Summer 2001 Texas Psychologist

SCHOOL SAFETY

psychologist T E X A S

SUMMER 2001

Volume 52, Issue 2

PSYCHOLOGY Responds to Violence

SCHOOL SAFETY The Importance of Non-Hardware Solutions PRSRT STD U.S. POSTAGE PAID AUSTIN, TX PERMIT 1193

Rockport Insurance Associates Full 1c pu IFC

Robert McPherson, PhD Editor Director of Professional Affairs David White, CAE Executive Director

SUMMER 2001

VOLUME 52, ISSUE 2

Lynda Keen Executive Director’s Assistant Sherry Reisman Director of Membership Lila Holmes Membership Assistant

TPA BOARD OF TRUSTEES

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President Sam Buser, PhD

by Dr. Sam J. Buser, PhD, and Ron L. Cohorn, PhD

President-Elect Walter Cubberly, III, PhD President-Elect Designate Deanna F. Yates, PhD

PSY-PAC News: A History of the Prescription Authority Movement in Texas

12 The Non-Hardware Side of School Safety: Why It’s Important

Past-President Richard M. McGraw, PhD

by Scott Poland, EdD

BOARD MEMBERS

18 Personal Reflections:

Gary Brooks, PhD Ray Brown, PhD Mary Connell, EdD Patrick J. Ellis, PhD C. Alan Hopewell, PhD Sheila Jenkins, PhD Joseph C. Kobos, PhD Alaire Lowry, PhD Elizabeth L. Richeson, PhD Jose Luis Torres, PhD Jarvis A. Wright Jr., PhD

Psychologists are People, Too

by E. Edward Reitman, PhD

26 Dual Diagnosis on Death Row

by Ollie J. Seay, PhD, and Genevieve Tarlton Hearon, MA

28 Collaborative Practice Between Psychologists & Primary Care Physicians

EX-OFFICIO BOARD MEMBERS Foundation President Robbie N. Sharp, PhD PSY-PAC President Ron Cohorn, PhD

by James H. Bray, PhD

30 Report: APA Council of Representatives Meeting

by Joseph C. Kobos, PhD

Corporation President Rick McGraw, PhD Federal Advocacy Coordinator Thomas A. Van Hoose, PhD Federal Advocacy Coordinator Paul Burney, PhD

PUBLISHER Rector Duncan & Associates P.O. Box 14667 Austin, Texas 78761 512 454-5262 Kim Scheberle Managing Editor

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President’s Message: Psychology Responds to Violence

by Sam J. Buser, PhD

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From TPA Headquarters: Measuring TPA’s Effectiveness

by David White, CAE, and Bob McPherson, PhD

10 Inside TPA

Matt Stillwell Advertising Sales

31 Classified Advertising

Scott B. Williams Art Director

32 PSY-PAC Contributors

The Texas Psychological Association is located at 1011 Meredith Drive, Suite 4, Austin, Texas 78748. Texas Psychologist (ISSN 0749-3185) is the official publication of TPA and is published quarterly.

32 New Members

www.texaspsyc.org

SUMMER 2001

Texas Psychologist

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FROM THE PRESIDENT

PSYCHOLOGY Responds to Violence Dr. Sam J. Buser, PhD

Violence pervades our country.

It lives in our homes. It permeates our workplaces. It cruises our streets. It grows on our playgrounds. Whether motivated by hatred, bigotry, low self-esteem, media stimulation, or mental illness, the purveyors of violence are all around us.

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wice more in recent months we have watched the video clips of children running in terror from their schools.

Although we have been assured that the schools are the safest places for children—safer than homes, safer than the streets— there is little comfort in that statistical fact when we watch panic-stricken students streaming from these supposed refuges. Nor are we reassured as we see mothers and fathers holding their children while their tears mingle— tears of relief that they survived and tears of grief for those who were killed or wounded.

Somehow, this violence must stop.

In my own practice, like most of you, I have often come into contact with violence and its effects. I have treated the PTSD of persons wounded during robberies—people who cannot understand why they were struck down. I have seen both the victims and perpetrators of sexual abuse, and I know that the scars from these experiences can sometimes color whole lives. I have counseled women struck by their husbands and the husbands who assaulted them, and 2

Texas Psychologist

I have come to believe that both groups need my help. I have met with anxious men who feared being stalked and shot by their ex-wives, and I know that violence is not only the handiwork of men. I have worked with children whose own parents murdered their siblings, and I have seen adolescents who think they are ready to die by their own hands. As a psychologist, I have come to view violence as my foe, my opponent in a societal struggle for sanity.

Of course, I am only one of the many Texas psychologists who serve in the front lines against this enemy. Some like Sheila Jenkins, a school psychologist for Houston ISD, have had to respond to a tragedy on campus. Others, like psychologist Larry Fisher of Austin, have sought to understand neuropsychological correlates for violent episodes. Some, like Mary Connell of Fort Worth, employ psychological testing to identify potentially violent persons.

Research psychologists Earnest Jouriles and Julia Babcock at the University of Houston study the effects of family violence on victims at women’s shelters.

Psychologists in public agencies, like Ollie Seay in Austin, treat persons with developmental disabilities who are at greater risk for victimization and may have difficulty in

modulating the emotions related to violent actions.

In Texas prisons, psychologists like Rod Kennedy and Gus Roberts seek to prevent recidivism by violent offenders. At Baylor University, psychologist Gary Brooks writes about helping traditional men avoid the dark side of masculinity: violence and sexual assault. Dr. Stephen Pierrel of Baylor College of Medicine, as well as other psychologists, participate in crisis intervention teams when violence has struck. While Robert McLaughlin and Robbie Sharp of Houston treat youthful sexual offenders.

Virtually every psychologist in public or private practice in Texas treats victims and perpetrators of violence. We psychologists are the first responders against the plague of violence that attacks the mental health, emotional stability, and social fabric of our state.

Like everyone else, I have been appalled by the seemingly ever-worsening violence in our land. I have wanted, as a psychologist, to do my part in addressing the causes and solutions. As I thought about my goals as your TPA president, I became convinced that psychology, and TPA in particular, must speak out about violence. No science is better suited to investigate the reasons why young people seek to shoot their classmates. No healers know more about treating the trauma caused by violence. No diagnosticians are better equipped to predict who will become violent. No learned profession has more skill in helping persons with violent potential.

For these reasons I have designated this year’s presidential theme: “Psychology Responds to Violence.”

To promote this theme TPA will sponsor special events focusing on our ability to detect, treat, and prevent violence and the effects of violence on the people of Texas. I have invited Scott Poland, a school psychologist who is nationally recognized for his work after the Columbine shootings, to be our featured speaker for our summer continuing education event (Summer Getaway Cruise to Cozumel). Also, see Dr. Poland’s article in this issue of the Texas Psychologist SUMMER 2001

(page 12).

In addition, our annual convention, to be held Oct. 4-6 in Austin, will focus on the theme of psychologists’ response to violence and will include national experts on the treatment and prevention of violence. I encourage each of you to submit papers and presentations regarding your own work concerning violence in any of its forms.

Not only will we be learning from each other, we will also reach out to the community of Austin by having a town hall forum in which community citizens and civic leaders will interact with psychologists about preventing violence in our cities. We will be

Introducing the Newest Generation of

TEXAS PSYCHOLOGY ONLINE

No healers know more about treating the trauma caused by violence. No diagnosticians are better equipped to predict

texaspsyc.org www.texaspsyc.org

who will become violent. No learned profession has more skill in helping persons with violent potential. presenting the acclaimed MTV/APA video on youth violence as part of our program, and we have invited prominent psychologists from APA’s Practice Organization to help us learn about psychology’s response to violence at the national level. I have also invited volunteer organizations concerned with violence such as “The Million Mom March” to participate at our convention.

I hope you will unite with other Texas psychologists as we take a public stand against the violence in our society. We can make a difference.

We have the tools, the knowledge, and the clinical skills to reduce the tragedies that are going on daily in our homes, schools, and work places. Join TPA as “Psychology Responds to Violence.” ✯

SUMMER 2001

SURVIVAL Introducing The SurvivalGUIDE Guide To Private Practice, 2000 Do you have what it takes to be successful in Private Practice? Need to create or expand your referral base? Want to have an “office in a box”?

Now available from TPA, The Professional ToolBox, a step-bystep guide to setting up a mental health private practice: Along with the manual you receive an extensive document library useful in the office. Printed copies of business, clinical, and marketing material is contained in the textbook. The same document library is also found in a computer format on an accompanying CD so you can have the ability to directly utilize the information in your office.

The Professional Toolbox is a great addition to your bookshelf. Find out more about the book and content by visiting www.texaspsyc.org and click on the “Practice Resources” link or call (512) 280-4099.

2000 Texas Psychologist

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FROM TPA HEADQUARTERS

Measuring TPA’s Effectiveness

By David White, CAE, TPA Executive Director & Bob McPherson PhD, Director of Professional Affairs

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one of the largest in the country and highlights some of the most prominent researchers and clinicians from around the nation. This year’s convention will be held in Austin, Oct. 4-6. Be on the lookout for your CD program that will be mailed to you in mid-July.

etween us, we have a total of seven children attending school (kindergarten through college). As parents, we are acutely aware of how important report cards are in providing information about our children’s learning achievement and academic progress.

Furthermore, as businessmen, and specifically as Texas Psychological Association (TPA) Executive Director and Director of Professional Affairs, we are equally attuned to the bottom line measure of success in the business aspects of professional association management.

In the more traditional business environment, customer satisfaction, as measured by repeat business, is one of several key indicators or predictors of financial success. For service oriented professional organizations

Drop us a line, call the TPA headquarters, and/or e-mail us with your suggestions, feedback, and criticisms. Provide us with a report card on our progress and achievements in providing you the services and membership benefits YOU require to be a repeat customer and renewing member of the Texas Psychological Association.

The following provides you a summary of some of our activities and accomplishments for the past year in continuing education, membership benefits, and legislative advocacy, as you consider your dues renewal and grade for our efforts.

Continuing Education Over the past six years, we have added a new dimension to our CE offerings.

Member Benefits TPA also offers some outstanding membership benefits that will enhance your professional and personal life. The following highlights several of the most popular services utilized by our members.

Legal Consultation. In partnership with Sam Houston, an exceptional attorney based in Houston, TPA offers you the opportunity to have unlimited phone consultation with an attorney who will answer questions ranging from professional issues to personal matters. For a nominal fee of $145/year, you can receive legal advice from an experienced attorney who has worked with psychologists for over 15 years.

Professional Issues. In January 2000, TPA hired Robert McPherson, PhD, as

like TPA, the single best measure of our success is YOUR membership dues renewal. When YOU make the decision to renew your membership with the Texas Psychological Association, you are providing us with at least a general evaluation and expression of your satisfaction of our efforts to meet your needs and expectations as a professional psychologist.

Please let us know how we are doing.

Referred to as our “Family-Get-Away,” we have provided psychologists in Texas and around the country the opportunity to learn from nationally recognized speakers at top rated resorts. We have traveled from Vail to Cancun to Puerto Vallarta and will be sailing the high seas this summer with Dr. Scott Poland as we cruise the Caribbean.

In addition, our annual convention is

Director of Professional Affairs. Dr. McPherson’s key responsibility is to assist members in matters concerning professional affairs including, but not limited to, ethics, insurance/managed care, and practice management. Dr. McPherson is a past TPA president and offers a wealth of knowledge about professional issues.

Professional Liability and Health Insurance. Many of you are small business

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Texas Psychologist

SUMMER 2001

American Professional Agency Full 1c pu p5

owners and you fully understand the importance of liability and health insurance. TPA strongly recommends the American Professional Agency for professional liability and USA Benefits Group for health and life insurance. If you are ever in the market for either of these products or just want to compare premiums to make sure your current coverage is both competitive and comprehensive, these companies will be more than happy to assist you. Having worked with psychologists for many years, these companies know how to give top rate service to small business owners.

Legislative Advocacy Among the most important aspects of TPA activity and service to members is legislative advocacy. The TPA leadership understands that the advancement of the profession requires active participation in the state legislature. Last August, TPA hired Rusty Kelley, one of Texas’ top lobbyists, to work closely with Executive Director David White to represent our interests in Austin.

Please note that many of the bills were left pending in committee.

We entered the recently concluded legislative session with clear recognition that congressional redistricting would drastically slow and impede the passage of much of the legislation we initiated and/or supported.

Conversely, we also knew that the redistricting slowdown would enhance our efforts to counter legislation that may have negative consequences for psychologists. As a matter of fact, during this session, there were 5,544 bills introduced and only 1,600 passed.

Most importantly, with the efforts of Rusty Kelley and his staff and David White, TPA was able to build some new strategic political alliances and make important relationship strides with key members of the legislature for future years.

Following is an overview of TPA’s legislative activities during the 77th Legislature.

HB 418-Relating to the requirement that certain mental health professionals provide pro bono service.

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Texas Psychologist

PURPOSE: This bill was sponsored by Rep. Glen Maxey (D-Austin) and required that psychologists perform 50 hours of pro bono work before being eligible to renew their license.

TPA POSITION: TPA opposed this bill.

FINAL OUTCOME: Left pending in committee without hearing.

HB 760-Relating to health benefit plan coverage for a minors’ self-inflicted injuries.

PURPOSE: This bill was sponsored by Rep. Garnet Coleman (D-Houston) and required health benefit plans to cover medical costs associated with a self-inflicted injury.

TPA POSITION: TPA supported the bill.

FINAL OUTCOME: Bill had hearing in House Insurance Committee and was sent to subcommittee of House Insurance Committee. The bill was left pending in subcommittee.

HB 849-Relating to the coverage of anorexia as a serious mental illness.

PURPOSE: Rep. Coleman authored this bill, which added anorexia and bulimia to Texas Insurance Code as serious mental illnesses under certain group health benefit plans.

TPA POSITION: TPA supported this bill.

FINAL OUTCOME: Passed the House Insurance Committee and the entire House. It was left pending in the Senate Business and Commerce Committee.

HB 859-Relating to the prison geriatrics community.

PURPOSE: This bill, sponsored by Rep. Harold Dutton (D-Houston), established a program to confine and treat in-prison geriatrics communities inmates who are 60 years of age or older.

TPA POSITION: TPA supported this bill.

FINAL OUTCOME: Left pending in the House Corrections Committee with hearing.

HB 1491-Relating to the health benefit plan coverage for mental disorders in children.

PURPOSE: This bill was sponsored by Rep. David Farabee (D-Wichita Falls) and required that certain health benefit plans provide mental health benefits for children

younger than 19 years old.

TPA POSITION: TPA supported this bill.

FINAL OUTCOME: Bill passed the House and was sent to the Senate Business and Commerce Committee. The bill was left pending in Senate Business and Commerce Committee after hearing.

HB 1593-Relating to subpoena authority of the Texas State Board of Examiners of Psychology.

PURPOSE: This bill was sponsored by Rep. Art Reyna (D-San Antonio) and gave TSBEP the authority to subpoena psychologists’ records during an investigation.

TPA POSITION: TPA supported this bill.

FINAL OUTCOME: Passed out of the Health and Human Services Committee; left pending in calendars committee.

HB 1676-Relating to health benefit plan coverage for survivors of traumatic brain injury.

PURPOSE: This bill was sponsored by Rep. Lon Burnam (D-Ft. Worth) and mandated that certain health benefit plans may not exclude coverage for cognitive rehabilitation therapy, cognitive communication therapy, neuropsychological therapy along with others as a result of and related to an acquired brain injury.

TPA POSITION: TPA supported this bill.

FINAL OUTCOME: Bill passed both the House and Senate. It is on the Governor’s desk for his signature. If you would like a copy of this bill please call the TPA central office.

HB 3198-Relating to the establishment of an electronic system for occupational licensing transactions, public access to certain information regarding licensing holders and fees imposed by occupational licensing agencies.

PURPOSE: This bill was sponsored by Rep. Glen Maxey (D-Austin) and required that certain state agencies (TSBEP included) administer a common electronic system using the Internet through which agencies can electronically submit profiles of licensees and receive applications, send documents and receive payments from licensees SUMMER 2001

and the public.

TPA POSITION: TPA supported this bill FINAL OUTCOME: Bill left pending in House Public Health Committee.

voice, video and data communications.

TPA POSITION: TPA supported this bill.

FINAL OUTCOME: Bill was referred to Health and Human Services Committee.

SB 11-Relating to medical records privacy.

PURPOSE: This bill was sponsored by Sen. Jane Nelson (R-Flower Mound) and relates to the protection of health information that is necessary for the payment or administration of health care claims.

TPA POSITION: TPA supported this bill.

FINAL OUTCOME: Bill passed both the House and Senate. It is on the Governor’s desk for his signature. If you would like a copy of this bill please call the TPA central office.

SB 553-Relating to the creation of a Task Force to review the methods and procedures used to evaluate a criminal defendant’s competency to stand trial and use of the insanity defense.

PURPOSE: This bill was sponsored by Sen. Robert Duncan (R-Lubbock) and establishes a task force to review the methods and procedures used to evaluate a criminal defendant’s competency to stand trial and the use of insanity defense. A psychologist will be a member of this task force.

TPA POSITION: TPA supported this bill.

FINAL OUTCOME: Bill passed both the Senate and House. It is on the Governor Perry’s desk for his signature. If you would like a copy of this bill please call the TPA central office.

SB 93-Relating to providing telemedicine services.

PURPOSE: This bill was sponsored by Sen. Nelson and develops a uniform definition for telemedicine that provides for the use of advanced technology including still image capture and real-time two-way interactive

SB 818-Relating to the prescriptive author-

ity of certain psychologists.

PURPOSE: This bill was sponsored by Sen. Kenneth Armbrister (D-Victoria) and would allow trained psychologists to independently prescribe medication.

TPA POSITION: TPA supported this bill.

FINAL OUTCOME: Left pending in the Senate Public Health Committee without hearing.

We believe that TPA was especially effective in gaining a strong willed champion to sponsor this bill. The decision to leave the bill pending was a carefully considered maneuver employed by the TPA leadership and will likely provide great benefit and additional political allies on this front in the coming months. Stay tuned.

So there you have it. We have most certainly been very busy, and hope, effective in meeting your needs and inspiring your willingness to sign on with TPA for another year. We stand ready to receive your feedback and most eager to process your dues renewals. ✯

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PSY-PAC NEWS

A History of the Prescription Authority Movement in Texas

By Sam J. Buser, PhD Ron L. Cohorn, PhD

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he effort to establish prescription authority for psychologists in Texas is part of a national movement that began in the mid-1980s. In 1984, Senator Daniel Inouye, in an address at the convention of the Hawaii Psychological Association, urged psychologists to seek prescription privileges. This address has usually been considered the birth of the prescription authority movement. His idea was given support in 1985 when Dr. Richard Samuels, then president of APA’s Division 42, published an article in the division newsletter entitled, “A Prescription for Psychologists.” This article was probably the first open statement in a national publication by a psychologist supporting prescription privileges.

That same year in Texas, Dr. Ron Cohorn of Big Spring encouraged psychologists at the Texas Psychological Association’s annual convention to initiate efforts to obtain prescription privileges. The suggestion met with little support, but a small group within TPA continued to discuss the idea. The association leadership at the time felt that hospital admission privileges were a more critical issue. Although a bill for hospital admission privileges was 8

Texas Psychologist

never passed, some psychiatric hospitals in Texas began to allow psychologists to admit patients to their facilities. Unfortunately, as a result of the scandal in psychiatric hospitals in Texas, the Texas Department of Mental Health and Mental Retardation issued a ruling prohibiting psychologists from admitting to hospitals. This ruling was issued even though no psychologist had ever been implicated in the admission abuses to psychiatric hospitals.

In 1990, the American Psychological Association approved an Ad Hoc Task Force on Psychopharmacology. In 1992 the task force issued its report. They concluded that psychologists trained in psychosocial and psychopharmacological treatments could dramatically improve patient care. The task force recommended three different levels of training in psychopharmacology which varied according to the role of the psychologist. Level Three training was designed to prepare a psychologist to prescribe medications for mental health conditions.

The Department of Defense (DOD) initiated a Psychopharmacology Demonstration Project in 1991. The DOD wanted to demonstrate that psychologists could be trained to safely prescribe medications for

mental health conditions. This would fulfill a vital need for the military because there was a shortage of psychiatrists within the ranks, but psychologists were more widely available. Ten psychologists completed an extensive training curriculum to learn the skills necessary to prescribe medications.

Follow-up studies of their performance on duty revealed that they were highly effective. There were no adverse effects on patient health, and the psychologists were lauded for their competence and success.

Several of these psychologists remain in the military and are still prescribing. Some have been stationed in Texas.

The first TPA publication endorsing prescription privileges for psychologists appeared in the Division of Applied Psychology Newsletter in October 1992.

The article, authored by Dr. Ron Cohorn, was entitled “A New Identity for Practicing Psychologists.” A second article by Dr. Cohorn, “Prescription Privileges Revisited,” appeared in the August 1995 edition of the Texas Psychologist.

In 1994, the president of TPA’s Division of Applied Psychology, Dr. Patrick Lawrence, allocated money to bring a major presenter on psychopharmacology for the first time to the TPA convention. Dr. Lawrence was an early supporter of prescription authority for psychologists and actively promoted the issue in TPA governance. The speaker for the convention was Dr. Patrick DeLeon, the Chief of Staff for Senator Inouye and a psychologist. Dr. DeLeon was then and has remained the most outspoken advocate for prescription authority for psychologists.

In 1995, the TPA Executive Committee, under the leadership of TPA President Dr. Kimberly McClannahan, unanimously endorsed the establishment of a committee on psychopharmacology. Recognizing his seminal interest in this area, Dr. Ron Cohorn was appointed its first chair. The committee eventually grew into a task force that has spearheaded TPA’s efforts in psychopharmacology.

Dr. Rick McGraw of San Angelo was TPA’s Local Area Society (LAS) Officer in SUMMER 2001

1996. During the LAS Training Day held in conjunction with the annual convention, the prescription privileges idea was extensively discussed. Dr. Betty Richeson, of El Paso, introduced the idea of prescription privileges during her presentation. The topic received enthusiastic support from those in attendance. Dr. McGraw, also an early supporter of prescription authority, drew up a resolution on behalf of the LAS officers that was presented to the TPA Executive Committee. The resolution petitioned TPA to move forward on the prescription authority issue. That same year a debate on prescription authority was held at the annual convention with Dr. Rick McGraw, Dr. Ron Cohorn, and Dr. Morgan Sammons endorsing the pro position. Dr. Sammons was a recent graduate of the DOD’s Psychopharmacology Demonstration Project.

In December of 1996, the TPA Executive Committee and members supporting prescription authority met in Galveston to develop a long-range plan for attaining prescription privileges for Texas psychologists. The plan marked the first time that TPA had gone on record officially supporting prescription authority for Texas psychologists. Since that time, the Galveston plan has guided TPA’s efforts for prescription authority.

In the spring of 1998, TPA President Robbie Sharp convened a task force in Austin to execute action steps necessary to obtain prescription authority for psychologists. Dr. Dee Yates and Dr. Ron Cohorn were appointed chairs of this task force.

High on the agenda for the task force was to establish a training program modeled after APA’s recommendations to prepare Texas psychologists for prescription authority.

After discussing several alternatives, the task force voted to recommend that the TPA Board endorse a program developed by the California School of Professional Psychology (CSPP) and offered through distance learning facilities provided by Texas A&M University. It was further recommended that participants in this training program must have a doctoral degree in SUMMER 2001

psychology, a current state license, and must be providing health services.

In August 1998, the TPA Board of Trustees voted to accept the task force’s recommendations and to move forward with training. At about the same time the Prescribing Psychologists’ Register (PPR) independently decided to establish a training program in Texas. Under the direction of Dr. Tom Kozak and Dr. Gale Joslin, the first PPR class met in the fall of 1998. The CSPP program began offering classes in February of 1999. The first cohorts of both programs have now completed the two years of didactic training recommended by APA and are beginning to work on the required internship in psychopharmacology. More than 100 psychologists are now trained and are preparing to serve the citizens of Texas.

The American Psychological Association invited all state psychopharmacology chairs to attend the State Leadership Conference in Washington, D.C., in March 1999. The primary emphasis of the meeting was on the prescription privileges movement. It was clear that APA was putting tremendous emphasis on the issue. The following year Dr. Patrick DeLeon became president of APA. He had campaigned on his promise to prioritize the prescription authority agenda.

Obviously, for psychologists to be able to prescribe, it would be necessary for TPA to mount an effective legislative campaign that would culminate in the passage of a bill authorizing appropriately trained psychologists to prescribe. The Texas Psychology Political Action Committee (PSY-PAC) was called upon to begin raising substantial sums of money to underwrite the legislative campaign.

Most significantly, students and graduates of psychopharmacology training programs in Texas were each asked to pledge $2,000 per year for three years in an effort to provide the necessary financial resources for the legislative efforts. Most of these students and graduates made these commitments and began contributing on a regular basis to meet their pledges.

During the 2000 State Leadership

Conference, Dr. DeLeon and other leaders of APA met privately with leaders of the Texas Psychological Association including TPA president Dr. Rick McGraw. The Texas delegation expressed our intent to introduce a prescription authority bill in the next legislative session. The APA leaders encouraged TPA to submit a grant proposal to the Committee for the Advancement of Professional Psychology (CAPP) to underwrite some of the costs of our legislative efforts. The grant proposal was subsequently submitted, and a $30,000 grant was funded.

Armed with the legislative grant from CAPP and additional funds from PSY-PAC, the TPA Board was motivated to think in bold terms in hiring a new lobbyist for the organization. After an extensive search for the best candidate for the position, TPA employed Rusty Kelley and Associates in June 2000.

Kelley has consistently been rated by Texas legislators themselves as one of the best lobbyists in Texas. Kelley was the lobbyist who represented the nurse practitioners when they successfully obtained prescription authority. Kelley and his associate, Joey Bennett, have become the key tacticians as the organization moves forward for prescription authority.

In the most recent chapter of this story, Senator Kenneth Armbrister of Victoria introduced Senate Bill 818 during the 2001 legislative session. The bill would have permitted appropriately trained psychologists to prescribe medications in Texas. In addition, we are submitting a grant request to the American Psychological Association Practice Directorate in order to obtain additional funds to continue this effort. We will continue to work diligently on the endeavor until we are successful in passing a psychopharmacology bill. ✯ Dr. Sam Buser is President of TPA and is a clinical psychologist in private practice in Houston. Dr. Ron Cohorn is President of PSY-PAC, TPA’s Political Action Committee.

He is a clinical psychologist in private practice in Big Spring.

INSIDE TPA Melba Vasquez, PhD, ABPP, past TPA Board member, and psychologist in independent practice in Austin, has received the Distinguished Service Award from the American Board of Professional Psychology’s (ABPP) Academy of Counseling Psychology.

In addition to being active within APA, Dr. Vasquez has been an active TPA board member and member of TPA. Dr. Vasquez is currently the chair of the Psychology of Women Special Interest Group within TPA. Our association has been fortunate enough to have Vasquez present numerous workshops at TPA continuing education events such as the annual convention and Professional Education Conference.

TPA member and former TPA Medicare/Medicaid Liaison Paul K. Chafetz, PhD, is co-editor, with Kevan Namazi, PhD, of a new book, Assisted Living: Current Issues in Facility Management and Resident Care (2001), just published by Auburn House of Westport, Conn.

This volume is designed for readers with experience in geriatric long term care management who wish to expand into assisted living. Chapters deal with a broad range of clinical and business aspects of operating a modern assisted living facility for older adults.

Dr. Chafetz, a clinical geropsychologist, practices in Dallas and is associate professor in the Gerontology Department at the University of Texas Southwestern Medical Center in Dallas.

Dr. Bonnie L. Blankmeyer, Professor of Psychiatry at The University of Texas Health Science Center at San Antonio(UTHSCSA) Department of Psychiatry, Medical School, has been elected to the Board of Educational Affairs of The American Psychological Association (APA). She will serve a three-year term.

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Carolyn Bates, PhD, is currently serving on the Advisory Council and Board of Directors of AdvocateWeb, a web site designed to address the issues of sexual misconduct, exploitation and abuse of clients by professionals in positions of power, authority or trust. AdvocateWeb is a nonprofit charitable organization devoted to offering free resources for victims, survivors and their families, friends, victim advocates and professionals.

On February 1, Drs. Leslie Crossman and Stephen Loughhead became the proud parents of twins, Hunter and Connor Loughhead. We wish them all the best.

At a recent graduation exercise for the Psychiatric Residents in the Department of Psychiatry at the University of Texas Southwestern Medical Center, the Arthur M. Griffin Award was presented to a clinical faculty member who exhibited outstanding contributions to medical student education. This awardee, Harold B. Crasilneck, PhD, A.B.P.H, has been a Clinical Professor in the Department of Psychiatry and the Department of Anesthesiology for over 36 years. This is the first time a psychologist has ever been selected as the recipient for this honor.

James E. Goggin and Eileen Brockman Goggin have authored Death of a ‘Jewish Science’:Psychoanalysis in the Third Reich (Purdue University Press, 2001). The book traces what happened to the Berlin Psychoanalytic Institute (BPI) once Hitler came to power. Between 1920 and 1933 the BPI had become the role model for all psychoanalytic institutes. Then it describes the steps by which the BPI, and the psychoanalytic tradition that it represented, were transformed beyond recognition by what the Nazis called salami tactics (slice by slice). The authors conclude psychoanalysis did not survive World War II.

TPA’s Executive Director David White, CAE, was honored again recently by being named to serve on the American Psychological Association’s Division 31 Board. Division 31 is the division of State Psychological Association Affairs. Division 31 promotes the interests of state and provincial psychological associations within APA by assisting leaders to become active in APA governance; offering the possibility of Fellow status to individuals who have made unusual contributions through their leadership activity; providing program time at the APA convention to address issues of importance to state and provincial associations; and presenting three annual awards.

Additionally, White was named to the board that governs his professional association, the Texas Society of Association Executives (TSAE). TSAE is the professional society for persons engaged in the management of voluntary trade and professional organizations in Texas. TSAE provides the highest quality educational, leadership, and professional development opportunities to association executives and affiliate members, and enhances the performance of the organizations they represent. We are proud that David has been recognized as a leader in the profession of association management.

Furthermore, David recently completed re-certification as a Certified Association Executive (CAE). The designation of CAE is a voluntary certification effort that is designed to elevate professional standards, enhance individual performance, and designate those who demonstrate knowledge essential to the practice of association management.

For those of you who know David, you know that he is full of a contagious energy.

This contagious energy is what motivates and inspires his staff to be the best they can be and to accept new challenges to make TPA the best association it can be. On behalf of the TPA staff, I offer my sincerest congratulations and thanks to him.

Sherry Reisman ✯

SUMMER 2001

TPA Annual Convention

TPA Member

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PSYCHOLOGY Responds to Violence October 4-6

2001 Austin, Texas Marriott at the Capitol

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Texas Psychologist

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The Non-Hardware Side of School Safety:

Why It’s Important

By Scott Poland, EdD

The top school officials in Jefferson County, Colorado, where Columbine High School is located, were uncertain that they agreed with my recommendation that the Columbine school community would demand additional security measures.

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explained that in Paducah, Kentucky and Jonesboro, Arkansas (where I also led crisis teams) a number of hardware security measures were now in place in the aftermath of school shootings. How many increased security measures should schools employ in the aftermath of the Columbine massacre? We also must recognize that less than 1 percent of violent deaths for children occurred at school last year. Schools are far safer than communities. But, a single violent death in a school is unacceptable.

The Columbine shooting sent shock waves across the country unlike any other previous act of violence at school. The extensive horrific and sensationalistic television coverage scared many children, including my own 13-year-old daughter. There were bomb threats in many schools across the country in Columbine’s wake.

Numerous students reported that principals got on the public address systems and said for students not to worry and to get back to work. But, is it that easy and will spending millions of dollars on school police, surveil12

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lance cameras, identification badges and metal detectors alone result in eliminating the possibility of further multiple homicides at school?

After all, none of the above hardware measures are new.

Several school systems have enacted elaborate and very realistic crisis drills where local police officers storm schools and disarm students who are armed with fake weapons and dressed in camouflage. Many of these drills have involved simulated blood and firing of weapons loaded with blanks. As a psychologist, I am very concerned that those drills are too realistic and that they scare and confuse children who cannot truly distinguish reality from fantasy. I do advocate crisis drills that teach students to follow the directions of adults and to move to a protected place. Those drills can be practiced without scaring anyone.

There is much more information about how to carry out a crisis drill in my recent publications.

I believe that every day since April 20,

1999, has provided a teachable moment in every classroom in America to discuss school safety and violence prevention and to empower students that they hold the key to school safety. Few classroom teachers and administrators have taken advantage of this teachable moment. I am at a loss to explain why educators did not arrange desks in a circle in every classroom so that students could express their fears and concerns and identify prevention strategies to help make their schools safer. I do know that educators in every state are under tremendous pressure to raise academic scores on the state accountability test.

School principals have told me that they would like to devote curriculum time to topics such as managing anger, violence prevention and learning to get along with others regardless of race and ethnicity, but time cannot be taken away from teaching the basic subjects. When I addressed a crowd of over 3,000 in the aftermath of the Columbine shooting, the first question I was asked by a parent was, “We know this SUMMER 2001

massacre was because of racism and I want to know what is being done about it!” My response was, “Sir, there is so much that we do not know about the motivation of these perpetrators, but I do believe that racism is a problem in every school in America and the question is what are all schools going to do about it?” It is frustrating to know that there are many excellent curriculum programs available to work on the topics listed above, but school personnel do not feel they have the time, mandate or resources to implement prevention programs.

One question that I raised in my most recent U.S. Congressional testimony was: Does anyone have a good reason why we send millions of school children in America home early in the afternoon, some as early as 2:30 p.m.? Is there something safe, productive and supervised for them to do?

Why not lengthen the school day, which in turn would provide more curriculum time for prevention, programs and extra curricular activities for all students not only those gifted in athletics.

I presented with then Vice President Al Gore on school violence, and he was openly critical of large high schools in America.

He cited that the size of high schools has nearly quadrupled in the past 30 years. I do believe that it is a particular challenge in a large school to make each student feel valued and that they belong. I recommend that all large schools do everything possible to personalize them and make them seem smaller, and I hope that across the country we will stop building massive schools that increase competition, pressure and anonymity among students.

There has been much discussion of how to end the conspiracy of silence that allows guns and weapons in our schools. I will never forget leading the intervention in the aftermath of a shooting in one of my school district’s large high schools. Several students who witnessed the accidental shooting in their classroom said, “That was so serious.

She could have been killed! That could have been me! But, you know what, I don’t think I would tell an adult tomorrow if I saw a gun on campus!” My experience has been SUMMER 2001

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that students almost always talk to their friends about homicidal thoughts, suicidal thoughts, and plans to bring guns to school.

We have done a poor job in our society of separating incessant tattling about things that don’t matter from the things that do.

We must devote curriculum time to ending the conspiracy of silence. I certainly support the use of crisis tip lines in schools, but students are not using them because we have not addressed prevention and personal responsibility issues in the classrooms. I have just completed a videotape series for the classroom where I talk to students about what they can do to make their schools safer. My wife has developed a workbook with violence prevention activities for the classroom. The workbook and videotapes entitled, Take Back Your School: Challenging Students to Prevent Violence can be ordered from Orracle Educational Video at 800-542-9243.

I had numerous conversations recently with Dr. Jane Hammond, superintendent of Jefferson County Schools in Littleton, and Mr. Jon Destefano, school board president. They have done an excellent job of managing a very traumatic situation. They made the following key points about what they learned: • It is a community crisis.

• They could not control the media, which at their peak numbered 750.

• They could control their reactions to the media.

• Prior relationships with police, clergy, mental health, parent, and teacher groups were very helpful.

• They recognize that their school system will be forever identified by the tragedy, but they hope we will remember how they have dealt with it.

• Assistance from the National Public Relations Association and the National Association of School Psychologists was very helpful.

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olumbine High School reopened on August 16, 1999, with a carefully planned rally with the focus on students and staff taking back their school and work-

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Columbine High School reopened on August 16, 1999, with a carefully planned rally with the focus on students and staff taking back their school and working together to provide support for each other and to create a climate where violence will never reoccur.

ing together to provide support for each other and to create a climate where violence will never reoccur. Columbine does have new hardware security measures in place such as more school police, surveillance cameras, metal detectors and identification badges for staff and students. These are all logical, helpful and preventative measures in the aftermath of school violence.

Jefferson County implemented these measures after gathering input from parents, staff and students. My own school superintendent, Mr. Rick Berry, implemented a safety task force a year ago with membership composed of school personnel, community members, and perhaps most importantly, students. A number of additional hardware measures have been implemented, but the task force also recommended preventive curriculum programs and hiring additional mental health professionals.

There has been criticism this fall that some schools have gone too far with the implementation of hardware measures only.

I believe that the wise superintendent or principal would form district and building level task forces on school safety. I very importantly point out that Jefferson County has increased the number of mental health workers at Columbine High School

and at many other county schools. They also have many curriculum prevention programs in place to teach tolerance of diversity and individual differences and to promote a climate where everyone is treated with respect.

The head of a U.S. Congress committee asked me how we can spot a troubled and potentially violent student in America. My response was that school personnel spot them every single day, but that schools do not have the resources to help them. It is the rare school psychologist or counselor who actually provides mental health services. High school counselors in particular spend almost all their time on clerical tasks such as scheduling.

Many schools are increasing hardware school security measures to start the 19992000 school year, and adding metal detectors is one of the most common strategies.

Metal detectors in schools are not new. I would like to make the following analogy: Has any single strategy ever stopped contraband from crossing the border between Mexico and the U.S.? Then, why would we expect hardware measures alone to stop weapons from entering our schools? Why not work on reducing the availability of guns to children? I believe the issue is gun responsibility, not gun control. Adults must keep guns away from children. Children do not understand the finality of death, are very influenced by violence in the media, and have difficulty controlling aggressive impulses.

On a recent trip to Colorado, I noted with great interest that the school board in Mancos voted to hold a gun show at the local high school. Ghandi said, “What we do speaks so loudly to children that they cannot hear what we say!” The school board’s action sent a powerful and unfortunate message.

The most heartwarming and encouraging signs I observed while assisting in the aftermath of the Columbine massacre were the “I Will” messages written by thousands of Jefferson County students. The real question is what will every educator and student do to make a difference? Educators must SUMMER 2001

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step forward to stop the bullying and harassment in schools. Those signs posted at entrances to school campuses that say, “No guns, drugs, or weapons allowed” should also say “No bullying allowed” and educators should mean it. I know that our daughter is a very capable learner, but what I want as a parent is for her to come home safe from school every day and not to be harassed in any way. Schools have been slow to recognize that safety is what parents want above all.

I do a lot of training on school crisis teams and so often an educator comes up and says, “We have a crisis team. At least I think we do. I might be on the team, but we have never met and I have no idea what I am supposed to do!” Shakespeare wrote in Macbeth, “A false sense of security is mortal’s chiefest enemy.” Many schools with crisis plans about what to do in the aftermath fail to include prevention activities.

I applaud legislation in Texas that requires every school to have a violence prevention plan. It is my hope that curriculum time will be devoted to that goal. Since the leading causes of death for children in order are: accidents, homicides, and suicide, it is important that prevention programs be implemented to reduce each of these. Why can they not be a part of school curriculums and crisis plans? Adolescents are dying at a record rate. The Center for Disease Control estimates that approximately one out of 1,000 high school students dies or is killed each year. There are approximately 5,000 gun deaths for children each year. There has been so much written about the 14 students who were killed by guns at Columbine, but that is the daily average number of gun deaths for children in our country. Many Americans believe that we live in the best country in the world, but we are the only country where kids bring guns to school and shoot their classmates and teachers.

Why don’t we develop and implement prevention programs to address the leading causes of death for children?

There has been much attention placed on how to spot a potentially violent child in

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The head of a U.S. Congress committee asked me how we can spot a troubled and potentially violent student in America. My response was that school personnel spot them ever y schools

single do

day, not

but

that

have

the

of the last seven school shootings are alive, but have they shed any light on why they committed their crimes? Is anyone satisfied with what these perpetrators have said which is nothing really!

The American Psychological Association and the National Association of School Psychologists have identified the major factors in our society that cause youth violence: • child abuse, • ineffective parenting, • media violence, • violence in the home, • poverty, • prejudice, • substance abuse, and • gun access.

resources to help them.

America. The most common factors from the Early Warning guide published by the U.S. Department of Education are: • Fascination with guns, violence and bombs.

• History of bullying and being aggressive.

• History of being victimized.

• Interpersonal deficits.

• History of depression.

• Cruelty toward animals.

• Violent talk, writings and/or artwork.

• Fascination with violent video games.

• Firesetting.

• Lack of remorse or empathy.

There is only one problem with these descriptors—unfortunately they fit thousands and thousands of children. I am concerned by attempts to develop profiles of potentially violent youth that do not include intervention programs with a mental health component for students and families. We also must end the conspiracy of silence that stops friends from coming forward and getting help for someone who is homicidal or suicidal.

Everyone wants to know why school shootings occurred. The perpetrators of six

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hose are the issues we must address in our society. In just the three locations where I led national crisis teams—Paducah, Jonesboro and Columbine—23 people were killed and 38 were wounded. Many of the parents of the children who were murdered are angry. They all want a promise that their children did not die in vain. They want changes in our country and in our schools.

I am absolutely committed to prevention. The philosopher Dac wrote, “The future is the past in preparation.” My question is what have we changed? What are we doing to reduce the senseless deaths of young people in our country? Where are our prevention programs? Then, why would we not expect the future to be the past in preparation? ✯ Dr. Scott Poland, President Elect of the National Association of School Psychologists, has led national crisis teams and has written extensively about crisis intervention in the schools. Dr. Poland is Director of the Department of Psychological Services, CypressFairbanks Independent School District, Houston TX. He will be presenting “Tragic and Violent Deaths of Children: What Intervention and Prevention Assistance Can Psychologists Provide?” at TPA’s Family Getaway Cruise to Cozumel. (4 hours CE)

SUMMER 2001

ARTICLE REPRINTS

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After 40 years as a practicing clinical psychologist, you would think it would be different.

But there I was again. It was pouring buckets. Many of Houston’s streets were already flooded and it was more than understandable when two patients in a row called to cancel their appointments. One lived approximately 20 miles from my office and was justifiably concerned about traffic. (Houston drivers are notorious.

All it needs to do is sprinkle and their driving skills regress to the time they first obtained their learner’s permits.) The other had to pick her children up from school because students were being sent home early, due to the weather.

PERSONAL REFLECTIONS:

Psychologists are People, Too

By E. Edward Reitman, PhD

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evertheless, as I sat in my swivel chair, facing several stacks of paperwork that desperately needed attending to, there was a sick feeling in the pit of my stomach.

Was I being rejected? Had I failed in some way? Or had they found out? Found out what? There wasn’t anything to find out, except that, deep inside me, was an insecure, insufficient feeling, wounded little kid who still doubts his own worth and still questions his lovability. Intellectually, I can rationalize it away. There is a voice inside that says “Ed, despite your fears and shortcomings, your warts and your scars, you’re okay.” On a bad day, when I’m faced with cash flow problems, taxes that need paying, an air conditioner compressor that died a month after the warranty expired, patients who had been doing well, but suddenly regressed to where they were a year earlier in therapy, or two cancellations because of tornado warnings and flooded streets, I hear a different voice. It says something akin to “You’ll never be good enough.”

It is then that I wish they had told me 40 years ago that psychologists are people, too.

Then again, over those 40 years, I’ve learned some other lessons that I wish they 18

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had taught me. Valuable lessons, which I believe all of us need to remember every day of our professional and personal lives. I started to jot them down, but the list seemed endless, so I narrowed them down to seven rules of thumb, which I try to use as a guide for living, both as a psychologist and as a person. I’m not always successful, but when I forget them or fail, I go back and try again, a little harder.

Real is more important than right When I first got out of school, I went to the V.A. hospital for my internship. Everything was fresh in my head. I knew all the rules and theories about therapy. I was a cocky little guy who thought, “These people aren’t trying hard enough. When I get the opportunity, I will give all of me. I am really going to make a difference.” I think that attitude may have offended a few of the old time psychiatrists who had been at the V.A. for years.

Consequently, when it came time for my second rotation, they put me on the women’s ward. I had no idea what I was getting into. The supervising psychiatrist assigned me a patient who was to be all mine for the six weeks I was going to be

there. She was a paranoid schizophrenic, catatonic type, who even demonstrated waxy flexibility. You could move her arms and they would remain stationary wherever you placed them. I was amazed. However, she had also bitten several staff members she encountered on the ward whom she didn’t particularly care for. I was told the attacks were unprovoked and vicious in nature.

Nevertheless, I thought there has got to be something I can do to cure her.

I was given an office with a desk that faced a west window, causing the sun to shine into my eyes in the afternoon, and told to see the patient for 50 minutes on Friday afternoons. That meant that her appointments followed the psychology staff meeting and lunch, which usually took place at a wonderful Mexican restaurant.

Need I tell you that, if you consume enough Mexican food and sit facing the sun, your eyes tend to get very heavy and when the person you’re talking to doesn’t say a word, it takes every ounce of concentration you possess to stay awake. I should add that, at that time, I never realized that I could have any influence on my environment. If the sun was shining in my eyes, I could have SUMMER 2001

moved the desk. But I didn’t, because everything was the way it was “supposed to be”. I imagine I assumed it must have been right.

Even more, why did I spend 50 minutes trying to talk to a wall? In retrospect, I could have seen her twice a week for 25 minutes. But even that never crossed my mind at the time. Far worse, during our third visit, she very deliberately reached into her V.A.-issued handbag, which was clear plastic so the staff could see what they contained, and slowly pulled out a box of Chiclets. With almost machine-like movements, she extended her hand to me, offering me one. My head went back to the books; “Never accept gifts from a patient, you will be obligated.” So, I made a therapeutically fatal mistake. I said “No thank you”. She had reached out, no matter how minimally, and I turned her down because I was trying to do it “right”.

For the remainder of our sessions, she never said a word and never attempted to reach out again. As you may have already anticipated, on the last day of my six weeks’ rotation, I came to the appointment after having consumed far too much Mexican food. I sat there, the sun shone, she stared silently, and it was the fastest session I ever had with her. I fell sound asleep. Thirty to forty minutes later, I woke, startled. My first thought, albeit a vague one, was that she had bitten me. As my head cleared, I checked my body parts. They were all intact, nothing was missing or injured. I felt terribly embarrassed and hastily said my goodbyes to her. I do recall telling her that I wished her well.

She seemed to smile slightly, or at least I thought so, and that was it.

Approximately six months later, I passed her in the corridor near occupational therapy, but I didn’t recognize her. She was gingerly walking down the hall, when she suddenly turned and said “Dr. Reitman”. She had never spoken to me before! I said “My God, how are you?” We greeted one another and she went on to say “I want to thank you for everything you did.” “What did I do?” “You went to sleep.” Sheepishly, I acknowledged that I had. Then she said, “When you did, I knew you trusted me.

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You were the first person who trusted me the whole time I had been at the hospital.”

I tried to sell that later on. I called it a new form of treatment-sleep therapy. However, no one ever bought it.

More importantly, however, I discovered that, when you get out in the real world and deal with real people, real becomes more important than right. People don’t always follow the books or the rules or, for that matter, the diagnostic criteria. But, whatever they do is real to them. To effectively interact with them, we have to be a part of their real world. Several months later, when I recalled this incident, I learned another

Be yourself Don’t act the doctor, the teacher or the parent. One of the things I believe academic psychology fails at is that we have terrible training programs for becoming a clinician in private practice. Physicians have equally poor training programs for being doctors.

The only professions I know of that really educate individuals to be private practitioners are dentistry and physical therapy. They have courses dealing with how to talk to patients, how to operate an office, how to hire your help, how to charge and how to network with allied professions. We lack all those. We only teach psychology.

lesson. Each of us is far more important than we may think. I realized that, even when it appeared that what I said is being ignored or rejected, it had far greater impact on the human being I was dealing with than I suspected. I was important to her. What I said and did or didn’t do was, as well.

It is the same for every patient we see.

Consequently, we must take care that we deal with them in a nurturing and caring manner.

But, in the real world, there are other issues you have to face. Unfortunately, all I knew 40 years ago about being a businessman, I learned from the actions of Daddy Warbucks in the Little Orphan Annie cartoon. He was successful, he had many phone calls and he was always harried. In contrast, I knew that real doctors had stethoscopes and clicked their heels as they walked down the halls of the hospital.

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nitely know his voice. That’s not him!” The operator, however, accepted my statement and connected mom on the spot. She was unhappy, but she never did that again.

Why do I tell you this story? Because I finally reached the president of the oil company and I said, in my deep “doctor” voice, “This is Dr. Reitman. Is there anything I can do for you?” He said “Yes. I was at a convention in Atlantic City, New Jersey recently, and the waitress who waited on me was your mother. She said when I got back to Houston, I was to call and tell you that she’s fine.” This psychologist lost his voice.

There was a pregnant pause, followed by my weak “thank you”. Still, another lesson was learned. You don’t have to be a doctor, you just have to be you.

(Everyone else sort of tiptoed.) That was, of course, before the days of beepers and cellular phones. Real doctors also spoke in a deep, authoritative manner and measured their words. Accordingly, the first couple of years I was in practice, I was a combination of both. I was an authoritative, deep-speaking, serious individual who was constantly on the run and besieged by phone calls.

In the beginning, I shared a one-room office with a surgeon who practiced in the morning. I was there in the afternoon. One day, I received a call from the Shamrock Hotel. You have to understand that, in my mind and, to a great extent, in reality, I was this poor little kid who had never been to the Shamrock. I couldn’t afford it. It was the newest, most expensive hotel in the south.

Nevertheless, there I was, receiving a call from the Shamrock Hotel, from the president of an oil company. I had arrived. I thought “An oil man is calling me!” I returned his call ten times. The last nine times, I didn’t leave my name, because I didn’t want him to think I was half as anxious as I was.

Now, to fill you in on this story, you 20

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should know that I had a mother who held a vendetta against AT&T. She carried on a one-woman campaign to ensure that their profit margins stayed as low as possible.

Therefore, whenever we called long-distance, we spoke in code. She would call person-to-person and say “Is John there?”

(That’s “Ed” in code.) I would then respond “John just left. He’ll be back in ten minutes.” Then she would hang up, knowing I was there, and call back station-to-station, which did not carry the surcharge. Of course, my wife’s presence was of no consequence. Mom would have denied that, but she never gave Harriet a code, only me.

There were other codes. For example, when you arrived home from a trip, you were supposed to call and say “Is Mrs. Goodday there?” That meant everything was okay. After the incident with the phone call I’m about to describe to you, I finally put a stop to all that behavior. It was easier than I ever imagined. The operator called one day and asked the old, familiar question “Is John there?” I said “Yes, this is John.”

On the other end of the line, I heard mom shouting “No, no! That’s not John. I defi-

Never assume Ask questions, because you don’t always know and the only way to find out is to question. Also, it helps people realize that you’re not sleeping. Early in my practice, I worked as a consultant for a small independent school district. It was a wonderful way to network and gain recognition in the community. Before long, I was seeing almost everybody-staff, teachers, parents and students. At that time, I would do a fast interview, a few tests (the Wechsler or Bender-Gestalt), discuss my impressions with the parents and write a report to the school district, all that for $35. It required an hour and a half, plus a half hour, more or less, to dictate a report. Obviously, it was a rush job.

Well, one day, I gave this cute little guy the Wechsler. A whole picture suddenly unfolded in my lap. His verbal IQ was 122.

His performance IQ was 101. Obviously, there was a great disparity. In my head, the picture was very clear. I had the report written and my whole explanation ready for the parents. In my mind, the youngster obviously had a learning disability, with severe visual-motor problems. I brought the parents in and said “Well, I’ve just been seeing little Johnny and I want you to know that he is really a fine young man. He demonstrates a lot of positive attributes and abiliSUMMER 2001

ties that I feel will help him to deal with his problems. Of course, you know that his handwriting is extremely poor. His ability to copy geometric designs is lacking and...”

Before I could get another word out, his mother said, “Yes. You know, he just got his hand out of a cast after six months.” “Of course,” I responded, “that’s why the disparity is there...”. Never assume. Question.

You see, we don’t have to know all the answers in advance, but we do have to learn to search for them.

Take your own temperature For about eight years, I was the “resident psychologist” on a daily woman’s TV show broadcast on Houston’s NBC affiliate. Two or three days a week, I would be there, fielding telephone calls from listeners, sharing interviews with the show’s hostess and discussing problems encountered in the course of daily living on the job, in marriage and child rearing. During one show, I asked the hostess to close her eyes and open her mouth. We were before a live audience and,

although hesitantly, she complied. I then put a thermometer in her mouth and asked her to open her eyes. “What am I doing?” I asked. “You’re taking my temperature.”

“No, I’m taking my temperature.” “You’re crazy. The thermometer is in my mouth.”

“That’s absolutely right. But, do you know how many of us go through the world taking our temperature by putting a thermometer in somebody else’s mouth?”

Whether you’re a therapist, a husband, a wife, a girlfriend or boyfriend, there is a rule we should all follow - Always put the thermometer in your own mouth if you want to take your temperature. However, that isn’t the way it works. Try to picture this: A wife is at home, having a very hard day. The dog has to go to the vet. One of her children is home from school, sick. A pot intended for pasta has boiled over on the stove. She has an appointment she needs to keep with the school counselor, for her other child. It is apparent that her world is in disarray and she is as tight as a spring.

Her husband comes home early in order

to see her. When he does, he says to himself “My lord, I know what kind of night I’m in for.” Where did he put the thermometer?

The answer, immediately, is in her mouth.

Her bad day was going to cause him to have a bad night. Had he taken his own temperature, he might have said, “I’m sorry you had a bad day. Let me help. I’ll take care of our sick child and clean the stove while you try to calm down. You can still make it to the vet and the school counselor. Later, we’ll try to make tonight better than today.”

Figuratively speaking, when you put the thermometer in your own mouth, more often than not, you’ll be in a better place to help the people you interact with, and yourself as well. Over the years, however, I, too, have misdirected a few thermometers. I can think of the times that I have gone through a session with a patient and thought “That’s one of the best interactions we’ve ever had.

The patient made some wonderful breakthroughs.” The next week, the patient didn’t keep his/her appointment and later canceled all future appointments. At that

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point, I wondered “What did I do? They, too, must have found out.”

Once again, I don’t know what they found out, but it had to be something lacking in me, because they canceled their appointments. I now thank God for the few times, years later, that I have received letters such as the following: “Dear Dr. Reitman, four years ago when I was seeing you, we had an appointment where everything became so clear that I couldn’t bear to face it or even talk about it, so I ran from therapy. I even moved to Dallas. Time, however, is healing in itself and things are much better now. I wish I hadn’t run back then, but I will never forget what you did for me.”

Nor will I forget what his letter did for me.

It helped to remind me to look at myself, to take my own temperature and to recognize that all I can do is ensure that I perform my job well, with integrity and that I value myself for just that. When the people I come into contact with do well as a consequence of my efforts, that is their triumph and my reward.

Look for the miracles Being a therapist is a tough job, especially if you care. When you see human beings, they don’t grow in a straight line. There are sad 22

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lows and joy-filled highs. You can work for months with a patient, who seems to be doing well, and then, in a period of several days, he or she can regress all the way back to where they were when you first saw them. During those times, you can’t help but think “All my efforts were in vain.”

That’s probably why the hobbies I have photography, cooking and electricity - are activities that give immediate gratification.

You can’t expect that from your patients.

Every once in a while, there are miracles.

They are few and far between, but they are the exceptions that can help us feel rejuvenated and hopeful. Sadly, we sometimes go through life blind to them. As a result, we fail to benefit from them.

Years ago, I saw a PhD clinical psychologist in therapy. He came to me because he was considering getting a divorce. He described things at home as “terrible.” Some time later, I looked back on our interactions and thought, “I did a pretty good job.” Of course, so did he, thank goodness, because therapy truly is a two-way street. At any rate, I was extremely proud of this guy. He helped to remind me that therapy really does work. It makes you feel that you’re involved in doing something that’s meaningful and wonderful.

Near the end of therapy, he said “Dr. Ed, I want to tell you how much you mean to me and what you’ve done for my whole life, as well as my family. It really came to me because of something that happened the other night. You know, my wife is pregnant.

I leaned over in bed to give her a kiss and she took my hand and placed it on her stomach. Together, we watched her stomach move as the baby kicked and we felt his movement. Then we had the strangest experience. My wife is an OB-GYN emergency room nurse and I was in pre-med before psychology. The two of us know a great deal about science and the reproduction process, but when our two hands touched as we held her stomach, we felt something more. We experienced the miracle of life: two people coming together and creating something wonderful, that’s living and breathing and a part of both of us. I attribute my being able to experience these feelings to what I learned from you in therapy.”

His words deeply touched me, but, at the same time, I felt a sense of irritability within me. I could hear a voice saying “Well, it’s easy for you. Your wife is making more money on her own than I ever made as a student. Your father is a physician who put you through school. My parents never helped.

You, yourself are making a good living. You have no money problems, you have the time to experience miracles. I had to work.” I never let on or shared those thoughts with him but, inside, they bothered me.

I now know what I was really feeling.

When my wife was pregnant, I put my hand on her stomach, I saw the babies’ movements, I felt them kicking, but never experienced the miracle of life. I didn’t take the time. Even more, I didn’t even perceive that a miracle was happening.

I was angry at myself for that. I know that there is something greater than the sum of our behaviors and our thoughts. That something is our emotions and our feelings and they make up the miracles. Knowing that isn’t enough. In order to experience them, we have to put out the effort and make the time or else they’ll remain invisible to us forever.

SUMMER 2001

Loving counts I saw a 28-year-old woman, who came to me because her husband had divorced her for another man, and had taken every cent they had.. She was left with one child, no money and was working as a secretary.

Somehow, the family law court didn’t work the way it’s supposed to. She got the short end of the stick. It was a total miscarriage of justice. I knew she couldn’t afford me, but my secretary didn’t know that when she made the appointment, so I saw her that one time, without charge.

She was overwhelmed by her situation.

Every day was the same-she woke early in the morning, made breakfast and lunch, helped her son get off to day school and then raced to her job. Two or three times a week, the day school would call her about her son. Either he had misbehaved or was sick again. It was a repetitive pattern. To make matters worse, her boss was threatening to fire her because she was missing work. At night, she’d go home, clean up, make dinner and try to bathe her son. She

said, “I just can’t handle it any more. When I put him in the bathtub, it’s horrible. He kicks and screams and yells. There’s water all over the place. Later, after I put him to bed, I have to clean the bathroom again.

What can I do?”

“You have got to make your life a little easier. Tell me, what is the worst thing that you have to do every day?” Without hesitation, she said, “Bathe him every night.”

“Well then, don’t bathe him.” “You can’t do that”, she said, “you’ve got to bathe every day.” I said “No. Just drip dry him.”

“What’s that?” “What you do is wash him off with a wash cloth, dip him in the water quickly, then dry him off. That should save you about 30 minutes every evening and an awful lot of mental anguish. But, if you do that, you have to take 15 of those 30 minutes you save and do something else with him that’s pleasurable to both of you. Try it.

I promise you it will make things better.”

Then, I crossed my fingers, hoping it would really work!

Four weeks later, she called me up

because I had requested that she give me a progress report. “It’s a miracle”, she said, “you can’t believe what happened. He’s changed.” “What did you do that’s different?” She said “I’m drip drying him.” I said, “No, what did you do with the extra time you saved?” She responded “I wrap him in this huge Turkish towel and carry him into the living room. With the light low, I rock him, relax with him and I tell him how much I love him.” Then I thought to myself, “I know my mother gave me baths when I was young, but, as hard as I try, I can’t remember one of them. At the same time, I also know that, if she had held me in a Turkish towel and rocked me and told me how much she loved me, I would have remembered every one of those times for the rest of my life.”

Unfortunately, I don’t remember that happening, either, and it makes me realize how much loving really does count.

Have humility and learn to laugh at yourself If you haven’t learned it yet, you will come

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to see that people truly are funny. We have shortcomings and failures and flaws and they’re humorous, because they’re human.

No one of us is radically different from any patient we see, at least not on the inside. We may not do what they do, we may have better boundaries or better ego controls.

Hopefully, we do. But we’re no different, emotionally or dynamically. We need to remember that and we need to be able to laugh at our own shortcomings so that we can help others to laugh at theirs.

Let me tell you one last story. It’s about the best professor I ever had. I thought he was terrible. I hated his guts. I don’t know if he hated me or not, but there were always sparks between us. When I registered for Learning 601, it was the last class he was scheduled to teach prior to his retirement. I resented him to the degree that when the class decided to get him binoculars for his retirement present, (he was a bird watcher), I was the only one who refused to give anything toward his gift.

He was supposed to teach us learning theory. He was supposed to come in with books. He was supposed to help us so we could pass a qualifying exam to enter the PhD program. He did none of those things.

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He just had us sit in class and talk. It was all B.S. He would pose situations or problems and ask us to play the therapist, or discuss the issues. Then he’d ask “What did you learn?”

On one occasion, I said “I learned that I can’t pass the qualifying exam because I don’t know how this class is going to help me in a PhD program.” He just ignored me. I thought, “This guy definitely needs to retire.”

Finally, it was the end of the semester and the end of him. I thanked God and figured that I’d get the information I needed in the spring semester. I should add that I was on a scholarship that paid my tuition, but required that I work in the experimental lab, where I killed rats. It was one of the worst jobs I’ve ever had, but it helped pay the bills. I had a wife and child and I needed it. During the Christmas vacation, the Chairman of the Psych department called me and said, “How would you like to teach Experimental Psychology 101 next semester?” My answer was a resounding “Yes!” I thought “Ed Reitman teaching Experimental Psychology 101!”

I went back to school renewed. I was a professor, of sorts. I had achieved something. I went to my first class in Experimental Psychology 602 excited and

eager to learn. But there he was! The fool was back! I know I stood there with my eyes as wide as silver dollars. Suddenly, it was all clear to me. The professor I was pinch hitting for in Experimental Psychology 101 was also his replacement. This was the price I had to pay in order for me to teach my own class. There was nothing left to do, other than endure.

There we were, all seated in our usual places. “Well, what are you doing this semester?” he asked. One by one, the students said, “I’m helping out in the lab”, or “I got a job interning at this or that hospital”, “I’m working on a research study”.

Then he got to me. I pulled myself up in the chair, similar to a peacock spreading his feathers, and answered, “I’m teaching Experimental Psychology 101.” There was a loud silence in the room. Then he said something I have never forgotten. “That’s funny, I teach students.” I wanted to crawl out under the door. I wanted to be far away from that place. But, he was right then and he still makes sense today.

I later discovered he was the individual who had recommended that I teach Psychology 101. He was also the person who taught me the most important lesson of my life. You don’t teach content or courses, you teach human beings.

Now, when I talk to friends, I try to remember to talk to people who are my friends. When I’m home with my wife, I’m not with a wife, I’m with a person who happens to be my wife. When I’m with a patient, I’m with a human being who is also a patient. That’s on my good days, when I’m able to smile at myself because I know that the “worst” professor I ever had was a very special person in my life. When I am consciously able to remember that, my interactions with my friends, spouse, children and patients are all successful, because they can see that this psychologist is a person, too. ✯ Dr. Edward Reitman is a clinical psychologist practicing in Houston since 1963. His latest book, “Hungry For Love”, is available from Barnes & Noble and Amazon.com.

SUMMER 2001

In a CE Jam? Are you near your license renewal date and still one, two or three hours short on continuing education hours?

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You can earn up to three hours of CE by reading these articles and completing a test for each.

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Psychotherapy

• Ethical Principles That Need Consideration When Providing Services Electronically

If you are in a CE jam and would like more information on the articles, contact Sherry Reisman at 888-872-3435 or 512280-4099.

SUMMER 2001

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Dual Diagnosis on Death Row Ollie J. Seay, PhD Genevieve Tarlton Hearon, MA Executive Director Capacity for Justice

Abstract When a person with a dual diagnosis of mental retardation and mental illness ends up on Death Row, questions of competency, capacity and procedural fairness arise. These issues must be raised and examined from the point the person is questioned about a crime to the time of scheduled execution.

How Does This Happen?

People who have mental retardation are represented in the criminal justice system in greater numbers than in the population at large (Conley, Luckasson, & Bouthilet, 1992). They appear to be at a higher risk of being unjustly convicted and incarcerated due to characteristics associated with their mental retardation, such as limited communication and memory skills, impulsivity, level of moral development, denial of their disability, passivity and lack of knowledge of basic facts (Ellis & Luckasson, 1985).

Add to this the presence of a coexisting mental illness, and the accused person has multiple barriers to obtaining fair treatment in the criminal justice system. Luckasson (1988) notes that many people with mental retardation go undetected in the system, but the problem compounds for those with a dual diagnosis since mental retardation may overshadow the mental illness.

Frequently, people with mental retardation go to great lengths to avoid detection of their disability, even when such detection would assist in their own defense and could 26

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result in more favorable treatment. Edgerton (1967) referred to this phenomenon as “the cloak of competence” and further pointed out that many people who have mental retardation, especially at the upper end of the range, often acquiesce to authority figures. This propensity to give the answer that one thinks the questioner wants may lead people with mental retardation, or dual diagnoses, to confess to crimes, even if they did not commit them (Sigelman, Budd, Spanhel & Schoenrock, 1981).

Arresting officers, judges and attorneys do not generally recognize mental disabilities. They then do not request specialized assessments that may identify competency issues and/or divert the person to needed services. Baroff (1991) observed that in failing to be aware of their clients’ disabilities, attorneys may give confessions more credibility than is warranted. This is likely the case with law enforcement officers, judges and others in the legal system.

Many misconceptions about mental retardation and dual diagnosis can be found within the criminal justice system. Some of these can be traced to Dr. Henry Goddard, who said in 1915 that people with mental retardation represented a menace to society and should be locked away in institutions for the protection of the public and of themselves (Ellis & Luckasson, 1985; Luckasson, 1991.) Attorneys may believe that they are doing their clients a favor by not bringing up their disabilities so as not

to prejudice the juries against them.

Most states already have processes on the books which allow for competency to be investigated at various points. Baroff (1991) pointed out that the accused person’s ability to understand Miranda rights ought to be questioned. Baroff (1991) also noted that, as an expert witness, he has typically been called in at post conviction proceedings suggesting that defense attorneys were either unaware or insensitive to their clients’ mental disabilities.

Despite the presence of safeguards, they are not always used. Juries convict and sentence people with dual diagnoses to death without ever hearing about their disabilities. Polls of juries in capitol cases have shown that, in most instances, had the mental disability been brought up, the jury would have considered it as mitigating and recommended lesser punishments (Dyer & Claasen, 1988).

What Can be Done About it?

Some states, including Virginia, Ohio and Florida, have enacted legislation that created systems of impartial forensic evaluations.

Such evaluations, done primarily in the community during pretrial, can divert people with mental disabilities to appropriate services and treatment and can save the taxpayers money. This is one possible solution.

Continued education of professionals and the public about the abilities and needs of people with dual diagnoses must be prioriSUMMER 2001

tized along with the clear intent of not excusing criminal behavior or aiding those who commit criminal acts to avoid accepting responsibility. The focus must be on fair treatment within the criminal justice system.

Putting legislation in place to address these issues and to get grants to demonstrate effectiveness of any intervention requires collaboration and efforts of advocates, mental health and mental retardation professionals, attorneys, judges and other criminal justice professionals. Advocacy groups or individuals can be important links between attorneys, families, lawmakers and the public.

Within the field of mental retardation, advocacy has a long history of shaping laws and social practices. Since 1876, the American Association on Mental Retardation (AAMR) has worked on behalf of people with mental retardation to improve services and knowledge about their needs (Sloan & Stevens, 1976).

The ARC began in 1950 as the National Association of Parents and Friends of Mentally Retarded Children (ARC, 1997).

Under this name, and later as the Association for Retarded Citizens, they presented programs to Congress, began supporting research projects to make programming and institutional care more comprehensive and began programs of their own. Both AAMR and the ARC have formal position statements that oppose the death penalty for people with mental retardation. The American Bar Association (ABA) has also made a formal resolution urging that no person with mental retardation should be sentenced to death or executed (American Bar Association, 1989).

Mental health advocacy, though with a shorter visible history, has also been a factor in the reform and creation of numerous laws and practices to better the lives of people with mental illness. The National Alliance for the Mentally Ill (NAMI) began in September of 1979 in Madison, Wisconsin, as a support organization for families (Dearth, Labenski, Mott & Pellegrini, 1986; Drescher, 1986). NAMI, with its state and local chapters, has moved SUMMER 2001

on to become a major influence in changing systems of mental health treatment. The National Mental Health Association and its affiliates is also a principle organization working to improve the mental health of all individuals and to achieve victory over mental illnesses (National Mental Health Association, 1997). However, no formal positions about criminal justice involvement or the death penalty for people with mental illness was located in the literature reviewed for either organization.

The National Association for the Dually Diagnosed (NADD), established in 1983, attempts to bridge the gap between mental health and developmental disabilities structures. NADD’s provision of educational training materials and opportunities has helped influence programs and policies for people with dual diagnoses. There was also no formal statement or position by NADD in the literature reviewed concerning people with dual diagnoses in the criminal justice system.

If competency and capacity of defendants with dual diagnoses are to be given appropriate attention, there is an overwhelming need to bring the functions of all these camps together. While each group brings its own set of skills and specific interests, fair treatment within the criminal justice system for people with mental illness and developmental disabilities requires the collective efforts, energy and knowledge of all who purport to work on their behalf. âœŻ

G.S. (1992). The criminal justice system and mental retardation: Defendants and victims. Baltimore, Maryland: Paul H. Brookes Publishing.

Dearth, N., Labenski, B.J., Mott, M.E. & Pellegrini, L.M. (1986). Families helping families: Living with schizophrenia. New York: W.W. Norton & Company, Inc. Drescher, R. (1986). Mutual support groups for families of the mentally ill.

In M.Z. Goldstein (Ed.) Family involvement in the treatment of schizophrenia. Washington, D.C.: American Psychiatric Press, Inc. Dyer, J. & Claasen, J. (1988, November 15). Death penalty gets overwhelming support, except for the retarded. The Texas Poll.

Edgerton, R.B. (1967). The cloak of competence: Stigma in the lives of the mentally retarded. Berkeley: University of California Press.

Edgerton, R.B. & Bercovici, S.M. (1976).

The cloak of competence-years later.

American Journal on Mental Deficiency, 80, 485-497.

Ellis, J.W. & Luckasson, R. (1985).

Mentally retarded criminal defendants.

The George Washington Law Review, 53, 414-493.

Luckasson, R. (1988). The dually diagnosed client in the criminal justice system. In J.A. Stark, F.J. Menolascino, M.H. Albarelli & V.C. Gray (Eds.).

Mental retardation and mental health: Classification, diagnosis, treatment,

References & Selected Bibliography American Bar Association. (1989).

services. New York: Springer-Verlag.

National Mental Health Association

American bar association criminal jus-

(1997). Working for America’s mental

tice section individual rights and

health. [Available on the Web at

responsibilities section recommenda-

http://www.nmha.org]

tion. Chicago: American Bar Association.

Arc (1997). Milestones. [Available on the Web of the Arc of the U.S. at http://www.the arc.org/welcome.html] Baroff, G.S. (1991). Establishing mental

Sigelman, C.K., Budd, E.C., Spanhel, C.L. & Schoenrock, C.J. (1981). When in doubt say yes: Acquiescence in interviews with mentally retarded persons.

Mental Retardation, 19, 53-58.

Sloan, W. & Stevens, H.A. (1976). A cen-

retardation in capital cases: a poten-

tury of concern: A history of the

tial matter of life and death. Mental

American association on mental defi-

Retardation, 29, 343-349.

ciency. Washington, D.C.: American

Conley, R.W., Luckasson, R. & Bouthilet,

Association on Mental Deficiency.

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Collaborative Practice Between Psychologists & Primary Care Physicians James H. Bray, PhD Department of Family & Community Medicine Baylor College of Medicine

C

ollaboration between health care providers and the use of a collaborative practice model between psychologists and physicians is a growing area, created to meet the multiple needs of patients. With managed care there are increased pressures on primary care physicians to diagnose and treat a broad spectrum of biomedical and psychosocial problems. Psychologists are represented in both urban and rural areas and are often the most highly trained mental health and substance abuse professionals functioning in these communities. Having psychologists collaborate with family physicians can improve the effectiveness of assessment and intervention.

A pilot demonstration project that linked psychologists and family physicians to improve the care of patients with alcohol and other drug abuse (AODA) problems was undertaken. The purpose of the project was to demonstrate that collaborative practices between psychologists and family physicians could be developed to enhance the assessment and treatment of AODA and other behavioral problems. The goals of the project were to: (1) facilitate linkages between family physicians and psychologists; (2) educate psychologists and family physicians regarding models of collaborative practice and treatment of AODA problems; (3) increase the knowledge base of participating providers about AODA abuse identification, treatment, and prevention; and (4) enhance the level of service and treatment options for patients with AODA problems.

Psychologists and primary care physicians were recruited in Texas and Wyoming to participate in the project. The two groups met in their respective states for a day of initial training on collaborative practice and were monitored for five months by program staff. The professionals then par-

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ticipated in another of day of training and debriefing on the progress of their collaborative practice.

The program was successful in linking providers and in enhancing the level and quality of collaborative practice between these professionals. The predominant shifts in the collaborative relationship were from independent practitioners who had little or no contact with each other and only dealt with their professional area to independent practices with limited referral and some consultation between professionals. In most cases, this type of arrangement was a step forward, but the training did not result in fully integrated forms of practice, with the exception of one psychologist and family physician that already shared offices prior to the training.

The goals of the project were accomplished, at least to some limited degree, and support the continued examination of this model of practice in rural settings. The participants indicated that collaboration enhanced the effectiveness of each professional and resulted in better diagnosis and treatment of medical and psychosocial problems. Participants reported that the linkage improved their own sense of efficacy and satisfaction in working with patients with AODA problems. In addition, through the collaboration, patients were provided enhanced treatment options for their problems. The results of this project suggest that collaboration and linkage between physicians and psychologists can be effected and that such linkages are beneficial for professional practice. It appears that many of the basic parts of this model of training are applicable to both rural and urban settings.

Additional research is necessary to evaluate the beneficial aspects of this practice

model and, in particular, to assess the impact on outcomes for patients. Future work focusing on whether linking psychologists and physicians in practice is costeffective and enhances the level of service provided to patients is imperative. While collaboration appears effective, there were a number of strong barriers identified to collaborative practice. Some of these are unique to rural practice, such as distance between providers and limited treatment resources, while others occur in both urban and rural settings, such as problems with managed care and reimbursement limitations. With national health care reform on the horizon, it is imperative that we examine alternative models of service delivery that will meet the medical and psychological needs of all Americans.

A complete description of these projects can be obtained by writing the Department of Family & Community Medicine, Baylor College of Medicine, 5510 Greenbriar, Houston, TX 77005, (713) 798-7751. âœŻ References Bray, J. H., & Rogers, J. C. (1995).

Linking psychologists and family physicians for collaborative practice.

Professional Psychology: Research and Practice, 26, 132-138.

Bray, J. H. & Rogers, J. C. (1997). The linkages project: Training behavioral health professionals for collaborative practice with primary care physicians. Families, Systems, & Health, 15, 55-63.

Haley, W. E., McDaniel, S. H., Bray, J. H., Frank, R. G., Heldring, M., Johnson, S. B., Lu, E. G., Reed, G. M., & Wiggins, J. G. (1998). Psychological practice in primary care settings: Practical tips for clinicians. Professional Psychology: Research and Practice, 29, 237-244.

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James H. Bray, PhD, is a candidate for president of the American Psychological Association. He is Director of Family Psychology Programs and Associate Professor in the Department of Family and Community Medicine at Baylor College of Medicine in Houston. He received his PhD in clinical psychology from the University of Houston in 1980. He has received numerous awards including election into the National Academies of Practice for Psychology, the Karl F. Heiser APA Presidential Award for Advocacy on Behalf of Professional Psychology, and the 1992 Federal Advocacy Award from the APA Practice Directorate.

Dr. Bray has published and presented numerous works in the areas of divorce, remarriage, adolescent substance use, intergenerational family relationships, and collaboration between physicians and psychologists. He was the principal investigator of the federally funded longitudinal study, Developmental Issues in Step Families Research Project, and is principal investigator of a federally funded project on alcohol and other drug abuse in families with adolescents. He is a member of the APA council of representatives for the Division of Family Psychology. In addition to his research, he also maintains an active clinical practice focusing on children and families.

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REPORT

APA Council of Representatives Meeting February 22-25, 2001 Joseph C. Kobos, PhD

T

he Council of Representatives of the American Psychological Association met in Washington, D.C,. on Feb. 22-25, 2001.

President Norine Johnson, PhD, reported on her initiatives, which have the theme of “Psychology: Building a Healthy World.” The initiatives are to inform the public and policymakers about psychology’s contributions to building healthy families, healthy communities and healthy workplaces. Her initiatives include increasing awareness of expanding opportunities in psychological practice and emerging opportunities in science.

Ray Fowler, PhD, Chief Executive Officer, briefed Council on how APA seeks to be a model employer. Each year, APA is closer to reaching affirmative action goals of optimum representation of ethnic minorities and women in every category of employment. Dr. Fowler described changes of leadership in Washington that can affect APA and how APA is positioning itself to seek opportunities that change can bring.

The issues to be emphasized in Congress include: Parity for mental health; Patients’ Bill of Rights to include legal responsibility of HMOs; and Medicare GME funding.

Members will be asked to send messages to Congress regarding these important issues.

Dr. Fowler said that retention of members in APA has emerged as a key issue, as membership gains are lessening, due primarily to aging members who are duesexempt. (By 2013 there will be 24,000 dues-exempt members.) Also, the percentage of members attending the convention has dropped recently. Dr. Fowler described the new convention format to be tried in Chicago in 2002. Convention time will be cut to four days to make it shorter and more vibrant. He also reported that the American Psychological Foundation (APF) has a campaign to raise $7 million over the next five years to provide scholarships and grants for

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psychological research and innovative programs. Contributions to APF are requested.

Charles L. McKay, APA’s chief financial officer, presented an update to the Council on APA’s finances. He presented a chronology of our two buildings, which are now fully leased and occupied. The buildings provide an important source of non-dues revenues. A final budget for 2001 of approximately $87 million was passed. The budget includes a small $300,000 deficit.

Two new divisions of APA were approved: the Division of Clinical Child Psychology (Division 53) and the Society of Pediatric Psychology (Division 54).

The Ethics Code Task Force is seeking comments on the Draft of the Ethical Principles of Psychologists and Code of Conduct. (The draft was published in the February 2001 APA Monitor.) There will be a question and answer session in San Francisco at the APA Convention about the revised ethics code. You can give feedback about the proposed code on the APA web page, www.apa.org.

A controversial proposal to Council being discussed, but not yet an action item, is that ethics adjudication by APA’s Ethics Committee be limited to expellable behaviors. The proposal recommends that educative efforts of the APA Ethics Committee be enhanced and expanded. The proposal would sharply limit the number of formal hearings that the APA ethics committee would conduct.

In the controversy, one point of view is that almost all psychologists are regulated under a practice license. Data suggests that almost all ethics complaints could be dealt with at other levels including a licensure board. The Association would maintain the right to expel members whose professional behavior is deemed incompatible with the association’s ethical standards. The other

point of view is that our national association has a responsibility to both produce a code and be willing to adjudicate case that is presented. If you have opinions, please contact me or the APA Ethics Committee.

After much discussion, a Resolution on Assisted Suicide was passed by Council.

This resolution neither endorses nor opposes assisted suicide at this time, but supports the APA in preparing the profession to address the issue of assisted suicide by actions such as promoting psychologists’ participation in multidisciplinary teams and ethics committees involved with reviewing end-of-life requests and encouraging psychologists to obtain training in the area of ethics as it applies to end-of-life decision and care.

A Commission on Education and Training Leading to Licensure in Psychology presented its report, which was accepted by Council. The major recommendation of the commission is that the profession should harness and coordinate all relevant parties to develop an educational model that enables a psychologist to be licensed with the doctoral degree. The report will now be circulated to appropriate APA Committees and other governance groups. It will also be sent to external groups, including State Associations, for review. At a later date the report can be amended or changed, prior to a decision by Council to adopt the recommendations.

A Committee, chaired by Drs. Bill Howell and Dorothy Cantor, has been established to develop the procedure for selecting the replacement for Dr. Ray Fowler, our CEO. It is prudent that the association plan in advance for Ray’s replacement. Under Dr. Fowler’s leadership, the association has grown in effectiveness and we have developed a very strong foundation for continued growth.

The Board of Convention Affairs is developing an altered format for the 2002 convention in Chicago. The event will be one day shorter. All events will be housed in one setting, and there will be more featured speakers from all areas of psychology including science and practice. ✯ SUMMER 2001

SAN FRANCISCO AUGUST 24-28 Join the American Psychological Association and APA President Norine G. Johnson, PhD, in San Francisco, Aug. 24-28, for the 109th Annual APA Convention.

Each session will include learning objectives, handouts and infor-

mation that attendees can take with them and use such as ideas to build their practices and ideas for new research challenges. Rather than providing broad overviews, the speakers will cover new infor-

Highlights of the meeting you won’t want to miss include the

mation that addresses the needs of the general public as well as

Opening Session keynote address by Mary Pipher, PhD, and the

those of psychologists. Speakers in each session will show how psy-

2001 Presidential Mini Convention, “Psychology Builds a Healthy

chology can help and will identify the leading research and the most

World: New Markets, New Research.” The Healthy World mini con-

effective applications. They will also invite audience participation.

vention, which takes place in the Moscone Convention Center from

The mini convention program was developed by the APA Task

Saturday, Aug. 25 through Monday, Aug. 27, features three days of

Force on the 2001 Presidential Initiative on Health and its three

cutting-edge programs that showcase some of psychology’s most

dedicated co-chairs: Carol D. Goodheart, EdD, Rodney Hammond,

distinguished scientists and practitioners.

PhD, and Ronald H. Rozensky, PhD. The task force’s mission is to

Each day of the mini convention will focus on a special theme

identify core health needs of the public and the policy implications;

and feature a presidential invited speaker in addition to workshops, dialogues and roundtable discussions. Friday’s theme will be

APA President Norine G. Johnson, PhD, Showcases

Psychology’s Role in Building a Healthy World

Healthy Families and the invited speaker will be William Pollack, PhD, who will talk about “Real Boys, Real Girls,

to use the collective power of all psychology’s constituencies to

Real Parents: Preventing Violence through Family Connection.” On

partner with other relevant organizations; and to translate psychol-

Saturday, the theme will be Healthy Communities and the invited

ogy’s intervention and prevention techniques back to the public in

speaker will be Susan Pick, PhD, whose address will be “Healthy

both visual and written products.

Sexuality for All: The Role of Psychology.” James Campbell Quick,

To learn more about the Psychology Builds a Healthy World mini

PhD, will be Monday’s invited speaker. His presentation, “Working

convention, the 2001 presidential mini conventions on Expanding

Together: Balancing Head and Heart”, will kick off a day of pro-

Opportunities in Science and Practice, and other 2001 presidential

gramming on Healthy Workplaces.

initiatives,

visit

the

APA’s

president’s

web

page

at

This year, for the first time, APA will offer continuing education

www.apa.org/about/president http://www.apa.org/about/presi-

credits for attendance at the mini convention sessions. The CE

dent. For more information about the APA convention, visit

credits are free and no pre-registration is required. However, atten-

www.apa.org/convention.

dance is limited to 350 people on a first-come, first-serve basis, so plan to arrive early.

109th Annual APA Convention

CLASSIFIEDS Join a Winning Team!

North Texas State Hospital's Maximum Security Unit, Vernon A recognized leader among U.S. Forensic Hospitals is seeking a Doctoral-Level Psychologist to join a dynamic, multi-disciplinary team of mental health professionals providing services on a fast-paced, pre-trial forensic program. Responsibilities include: conducting forensic and psychodiagnostic assessment. For additional information and application materials, contact Marilyn Clements at 940-5529901, or marilyn.clements@mhmr.state.tx.us An Equal Opportunity/Drug Free Workplace Psychologists Wanted: Red Oak Psychiatry Associates, P.A., is a large successful multidisciplinary private practice that includes MDs, SUMMER 2001

PhDs, Master's Level Therapists and RNs in the Northwest Houston area. We are looking for full-time licensed psychologists who can perform testing as well as therapy. For more information please call 281-893-4111 ext. 157 or fax your resume to the attention of Kalea at 281-893-8082 Private Practice Psychologist Needed Psychologist needed to provide managed care counseling and assessment in an expanding private outpatient setting. Part to full-time.

Referrals, staff support, and office space will be provided. Clients are predominantly adults.

Strong clinical skills, extensive managed care eligibility required. Apply to drcgray@aol.com, phone 713-774-2122, fax 713-774-3223. Address: 8303 SW Frwy #303, Houston, TX 77074.

OFFICE SPACE AVAILABLE IN AUSTIN TO RENT ON HOURLY OR DAILY BASIS. CALL CLAUDIA AT 512-238-7253 OR 512-507-8940.

PSYCHOLOGISTS (Licensed) needed to do assessment and treatment in nursing homes in Texas. Join a leading provider of geriatric health services in the country servicing over 300 Texas facilities. Areas covered by our group include: Amarillo, Lubbock, Odessa, Abilene, Corpus Christi, San Antonio, Austin, Waco, Houston, Dallas, Ft. Worth and East Texas.

Visit our web site: www.seniorpsychologyservices.com. Please send your C.V. to: fax 800503-3842, or e-mail laura.severns@spsontheweb.com or CALL 800-508-5151.

Texas Psychologist

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PSY-PAC

NEW MEMBERS

2001 PSY-PAC Contributors Ron Cohorn, PhD, PSY-PAC President

TPA Welcomes New Members!

hank you for your year 2001 contribution(s) to PSY-PAC, the Texas Psychological Association’s Political Action Committee. As a supporter of PSY-PAC, you are among the special group of individuals who make the sacrifice to protect and enhance the practice of psychology in Texas. Thanks to your donation(s), psychology is still a doctoral level profession and we have initiated the process of obtaining prescription privileges. However, PSYPAC is not limited to these issues. Our lobbyist and Central Office staff are constantly monitoring all legislation and responding appropriately. Without your contribution(s), psychologists would have no voice in the Texas political process.

Please make a personal commitment to contribute regularly to PSY-PAC. Again, thank you for your support; YOU ARE APPRECIATED.

T

Member Stacey L. Bourland, PhD Christina L. Della Nebbia, PhD Libbe A. Gray, PhD Barbara Hall, PhD Richard Kownacki, PhD George Lazar, PhD James Gary Marsh, PhD Karen Merkel, PhD Pat N. Moran, PhD

Contributions made January 1- May 1, 2001

Associate Katy W. Adams, MA

$2,500 and above J. Paul Burney, PhD $1,000-$2,499 Ron L. Cohorn, PhD Cary A. Conaway, PhD Mark Foster, PhD James B. Quinn, PhD Elizabeth L. Richeson, PhD Deanna F. Yates, PhD $500-$999 King L. Buchanan, PhD Cheryl L. Hall, PhD Ethel W. Hetrick, PhD Kevin G. Smith, PhD $250-$499 Maria Cruz, PhD Richard Fulbright, PhD C. Elizabeth Salmeron, PhD $100-$249 Tim F. Branaman, PhD Jim L. H. Cox, PhD Michael Duffy, PhD, Thomas H. Edwards, PhD Kenneth D. Huff, PhD Ronald J. Jereb, PhD Kevin T. Jones, PhD Jerome Mabli, PhD Barbara S. Peavey, PhD 32

Texas Psychologist

John Pinkerman, PhD Robbie N. Sharp, PhD Bryan E. Smith, PsyD Daniel J. Thompson, PhD John W. Worsham, Jr, PhD Under $100 Walter Ray Allberg, PhD Bonnie Brookshire, PhD C. Munro Cullum, PhD Sally Davis, PhD Philip J. Davis, PhD Patrick J. Ellis, PhD Alan B. Frol, PhD Marsha T. Gabriel, PhD Ronald A. Garber, PhD Sylvia Gearing, PhD Judy W. Halla, EdD A. S. Helge, PhD Nancy A. Leslie, PhD Raul Martinez, PhD Joseph McCoy, PhD Frank D. Ohler, PhD Shannon E. Scott, PhD James P. Thompson, PhD Niki Valentine Vick, PhD Debbi S. Wagner-Johnson, BA Lee T. Wallace, PhD Colleen A. Walter, PhD Patricia D. Weger, PhD Jack Wiggins, PhD

Student Alfred J. Amado Linda J. Eklof LeAnn Rissler Scheyda Stasik

VISIBILITY PROBLEMS? Advertise in Texas Psychologist Use Texas Psychologist to improve your visibility with professionals across the entire state of Texas.

Contact Matt Stillwell for more information at 512 454-5262 or mstillwell@rector-duncan.com

SUMMER 2001

Associaton for Advanced Training in the Behavior Full 1c New - Film Inside Back Cover

Academic Review Full 1c New - Film BC