land (2006), David A. Clark (2006) and, with respect to behavioral medicine applications, James R. Rodrigue (personal communication, October 30, 2005), and, with respect to coaching and industrial/organizational psychology applications, Paul Lloyd, past-President of the American Psychological Association’s Society of Consulting Psychology (personal communication, October 27, 2005). QOLT/C is being taught to students in the University of Pennsylvania’s Masters of Applied Positive Psychology Program founded by Marty Seligman (James O. Pawelski, personal communication, July 30, 2006). QOLC/T has been empirically supported in a randomized trial which found QOLT/C to be “more effective”(pp. 2430) than the standard treatment (Rodrigue et al., 2005).

Positive psychology.

Positive psychology approaches to enhancing human fulfillment, happiness, and quality of life may boost the acute treatment response to psychotherapy and/or medication (Clark, 2006). When presented near the end of therapy it may prevent relapse much as schema work and mindfulness training have been cast to do, according to the co-author of Aaron T. Beck’s latest theory of psychopathology and cognitive therapy, David A. Clark (Clark, 2006; Clark and Beck, 1999—also see empirical studies by Fava and colleagues, 2003).

Positive psychology interventions can also be applied to an entirely new area of practice, that is, “positive psychology clients” such as professionals devoid of psychological disorders who nevertheless wish to be happier and more content with their lives (Frisch 2006; Seligman 2002). These professionals have FALL 2006

included lawyers, teachers, business-people, physicians, clergy of all stripes and persuasions, police and probation personnel, university student life professionals, and even quality of life/positive psychology researchers and students themselves from around the world.

In an era in which executive coaching is in vogue, many CEOs wish to have an executive coach to help them feel and function better; often the intervention of choice is positive psychology. In this way and others, positive psychology is a dominant paradigm in Industrial/Organizational psychology.

In either case—clinical or organizational/ professional, positive psychology intervention may be as simple as applying interventions to valued areas of life that are less than satisfying or fulfilling at the present time. According to QOLC/T, these areas of life may include Goals-and-Values which may include Spiritual Life, Self-Esteem, Health, Relationships (with friends, lovers, children, relatives, coworkers, deceased or unavailable loved ones, and the self ) and, Work and Retirement, Play, Helping, Learning, Creativity, Money, and Surroundings—Home, Neighborhood, Community (see Frisch 2006 for specific definitions of these areas as well as area-specific interventions). Much as B.F. Skinner used to tout his “technology of behavior,” there exists an empirically derived and often validated technology of positive psychology intervention along with various comprehensive systems of positive psychology intervention that may be applied to areas of dissatisfaction as clients build a more balanced life, one allowing for fulfillment in all valued areas of life and one that is consonant with their overall goals and values.

References Clark, D.A. Foreword. (2006). In M.B. Frisch, Quality of Life Therapy: Applying a Life Satisfaction Approach to Positive Psychology and Cognitive Therapy (pp. xi-x). Hoboken, New Jersey: John Wiley & Sons.

Clark, D. A., & Beck, A. T. (1999). Scientific foundations of cognitive theory and therapy of depression.

New York: Wiley.

Diener, E. Foreword. (2006). In M.B. Frisch, Quality of Life Therapy: Applying a Life Satisfaction Ap-

proach to Positive Psychology and Cognitive Therapy (pp. vii-viii). Hoboken, New Jersey: John Wiley & Sons.

Diener, E., & Seligman, M. E. P. (2004). Beyond money: Toward an economy of well-being. Psychological Science in the Public Interest, 5(1), 1–31.

Fava, G. A., & Ruini, C. (2003). Development and characteristics of a well-being enhancing psychotherapeutic strategy: Well-being therapy. Journal of Behavior Therapy and Experimental Psychiatry, 34, 45–63.

Frisch, M. B. (1998a). Quality of life therapy and assessment in health care. Clinical Psychology: Science and Practice, 5, 19–40.

Frisch, M. B. (2006). Quality of Life Therapy: Applying a Life Satisfaction Approach to Positive Psychology and Cognitive Therapy. Hoboken, New Jersey: John Wiley & Sons.

Frisch, M. B., Clark, M. P., Rouse, S. V., Rudd, M. D., Paweleck, J., & Greenstone, A. (2005). Predictive and treatment validity of life satisfaction and the Quality of Life Inventory. Assessment, 12(1), 66–78.

Frisch, M. B. (1994). Manual and treatment guide for the Quality of Life Inventory or QOLI®. Minneapolis, MN: Pearson Assessments (formerly, National Computer Systems).

Land, K. C. (2006). Quality of Life Therapy for All!: A review of Frisch’s approach to positive psychology, Quality of Life Therapy. SINET (Social Indicators Network News), 85, 1-4.

Peterson, C. (2006). Back cover. In M.B. Frisch, Quality of Life Therapy: Applying a Life Satisfaction Approach to Positive Psychology and Cognitive Therapy (pp. back cover of book). Hoboken, New Jersey: John Wiley & Sons.

Rodrigue, J. R., Baz, M.A., Widows, M.R. , & Ehlers, S.L. (2005). A Randomized Evaluation of Quality of Life Therapy with Patients Awaiting Lung Transplantation. American Journal of Transplantation, 5(10), 2425-2432.

Seligman, M. E. P. (2002). Authentic happiness.

New York: Free Press.

Snyder, C.R. (2006). In M.B. Frisch, Quality of Life Therapy: Applying a Life Satisfaction Approach to Positive Psychology and Cognitive Therapy (pp. back cover of book). Hoboken, New Jersey: John Wiley & Sons.

Author Notes Correspondence regarding this article may be directed to Michael B. Frisch, PhD, Professor, Department of Psychology and Neuroscience, Baylor University, P.O. Box 97334 , Waco, TX 76798-7334; telephone(254) 710-2252 or -2961; Fax(254) 710-3033; Email: michael_frisch@baylor.edu .

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Positive Psychology

Psychological Assessment and Treatment of Patients with Chronic Pain Jeff Baker, PhD, ABPP Associate Professor & Chief Psychologist Anesthesiology Pain Clinic University of Texas Medical Branch Galveston, Texas 77555-1152

T

he psychological assessment of patients with chronic pain is typically done by a licensed psychologist to provide the patient and other health care providers with insight into the psychological functioning and/or overlay that may be influencing the patients’ pain experience. The integration of psychological assessment and treatment of patients with this unique and complicated medical condition has become part of the gold standard in the medical world. Primary care psychology addresses the “whole” patient and an effective psychologist does not ignore medical issues anymore than an effective medical doctor would ignore psychological issues. Integrated care is still atypical, but medical centers and teaching hospitals are experiencing increasing opportunities for psychologists as more health care providers are exposed or trained in “alternative” intervention strategies.. Anecdotal data suggests that patients are less likely to address these issues if care is provided off-site versus integrated into the medical providers setting.

Patients like one-stop shopping and since chronic pain has a higher likelihood of involving multiple providers such as the medical doctor, physical therapist, occupational therapist, psychologist and the vocational rehabilitation counselor, it is a great benefit to the patient when they can all work together on site.

Integrated care is the current buzzword in health care and psychologists would do well to prepare for empirically based treatments with chronic medical conditions. One area of growth for psychologists is in Clinical Health Psychology. There are a few doctoral programs out there that have an emphases in health psychology but most training still involves more 20

severe mental health and DSMIV diagnostic intervention training than familiarity with ICD9 and chronic medical conditions. More and more health care providers are looking for primary care psychology providers. Primary care psychology is also a relatively new description for providing care to patients with medical problems. Bob Frank, author of an excellent book on primary care psychology, provides a must read for those interested in learning more about this new area. In addition, there are several articles out that address providing psychological services in a medical setting (Robinson & Baker, PPRP, 2005).

This brief newsletter article will address one area of growth with a focus of working with patients with chronic pain. Pain clinics continue to open and expand throughout Texas and the U.S. As the U.S. population continues to age, there is an increasing need for psychologists interested in addressing quality of life issues and how these are many times negatively affected by medical problems. As a body ages there is a higher likelihood that low back pain develops and as Americans continue to increase their body size/weight, low back pain, as well as other forms of chronic pain, becomes almost inevitable.

Progression of Chronic Pain Patients do not see the psychologist if their condition is within the normal expectations such as acute pain from a recent injury. However, there are a number of flyers around the clinic advertising a pain group and relaxation training provided by psychology and some patients request to be seen by the psychologist. Patients are expected to resolve their pain in conjunction with seeing their primary care provider and are usually given a simple an-

algesic such as NSAIDS (nonsteroidal antiinflammatory agents) or something slightly more potent such as Hydrocodone (Vicodin).

In normal circumstances the injury will begin to heal, swelling decreases, nerve endings begin healing, blood vessels and muscle tissue are repaired. These patients return to full functioning and the pain has decreased significantly over the normal healing period and is completely gone within a 12 week period of time. Another group of patients includes those that may need extended healing time but continue to do better; the pain, range of motion and flexibility are slow in returning but there is continued improvement over time usually within 6 monts. . Finally,, there are a number of patients that do not experience this normal healing period and thus the definition of chronic pain. Patients who do not experience much pain relief may find themselves taking more pain medication than prescribed and developing a syndrome known as analgesic failure. They are literally taking so much pain medication that it actually does nothing but provide a euphoria which doesn’t do much for the pain, but does provide some psychological relief from the misery of the pain. This unfortunately leads to more indiscriminate use of the pain medication which results in medication seeking behaviors for the patient. This is a time when the psychologists are called in to assist with the care of the patient.

Characteristics of Chronic Pain Chronic pain has a number of characteristics that need to be addressed by both medical professionals and psychologists. Most patients are interested in a quick fix that will allow them to return to their previous pain free condition as soon as possible. This is not FALL 2006

Positive Psychology an unreasonable goal but it is highly unlikely when the pain continues for an extended period of time. Unfortunately, after an extended period of time, full pain relief is rare and most patients go through a very difficult period of time as they begin to realize there are few things that will bring pain relief, much less return them to their previous level of physical functioning. After an extended period of time experiencing pain, pre-existing psychological conditions often become more complicated and have significant consequences on both the physical and medical condition of the patient.

Also, having unrelenting chronic pain usually increases depressive symptoms (loss of sleep, appetite, increase in stress, loss of income and self-esteem if the patient can not work, and an increase in problems in relationships since the patient can often not do much work around the house or yard. It is for these reasons that psychosocial stressors, personality, pain behaviors, and coping skills are best addressed by including a psychologist in assessing and providing interventions for patients with this type of a medical problem.

Chronic pain is best defined as pain that continues for an extended period of time (greater than 6 weeks). Pain from an injury is expected, but pain is not expected to continue past the initial 6 weeks of time unless there are complications or difficulties with the injury. When this happens the patients may begin to spiral down as they enter a period of time when they don’t fully understand what is happening and why someone cannot address (fix) their pain. The medical professionals are sometimes considered incompetent or not helpful if there is not immediate relief. In truth most practitioners are very hesitant to provide opioid medications beyond that initial injury period. If there are no organic findings to substantiate or correlate with the reported pain experience, medical professionals actually become more reticent to provide therapeutic levels of analgesics.

Working in an anesthesiology pain clinic at a major medical center brings in a wide variety of patients. There are some common factors. Patients are frustrated, depressed, anxFALL 2006

ious, tired, exasperated, and disappointed that something has not already been done to relieve their pain. Most patients have been through several doctors, some have been through multiple surgeries, and some are angry that traditional medicine cannot do anything to treat their pain. Most patients do not have a psychiatric diagnosis; they are distressed but do not meet diagnostic criteria beyond adjustment disorder. The stigma of psychology works against our profession and patients are typically distrustful. Their fear is that they are being written off as a “head case” and they only reluctantly follow through to seeing a psychologist. In this clinic providing care to patients that are in the last desperate search is especially successful since psychology is well integrated into the clinic.The psychologists’ offices are connected to the anesthesiologists’ offices in the same suite where medical residents and psychology postdocs intermingle in a joint conference room. Anesthesiologists consult with the psychologists to get clarification of the patient’s ability to manage and psychologically cope with chronic pain. Similarly, psychologists seek out the anesthesiologists to check out medical questions regarding the patients current complaints or side effects from medication. An example of such collaboration occurred with a patient who was complaining of panic attacks late at night.

After consultation with the anesthesiologist it was learned that the patient was using Chinese herbs to treat prostrate problems.

The herb increased the patients’ anxiety level and late at night his cognitions and high blood pressure exacerbated the herbs and led to anxiety attacks.

Psychological Assessment Initial consultation with the patient involves an extensive clinical interview which assesses the history and onset of the pain, the patient’s pain rating (0-10), the history of the progression of the pain (has it always been a 10?) and the radiation (where does it start and spread to?) as well as what patients do for relief of the pain (e.g., takeshot baths or showers, lies down, takes medication, prays, etc). In ad-

dition, a review of medications including past failures and successes with managing the pain, a thorough family history including support and understanding, as well as how close the patient is with her or his family, are all important aspects when assessing patients’ ability to manage their pain. The clinical interview normally takes 60 – 90 minutes and is billed either as a psychiatric code (CPT90801) or a health and behavior assessment code (CPT96150).

The latter requires no psychiatric diagnosis and is typically much more appropriate for the vast majority of patients with chronic pain.

After the extensive clinical interview the patient is given a series of psychological assessments including the MMPI (Minnesota Multiphasic Personality Inventory-2); the CSQ (Coping Skills Questionnaire); the BDI-FMS (Beck Depression Inventory Fast Medical Screen); The Type D Questionnaire (an instrument developed to measure recovery from heart attack that also provides clinical data on the patient’s ability to recover from chronic pain); and the BPI (Brief Pain Inventory).

There are times when not all of these assessment instruments are given and times when additional assessments are given to assess cognitive abilities, interpersonal relationships, etc.

These instruments will give the practitioner an idea of how the patient’s psychological overlay may or may not affect the patient’s ability to cope with hie or her pain. These instruments take 1-2 hours additional time and can be billed as CPT96101 and includes administration, scoring, interpretation, as well as writing the results in a report. It is not permissible to bill for the patients’ time for taking the tests but it is appropriate to bill for the actual time the psychologist spent with the patient for giving instructions or tests that the psychologist administers directly face-to-face. It is permissible to bill for time administering (explaining the instructions or direct administration to the patient) as well as writing and interpreting the results in the report. Psychologists in our clinic meet with the patient and as part of the assessment process provides an interpretation to the patient. This is part of the assessment and intervention to assist the patient in reach21

Positive Psychology ing a better understanding of how their pain is affected by psychosocial stressors, personality, support, and coping styles.

There is not enough space to fully explain the psychological instruments or the meaning of the results so the discussion in this article is very limited. The MMPI-2 has been one of the most widely studied instruments for working with patients and chronic pain. It is expected the majority of the patients will have a 1-3-2 profile. When other scales are elevated or the patient has a validity profile where F minus K is greater than 11, it brings into question the patients’ ability to manage chronic pain.

As with any psychological instrument much of the interpretation depends on the clinical interview and how those correlate with other data.

The CSQ provides 6 measures of coping (reinterpreting pain, coping self statements, ignoring pain sensations, catastrophizing, behavioral activity, pain behaviors, diverting attention and spirituality) will give the clinician additional insight on how the patient manages their pain. The BDI-FMS is a very brief assessment of depression for medical patients. It is expected there will be a correlation between the MMPI-2 and the clinical interview and the BDI-FMS. If there is not, there is likelihood that the results are suspect. The Type D Questionnaire provides a measure of negative affect and social inhibition. This questionnaire was first studied with heart patients, and results indicated that patients with high negative affect and high social inhibition indicated they were less likely to fully recover from a heart attack. The results of the Type D are part of the full assessment with chronic pain that is still being reviewed by us. It appears to provide some very rich clinical data. Patients with high scores (negative affect and social inhibition) are less likely to be able to manage their chronic pain. The BPI provides the patients’ report of the pain in the last 24 hours, last 7 days and the last 30 days both at its best and its worst. Again, this information is expected to correlate with the clinical interview and the other test results. As discussed earlier, when there is inconsistent information, the case is 22

more complicated and the expected results of success in managing chronic pain are significantly reduced.

treatment. Less than ½ individuals recommended for group treatment actually choose to participate, even when there is no cost to participate.

Psychological Intervention Such assessment provides clinicians with important information as they begin to develop an intervention plan for a patient with chronic pain. In general, the higher the scores on the psychological instruments the less likely the patient will be responsive to pain management including both pain medications and psychological interventions. The vast majority of those patients do not return for follow-up psychological treatment. Anesthesiologists have limited resources and may require the patient to follow-up for psychological care and if they do not, they are often hesitant to provide increasing doses of pain medication or other interventions if the patients are not addressing their psychosocial stressors. Psychological interventions are focused on empirically based treatment programs such as cognitive behavioral therapy. The vast majority of the patients with chronic pain also have symptoms of depression. In addition, a number of other types of intervention may be offered to a patient.

These include relaxation training and stress reduction treatment for anxiety and muscle tension. Biofeedback and hypnosis are used to treat similar issues. Group treatment is provided in a structured 6 week treatment program that addresses coping, stress management, relaxation training, cognitive reframing, pharmacology and physiology and family support.

This is a common treatment program offered at this clinic. It appears to be helpful especially because many of these patients feel very isolated and lack social support. The group treatment program is very effective for treating the psychological overlay in patients with chronic pain as well as providing needed human interaction and support. It is sometimes difficult to get a patient to agree to participate in this type of a program due to the many hurdles such as traveling long distances, parking, transportation, etc. These are hurdles that need to be addressed or at least acknowledged at the patient contemplates participating in group

Common forms of Medical Intervention for Chronic Pain Anesthesiologists involved in the management of chronic pain are very interested in providing integrated care as they have discovered that a number of their patients do not seem to get much better, no matter how much medication is given to them. At some point, the anesthesiologist becomes very uncomfortable with the increasing medication doses that seem to have little or no effect on the patient’s pain. This is one of the reasons for referring the patient to the psychologist, but there are a number of other reasons for a referral. There are a number of medical interventions that anesthesiologists can provide to patients. Having a psychological evaluation provides additional rationale for what procedure the anesthesiologist, along with the patient, may choose to address chronic pain. In addition to providing patients with opioid medications, the following can be very effective : Epidural Steroid Injections (ESIs) are provided at trigger points to decrease swelling and provide anesthetic directly at the nerve root.

Some patients experience 3-6 months relief, some patients experience 1-3 weeks of relief, some patients experience only an hour or two relief and a few patients either feel no relief or the ESI makes their pain worse.

Intrathecal Morphine Pumps are implanted underneath the skin and allow the medication to be delivered in a steady dose in order to provide constant relief. This removes the euphoria from oral analgesics and provides the patient with stable pain relief. This procedure is usually not indicated until a number of conservative treatments have failed to address the pain.

Dorsal Cord Stimulators are implanted electrical stimulation units. The electrical discharge is managed by the patient and works on the gait theory of pain. When the nerve pathway is interrupted by the mild electrical FALL 2006

Positive Psychology discharge the pain is lessened and the patient experiences more control over the management of their pain. This procedure appears to be more effective for leg pain that has resulted from extended low back pain.

All of these medical interventions require a psychological assessment in our pain clinic.

The assessment will give the anesthesiologist better information about the psychological overlay and can result in better care of the patient. Integrated treatment is one place where psychologists can be more involved in the medical care of the patient as psychology gains a larger place in the medical treatment of patients with chronic medical conditions.

Case Example A 21 year old female patient was previously diagnosed with cancer at age 3 and currently reports ďŹ bromyalgia, PTSD symptoms, an eating disorder, unrelenting pain and depressive symptoms. The patient is currently cancer free but complains of general pain. A history determines she is committed to pain reduction but is hesitant to take opioid medication and prefers to only take Tylenol. She was very pleasant and cooperative throughout the interview but seemed guarded . She reported that her father was also being treated for chronic pain. The patient was remarkable for suicidal ideation but reported no previous attempts.

She reported a pain rating of 6-7 on a scale of 0-10. She was able to ride her bike on the seawall and used it as her main transportation around this part of Galveston. The patient reported no history of sexual abuse and had

0ARTNERING 7ITH 9OU IN THE 4REATMENT OF %ATING $ISORDERS

one sister living in another state. Both parents were concerned and she continued to live with them though they had moved to Galveston only a few months before.

The patient reported no depressive symptoms on the BDI-FMS but reported depressive symptoms on the MMPI-2. Her scores were elevated on social inhibition but low on negative affect. Her scores were elevated on scales 1, 3 and 2 and were also elevated on scale 7 and 9 on the MMPI-2. These scores were inconsistent with each other and did not correlate with the clinical interview.

The patient atient was provided cognitive behavioral therapy and relaxation training to address stress and muscle tension. Biofeedback was used in session 2 and 3 with fair to moderate results. She was provided access to group treatment but declined. Pt continued to report improving symptoms and less pain.

After session 4 it was reported the patient had been hospitalized for suspected suicide and test results indicated she had injested methadone and 20-30 aspirin The patient denied she was trying to commit suicide but stated she knew it was suspicious. The patient reported she was just trying to take something for the pain and forgot how much she had taken. She was put on restrictive access to medications (father agreed to lock up medications) and patient agreed to be “more honest� in her interactions with the treating psychologist. She was referred for psychiatric treatment but was also allowed to continue in pain management therapy. Eating disorder characteristics were addressed as well as how the patient

7E RECOGNIZE THAT NOT ALL EATING DISORDER CLIENTS NEED INPATIENT TREATMENT (OWEVER WHEN A HIGHER LEVEL OF CARE IS REQUIRED

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FALL 2006

might have been trying to play out her “good girl� role in the therapeutic relationship. These issues were only addressed as to how they affect her pain and how she has learned to be somewhat helpless.

Follow up treatment strategies continue to focus on pain management and encouraging her to address psychiatric issues with the treating psychiatrist and pain issues with the pain management team though many times these are intertwined. Goals for the patient include decreasing pain, cognitive retraining for managing stress and support as she explores possible PTSD symptoms from the cancer treatment. Pain management continues with addressing pain reduction strategies and biofeedback.

This case was chosen to demonstrate the complexity of chronic pain and how psychosocial stressors may play a signiďŹ cant role in pain management. Physicians have agreed on a conservative approach with medication but have also agreed to explore with the patient other options to manage her pain. The patient has agreed to this plan.

References Block, A.R.; Garchel, R.J.; Deardorff, W.W.; and Guyer, R.D. (2003), American Psychological Association, Washington, DC. Frank, RG; McDaniel, SH; Bray, JH; and Heldring, M. (Editors) (2004) Primary Care Psychology, American Psychological Association, Washington, D.C. Turk, DC and Melzack, R. ( 1992) Handbook of Pain Assessment, The Guilford Press, New York.

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7HEN YOUR CLIENT NEEDS INPATIENT TREATMENT CALL 2EMUDA 2ANCH "Y PARTNERING TOGETHER WE CAN MAKE RECOVERY A REALITY

23

Positive Psychology

The Positive Psychology of Humility Relative to Arrogance Wade C. Rowatt, PhD Department of Psychology & Neuroscience Baylor University Wade_Rowatt@Baylor.edu

T

his article reviews emerging theory and research that point to the positive nature of dispositional humility, and possible benefits afforded to those who are humble. Challenges to the measurement of humility are discussed, along with some preliminary ideas about its development.

A Zen Story In the Zen story, A Cup of Tea (see Senzaki & Reps, 1957/1998), there are some hints about the role of humility in everyday life and learning. As the story goes, when a university professor approaches a Japanese master to inquire about Zen, he is served tea. The master pours the professor’s cup full…and then keeps pouring. “The professor watches the overflow until he can no longer restrain himself.” “It is overfull. No more will go in!” says the professor. “Like this cup,” the master says, “you are full of your own opinions and speculations. How can I show you Zen unless you first empty your cup?”

Characteristics and Paragons of Humility Some of us are so full of ourselves and preconceptions that we have little room for growth. However, a variety of facets of humility (see Table 1) could be intertwined with intellectual or interpersonal flourishing.

Facets of arrogance – such as egotistical, selfcentered, or conceited – are not only uniformly disliked (Anderson, 1968) but could be impediments to such growth.

A few probable paragons of humility are listed in Table 2. However, many of the most humble people are not famous and are out of the limelight. As Mother Teresa remarked, “humility must always be doing its work like a bee making honey in the hive; without humility all would be lost.”

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Perceptions of Humility as a Strength Exline and Geyer (2004) found that college students perceive humility to be a psychological strength and do not see humility to be synonymous with low self-esteem or humiliation. When asked why a humble person was seen as humble, “participants identified positive characteristics such as being kind or caring toward others (56%), refraining from bragging (55%), success or intelligence (47%), and unselfish or self-sacrificing stance (21%; Exline & Geyer, 2004, p. 103).” Some students (14%) noted that the humble person was timid, quiet, or unassertive (Exline & Geyer, 2004). However, people often like or admire individuals who give modest accounts for success (Hareli & Weiner, 2000).

In contrast to humble persons, arrogant individuals often brag too much or erupt in repulsive in-your-face dominance displays.

Rather than accept success or victory with grace, the egotistical person may continue to derogate a competitor or take more credit and glory for success than deserved. Sometimes the conceited person really is talented and continues to excel. However, when an arrogant person eventually fails, observers may experience a wry sense of enjoyment or schadenfreude (Smith et al., 1996). Although narcissistic persons might think they’re highand-mighty, such self-perceptions could be signs of insecurity, vulnerability, or weakness (Wink, 1991).

Potential Benefits of Humility “To know when one does not know is best. To think one knows when one does not know is a dire disease.” This passage from the Tao Te Ching hints at the value of intellectual humility. Modern philosophers also

posit that, “humility seems to promote more constructive research collaborations among colleagues, teachers, and students than intellectual arrogance or vanity. Intellectually vain people might not admit or notice valid objections or threats to the validity of one’s research findings; they might fake some data or exaggerate the stability of one’s findings (Roberts & Wood, 2003, p. 272).”

In a study of Israeli undergraduates, overconfident students earned significantly lower grades on a psychology test than students who were not overconfident (Zakay & Glicksohn, 1992). More recently, Rowatt et al. (in press) found that an implicit measure of humility correlated positively with college students’ course grades in a psychology course.

In a recent survey 70% of respondents said that modesty was an important quality for elected leaders (The Modesty Survey, 2006). Some successful leaders appear to realize that humility is not only necessary, but critical for personal and corporate success.

For example, the current Supreme Court Chief Justice (John G. Roberts Jr.) wrote to members of the Senate Judiciary Committee before his confirmation hearings, “that a good judge must have humility to be fully open to the views of his fellow judges….and must recognize when their initial perceptions turn out to be wrong (see Stolberg & Rosenbaum, 2005).”

Collins’ (2001) research demonstrates the remarkable applied value of humility when coupled with competitiveness. CEOs who possessed a rare combination of extreme humility and strong professional will appeared to be catalysts for transforming a good company into a great one (Collins, 2001). Genuine humility likely engenders flourishing in other domains as well.

The Paradox of Self-Reported Humility: FALL 2006

Positive Psychology Will humble people say they’re humble?

C. S. Lewis (1952/2001, p. 128) surmised that, “If you think you are not conceited, it means you are very conceited indeed.” Preliminary indications are that most people say they are humble, not conceited. For example, Rowatt et al. (in press) found that 92% of students “agreed” or “strongly agreed” with the item, “I try to be humble.” When asked to report, on a semantic differential item, the degree to which

they were conceited or not conceited, 80% of students selected a value above the item’s midpoint (Rowatt et al., in press).

These high baseline levels of self-reported humility/modesty are a reminder of pervasive self-enhancement biases largely inconsistent with humility. For example, Rowatt et al.

(2002) found that 74% of students rated the self to be better than others on positive traits (e.g., kind, intelligent, attractive) and 98%

Table 1 Tendencies of Persons with Humility or Arrogance HUMILITY open to new ideas and contradictory information eager to learn from others acknowledges his or her own limitations and mistakes, and attempts to correct those than can be corrected accurate sense of one’s abilities and achievements accepts failure with pragmatism asks for advice has a genuine desire to serve others respects others shares honors and recognition with collaborators accepts success with simplicity is not narcissistic and repels adulation shuns public adulation; never boastful doesn’t blame others relatively low focus on the self or an ability to “forget the self ” down-to-earth ARROGANCE conceited, egotistical, condescending overly competitive with others denies faults; overly defensive when criticized overestimates abilities and accomplishments attempts to hide failures know-it-all self-serving disrespectful of others takes more credit than s/he deserves brags about successes narcissistic, seeks praise attempts to be center of attention blames others for mistakes/failures overly concerned with self-image; high vanity high-and-mighty

FALL 2006

of students reported that they followed biblical commandments more closely than did other people. It might be of interest to know that Rowatt et al.’s (2002) study was inspired in part by a New Testament scripture that reads, “in humility count others better than yourself (Philippians 2:3).”

Smith (2006) wondered if persons living in a monastery confess being very humble.

They didn’t. Within a small sample of Cistercian nuns and monks, only 3 out of 57 individuals (5%) reported that they were very successful, “always exhibiting humility in one’s heart and anywhere else” (Smith, 2006).

And therein is a paradox. The most humble people on earth probably will not admit being humble. However, the most arrogant -- those with Narcissistic Personality Disorder -- may attempt to create an appearance of humility to mask their narcissism (see American Psychiatric Association, 1994, p.

659). As Schimmel (1992, p. 39) puts it, “in a society which rewards humility with social esteem, some people may mimic behaviors typical of authentic humility.” Such patterns point to the great difficulty of measuring humility. Tangney (2002, p. 415) even concluded that, “humility may represent a rare personality construct that is simply unamenable to direct self-report methods.”

The Measurement of Humility Despite Tangney’s critique, there are a few internally consistent self-report measures of humility/modesty. More evidence is needed for the predictive and known-groups validity of these measures.

1. Costa & McCrae’s (1992) 8-item measure of modesty is positioned within the Agreeableness dimension of the NEO-PIR. One item reads, “I try to be humble.”

2. Peterson & Seligman’s (2004) 10-item measure of humility-modesty was theorized to fit with other character strengths of temperance (e.g., forgiveness, prudence, self-regulation). Specific items focus on not wanting to appear special, not bragging, and not wanting to appear arrogant.

25

Positive Psychology

3. Ashton, Lee, and their colleagues found that humility-related words in several languages loaded on a personality dimension interpreted to be honesty-humility (Ashton, Lee, & Goldberg, 2004; Ashton, Lee, Perugini et al., 2004). Facets of this dimension include sincerity, fairness, greed avoidance, and modesty (Lee & Ashton, 2004).

My collaborators and I are in the process of developing and validating an implicit measure of humility based on the reaction-time to associate humility trait terms with the self relative to others (Rowatt et al., in press). The logic is that a more humble person will more quickly associate humility terms with the self and be more slow to associate “arrogant” terms with the self. The Humility Implicit Association Test (IAT) was found to be internally and temporally consistent. Implicit humility correlated with self-reported humility relative to arrogance, implicit self-esteem, and self-reported narcissism (inversely). Humility was not associated with self-reported low self-esteem, pessimism, or depression. In fact, self-reported humility relative to arrogance correlated positively with self-reported self-esteem, gratitude, forgiveness, spirituality, and general health (see also Powers et al., 2006). These patterns appear to support the construal of humility as a positive dimension.

However, even IATs are not without limits (see Blanton & Jaccard, 2006; Greenwald et al., 2006).

Preliminary Thoughts About Cultivating Humility Given the relative stability of personality traits in adulthood (Terracciano, Costa, & McCrae, 2006), the range in which dispositional humility could change within a person over time may be narrow regardless of one’s motivational strength. Nevertheless, it seems worthwhile for personal and interpersonal reasons for individuals to strive to be genuinely humble.

Like many personality traits, a complex combination of genetics, environment, and other influences likely affect the development of humility or lack thereof. About 64% of the variability in a measure of narcissism was attributed to genetic influences (Livesley et al., 1993). Steger et al. (in press), found that 25% of the variability in self-reported humility/modesty was attributable to genetic similarity. Non-shared environmental influences contribute substantially to individual differences in humility and other character strengths (Steger et al., in press).

If humility/modesty can be accurately assessed, and there prove to be benefits associated with humility (such as intellectual advancement, effective leadership, or prosocial relations), how might one go about cultivating humility as character strength? Is it possible for persons who desire to develop humility to do so?

At present, there appears to be no solid

Table 2 Some Probable Paragons of Humility Individual Jimmy Carter Mahatma Ghandi Thich Nhat Hanh Rosa Parks Ichiro Suzuki Albert Schweitzer Mother Teresa

26

Notable Contribution(s) 39th President of the United States, 2002 Nobel Peace laureate Political and spiritual leader of India Vietnamese Buddhist monk, peace activist African American seamstress, civil rights activist Major League Baseball All-Star German theologian, philosopher, physician, medical missionary Albanian Catholic nun, founded the Missionaries of Charity

research evidence to support a conclusive or exhaustive list of steps to achieve humility. However, there are clues about how to develop humility within existing models of character strength (Exline et al., 2004) and effective leadership (Collins, 2001; Morris, Brotheridge, & Urbanski, 2005; see Table 3).

Possible Ways to Develop Humility Realize pride. C. S. Lewis (1952/2001, p. 128) remarked that, “if anyone would like to acquire humility…the first step is to realize that one is proud.” Pride is one of the seven deadly sins (Schimmel, 1992); however, being proud and being humble are not mutually exclusive experiences. Geyer (2006) reported that feelings of humility were elicited by thoughts about experiences of being praised. People appeared to feel proud and humble when they were praised by a person they respected and felt that they deserved the praise.

Realize limits and broaden perspective.

To Lewis’ insight we might add that to acquire humility...the second step is to realize that one is limited. Humans are finite, yet gifted in many ways. On a sensory level humans (able to see) can only detect a narrow spectrum of electromagnetic energy…. yet how wonderful it is to be able to see.

Our lifespan is short. We’re small relative to the magnificent, expanding universe (or universes). To be humble requires a broadening of one’s perspective. The humble person seems to look up at the stars and accept his/her place in the universe, limits and all.

The arrogant person, on the other hand, seems rather oblivious about his/her finiteness, and usually acts as if s/he is the center of the universe.

Reflection and mentoring. Collins (2001) writes about a five-level leadership model.

The best leaders, Level 5 leaders, “build enduring greatness through a paradoxical combination of personal humility plus professional will (Collins, 2001, p. 70). About FALL 2006

Positive Psychology

developing leaders, Collins (2001, p. 7576) writes, “there are two categories of people: those who don’t have the Level-5 seed within them and those who do. The first category consists of people who could never in a million years bring themselves to subjugate their own needs to the greater ambition of something larger and more lasting than themselves…The second category consists of people who evolve to Level 5…the capability resides within them…under the right

Table 3 Possible Steps to Cultivate Humility Personal Attitudes and Practices 1. Realize that one is not that humble 2. Be honest about one’s mistakes & limits 3. Accept success with simplicity and grace 4. Avoid bragging and boasting about accomplishments 5. Avoid taking too much responsibility for success 6. Attempt to be well-grounded (downto-earth & approachable) 7. If timid, maintain assertiveness 8. Give best effort even on seemingly small or menial tasks Social and Communication Practices 1. Acknowledge strengths in others 2. Avoid blaming others 3. Ask others for advice 4. Be open to others’ ideas and perspectives 5. Give credit where credit is due 6. Share honors and recognition with collaborators 7. Be respectful, especially when disagreements arise 8. Engage in community service activities (on a regular basis) 9. Appreciate the beauty in each person and of the natural world FALL 2006

circumstances – with self-reflection, a mentor, loving parents, a significant life experience, or other factors – the seed can begin to develop.”

Modeling and responsiveness to feedback.

Exline and her colleagues (2004, p. 470) suggest that, “in order to become humble, it seems crucial that a child learn that both positive feedback and negative feedback are worth considering. Such lessons could come from parental modeling of humility, or they might come from humbling feedback. Reality-based feedback from a parent or teacher about one’s strengths and weaknesses would probably be especially useful, particularly if conveyed in an atmosphere of caring and respect.” Exline et al. (2004, p.

471) also point out that several experiences could work against the development of humility in children such as extreme emphasis on perfect performances, inaccurate or excessive praise or criticism, or frequent comparisons to others coupled with competitive messages.

Serving others and practicing humility.

For some people humility could develop during years of selfless service or work with disadvantaged persons. For others humility may be the result of a gradual religious/ spiritual conversion or might develop after a significant loss or coping with that experience (Worthington, 1998). Character development programs or psychotherapeutic interventions aimed at reducing narcissistic processes (Schwartz & Smith, 2002) might also be effective at increasing humility or at least reducing unhealthy pride.

Conclusion Humility appears to be associated with a variety of positive experiences. If humility is possible to cultivate, it probably develops gradually, perhaps like the way a river slowly carves a small path into a grand canyon. Over time, good habits of helping and serving others, acknowledging one’s own limits and sharing credit for success, and being open to others views, could lead to

beneficial forms of humility. However, trying to learn humility without practicing humility or other virtuous behaviors could be difficult. Likewise, focusing too much on developing humility could backfire and lead one to be overly meek or too analytical or self-focused. As the Zen master queried in the “Cup of Tea” story (Senzaki & Reps, 1957/1998), “How can I show you Zen unless you first empty your cup?” When asked by this professor, “How can one learn humility?” the Zen master might reply, “Would you like a cup of tea?”

References American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders.

4th Edition. Washington, DC: Author.

Anderson, N. H. (1968). Likableness ratings of 555 personality-trait words. Journal of Personality and Social Psychology, 9, 272-279.

Ashton, M. C., Lee, K., & Goldberg, L. R. (2004).

A hierarchical analysis of 1,710 English personality-descriptive adjectives. Journal of Personality and Social Psychology, 87, 707-721.

Ashton, M. C., Lee, K., Perugini, M., Szarota, P., De Veries, R. E., Di Blas, L., Boies, K., & De Raad, B. (2004). A six-factor structure of personality-descriptive adjectives: Solutions from psycholexical studies in seven languages. Journal of Personality and Social Psychology, 86, 356-366.

Blanton, H., & Jaccard, J. (2006). Tests of multiplicative models in psychology: A case study using the unified theory of implicit attitudes, stereotypes, self-esteem, and self-concept. Psychological Review, 113, 155–169.

Collins, J. (2001). Level 5 leadership: The triumph of humility and fierce resolve. Harvard Business Review, 79, 67-76.

Costa, P. T., Jr. & McCrae, R. R. (1992). Revised NEO Personality Inventory (NEO-PI-R) Professional Manual. Odessa, FL: Psychological Assessment Resources.

Exline, J. J., Campbell, W. K., Baumeister, R. F., Joiner, T., Krueger, J., & Kachorek, L. V. (2004).

Humility and modesty. In Peterson, C., & Seligman, M. (Eds.), The Values In Action (VIA) classification of strengths (pp. 461-475). Cincinnati, OH: Values in Action Institute.

Exline, J. J., & Geyer, A. L., (2004). Perceptions of humility: A preliminary investigation. Self and Identity, 3, 95-114.

References continued on page 31 27

Texas Psychologist

Uncovering the Elephant in the Living Room Texas Psychological Foundation Spotlight on the prevention of violence

Elizabeth L. Richeson, PhD, M.S. PsyPharm President TPF

O

ne of the many roles of the Texas Psychological Foundation (TPF) is to facilitate the education of the public in areas of psychological significance, where to do so would create a more mentally healthy environment. Thanks to the financial support of TPA members and others, TPF has been involved in creating and awarding grants to students in psychology for four years. We are now exploring ways to reach out to our communities, to provide direct services that will engender mental health for the public.

from 2003, these preventable losses remain unacceptable.

Christy Still, 38 – San Antonio – Christy was found shot to death at her home. According to police, Christy and her ex-boyfriend Jason Edward Love, 25, had a short and violent relationship. She had called police several times in the past when Love turned violent.

He was charged with her death.

Cynthia Wilkerson, 22 - Texarkana Cynthia’s body was found in the driveway of a manufacturing plant warehouse where her husband worked. Her husband Hance

Violence toward women has been the elephant in the living room of psychology.

While contemplating the potential issues on which to focus, a heartbreak was thrown at us this year by the murder of an 18 year old woman in Austin the day after Valentine’s Day. Jennifer was known to many of us in TPA and APA by her attendance at numerous conventions. It was her plan to become a psychologist – to help others.

As a result of that tragedy, we began the process of taking steps to educate consumers about domestic violence and violence against women in Texas in particular, in order to uncover the elephant in the living room. In 2004, the last year that statistics are available, there were 182,087 family violence incidents and 115 women killed by intimate male partners* in Texas alone. While the 2004 statistics show a decrease of about 25 percent 28

Lee Wilkerson, 34, was arrested and charged with her death. . . Hance allegedly got into his truck and ran over Cynthia. She sustained fatal injuries as a result of the impact.

Lorena Godoy, 21 – Richardson – In an apparent murder-suicide, Lorena was thrown to her death from a freeway overpass by her boyfriend, Paul Stephens, 30. Stephens jumped from the overpass and later died at an area hospital. . .Stephens was arrested in 2000 in connection with an assault against Lorena, but he was not convicted. An exgirlfriend had a restraining order against Stephens in 1998.

Maria Navarro, 37 – Houston – Maria died of stab wounds to her neck, chest and arms after a fight with her boyfriend, Benito Sanchez Jimenez, 22. According to witnesses,

he was also stabbed in the neck, chest and arms. Police have not established a motive for the incident.**** Jennifer Crecente, 18 – Austin – Jennifer’s body was found in a wooded area near her home one day after she was reported missing.

She died of a gunshot wound to her head. An ex-boyfriend, Justin Crabbe, 19, also of Austin, has been charged in her murder.

“In 2002, The Texas Council on Family Violence conducted a statewide polling on prevalence and attitudes on domestic violence. Below are some of the findings: • “74% of all Texans have either themselves, a family member and/or a friend experienced some form of domestic violence.

• “47% of all Texans report having personally experienced at least one form of domestic violence, severe (physical or sexual), verbal and/or forced isolation from friends and family at some point in their life time.

• “31% of all Texans report that they have been severely abused (physically or sexually abused) at some point in their life time. Women report severe abuse at a higher rate than men.

• “75% of all Texans report that they would be likely to call the police if they were to experience some form of domestic violence. Yet only 20.3% indicated that they actually did call the police when they or a family member experienced domestic violence.

• “73% of all Texans believe that domestic violence is a serious problem in Texas.

HHSC (Formerly DHS) estimates that 924,042 Texas women were battered in 2004.”*** FALL 2006

Texas Psychologist

In 2005 the U. S. Senate voted to renew the Violence Against Women Act. That same year according to Robert Kleeman of the Daily Texan, there was “A wall of red wooden cutouts representing the 115 of Texas women killed by domestic violence in 2004 covered the Capitol Steps. . .” Now in 2006 to launch TPF and psychology’s investment in the understanding and prevention of violence, TPF created a new graduate student award, is collaborating with APA for redistribution of their brochure Warning Signs, and added a convention presentation.

The graduate student award has been named The Jennifer Ann Crecente Memorial Grant, in memory of our Jennifer, the first homicide victim in Austin in 2006. This grant will provide $5,000 support for a currently enrolled psychology graduate student in good standing, who is conducting research addressing potential causes and/or prevention of violence against women. (See the TPF section of the TPA website for further information on this and other grants and awards.)

The TPF/TPA campaign, in conjunction with the TPA Education Committee chaired by Dr. Edward Davidson, will be kicked off this year at the TPA annual convention where APA brochures will be distributed**. Phase II of our campaign will commence with a Texas specific brochure that will be made available for distribution by our member in a downloadable format.

The statistics on violence are frightening and seem to be rising around the country – perhaps around the world. The Warning Signs Campaign was begun by the American Psychological Association in 1999 and included an Outreach to the Community component. This is the opportunity for Texas to take lessons from that successful campaign and tailor it to Texas.

The convention workshop, entitled Stand against Violence: a Community Outreach Plan scheduled for Thursday, November 16, 1-2:50 p.m., will take attendees from the identification of the problem FALL 2006

through plans for education and prevention that can be implemented in their own community. This program will be presented by this author with Dr. Michael Hand as a part of the kick-off for the grass roots efforts planned throughout the state. Look for other presentations on this subject at the convention.

An additional component of the project will include information about a Speaker’s Bureau with the TPA website and the Local Area Societies’ offices as point of contact.

This will facilitate a community’s request for psychologists to address their organization concerning demographics, risks and, most importantly, prevention of violence.

The violence towards women in Texas has been the elephant in the living room of psychology for too long and it is time to recognize it and rid it from our lives once and for all.

YOU CAN HELP – please contact TPA at 1-888-872-3435 or go to their website at www.texaspsyc.org and click on the Texas Psychological Foundation link to make your TAX DEDUCTIBLE donation. * defined as husbands, ex-husbands, common-law husbands, boyfriends and ex-boyfriends. ** numbers of brochures available per attendee are limited, however, additional brochures can be ordered for a nominal fee. The downloadable brochure will be available at a later date TBA free of charge. *** taken from the Texas Council on Family Violence website www.tcfv.org **** List of Women Killed in Texas - partial list 2004 - www.tcfv.org

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The Great Local Area Society Challenge Rob Mehl, PhD, PSY-PAC

Greetings, fellow Psychologists!

Thank each of you who have taken the time and made the effort to contribute to PSY-PAC! Your donations support the efforts of our legislative committee to protect, sustain, and advance our profession!

Your PSY-PAC Board has worked diligently through the summer with efforts to raise professional awareness concerning the importance of active political action. We are in the process of considering a name change for PSY-PAC in order for TPA members, non-members, and the public at large to understand at once that the purpose of this arm of TPA is to support and advance psychology as a profession in Texas. This should be finalized before the 2006 TPA Annual Convention in November.

Please feel free to contribute to the PAC and to get more actively involved. Be prepared to have fun at Convention and enjoy the exciting, friendly competition that Dr. Rob Mehl explains below!

Sincerely, Mimi H. Wright, PhD, 2006 PSY-PAC President

One of the penalties for refusing to participate in politics is that you end up being governed by politicians (adapted from Plato).

Politicians with the best motives certainly have a limited understanding of the issues that face psychologists. Within the legislature every year, there are multiple challenges to good mental health delivery, to availability of mental health services, to psychological services you may provide, to payment amounts, and challenges to the profession of psychology as a whole. While you are working in your offices, TPA constantly monitors this flurry of legislative activity and Psy-Pac works to raise money to fund the legislative and lobbying efforts. Without this effort in the past few years, we would be earning less money, be defined as a masters level profession, and be increasingly limited in the services we can provide. Recent activity has been well documented in the Texas Psychologist by 30

Dr. Melba Vasquez, Dr. Mimi Wright, David White and others. Like it or not, we must participate in the legislative process, and we must fund the lobbying efforts. Be helpful to those that are helpful to you.

Support Psy-Pac and the legislative efforts.

For the past several years at the TPA annual convention, there has been a Psy-Pac Challenge pitting the Houston Psychological Association against the Dallas Psychological Association. The two largest local area societies (LASs) have vied for top honors as the largest contributor to Psy-Pac. There are a number of problems with this challenge of the past.

The first problem is that Houston seems to win. There is nothing wrong with Houston winning, but it always seems to win.

The second problem is that only two LASs are involved, accounting for only 39% of the TPA membership. Why should the rest be left out? A little research showed

one reason why Houston dominates. Not that their political giving isn’t stellar, but Houston has 329 TPA members and Dallas has 233. Is that really fair to Dallas? Why not level the playing field and include all of TPA? Hence, “The Great Local Area Society Challenge.”

The Group Challenge: In order to include all LASs and make it a fair challenge, each society was grouped with a large association anchor. Because of the size of the Houston LAS, the math dictates that no more than four groups be formed. The goal was to make the groups as closely identical in size as possible and to create a rough geographic association. With size of the group most important, sometimes geographic association was sacrificed (Fort Worth, you’re with San Antonio; Corpus Christi, you’re with Dallas). TPA automatically geographically assigns each member to a LAS whether or not you actually belong to that LAS. Thus, every TPA member can participate in this challenge. Group One: San Antonio, Fort Worth and West Texas includes the Abilene Psychological Association, Bexar County Psychological Association, El Paso County Psychological Association, Fort Worth Area Psychological Association, Panhandle Psychological Association, Psychological Association of Greater West Texas, Red River Psychological Association, South Plains Association of Psychologists, and the out of state psychologists. Group Two: Austin, Central Texas and Rio Grande Valley includes the Bell County Psychological Association, Brazos Valley Psychological Association, Capital Area Psychological Association, McClennan County Psychological Association, Montgomery County Psychological Association, and the Rio Grande Valley Psychological Association. Group Three: Dallas, East and North Texas, and Nueces County includes the Collin County Psychological FALL 2006

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Association, Dallas Psychological Association, East Texas Psychological Association, Nueces County Psychological Association, and the Texoma Psychological Association. Group Four: Houston, Sugar Land, Beaumont includes Fort Bend County Psychological Association, Houston Psychological Association and the Southeast Texas Psychological Association.

The group that contributes the largest amount to Psy-Pac from September 18 until the convention deadline will win a trophy that may be kept until the Challenge next year. All of the LASs have already been informed. The Group Challenge is on!

The Per Capita Challenge: The research revealed that there is a great discrepancy among the LAS groups in terms of per capita giving. Top honor goes to the Red River Psychological Association (Wichita Falls area) with a giving of $37.50 per capita. A close second is the Psychological Association of Greater West Texas with giving of $31.25 per capita. It falls off rapidly after that, with three LASs at $0 (ZERO????). Our goal is to increase contributions across the board both for the LAS and the individual psychologists.

Therefore, a second trophy will be awarded to the LAS which shows the largest dollar increase per capita from September 18 until the convention deadline. Red River and Greater West Texas set the standard. The Per Capita Challenge is on!

Can Houston maintain the lead with Sugar Land and Beaumont are helping?

Contribute as much as you can. Come to the convention and see who wins. Houston, the Challenge is set!

2006 Board Members Patrick Ellis, PhD, Past President Michael Pelfrey, PhD Robert Mehl, PhD Dee Yates, PhD Stephen Loughhead, PhD FALL 2006

References continued from page 25 Geyer, A. (January 2006). Proud and Humble, not Proud versus Humble. Conference poster presented at the annual meeting of the Society for Personality and Social Psychology. Palm Springs, CA. Greenwald, A. G., Rudman, L. A., Nosek, B. A., & Zayas, V. (2006). Why so little faith: A reply to Blanton and Jaccard’s (2006) skeptical view of testing pure multiplicative theories. Psychological Review, 113, 170-180.

Hareli, S. & Weiner, B. (2000). Accounts for success as determinants of perceived arrogance and modesty. Motivation and Emotion, 24, 215-236.

Lewis, C. S. (1952/2001). Mere Christianity: A revised and amplified edition. NY: Harper-Collins.

Lee, K., & Ashton, M. C. (2004). Psychometric properties of the HEXACO Personality Inventory.

Multivariate Behavioral Research, 39, 329-358.

Livesley, W. J., Jang, K. L, Jackson, D. N., Vernon, P. A. (1993). Genetic and environmental contributions to dimensions of personality disorder.

American Journal of Psychiatry, 150, 1826-1831.

Morris, J. A., Brotheridge, C. M., & Urbanski, J. C. (2005). Bringing humility to leadership: Antecedents and consequences of leader humility. Human Relations, 58, 1323-1350.

Peterson, C., & Seligman, M. E. P. (2004). Character strengths and virtues: A handbook and classification. Washington, DC: American Psychological Association; New York: Oxford University Press.

Powers, C., Nam, R., Rowatt, W. C., Hill, P. (2006). Associations between humility, spiritual transcendence, and forgiveness. Manuscript under editorial review.

Roberts, C. R. & Wood, W. J. (2003). Humility and epistemic goods. In M. DePaul & L. Zagzebski (Eds.) Intellectual virtue: Perspectives from ethics and epistemology. Oxford University Press.

Rowatt, W. C., Ottenbreit, A., Nesselroade, K. P., Jr., & Cunningham, P. A. (2002). On being holier-than-thou or humbler-than-thee: A socialpsychological perspective on religiousness and humility. Journal for the Scientific Study of Religion, 41, 227-237.

Rowatt, W. C., Powers, C., Targhetta, V., Comer, J., Kennedy, S., & LaBouff, J. (in press) Development and initial validation of an implicit measure of humility relative to arrogance. Journal of Positive Psychology.

Schimmel, S. (1992). The seven deadly sins: Jewish, Christian, and classical reflections on human nature.

New York, NY: The Free Press.

Schwartz, R. C, & Smith, S. D. (2002). Psychotherapeutic assessment and treatment of narcissistic personality disorder. Annals of the American Psychotherapy Association, 6/7, 20-21.

Senzaki, N. & Reps, P. (1957/1998). Zen flesh, Zen bones: A collection of Zen and pre-Zen writings.

Boston, MA: Tuttle Publishing.

Smith, R. H., Turner, T. J., Garonzik, R., Leach, C. W., Urch-Druskat, V., & Weston, C. M. (1996). Envy and Schadenfreude. Personality and Social Psychology Bulletin, 22, 158-168.

Smith, W. L. (2006). Monastic spirituality beyond the cloister: A preliminary look at lay Cistercians.

Research in the Social Scientific Study of Religion, 16, 17-39.

Steger, M. F., Hicks, B. M., Kashdan, T. B., Krueger, R. F., Bouchard, Jr., T. J. (in press). Genetic and environmental influences on the positive traits of the values in action classification, and biometric covariance with normal personality.

Journal of Research in Personality.

Stolberg, S. G. & Rosenbaum, D. E. (August 3, 2005). Court nominee prizes ‘modesty,’ he tells the Senate. The New York Times. Retrieved August 3, 2005, from http://www.nytimes.com.

Tangney, J. P. (2002). Humility. In C. R. Snyder & S. J. Lopez (Eds). Handbook of positive psychology (pp. 411-419). London: Oxford University Press.

Terracciano, A., Costa, P. T., Jr., & McCrae, R. R. (2006). Personality plasticity after age 30. Personality and Social Psychology Bulletin, 32, 999-1009.

The Modesty Survey Executive Summary. (Winter, 2006). In Character: A Journal of Everyday Virtues, 2. Retrieved August 1, 2006, from http:// www.incharacter.org/article.php?article=51 Wink, P. (1991). Two faces of narcissism. Journal of Personality and Social Psychology, 61, 590-597.

Worthington, E. L., Jr. (1998). An empathy-humility-commitment model of forgiveness applied within family dyads. Journal of Family Therapy, 20, 59-76.

Zakay, D. & Glicksohn, J. (1992). Overconfidence in a multiple-choice test and its relationship to achievement. Psychological Record, 42, 519-524.

Author Note Preparation of this article was supported in part by a grant from the John Templeton Foundation. Portions were adapted from Rowatt et al. (in press).

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2006 PSYPAC CONTRIBUTORS

Donations received 1/1 - 8/31

The only organizations that represent psychologists in the Texas Legislature are the Texas Psychological Association and the Psychology Political Action Committee (PSY-PAC). Legislative monitoring for bills which are detrimental to psychology and proactively introducing legislation to further the ďŹ eld are essential to the survival of our profession. These activities are not for just a few special interests, but for the profession as a whole. Unfortunately, only ten percent of TPA members contribute to the PAC and two percent contribute the majority of total funds. Please consider a contribution, consistent with your income, and help your profession. We can do great things if everyone pulls together.

$500 and above Edward Davidson, PhD Lane Ogden, PhD Dean Paret, PhD

$300 - $499 Sam Buser, PhD

$100 - $299 Joan Anderson, PhD Judith Andrews, PhD Paul Andrews, PhD Larry Aniol, PhD Kyle Babick, PhD Eileen Barbella, PhD Julie Bates, PhD Joan Berger, PhD James Berkshire, EdD Peggy Bradley, PhD Tim Branaman, PhD, ABPP Ray Brown, PhD Timothy Brown, PhD Larry Brownstein, PhD Joan Bruchas, PhD Erica Burden, PhD L. Carol Butler, PhD Brian Carr, PhD Betty Cartmell, PhD Ron Cohorn, PhD Sean Connolly, PhD Mary Alice Conroy, PhD Donna Copeland, PhD Mary Cox, PhD James Crawford, PhD Walter Cubberly, PhD Ronald Davis, PhD

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Sally Davis, PhD Mary De Ferreire, PhD Leah Dick, PhD Michael Downing, PhD Marie-Elise DuBuisson, PhD Richard Eckert, PhD Anette Edens, PhD Wayne Ehrisman, PhD Patrick Ellis, PhD Donald Ennis, PhD Alan Fisher, PhD Ft. Worth Area Psychological Association Richard Fulbright, PhD Cynthia Galt, PhD Bonny Gardner, PhD Elizabeth Garrison, PhD Karen Gollaher, PsyD Michael Gottlieb, PhD Jerry Grammer, PhD Charles Gray, PhD Dennis Grill, PhD Edmund Guilfoyle, PhD Michael Hand, PhD James Hardin, PhD Charles Haskovec, PhD Sophia Havasy, PhD Lillie Haynes, PhD Robert M. Hochschild, PhD Charles Holland, PhD C. Alan Hopewell, PhD David Hopkinson, PhD Sandra Hotz, PhD Carola Hundrich-Souris, PhD Daniel W. Jackson, PhD Charlotte Jensen, MA

Krista D. Jordan, PhD Rita Justice, PhD Stephen Karten, PhD Burton A. Kittay, PhD Joseph Kobos, PhD Amelia Kornfeld, PhD Richard Krummel, PhD John W. Largen, PhD David S. Litton, PhD Victor Loos, PhD Stephen Loughhead, PhD Alaire Lowry, PhD Thomas Lowry, PhD Ann Matt Maddrey, PhD Janna Magee, PhD Patricia P. Mahlstedt, EdD Rebecca Marsh, PsyD Patricia R. Martinez, EdD Stephen McCary, PhD, JD Jill McGavin, PhD Richard M. McGraw, PhD Sherry McKinney, PhD Robert J. McLaughlin, PhD Robert Mehl, PhD Robert S. Meier, PhD Daneen Milam, PhD Maritza Milan, PhD Janel H. Miller, PhD Robert W. Mims, PhD Suzanne Mouton-Odum, PhD Gina Novellino, PhD Fernando Obledo, PhD Sherry L. Payne, PhD P. Caren Phelan, PhD Shelley Probber, PsyD Manuel Ramirez, PhD

Robert Rankin, PhD Robin Reamer, PhD Carolyn B. Reed, PhD Catherine Rees, PhD Herbert Reynolds, PhD M. David Rudd, PhD David M. Sabine, PhD Gordon C. Sauer, Jr., PhD Steven Schneider, PhD Leigh S. Scott, PhD Robbie Sharp, PhD Joyce Sichel, PhD Sonia Simon, PsyD Karen E. Smith, PhD W. Truett Smith, PhD Brian Stagner, PhD Daniel J. Thompson, PhD Willson S. Thornton, PhD Thomas Van Hoose, PhD Deborah J. Voorhees, PhD Ann P. Vreeland, PhD Laural Wagner, PhD Michael Walker, EdD Beverly Walsh, PhD Joan Weltzien, EdD Richard Wheatley, PhD David White, CAE Connie S. Wilson, PhD James Womack, PhD John W. Worsham, PhD Jarvis A. Wright, PhD Mimi Wright, PhD Gary Yorke, PhD Sharon Young, PhD Robert Zachary, PhD

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Less than $100 Constance Adler, PhD Kay Allensworth, PhD Mary Alvarez-del-Pino, PhD Kim Arredondo, PhD Lisa Balick, PhD Patricia Barth, PhD Bexar County Psychological Association Bonnie Blankmeyer, PhD Ronald Boney, PhD Joy Breckenridge, PhD Glenn Bricken, PsyD Michael Bridgewater, PhD Amos Jerry Bruce, PhD Constance Byers, PhD Kay Campbell, PsyD Marla Craig, PhD Leslie Crossman, PhD Maria Concepcion Cruz, PhD Mark Cunningham, PhD Stephanie Darsa, PhD Dana Davies, PhD Daniel Diaz, PhD Sid Dickson, PhD

James Duncan, PhD S. Jean Ehrenberg, PhD Emily Fallis, PhD Joseph Fogle, PhD William Frazier, PhD Cheryl Fuller, PhD Sylvia Gearing, PhD Martin Gieda, PhD Guillermo Gonzalez, PhD Linda Gotts, PhD B. Thomas Gray, PhD Pamela Grossman, PhD Ranee Gumm, PhD William Gumm, PhD Cheryl Hall, PhD Paul Hamilton, PhD Philip Hanson JoBeth Hawkins, PhD Barbara Pugh Hinojosa, PhD William J. Holden, PhD Nahid Hooshyar, PhD David Ivey, PhD Linda Jackson, PhD Thomas Johnson, PhD Cliff Jones, PhD

LEGISLATIVE CHAMPIONS $100 - $299 Larry Aniol, PhD Connie BenďŹ eld, PhD, ABPP Joan Berger, PhD James Berkshire, EdD Constance Byers, PhD Sean Connolly, PhD Mary Cox, PhD Anette Edens, PhD Burton A. Kittay, PhD

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Marcia Laviage, PhD Sherry McKinney, PhD Ann Salo, PhD James Womack, PhD Constance D. Wood, PhD

Less than $100 William Frazier, PhD Richard Fulbright, PhD Dorothy C. Pettigrew, PsyD

Bruce Kruger, PhD Trinh Le, PhD Doreen Lerner, PhD Arthur Linskey, PhD Deborah M. Longano, PhD Melinda J. Longtain, PhD Martin Lumpkin, PhD Bruce Mansbridge, PhD Stephen K. Martin, PhD Lynn M. Matherne, PhD Donald C. McCann, PhD Marsha D. McCary, PhD Charles McDonald, PhD Rose McDonald, PhD James McLaughlin, PhD Robert McPherson, PhD Richard S. Mechem, PhD William Montgomery, PhD Craig Moore, PhD George R. Mount, PhD Gary Neal, PhD Margaret P. Norris, PhD Will Norsworthy, PhD Ronald Palomares, PhD Freddy A. Paniagua, PhD

Carmen Petzold, PhD Randy E. Phelps, PhD Cynthia Pladziewicz, PhD John Price, PhD Lynn Price, PhD Glenda Rice Tova Rubin, PhD Dale Rudin, PhD James Ryan, PsyD Earl S. Saltzman, PhD Ollie Seay, PhD Verlis Setne, PhD Robert M. Setty, PhD Terri L. Thompson, PhD Dana Turnbull, PhD Jennifer Unterberg, PhD Melba Vasquez, PhD Alisha Wagner, PhD Ken Waldman, PhD Mac Walling, PhD Patricia D. Weger, PhD Nancy Wilson, PhD Burton Zung, PhD

2006 TPF CONTRIBUTORS $1,000 and above

Less than $100

Anonymous

B. Thomas Gray, PhD Arthur Linskey, PhD

$100 - $299 Michael Blain Nicolas Carrasco, PhD Mary De Ferreire, PhD Jerry Grammer, PhD Victor Loos, PhD Ann P. Vreeland, PhD

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Texas Psychologist

WELCOME NEW MEMBERS 5/25 - 8/31 Member Verna Barron, PhD Sarah Carpentieri, PhD Susan Church, PhD Christine French, PhD Jennifer Hartman, PhD Gabriel Holguin, PhD Jennifer Jagielko, PhD Judy Sonnenberg, PsyD Member Out of State Susan Gelberg, PhD Recent Graduate Member Jennifer Farnum, PsyD Bret Moore, PsyD Celeste Riley, PhD Cressida Suess, PhD

Student Ami Bhaga Ashlee Brown, MA Arthur Cardona, BA Cindy Cheshier, MA Amy Collins, MS Laura Cooper Sandra Cordova, BS Teresa Correia, MS M L Dantzker, PhD Todd Dunn, MS Shawn Ferreiro, BS David Fonteno Charlotte Haley, BA Daniel Hoard, MA Jonathan Horowitz, MA Patricia Imadomwanyi, BS Chelsea Janke

Carolina Jimenez, MA Tracie Kaip, MA Katherine Kelsey, BS Charlene Key Felix Leal, MA Angela Lindley, BA Needhi Patel Andrew Reichert, MS Amanda Richter, BS Stacy Roddy, BA Pamela Schaber, MA Amber Simpler, MS Rebecca Stein, MA Deanna Vokes Eric Wood Elizabeth Young, MS Jason Yu, MA Karri Zumwalt, MS

Benefit Your Practice.

All TPA members are eligible for this unique member benefit that easily enables your practice to accept credit and debit cards.

You can accept every form of payment from every client and not waste your time managing the billing process. Accept payment for consultation fees, counseling sessions and insurance co-pays.

Benefit Your Profession.

Take advantage of a unique member benefit that gives back to the Texas Psychological Association with every transaction. Each credit or debit card payment you accept supports the future of TPA and our efforts to educate and support the profession of psychology.

Charge into Action!

Support TPA by Taking Credit Cards

Member Benefit Includes: • Reduced processing rates • VIP member service • No minimum processing • No start-up fees • Supports multiple psychologists per office • No cost to transfer services –call and compare!

Your participation makes a difference. For more information contact Sabine with Affiniscape at (800) 644-9060, ext. 6973 or visit our website at www.texaspsyc.org/creditcards.

In partnership with Affiniscape Merchant Solutions “The Power of the Association Network” “Affiniscape Merchant Solutions,” a registered ISO/MSP in association with Bank of America, N.A.

34

FALL 2006

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Save the dates for these Texas Psychological Association

Continuing Education Events

2007 Annual Convention

2006 Annual Convention November 16-18, 2006

November 15-17, 2007

Dallas, Texas

San Antonio, Texas

Westin Galleria

Westin La Cantera Resort

13340 Dallas Parkway

16641 La Cantera Pkwy

(discounted rate of $129 for reservations made before 10/27/06)

3 full days of continuing education credit available

Additional information coming to www.texaspsyc.org soon!