Summer 2004 Summer 2004 Volume 55, Issue 2
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w w w . a m e r i c a n p r o f e s s i o n a l . c o m
Elizabeth Richeson, PhD Editor David White, CAE Executive Director Lynda Keen Executive Assistant Sherry Reisman Director of Convention & Non-Dues TPA BOARD OF TRUSTEES
SUMMER 2004
Features 7
Melba J. T. Vasquez, PhD President-Elect Designate
Evidence-Based Practice and the Endeavor of Psychotherapy Carol D. Goodheart, EdD
C. Alan Hopewell, PhD President Paul Burney, PhD President-Elect
VOLUME 55, ISSUE 2
11
How Will Texas Implement Atkins? Ollie J. Seay, PhD
12
Sunset Committee Report Melba Vasquez, PhD
Deanna F. Yates, PhD Past-President
13 Board Members Ron Cohorn, PhD Donna Davenport, PhD Richard Fulbright, PhD Charlotte Kimmel, PhD Kimberly McClanahan, PhD Robert McPherson, PhD Suzanne Mouton-Odum, PhD Roberta L. Nutt, PhD Dean Paret, PhD M. David Rudd, PhD Ollie Seay, PhD EX-OFFICIO BOARD MEMBERS
Dallas, Houston, El Paso and Southeast Texas
16
Lane Ogden, PhD Texas Psychological Foundation President
“Lab Work” at McKenna Hospital Allison R. Williams, BS Ollie J. Seay, PhD
18
CE Credit Home Study - The Therapeutic Contract Eric Marine, American Professional Agency
25
Never Stand in Front of Flowing Lava—RxP on the Move Pat DeLeon, PhD
Randy Noblitt, PhD Federal Advocacy Coordinator Melba J. T. Vasquez CAPP Representative
Local Area Society Updates
Departments 2
From the Editor Elizabeth L. Richeson, PhD
Richard M. McGraw, PhD Business of Practice Network Representative
4 LaDonna Saxon Student Division Director PUBLISHER Rector-Duncan & Associates P.O. Box 14667 Austin, TX 78761 512-454-5262
From the President C. Alan Hopewell, PhD
6
From TPA Headquarters David White, CAE, Executive Director
26
LAW
Stephanie Shaw Managing Editor
27
2004 PSY-PAC Contributors
Lance Lawhon Advertising Manager
28
2004 Texas Psychological Fund Contributors
Megan Moller Production Coordinator
28
2003 Sunrise Fund Contributors
28
New Members
29
Classified Advertising
30
Disaster Response Network
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. www.texaspsyc.org SUMMER 2004
Texas Psychologist
1
FROM THE EDITOR
Our next issue of the Texas Psychologist is the fall pre-convention issue and will feature information on the convention. The format of the journal will change to an online newsletter beginning with the fall pre-convention issue. As we make this leap into the 21st centur y, we hope to reach even more psychologists, students and others across Texas or anywhere in the world. Additionally, this will give us the opportunity to include more timely articles because our production time is greatly decreased. If you are not receiving email from TPA and want to receive the new version of our newsletter, please email newsletter@texaspsyc.org. There is no need to email us if you are already receiving informational emails from TPA. We are excited to offer this ser vice to psychologists in the state of Texas!
Elizabeth L. Richeson, PhD, MS PsyPharm
T
his issue of the Texas Psychologist affords us a perfect opportunity to share some of the many exciting things that are happening with psychology around Texas. There was a good response from some of our Local Area Societies (LAS) updating us as to what their specific accomplishments and foci are at present as well as their plans for the future. In this issue you’ll read about the LAS of Dallas, El Paso, Houston, and Southeast Texas. It is my hope that these articles will inspire us all with ideas that we can incorporate into our
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Texas Psychologist
own cities and towns as we continue to make psychology a household word and proceed with our grassroots agenda for Sunset review. After reading Ms. Allison Williams and Dr. Seay’s article introducing us to Annie, the therapy dog, I gave Winnie our Springer Spaniel an extra hug for her therapeutic value in our household. There is no question the therapeutic value of our pets, and Williams and Seay share the story of a very successful program using a therapy dog in Texas. Attorney Sam Houston has provided us with a very timely article regarding duty to discuss adverse effects of psychotropic medications with our patients. This is an especially well-timed article given the recent press regarding suicide and antidepressant medications. Additional timely and pertinent information can be found in Dr. Melba Vasquez’s article that provides a report from the March 23rd formal testimony to the Sunset Committee in which she participated. Also in this issue is an opportunity for interested psychologists to become a part of the Disaster Response Network (DRN) in Texas. Please see the “Call for TPA Psychologists to Disaster Response” by the two Texas DRN Coordinators, Drs. Judith Andrews and Rita Justice. The Texas Implementation of the Supreme Court Decision in Atkins v. Virginia (Mental Retardation & Death
Penalty) is given a final review by Dr. Ollie Seay, the TPA Public Policy Chair, bringing us up to date on this critically important issue. In addition to reading what is going on around Texas, Dr. Pat DeLeon, Past President of APA, gives us an updated global picture about prescriptive authority in his article “Never Stand in Front of Flowing Lava—RxP on the Move.” Dr. Carol D. Goodheart of New Jersey, a Member of the Board of Directors at APA, provides a thought-provoking article, “Evidence-based Practice and the Endeavor of Psychotherapy,” which addresses an area of national significant interest today. As always, reading our regular columns “From the President” (Dr. Alan Hopewell) and “From TPA Headquarters” (David White, CAE, Executive Director) allows us to stay on top of the developments in psychology in Texas. I want to reiterate David White’s recommendation to go to the Web site at www.sunset.state.tx.us to review the information on the Sunset Commission and further recommend you familiarize yourself with this site in order to follow the developments of Sunset Legislation as they unfold. Please send articles for consideration to elricheson@earthlik.net or Dr. Elizabeth L. Richeson, 600 Sunland Park Drive, 6-400, El Paso, TX 79912. I look forward to hearing from you. ✯ SUMMER 2004
SUMMER 2004
Texas Psychologist
3
FROM THE PRESIDENT
The Texas Psychological Association, Board of Trustees, and the Central Office met a flurr y of activity in the beginning of 2004. Of paramount impor tance, our Sunset Committee worked steadily and then responded to the initial round of formal inquiries made by the Legislative Sunset Commission. In March, the Committee, along with the Board of Examiners, represented the views of TPA when they gave formal testimony at the public hearing of the Commission. The Sunset Committee, with the help of our legislative consultant Chris Shields and co-chairs Melba Vasquez, PhD, and David Rudd, PhD, worked extremely hard and did a ver y good job. Thanks to the work of the Committee and the suppor t we have received from TPA members, we believe we are well positioned as we enter the Sunset process. As expected, anything can happen during this time. We need to remain vigilant and work together to ensure that our licensing law is renewed as we wish to define it and not as those untrained in psychology would wish it to be defined.
C. Alan Hopewell, PhD, MS, Psypharm, ABPP
F
ollowing a Board retreat and a busy Board meeting in Fort Worth during January, several members attended the State Leadership Conference in Washington, D.C. This proved to be one of the busiest conferences ever as there was much to do and the Texas delegation was actively involved in more presentations and meetings than ever before. For the first
4
Texas Psychologist
time, central office staff member Sherry
well-attended
Reisman presented at one of the programs. David White helped network with groups like the Pennsylvania delegation, which
Education Conference, sponsored by the Houston LAS. The conference focused on practice, legal, and ethical issues, and also
Spring
Professional
sparked a number of helpful ideas we can
highlighted the quality of work which
use in Texas. Bob McPherson, Rick McGraw, Dee Yates, and Paul Burney had special assignments. Lane Ogden and
continues throughout the year by our local area societies. Other LASs have also been busy with Fort Worth preparing an
Randy Noblitt accepted appointments as
invitation for many of the Tarrant County
Federal Advocacy Coordinators and have been hard at work on my “Legislative 181 Project,” in which we are coordinating our
representatives to address legislative issues. Don Wolff of Collin County LAS sponsored a TPA update made by me, but
psychologist/legislator liaison network throughout the state as we build our
his wife was posted to Germany, so Bob Weiner carried on into 2004 as Past-
legislative relationships. Working with them on this is Walt Cubberly, who is serving as State Advocacy Coordinator for the Houston area. We were also pleased to have Celia Servin-Lopez as our diversity delegate. Many of us braved freezing rain and even light snow on our “Hill Day,” when we visited our representatives and urged them to vote for mental health parity against insurance plans, which could optout of state laws and mental health coverage, and for an extension of mental illness court demonstration projects. Our March Board meeting was held in the Woodlands in conjunction with a very
President. Also, with our large military population, the War on Terror continues to present challenges to us here in Texas. Nationwide, we have had some of our Reserve colleagues report for active service, including some of our TPA members for both stateside and overseas duty assignments. Especially at Ft. Hood, we have had a year with large numbers of military families with spouses overseas, many of them just now returning with the inevitable stress-related and adjustment issues. The war is not yet over, but we already owe our military and our first
SUMMER 2004
BECOME A
responders more than we can ever really repay. We as psychologists can also do much to help avoid some of the problems that we had when veterans previously returned from Vietnam. Even in doing routine rehabilitation work, I am surprised at how often a patient has a relative in the service (often it is a grandparent who brings their picture to the hospital room). Additional stressors can often interact with depression, pain, and other syndromes. Interested TPA members may also want to work with the APA Resilience Program or coordinate with our Disaster Response Network. If you see a first responder or military member while at the store or gas station,
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www.AngerBusters.com Texas Psychologist
5
FROM TPA HEADQUARTERS
Capital Update In the past, I have taken the oppor tunity to share with you the impor tance of getting involved in the legislative process by encouraging you to get to know your legislator and make contact with him/her on behalf of TPA to share the critical issues that are facing the profession. Well, let me give you an update on where we are on some legislative issues and what we need from you.
cases implementation, is state agency consolidation in which several boards will be collapsed into one. Many types of consolidation have been discussed ranging from internal functions to actual policy and rulemaking consolidation. The Sunset Advisory Commission staff has completed their recommendations, which they have presented to the 10-member panel of the Sunset Commission. I would STRONGLY encourage you to look at these recommendations at www.sunset.state.tx.us. Their recommendations were presented to the Commission on March 23, 2004 at which time our TPA leaders had the
David White, CAE ,TPA Executive Director
opportunity to testify about these recommendations. You can view the actual testimony by going to www.senate. state.tx.us/75r/Senate/AVarch.htm
SUNSET LEGISLATION
I
n the Summer 2003 issue of the Texas Psychologist, I shared with you the process that the Texas State Board of Examiners of Psychology must undergo to determine if the state will continue to license psychologists. Since that time we have met with the Sunset Commission staff and developed position papers on behalf of the profession, outlining what our concerns and desires are for psychology and, in particular, TSBEP. As the state of Texas continues to deal with budget issues, one strategy under consideration, and in some
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Texas Psychologist
and selecting the “March 23 – Sunset Advisory Committee.” (TSBEP was the first agency to testify so it will be the beginning of this tape.) As you know, the licensed psychological associates have been working on gaining the status of independent practitioners, and as we learned at this testimony, they will try again next session. If you are not engaged in this process by either contacting your legislator, joining and participating in your LAS, or joining TPA, you are risking a change in your current right to practice psychology. I cannot impress upon you the need to ACT and ACT NOW. Your profession is at stake.
MEDICARE/MEDICAID As many of you know, during the last legislative session a bill passed that took away Medicaid “optional services.” Well, we are getting hit again. In the next couple of weeks, the Medicare Advisory Committee will be discussing yet another cut in reimbursement which would significantly lower by 20 to 30 percent the reimbursement for physicians, psychologists, and nursing facilities and other providers of health care services to dually
eligible
Medicare-Medicaid
beneficiaries. The majority of nursing home residents are dually eligible beneficiaries, and health care providers might drop services to this group if the fee cut is severe. Those receiving mental health services are especially affected because Medicare pays only 50 percent (not the standard 80 percent) for mental health; thus the fee cut for these services will be even worse. We need psychologists to speak out against these cuts. We need to stand up as a profession and let the bureaucrats understand the impact these cuts will have on citizens of this state. Please monitor the TPA Web site and look for legislative alerts for the action you can take regarding these issues. ✯
SUMMER 2004
Evidence-Based Practice and the Endeavor of Psychotherapy Carol D. Goodheart, EdD Independent Practice Princeton, New Jersey Member Board of Directors, APA
M
any of us who are clinicians want to broaden the discussion of evidence-based
psychotherapy. We want to move beyond the basics of the easy to measure efficacy studies and into a more complex realm. In today’s climate, it is a challenge for practicing psychologists to balance the needs to develop and maintain a personally effective therapeutic voice, translate multiple streams of evidence into meaningful interventions, offer safe and confidential therapeutic relationships, and practice in the real world. Disparate voices carry conflicting messages about the need for psychotherapy and its costs,
worth,
components,
allowable
interventions, and effectiveness. These forces, both within the discipline of psychology and outside in the health care system, compete for supremacy and the attention of clinicians. It is important for clinicians to join in the discussion and to share information on practices that contribute to good results for patients. Our discipline needs a bidirectional conversation between clinical scientists and clinical practitioners. Our academic colleagues are giving us information daily about specific treatments and elements of the therapeutic relationship that work. We need to give them information about the problems we identify in our communities, the ways we approach those problems, and the outcomes. This article gives an overview of our knowledge about psychotherapy: the endeavor of psychotherapy, the evidence we use for its underpinnings, and the resources SUMMER 2004
we turn to for guidance in the absence of hard research findings.
Evidence What do we mean when we talk about evidence? The foundation for psychology is science, of course. The practice of psychology is built upon that base, although clinicians are faced also with problems that go beyond what the research has yet been able to describe, measure, or ameliorate.
The Institute of Medicine defines Evidence-Based Practice as: “the integration of the best research evidence with clinical expertise and patient values” (Sackett et al., 2000). The APA document, Criteria for evaluating treatment guidelines, integrates the same three components: empirical research, clinical judgment and expertise, and acceptability to the patient (American Psychological Association, 2002). Most knowledgeable psychologists support this kind of broad scientific Texas Psychologist
7
definition for psychotherapy. There are, however, some who would like to minimize or eliminate the roles of clinical observation, and judgment and patient values. That is a mistake, if one considers the nature of psychotherapy and the resources available that contribute to its success.
psychodynamic, and cultural competency orientations. Perhaps not surprisingly, different patients make different theories look good, depending on the “fit” in language and world view between the person seeking help and the person providing it. In practices across the country, underlying theories may differ but experienced clinicians look quite similar. They offer proven
Endeavor Psychotherapy is first and foremost a
interventions,
a
solid
therapeutic
human endeavor. It is messy. It is not solely a scientific endeavor, nor can it be reduced to a
relationship, and a shared expectation with the patient for a positive outcome. Good
technical
enterprise. The
clinicians borrow what works from each
triumvirate of factors that contribute to
other. There are few differences among bona
psychotherapy outcome is: the patient’s personal factors (e.g. motivation), the
fide therapies, widely practiced over time, that have a coherent theoretical structure and
therapist’s personal factors (e.g., capacity for
a research underpinning (Wampold, 2001;
empathy), and the interventions offered. Keep in mind that specific techniques contribute only 5 percent to 15 percent to the
Messer, 1995). Psychotherapy is an art as well as a science. It is a fluid, mutual, and interactive
outcome (Norcross, 2002). Therapist effects
process. Each participant shapes and is
are greater than treatment effects (Wampold, 2001). People get a substantial benefit from psychotherapy and no one modality is shown
shaped by the other. Good clinicians respond to the nuances of language, both verbal and bodily expressions. They are
to be better than all the others (Seligman,
masters of tact and timing, of when to push
1995). We know that suffering is a part of the human experience, and we know that psychotherapy is effective in easing that
and when to be patient. They are creative in finding paths to understanding, in matching an intervention to a need.
suffering, no matter how you define it. Psychotherapy is a rich process. It is an
Psychotherapy is complex. Our patients’ biological predispositions, personalities,
attempt to reach understanding, ease pain, solve problems, and find meaning within the context of a trusting relationship. Our patients want to be heard and understood. They want respectful help in obtaining relief, making sense out of their experiences and improving their lives. Each wants to be treated as a whole person, not a diagnosis or
preferences, developmental level, and psychological functioning intertwine with their life circumstances and stressors. The great preponderance of psychotherapy patients have cross diagnostic issues and comorbid conditions. Dual diagnosis is common. We know that individually tailored interventions can be as much as
a case. Real world psychotherapy involves working in the face of a few variables one can control and with the knowledge that there are many one cannot control. This is where clinical experience, judgment, and the ability to use creative combinations and adaptations of interventions come into play. Psychotherapy draws on many theories, including behavioral, cognitive behavioral, family systems, feminist, humanistic,
100 percent more effective standardized ones (Azur, 1999).
8
mechanistic
Texas Psychologist
than
Resources Where do clinicians turn for guidance to make decisions and treatment choices for psychotherapy? Psychologists use a combination of tools to do meaningful and effective psychotherapy. We use research evidence where it exists, modify it where
necessary, and create new interventions in the field on a case by case basis, often by combining accepted techniques from different areas in novel ways. We seek feedback and guidance from multiple sources on how it is working and how it can be improved. Where the research evidence is spotty, we draw upon evidence from our clinical experience and expertise. Here is a brief list of some of the sources of guidance valuable to clinicians: 1. Doctoral Training Program and Internship It is humbling to learn publicly in front of one-way mirrors with supervisors and fellow students how to do an intake; build an alliance; develop working hypotheses about a patient; make a diagnosis; offer trial interventions appropriate to the person and the situation; appraise the response; continue or change course; and come to a mutual agreement on a treatment plan, goals, and termination. The training period is also the initiation into a practitioner work ethic that values openness about one’s work and builds in an ongoing expectation of feedback. 2. Observation Observation, both in session and over time, is a powerful tool. It includes four types of observational skills: objective (from the
outside),
participant
(including
awareness of the reciprocal effects on observer and observed), subjective (empathic and intuitive), and self (selfexamination) (Shakow, 1976). A therapist functions as a finely tuned instrument and thinking person, not as a technician following a script. 3. Experience Clinicians turn frequently to their own experience for guidance. Faced with a difficult or murky psychotherapy situation, clinicians sort through their own experiences and expertise for a way to move the treatment forward. Often this process is associative, rather than linear. Clinical judgment is necessary. Sometimes we make mistakes, but then we learn from them and add to our expertise. SUMMER 2004
10. The Patient’s Impact
4. Patient Report Patients are a primary source of information about how psychotherapy is progressing. An attuned clinician gains valuable feedback about improvements or setbacks that are taking place outside the treatment room in the patient’s everyday life. 5. Third Party Report It is not only the patient who gives feedback to the clinician, but it may be a
This variable in the therapeutic relationship was described first in psychoanalytic theory as countertransference.
Azur, B. (1999). Tailored interventions prove more effective. APA Monitor, 30 (6), 38-9. Gelso, C. J., & Hayes, J. A. (2002). The
It is an important psychotherapy phenomenon and is now recognized across
management of countertransference, In:
other theoretical orientations, based on a
that work. New York: Oxford University Press.
somewhat limited but growing body of empirical research that shows its effects on
Messer, S.B. (2002). Empirically supported
treatment (Gelso & Hayes, 2002). It helps us
treatments: Cautionary notes. Medscape General Medicine 4(4). http://www.
Norcross, J.C. (ed). Psychotherapy relationships
observations about changes in the patient. In
all to recognize the impact of working in psychotherapy with people who are distressed
some particular circumstances, it may be the
and may be quite disturbing.
patient’s physician, attorney, or employer. 6. Consultations and Peer Discussion Regular consultations and case discussions shed light on our thinking and
11. Outcome Assessment This may be a formal or informal process used for guidance. More clinicians
broaden our perspective. They push us to talk about cases that are puzzling, or not going
formal methods at the end of psychotherapy, although this is changing. It is quite
well, or that may have one aspect that is bothersome or unique. Group consensus may
straightforward to ascertain information about global improvement and symptom
not always be correct, but it is a valuable tool. 7. Continuing Education Some programs are skill based, such as
reduction. It can be harder to tease out the multiple variables that have contributed to the result. Outcome measures are an
a workshop that teaches specific techniques for use with pain. Some programs might
excellent source of guidance for clinicians and a wonderful reinforcement for work well
better be characterized as focused on attitude and growth, such as the “Difficult
done. We can also use our outcomes to show the world psychotherapy works.
965-974.
Dialog” workshops held at the APA Multicultural Conference last year.
Conclusions
Shakow, D. (1976). What is clinical psychology? American Psychologist, 31,
spouse
or
parent
who
contributes
8. Professional Literature Often clinicians do not read journal articles that address research directly applicable to clinical problems. They do read books of clinical relevance to their practices, and they value the journals that are most helpful to clinicians, such as Professional Psychology: Research and Practice and the Clinicians Research Digest. 9. Internet Clinicians have benefited greatly from internet access, which did not exist when some of us started practice. From our offices we can gain needed information quickly, without taking time away from practice to go to the nearest university or medical school library.
SUMMER 2004
seem to use informal evaluations rather than
Clinicians need and prize evidence. We learn over time to use evidence and guidance without subscribing to artificially constructed hierarchies about which evidence is most important because usefulness varies widely. Our “best practices” are built on a foundation of empirical research; comprehensible and reasoned theories; clinical observation and expertise; and our patient’s values, contributions, and responses. ✯
medscape.com/viewarticle/445082 Norcross, J.C. (2002). Empirically supported relationships. In: Norcross, J.C. (ed). Psychotherapy relationships that work. New York: Oxford University Press. Sackett, D. L., Strauss S. E., Richardson, W. S., Rosenberg, W., & Haynes, R.B. (2000). Evidence based medicine: How to practice and teach EBM. Second Edition. London, England: Churchill, Livingston. Seligman, M. E.P. (1995). The effectiveness of psychotherapy: The Consumer Reports Study. American Psychologist, 50, (12),
553-560. Wampold, B.E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Erlbaum.
References American Psychological Association. (2002). Criteria for evaluating treatment guidelines. American Psychologist, 57 (12), 1052-1059.
Texas Psychologist
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Texas Psychologist
SUMMER 2004
How Will Texas Implement Atkins? Ollie J. Seay, PhD TPA Public Policy Chair
TPA Position Statement Texas Implementation of the Supreme Court Decision in Atkins v. Virginia (Mental Retardation & Death Penalty) March 26, 2004 In issues relating to the Death Penalty,
mental retardation would be
the Texas Psychological Association supports
decided before a capital trial was pursued and would allow the
legislation that provides a clear definition of
jury to be waived by the defendant such that a judge could make the determination after hearing testimony from
case would make the decision on
Significantly subaverage general intellectual functioning in this definition refers to measured intelligence on a
Capacity for Justice, a nonprofit organization that addresses competency issues for respondents and defendants
finding a difference of opinion. Bring up the Death Penalty in the Texas Legislature and you’d better hang on to your hat! For at least the last three sessions, at least one bill has been introduced to address a ban on the execution of criminals who have mental retardation. Yet as of today, Texas is no closer to implementing a law in this area despite the Supreme Court ruling in Atkins v. Virginia in June 2002. There are two points of view in the legislature as reflected in the bills presented by Sen. Rodney Ellis (D-Houston) and Rep. Terry Keel (R-Austin) during the last session. The biggest difference in the bills has to do with the timing of the determination of mental retardation and who will hear the case for this phase. In Sen. Ellis’ bill, the issue of
SUMMER 2004
requires three elements: significantly subaverage general intellectual functioning, limitations in adaptive behavior, and
defendant had been found guilty. In March of this year,
B
Such a definition of mental retardation
experts. In Rep. Keel’s bill, the same jury that heard the capital mental retardation after a
ring up the Death Penalty in any large group and you can be assured of
mental retardation that is consistent with nationally accepted professional standards.
origination during the developmental period.
standardized psychometric instrument of two or more standard deviations below the age group mean for the test used. Adaptive behavior means the effectiveness or degree to which a person meets the generally recognized standards of personal
with mental illness, mental retardation or concurrent
independence and social responsibility. Developmental period refers to the period
mental and substance use disorders, held the first of what should be
from birth to age eighteen. Any further qualification of the definition should be
several meetings on implementing the Atkins decision in Texas. They invited TPA
clearly articulated so that the result is measurable and necessary.
and representatives of other professional organizations, attorneys, service organizations and advocates to help make recommendations to the Legislature. One approach is to find areas in which we can agree first, then see what we can negotiate on the timing issue. The other issues to be discussed include the definition of mental retardation, who should conduct the assessment of mental retardation, and what factors should be considered in the evaluation and included in the report. An update will be included in the next issue of the Texas Psychologist. The adjacent Position Statement was adopted by the TPA Board of Trustees at their March 26, 2004 meeting:
Licensed psychologists, particularly those with appropriate training and experience in diagnosing mental retardation, are the most qualified professionals to determine mental retardation through use of psychometric instruments and assessment techniques. There are already precedents for the use of licensed psychologists in other laws relating to forensic assessment of competence to stand trial and juvenile fitness. In addition, other state statutes on determination of mental retardation specify the use of licensed psychologists. While collaboration with experts from other professions may assist in such areas as historical data collection, the resulting diagnostic determination must be made by the licensed psychologist.✯ Texas Psychologist
11
Sunset Committee Report Melba Vasquez, PhD
O
n Tuesday, March 23, 2004, the Texas Psychological Association provided testimony to the Legislative Sunset Review Commission. The Texas State Board of Examiners of Psychologists was the first of the scheduled groups to provide testimony during a two-day hearing. Drs. David Rudd and Melba Vasquez, who have served as co-chairs of the TPA Sunset Review
Committee, provided testimony that focused on the critical points to address in the Sunset Advisory Commission Staff Report during their
allotted five minutes of presentation. Dr. Robert McPherson, TPA’s Director of Professional Affairs, provided response to testimony from Psychological Associates who made a request for the independent practice of psychology. Dr. Paul Burney, TPA President-Elect, was available as a resource. Chris Shields, TPA lobbyist, and David White, TPA Executive Director, were also in attendance. The Sunset Review Commission will provide its recommendations to the legislature on May 18 and 19. TPA will continue to monitor information, and continue to provide input as appropriate. A draft summary of the commentary is included below.
TPA Testimony TPA would like to thank the members of the Sunset Commission for the opportunity to offer public testimony here
2. TPA supports continuation of the Board’s oral examination for psychologist licensure candidates, for three main reasons:
today. We would also like to acknowledge and thank the staff for their exceptional efforts and gracious assistance during this process.
• It ensures that all candidates meet minimal competency standards for practice. Most importantly, it protects the public
The staff has responded in courteous and timely fashion to our requests, allowing us ample time to review and respond to issues
from those few that do not possess the basic skills necessary for entry-level independent practice, including those skills that
raised. 1. TPA supports continuing the Psychology Board as an independent state agency and regulatory body. • For over 30 years the Psychology Board has served and protected the people of Texas as an independent state agency and regulatory body. • Given the complexity of professional psychology, an independent board provides critical public and professional representation, which is essential to the public. • A board provides protection in terms of both licensing qualified psychologists and enforcing rules of practice. • If reorganization is pursued at some point or the possibility of consolidation is discussed, TPA respectfully requests the opportunity to provide additional input and offer further testimony as the need arises.
12
Texas Psychologist
cannot be assessed by traditional paper and pencil exams. • It is a cost neutral activity for the Texas State Board of Examiners of Psychologists. • The oral examination is the national standard in licensure of psychologists. Continuing the oral examination allows Texas to participate in the national reciprocity agreement, as well as future options for reciprocity; it ensures Texas can continue in the multi-state agreement to ease the licensure process for psychologists moving from one state to another. 3. Texas Psychological Association strongly concurs with the recommendation of the Commission staff to dissolve the Psychological Associate Advisory Committee (PAAC): • Funding for the PAAC has been eliminated and the Committee has achieved its mission as originally conceptualized. • Current regulatory language regarding the roles of psychologists and psychological associates is clear and unambiguous. ✯
SUMMER 2004
LOCAL AREA SOCIETY UPDATES Dallas Psychological Association Getting to Know Us
high quality of services provided to members and the community. Three times each year, DPA welcomes current and new members to gather informally at social events for networking,
Michael McLane, PsyD Through its active and dedicated membership, the Dallas Psychological Association (DPA) has for almost 50 years played an integral role in serving the mental health needs of residents in North
eating, drinking, and being merry. Supporting excellence in psychology is a high priority of DPA; therefore, the organization offers three awards each year: the Distinguished Psychologist award to honor the accomplishments of an outstanding psychologist, the
Texas and in providing psychologists with opportunities for ongoing
Pam Blumenthal Community Service award to recognize a psychologist devoted to under served minorities, and the
professional development.
Dissertation award to acknowledge excellence in research.
Early in 1956, Dr. Joseph Siegel invited a small group of Dallas psychologists to form a local professional psychological association. From those humble beginnings, DPA’s membership has grown to approximately 200 psychologists of diverse backgrounds. There are many benefits to being a member of DPA. Professional membership in the DPA affords a variety of learning opportunities. For instance, special interest groups have been established in diverse areas, such as geropsychology, forensics, or child and adolescent issues, so members can collaborate with local experts. Members can also request to be contacted in their area of
Learn more about the exciting opportunities for ongoing professional development that membership brings by visiting our Web site http://dallaspsychologists.org or by calling DPA at 800306-8886.
El Paso County Psychological Society From the Ashes
expertise when local media contact DPA for referrals. Each year, DPA sponsors multiple workshops on a range of topics, such as
Elizabeth L. Richeson, PhD, MS PsyPharm
ethics, health psychology, geropsychology, cultural issues, and borderline personality disorder. DPA members pay a reduced
It was difficult to decide what or even whether to write about this LAS. Having concluded there are always lessons to learn, I felt
registration fee for these workshops. Like the boards of most non-profit organizations, DPA’s
I would be remiss in not sharing this story. The El Paso County Psychological Society (EPCPS) once
Executive Committee has worked hard to keep costs low without sacrificing quality of services. For instance, thanks to the generosity of the Texas Scottish Rite Hospital for Children, a local non-profit hospital that allows DPA to use their facilities at no charge, overhead for workshops is reduced. In return, DPA strongly encourages Scottish Rite employees to attend workshops for free. This ongoing partnership with Scottish Rite presents a “win-win” situation for all
existed as the El Paso Psychological Association (EPPA)—a much easier acronym. Due to events too tedious and ancient to revisit,
involved. Other creative methods to curtail expenses include replacing our local physical administrative office with a virtual one through our association with DKW Associates. Through the leadership of David White, DKW Associates has assisted DPA by providing secretarial support to answer general phone queries and by developing a highly functional Web site that allows online renewal of membership, workshop registration, and viewing of monthly DPA newsletters. Those who visit DPA’s official Web site, http://dallaspsychologists.org, can also obtain information about the professional services of its members. Through these and other cost saving measures, there has been dramatic improvement in DPA’s balance sheet over the past few years without sacrificing the SUMMER 2004
suffice it to say, it was reborn. Since that time it has struggled to maintain its membership. El Paso has a relatively small number of psychologists—21 clinical practitioners listed in the phone book and 25 academicians at the University of Texas at El Paso—with little growth in our professional community. However, there is a small core of psychologists that remain dedicated, and it is about them that I wish to write. Perhaps it is the greater distance from Austin that contributes to the limited insight for some psychologists in El Paso about the importance of legislative issues and their impact on psychology. However, the EPCPS works hard to ensure its support is felt even in Austin. It is this small but dedicated group that contributes financially as a group to the TPA PAC every single year. While the $500 contribution (there have been years in which it has been a $1000) may not seem like much to a large LAS, it is significant given the size of EPCPS. Additionally, the El Paso LAS historically held monthly brown bag lunch meetings that offered didactic Texas Psychologist
13
presentations in conjunction with the UTEP Psychology
the LAS, I went on to become President of the PAC, Chair of the
Department. In some years, there were also some very well attended area conventions that offered CEUs of interest to a wide variety of
Special Interest Group in Psychopharmacology, Member of the Board of Trustees of TPA, and now Editor of the Texas Psychologist.
mental health practitioners.
I continue to maintain my position of Liaison Officer with the
Most recently it has been difficult to maintain the organization
LAS keeping them informed of the developments within TPA.
at all. There was not an election last year, since those dedicated to the LAS have served as officers in the organization multiple times
None of this would have been possible without the support of the El Paso LAS.
and now refuse to do so. At our last social meeting, there were a few
Our fundraisers have not always been well attended but they
that agreed to run (most likely unopposed) as board members if three members were willing to run for board officers. I have been
have, nonetheless, made a political statement and served us well. Even our psychology socials have worked to keep us in touch with
working behind the scenes to identify those psychologists who do
each other and updated on the most pressing issues of our
not want this most important organization to simply slip away.
profession. However, in order to be heard, we must reestablish
When I first moved to El Paso in 1982, it was the EPPA that
ourselves as a professional organization.
welcomed me and encouraged me to get involved with the LAS and TPA. With their support I held the office of Secretary, Vice-
Whether it’s to support individuals in our professional community or to protect our licenses as we MUST do in Sunset, I
President and President before I moved on to my work with TPA.
cannot impress upon you the importance of a strong LAS in each
I worked on the Health Services Committee for six years as Chair of the Hospital Admitting Privileges Committee and three years as a member of the Prescriptive Privileges Committee. Supported by
and every community in Texas. This is the way we can make our voices heard. Over the years, there have been other LASs that have ceased their existence, most often in small communities. I encourage each and every one of you in communities that do not have an LAS to revisit the opportunity to create or reestablish your LAS for all the benefits listed here and those that are simply in our imaginations. I am pleased to announce that the EPCPS will be active again. We have the numbers needed for the much overdue election and will be up and running in the near future. Making psychology a household word can only be accomplished with efforts in each and every community in this state and across the country. It is the grassroots effort that ultimately makes the difference.
Houston Psychological Association Educational Opportunities Abound Julie Landis, PhD If you are a psychologist in Houston, there is no lack of things to do! We are a very busy professional organization offering a wealth of activities for psychologists to attend. During February, members attended a film series, “Mental Health and the Law,” with the Museum of Fine Arts. This series presented four films selected for their interpretations of the legal consequences surrounding sociopolitical issues and mental illness. Panel discussions led by local area psychologists followed each screening.
14
Texas Psychologist
SUMMER 2004
HPA was also lucky to benefit from some local area expertise. J.
relationship skills to improve a couple’s ability to communicate,
Ray Hays, PhD, JD, presented an ethics workshop on February 20, titled “Privacy for Couples, Families, and Groups: Split
parent, and negotiate differences. This event was held at the Christ Church Cathedral downtown. Childcare was available. For more
Alliances, Dual Duties, and Trust,” that resulted in a record
details and registration information about future workshops, check
turnout of psychologists meeting their three hours of continuing
out our Web site at www.hpaonline.org.
education in ethics requirement for license renewal. After the early morning workshop, we held our regular monthly luncheon
Finally, I wanted to let you know that I have represented HPA at meetings of the newly formed Houston Area Suicide
meeting with featured speaker, Patrick Brady, PhD, who spoke on
Prevention Coalition. It is composed of many area agencies
“Appropriate Interventions and Referrals for Addressing Addictions in Private Practice.” In March, instead of our usual
providing services to prevent and respond to people in crisis. They have asked us to put together a list of professionals
monthly luncheon, we encouraged our members to attend TPA’s
specializing in suicide response and trauma who would like to be
Professional Education Conference in the nearby Woodlands.
identified as providing services in this area.
Those who attended benefited from the practice tips and information offered. Members of our executive committee were very busy in preparation for HPA’s Annual Spring Conference held May 14 and 15. As we are all aware “about 1.5 million children experience the divorce of their parents each year—ultimately 40 percent of all children” (National Center for Health Statistics, 1995). While most adapt well, 20-25 percent suffer significant adjustment problems as children and teenagers. The negative impact often persists into adulthood, resulting in nearly twice the normal prevalence of mental health problems and impaired educational attainment, socioeconomic and family well being (NIH news release, 2002). Much more needs to be done at the community and practice level to strengthen the family unit so that they can adequately care for their children. For the previous two years, HPA presented very successful conferences, titled “Violence: Prevention, Intervention, Activism” in 2002 and “Violence 2: Prevention-Resilience” in 2003. These conferences were designed to provide the community with the knowledge and ability to confront and respond to the increasing level of violence in our society. This year, HPA has shifted the focus to individual practice and education to develop and enhance our therapeutic skills so that we may better address the needs of our clients. To this end, we brought Michele WeinerDavis, MSW, to Houston to present workshops for mental health professionals and the public. Michele was in Houston May 14, 2004 at the Derek Hotel to present a seminar, “Putting ‘Marriage’ Back into Marriage Therapy: Divorce Busting.” In this seminar, mental health professionals learned a new model of working with couples with very challenging problems so that they will be better able to help couples “resolve their differences rather than dissolve their marriages.” Also included in the conference was a day intended for the benefit of the Houston community at large. On Saturday, May 15, Ms. Weiner-Davis offered her seminar, “Keeping Love Alive,” to couples and individuals. This workshop is designed to teach SUMMER 2004
Southeast Texas Psychological Association Reorganized and Going Strong Charlotte M. Kimmel, PhD The Southeast Texas Psychological Association has been meeting every month since last year. This group of approximately 20 members includes psychologists from the Golden Triangle area of Beaumont, Port Arthur, and Orange, Texas. This chapter had been inactive for several years until approximately one year ago. Bob Meier, PhD, was integral in contacting all the local psychologists and arranging a lunch meeting. Since that time, the association members have continued to meet at a local restaurant during the lunch hour to network and share ideas. Current officers are President Bob Meier, PhD; Vice President/ Secretary Charlotte M. Kimmel, PhD; Treasurer Cristina Serrano, PhD; and Past President Andrew W. Griffin, PhD. Members have agreed to have a monthly program and speaker. Programs during the current year have included information on the following topics: Psychology Services in the Federal Prison by Jim Mann, PhD; Diagnosis and Treatment of Substance Abuse in Older Adults by Andrew Griffin, PhD; Differential Diagnosis and Treatment of Children: ADHD or Bipolar Disorder; and Ethics Issues by Bob Meier, PhD. The group also keeps current with legislative issues through legislative alerts posted to the group members via e-mail by Charlotte M. Kimmel, PhD, who is a Texas Psychological Association Board Member at Large and receives frequent updates of issues relevant to the practice of psychology in Texas. Several local members have been active in contacting their legislators about these issues to ensure that local representatives are informed about these concerns. ✯
Texas Psychologist
15
“Lab Work” at McKenna Hospital Allison R. Williams, BS Ollie J. Seay, PhD
What qualities or characteristics are necessary to create and offer a healthy workplace? Granted, there are numerous ways to do this, but Tim Brierty, CEO of McKenna Memorial Hospital, enlightened us on a key element that helped establish a healthy environment for both workers and patients. McKenna Health Systems, with its strong anchor, McKenna Hospital of New Braunfels, Texas, received the Healthy Workplace Award from the Texas Psychological Association (TPA) in 2003. The development of the environment for both patients and employees is partially accredited to a four-legged Labrador Retriever named Annie.
T
hree years ago, Annie and Tim went through six weeks of
obedience training with the Delta Society in Portland, Oregon. Delta Society’s mission is “to improve human health through service and therapy animals.” The society has three main goals: “to expand awareness of the positive effect animals can have on human health and development, to remove barriers that prevent involvement of animals in everyday life, and to expand the therapeutic and service role of animals in human health, service, and education.” The Delta Society helped establish the Standards of Practice in Animal-Assisted Activities and Animal-Assisted Therapy and provides guidance on the administrative structure of AAA/AAT programs, including such areas as the selection of animals, personnel training, treatment plan development, documentation, and more. Annie would fall into the Animal-Assisted Activities category since there are no specific treatment goals planned that include her—the handlers are not required to take detailed notes—and Annie’s visits are spontaneous and last for as long or as little as is needed for each patient. Annie spent an additional six weeks with the trainer who would be guiding her 16
Texas Psychologist
as she made her rounds in the rehabilitation ward. This allowed her to become acquainted with her supervisors at the hospital and helped her learn what duties and behavior would be expected of her. Annie is well trained to follow hand motions, and staff had to learn these, as well as to not to leave food lying around for her to eat. In her three years on staff at McKenna Hospital, Annie has primarily worked with patients in rehabilitation who are in the hospital for an extended period,
One of the tasks that Annie helps patients cope with is being reintroduced to basic functions. If these patients need to learn how to do simple things such as brushing their hair again, they can brush Annie’s hair for practice. Tim Brierty said that some people have a better connection with the animal than with people, and if they do not react well to a therapist, then Annie can assist them in getting the help they need. Another job that Annie performs is
usually after a complicated surgery or stroke. Annie assists these patients in reacclimating into the world.
being a friend who comforts patients by spending time with them. “Some people can’t get out of bed, so we are trying to SUMMER 2004
break down their depression, and Annie
Annie—and that was not just the patients.
patient who was recovering from surgery on
will hop up in the bed, always with permission, and most of the time you can
Staff members’ demeanors changed when Annie walked in the room. Everyone
his knees was particularly happy to see Annie and grabbed her with both arms to
find Annie lying perfectly still in someone’s
seemed glad to see her. Mr. Brierty took us
give her a great big hug. He did not want
bed because they have fallen asleep with
to the different rehabilitation rooms to
her to leave with us, so as we said goodbye,
her,” says Brierty. For some patients, Annie is a replacement dog for the one they had to
show us Annie in action. He made sure to ask permission to bring Annie into each
Annie stayed in his group rehabilitation session to keep him company.
leave behind while they are staying in the
patient’s room. While there was no
After making the rounds with Annie,
hospital. She becomes their new companion. In addition, some patients
requirement to see her, most patients said, “Sure, bring her in.” We saw how the
we could see that she was indeed an essential worker and that she gave her heart
must relearn how to take care of their
patients’ faces lit when Annie entered their
to each patient she saw helping them feel a
animals,
their
rooms. We encountered one woman who
little better in what could have been just
“training” dog. Annie works with a variety
was using a walker to go down the hall, and
another hospital stay. Given the benefits
of patients and is adaptable to meet the patients’ different needs.
she became very animated and excited when she saw this big black dog enter the door.
observed for everyone at McKenna Hospital, it is surprising that more hospitals
and
Annie
becomes
Annie is basically an alternative
Annie went up to a man who did not have
do not follow their example. It is easy to see
therapy, providing emotional support in ways that other forms of therapy cannot. “Sometimes the patients actually heal
much control of his arm, but he used that arm to pet her and was surprised that such an ordinary response to an animal could
why TPA chose them for the Healthy Workplace award. Theirs is definitely a healthy workplace, for people and for a dog
faster because their hearts and spirits are getting better,” says Brierty. Although no
help him learn to reuse the limb. Another
named Annie. ✯
research has been conducted concerning Annie’s role at the hospital, it is evident in the response from past and present patients that she has helped improve patient care. Many former patients return to McKenna Hospital just to see Annie, and sometimes she even receives Christmas presents. Brierty said that his research is based on the reactions people have and the fact that so many of them come back to see her once they have been rehabilitated. Some return patients come just to see Annie because they say she “saved their lives.” In addition, staff members have told him that patients who were either depressed or unwilling to cooperate in therapy changed once they met Annie. Despite the lack of formal research, Tim Brierty’s intuition tells him that Annie works. During our visit, we could tell by the way that he talked that he knew having Annie at McKenna Hospital had increased the morale of patients and staff members alike. As we were walking Annie to the rehabilitation floor, the people we met seemed much happier when they saw SUMMER 2004
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Texas Psychologist
17
CE Credit Home Study The Therapeutic Contract Eric Marine, American Professional Agency
Directions: To receive one hour of ethics continuing education credit for psychologists, licensed psychological associates, licensed professional counselors and licensed social workers, for this TPA sponsored home study assignment, you must: 1.) Read the article in its entirety; 2.) Take the test at the end of the article; Mail the test along with $25 (TPA Members) or $50 (Non-TPA Members) to the TPA Central Office at 1011 Meredith Drive, Ste. 4, Austin, TX 78748 or you can fax back to 512-280-4334.
O
ne of the fundamental elements of the therapeutic process is the
contract for services between the patient and therapist. This is generally referred to as the therapeutic contract. In the past, this document was very rarely written down. While verbal, it still contained the basic provisions for the services the therapist would provide to the patient. It was an evolving agreement. As the therapy progressed, the therapist would explain what was going on and what would happen next. Since it was assumed that the treatment would always be delivered in good faith, it was infrequently written down. Yesterday was a different world than today. In the past, therapists would hardly ever encounter the legal system. The relationship with the patient was intimate and private. The patient would never want their therapy made public and that was the end of that. The world we now live in is quite different. In the past 20 years, therapy has been recognized as mainstream health care. The client base has expanded and changed. It has become multi-cultural and quite diverse. The mental health profession has acquired the court system as a client and 18
Texas Psychologist
referral source. While the historic principles
for the provision of the services have also
that make up the therapeutic process have been altered and adjusted, the underlying
radically been altered. We will attempt to create a framework to remove the anxiety
concepts have remained constant. One of the most profound changes to
from practice in the future.
the therapeutic process is the advent of the consumer revolution. In all other forms of
LICENCED OR CERTIFIED
commerce, consumerism has met with some resistance by the manufacturers and purveyors of goods and services. In the therapy community, it has been met with outrage and misunderstanding. Also, the consumer protection apparatus has little understanding of the services they have the responsibility to regulate. This confluence of events has led us to where we are today. A place where most therapists try and carry on with limited understanding of the forces that operate around and inside the practice of therapy. As we go through some of the elements that have changed or become preeminent in the modern practice of psychotherapy, certain areas will be highlighted and discussed in detail. It is from these areas that the elements of a new treatment contract will be crafted. The scope of practice and client base for psychotherapy has changed dramatically in the past 100 years. The rules
The first step in the societal recognition process for therapy was the requirement for the licensure or certification of the professional. This was completed in the past 10 years in all states. It is important to note the license or certification does not make the professional a therapist, which is done with education and experience. The license or certification allows only those individuals duly approved by the various states to use protected terms, such as psychologist, social worker, counselor or marriage and family therapist. The laws protect the terms and allow only those individuals to call themselves what the license or certificate refers to them as. It also defines the type and extent of the services that can be performed by the duly licensed or certified practitioner. This protects the public from unqualified individuals using the protected titles and thereby deceiving the public into receiving sub-standard or unqualified care. SUMMER 2004
a
national organization’s requirements may
the license or certificate is a permission to conduct a business in the state. It defines
The prior paragraph not withstanding,
States
presumption of innocence in criminal investigations and prosecutions. The state
Constitution
not provide sufficient protection from the regulatory process. Where the organization’s
what services may be provided and by
regulatory law does not contain that same
rules and state law come into conflict, the
whom. It is intended to inform the
presumption. Additionally, the state may
state has primacy.
consumers of the state what they might expect should they see the therapist. It also
use the services of the Attorney General’s office to act as the primary investigatory
A further example of the rise of consumerism is the varying state
gives the state the right to regulate the
and
These
requirements for disclosure and informed
practice in order to protect the consumer.
individuals are used to protecting the
consent. The mental health community has,
Therefore, there is a presumption that the consumer is always right. It is this
citizens of the state from criminal activity. They bring the same mindset and zeal to
for years, been less than forthcoming about the therapeutic process. The education and
presumption that the therapist encounters
the regulatory process. While on the surface
experience required to become conversant
when a complaint is made to the state regulatory board. It is the same operative
this energy may be laudable, it fails to take into consideration the special circumstances
with the process is formidable. For years, the only information given out about the
presumption that the therapist would have
of mental health care.
process was the admonition to “trust me.”
prosecution
provides
personnel.
for
going for them should they make a
When the mental health professional
In today’s world, the full disclosure of all
consumer complaint against another provider of state regulated services, such as an automobile dealership.
achieves either licensure or certification, the state will provide a copy of the regulations that govern the license. Each time that
information generated by the therapist is almost a universal mandate. If a patient, former patient or a guardian of either of the
Historically, there were few complaints made against therapists to the various state
license or certificate is renewed, the therapist signs a statement that they are familiar with
previous two groups requests treatment information, it must be given.
regulatory agencies. This was probably because the patient did not wish to have the
all the regulations and are in compliance with them. If an investigation is begun, the
This has not always been the practice of the therapy profession. Treatment notes
fact that they were in therapy known to any one. This self-limiting factor stopped many
state is empowered to not only investigate the complaint, but any compliance issue
and information were guarded to protect the patient’s confidentiality. If the
clients from even considering bringing a complaint. This is not the world in which
they choose to look into. This means a therapist may be exonerated from the
information was released, it was generally done in the form of a treatment summary or
we live today. States advertise the services of the various consumer protection boards.
original complaint, but found in violation of something discovered during the initial
report. For a long time, this was acceptable. Today, it is not.
Some even require the therapist to inform the patient directly about the existence and
investigation. This may have nothing to do with the reason for the complaint, but the
While the state laws that govern the practice of therapy still require the therapist
procedures of the boards. Other states require the therapist to post in their lobby a copy of the approved “Patient’s Bill of Rights.” These are examples of the consumer protection mandate of the state. The basic nature of psychotherapy works against the therapist when a complaint is made. Because the services are delivered in private, there is little evidence of the actual quality of the service provided. Generally, the word of the patient is given at least equal value as that of the therapist as to what occurred during the therapeutic process. From this premise the state will begin an investigatory process. The reason is to find out why a consumer is unhappy with the services received. The United
state can apply penalties nonetheless. An example of this is record keeping. Contained within the state mental health or public health law or the actual licensure or certification statute is a specific requirement for record keeping. Each time the therapist renews the license or certificate, they warrant that they are keeping records in accordance with the requirement. If the investigation turns up a deficiency in this area, the therapist will face disciplinary action even though the complaint made by the consumer is dismissed. This may not seem fair, but the therapist had agreed that he/she was complying with all the rules, but the investigation showed a lack of compliance. Further, compliance with a
to maintain the patient’s confidentiality, they recognize it is the patient that controls the record. Confidentiality is the duty owed to the patient. Privilege is the right of the patient to keep confidential those communications made with the therapist. It is similar to the privilege provided between an attorney and a client. The patient controls this aspect. If the patient does not wish to waive privilege, the therapist cannot breach the patient’s confidentiality. There are, of course, exceptions to this rule— abuse, suicide and dangerousness being the most notable. There are many other aspects of any state licensure or certification law. They deal with who may sit for the state examination and the
SUMMER 2004
Texas Psychologist
19
general principles of what makes up an ethical
While this may seem an unwarranted
to make the best decision for the children;
and moral practice. Some are more spelled out, while others are less defined and open to
step in the therapeutic process, it is gaining support with the various states’ licensing
the court will often order a custody evaluation by a mental health professional.
interpretation. Keep in mind that the
authorities. Since this step would allow the
By this order, the fundamental relationship
consumer may use a different interpretation
consumer (patient) to participate in the treatment process and exhibit control over
of the client and the therapist is set. It is not the traditional one that any client might
treatment, some states have mandated the use
expect.
of the state law to instigate a complaint. The state will attempt to see the situation from the point of view of the consumer.
of informed consent documents. Managed
While the change dictated by a
INFORMED CONSENT
care facilities have long required the provider of services to use a form of informed consent
forensic examination would appear to be obvious, it may not be. In order to make
The concept of informed consent has a
documentation in the intake process. It can be
sure all parties know exactly what will
long history in the medical profession. It is intended to allow the patient to participate
expected by state mandate or best practice
happen and what to expect, using an
in the treatment decisions that most directly
recommendation that some type of informed consent documentation will be required from
informed consent document can be of immense help. It removes areas of
affect the patient. The physician has to
all patients before the therapeutic process
confusion and specifically covers any
explain what is going to be done and why. The patient must consent to the course of treatment outlined. The patient always has
can begin. While the clinical area of therapy can be enhanced by the use of informed consent
problematic features, such as confidentiality. In the January 1997 issue of the
the right to refuse the treatment. This refusal would be based upon all relevant information being provided about the
documentation, it is extremely helpful in
California Board of Psychology Update,
forensic practice. When a client visits a therapist, there are certain preconceived
Bruce W. Ebert, PhD, JD, wrote, “Every psychologist has a duty to obtain informed
treatment and the possible negative
notions at work. Foremost is the notion of
consent from each patient or client to whom
outcomes if the treatment is not performed. Therapy has no such history of the application of informed consent. For the
therapist-client confidentiality. A client can reasonably expect the information developed in therapy will remain sacrosanct.
he or she provides services in the professional capacity.” While this quote is from a psychologist, it is instructional for all
most part, the therapist has worked with the
The client must specifically release the
mental health professionals. It should be
patient in a one-way relationship. The patient participated in the therapy but was not completely informed of the modalities
therapist to allow for dissemination of the client’s information. In a forensic setting, the information is
noted that Dr. Ebert is the chairman of the California Board of Psychological Examiners. His comments are quite
to be used, the time frame expected for the problem, or, in some cases, the actual
being developed for release. Usually, the client is there as a result of some order from
instructional regarding the view of a state licensure board with regard to informed
diagnosis. With the advent of consumerism and regulation of the therapy profession, the changes have already begun. Informed consent means that the
an authority figure. That figure has been asked to settle a dispute for the client. This is the premise of a court action. The court has been asked to rule on a question brought to court at least partially by the client. The court has determined that in order to provide the best answer some help is needed. Therefore, the court will refer the
consent. Dr. Ebert goes further, in the same article, “The most important question is what information the client should receive in order to obtain thorough informed consent. It is recommended that the client be informed of:
patient has been fully informed of the problem being worked upon, the modality of treatment being used, the known positive and negative aspects of the modality, alternative treatments and the prospects of success. If a certain modality is the subject of controversy, such as hypnotherapy, the controversy must be explained. If there are alternatives to the method used by the therapist, these must also be explored and explained. The expected time frame of the treatment must be outlined and agreed upon. 20
Texas Psychologist
person to a forensic expert. The most common reason for forensic evaluation is in the area of child custody. In a typical child custody situation, the parents or guardians cannot or will not agree on the best location for children of the marriage to live. Additionally, they may not agree on what degree of access one of the parents is to have to the children. In order
1. 2. 3.
4.
Limits of confidentiality; Nature and extent of your record keeping system; Your title, training, experience and areas of special expertise or any areas in which you are not adequately trained to provide services to clients; Probable length of services; SUMMER 2004
5.
Risks involved with the services you
The previous recommendations should
disclosure statements that my be combined
6.
are providing; Alternatives to the services you are
be looked at as the absolute minimum requirements of any informed consent
in a contract. These are neither the definitive nor the only possible wordings
scheduled to provide;
document. As previously pointed out, if the
that may be used. They should be modified
7.
Your fee, as well as relevant billing
services are forensic in nature, special care
8.
practices; The rights of the person receiving
should be taken to point this fact out. It is the true informed consent of the patient
to meet the needs of your individual situation.
services;
and the empowerment that comes with
guarantee that legal action will be neither
The rights of not proceeding with
consent that are powerful deterrents to
taken or successful. They are given merely to assist in the preparation of a treatment
9.
anticipated services; 10. Emergency access
allegations of professional negligence. to
you
or
someone who can respond to a psychological crisis, if applicable.�
The use of these examples is no
contract. An attorney, to ensure their
SAMPLE CONTRACTS The following are examples of types of
conformity to the laws of your locality, should review all legal documents.
SAMPLE OF AN INFORMED CONSENT DISCLOSURE AND TREATMENT CONTRACT Welcome to the therapy practice of _______________. I am a (Licensed/Certified) ___(profession)_______________. I have been licensed in this state since ______. While I would like to be an expert in all things, I try and limit my practice to ______________. This is because I have a great deal of training and experience in this area. If you would like, I will provide you with a copy of my Cirriculum Vitae.
CONFIDENTIALITY It is axiomatic that all communications made during any therapy visit are to be kept confidential. I will endeavor to follow your wishes on this subject, as you are the one who generally controls this information. However, I must make you aware of those few circumstances where I am compelled to breach this important promise. In the event that our therapy session reveals any information concerning the abuse of either children or senior citizens, I am mandated by law to make a report to the proper authorities. By the signing of this document, you acknowledge your awareness of these facts. Additionally, if the course of therapy reveals any intent to harm either yourself or others, you acknowledge my legal and moral duty to prevent you from bringing this harm about. I specifically have your irrevocable permission to warn those parties that I feel may be harmed. If you reveal an intent to harm yourself, I have your permission, also irrevocable, to prevent you from accomplishing your intent. As an attachment to this document, there is a release to be signed by you that will allow me to discuss your case with your other health care providers. This will include your psychiatrist, if you have one, and any prior treating therapist. I may also request a copy of the treatment records from these individuals. I will inform you if I feel the need to get this information. If you have been referred to this practice by a managed care or insurance company, you should be aware of this arrangement. As a requirement of the referring organization, I may be required to provide them with a complete copy of the records generated by your therapy. Once these records are in the possession of the referring organization, I cannot guaranty their continued confidentiality.
RECORDS It is a state law that I maintain a record of the treatment given to you. This record will contain the information that will allow me to chart the course of your therapy. I will use it only for that purpose. It is my intent that no one will ever see what is contained in the file. You may get a copy of the file only by providing me with a signed and notarized release of information request. I may provide you with a synopsis of the course of treatment and outcome in lieu of the actual record. You agree you will pay, in advance, for either the copying cost of the actual record or the time required for the preparation of a treatment summary. This includes providing copies or reports to any court or legal representative or designate. In the event of your death, these requirements will be binding on any heirs, successors or executor(s). If the therapy sessions contain more than one patient, you agree that no one person may get the complete treatment file. I will attempt to maintain a separate record on each patient. However, only that individual is entitled to his/her own record. You agree I may synopsize the
SUMMER 2004
Texas Psychologist
21
course of each individual’s treatment as opposed to providing a copy of what notes may have been made during any therapy session. The laws of this state require that your record be maintained for a period of ____ years. I will maintain them for that period of time. At the end of that period, they will be destroyed. If you have been referred by an insurance plan, company or managed care organization; you must be aware that you may have waived your right to confidentiality as it pertains to the referring organization. If I am an approved provider for this organization, I may have to share all the information you provide with this organization. I will do so as required to get you all the treatment that is appropriate. You should be aware that the organization is not bound by my ethical and legal requirements on maintaining the confidentiality your treatment may require. By providing the required reports, you understand that I have no control over the use of the information made by the referring organization.
FORENSIC REPORTS If your purpose in coming to my practice is to obtain a forensic evaluation and report, there are some very important differences you must be aware of. THIS IS NOT THERAPY. YOU ARE NOT MY PATIENT. I have been hired to perform an evaluation and report my findings to a court of law. At a minimum, this means THE USUAL RULES OF CONFIDENTIALITY DO NOT APPLY. BY THE VERY NATURE OF OUR RELATIONSHIP, I WILL BREACH ANY CONFIDENCE WE MAY HAVE. This must be clearly understood. By signing this agreement, you acknowledge your understanding and agreement.
PAYMENT I expect to be paid in full prior to the provision of the final report. Before the first session, I require a retainer of $________. This is estimated to be equal to ___% of the total cost of the evaluation and report. Prior to the final evaluation session, an additional $_____ is expected to be paid. The final report will not be released unless the entire cost of the process is paid in full. By your signing of this contract you agree to be bound by this. _______ (Initials)
RELEASE OF INFORMATION (General) I, (name of patient), hereby request (name of therapist) to provide a complete copy of my Therapeutic Contract to (Name, and address of the party to get the records) for the purposes of (reason). I am aware that this information will contain personal and private disclosures made during the course of my therapy. The content of the file has been explained to me by (Therapist). I WISH TO AUTHORIZE ITS RELEASE. _________________________ (NAME OF PATIENT) __________________________ (WITNESS OR NOTARY PUBLIC) ________ (DATE)
RELEASE OF INFORMATION (Forensic evaluation) I, ______________, hereby acknowledge that the purpose of my coming to see ____________________ is to provide an evaluation and report to the referring organization. This is not therapy. I have no reasonable expectation of confidentiality. The information I provide during the evaluation process will be shared with other parties. I understand that the records generated by this process will only be released with the permission of and through the referring organization. I agree to this situation. I am aware that I have certain federal guarantees to confidentiality dealing with any incidence of substance abuse on my part. I hereby specifically waive those rights as they pertain to this evaluation and report. _____ (Initials) I am also aware that there are further federal rights to confidentiality dealing with a status of HIV positive or suffering from AIDS (Acquired Immune Deficiency Syndrome). I freely waive those rights to confidentiality as they pertain to this evaluation and report. ________ (Initials)
22
Texas Psychologist
SUMMER 2004
I, ______________________, HAVE READ THE ABOVE STATEMENT ON THE RELEASE OF CONFIDENTIAL INFORMATION. I UNDERSTAND THE INFORMATION CONTAINED AND HEREBY AGREE TO THE CONDITIONS CONTAINED. _______________________________________ Signature ______________________________________ Print name _________________________ Date _______________________________________ Witness
CONTROVERSIAL OR EXPERIMENTAL MODALITY OR PROCEDURE I, (name of patient)_, have had the modality of _(type of therapy)_ proposed as a possible course of therapy. (name of therapist)_, my therapist, has explained the process to me. The explanation included reference to all current information on this modality. I have asked and received answers to all my questions. I acknowledge that there is not complete agreement within the therapeutic community on the effectiveness of this form of treatment. It has been explained that there still is data being gathered by the scientific community on the results of this type of treatment. I have given all this information due consideration and have opted to proceed with the proposed course of treatment outlined by (name of therapist) . _________________________________ (Print name) Name of patient __________________________________ (Signature) __________________________________ Witness
TERMINATION OF TREATMENT The length of time required for therapy will be determined by your personal situation. I will do my best to fulfill your therapeutic needs and provide you with my best professional care. For your part, you agree to participate in the process to the best of your ability. It is intended that when your needs are met, to the extent that they can be, we will terminate our relationship. There is no guarantee of a cure. For your part, you may terminate my services at any time. This may be done in any one of several ways. These include, but are not limited to, putting it in writing, informing me verbally, failing to maintain your appointment schedule without proper notification or your failure to follow treatment recommendations that I may make. I will respect your wishes. If you do terminate therapy with me, it will be my decision as to whether we can re-establish our therapeutic relationship. Keep in mind that your decision to terminate therapy and the method chosen to accomplish the termination will impact any decision to resume a therapeutic relationship. About the Author
American Professional Agency, Inc. is the largest provider of mental health Professional Liability insurance in the United States. With over 30 years of experience and well over 100,000 policy holders in all endeavors in the mental health field, the agency provides some of the most comprehensive and cost effective insurance available. Eric C. Marine is the Vice President for claims of the American Professional Agency, Inc. With almost 30 years experience in the claims industry, he has written on and presented Risk Management seminars all over the country.
SUMMER 2004
Texas Psychologist
23
The Therapeutic Contract CE Exam First Name:
Last Name:
Degree:
Mailing Address: City/State/Zip: Email:
Phone:
Visa/MC/Amex/Discover:
Exp. Date:
Check #: Signature:
Date:
TEST QUESTIONS 1. The purpose of a written contract can be: a. To spell out the rights and duties of all parties. b. To memorialize the financial arrangements c. To explain the limitations of the therapist, as they pertain to the law. d. None of the above. e. All of the above 2. The purpose of a professional license is: a. To protect against the use of the professional title by unauthorized parties. b. Allow people to have something to aspire to. c. Allow the operation of heavy equipment. d. None of the above. e. All of the above. 3. Informed Consent: a. Is necessary for the release of any records. b. Should be obtained before any treatment begins. c. Is nice to have but is not ever required. d. Is a term that has no applicability in mental health care. 4. The concept of confidentiality: a. Helps people feel good about themselves. b. May be effective in all attempts to obtain private information. c. Allows Insurance Companies to obtain patient records. d. Is a basic principle of good therapy. 24
Texas Psychologist
5. Your professional license: a. Allows you to practice anywhere in the U.S.A. b. Never has to be renewed. c. Allows only people so licensed to practice in your state. d. Guarantees a profitable practice.
9. Terminating therapy with a patient is: a. A very important event. b. A good way to draw a complaint to a licensing board. c. Easier if instituted by the patient, d. None of the above. e. All of the above.
6. Records are: a. Highly over rated. b. Confusing and, of necessity, illegible. c. The single most important element that will evidence the appropriateness of your approach. d. Not needed.
10.When using a controversial or new treatment modality: a. Sometimes, it is not good to tell the patient. b. Tell the patient only about the positive aspects and outcomes that may occur. c. Obtain an informed consent agreement from the patient, in writing. d. Avoid anything that even suggests new or controversial.
7. Historically, complaints against therapist have: a. Been few. b. Been frequent. c. Been Frivolous. d. Hardly made any difference. 8. State Licensing Boards : a. Are there to collegially to review complaints. b. Protect licensees from frivolous complaints. c. Protect the consumers of your state from bad licensees. d. Made up of bad therapists.
11. If I obtain all the release and informed consent documents necessary: a. I will never have a claim or complaint lodged against me. b. If a frivolous complaint or claim is made, I will probably be exonerated. c. The patient will be happy and stay until the therapy is concluded. d. No patient will stay beyond the initial visit.
SUMMER 2004
Never Stand In Front of Flowing Lava: RxP On the Move Pat DeLeon, PhD, Former APA President
I
Presidential Commission, there is a “mental health crisis” in the US “due to lack of
Power of Psychology. As always, CPA was
primary care managers can be attributed to a
inspirational and once again reminded me
psychological problem. Psychologists are primary health care providers. Why should
was recently invited to participate in the California Psychological Association’s Annual Convention, Change: The
that we really are all one family, dedicated to improving the quality of life for our nation’s citizens. Friday’s “PAC Monte Carlo Night at the Races” was definitely fun, although I did miss seeing the Texas Blues Brothers who would have undoubtedly done quite well “at the tables.” As was evident at the Practice Directorate State Leadership Conference (SLC) earlier in the month, the prescriptive authority (RxP) agenda is nicely maturing. CPA President Sallie Hildebrandt instituted a very popular programmatic psychopharmacology track, including RxP didactic content by John Preston, a graduate of Baylor University and in depth discussions of practice and public policy issues. I was especially intrigued with the extent to which the graduates of Alliant University’s psychopharmacology program found their advanced training has already significantly enhanced their clinical practices, although California has yet to pass RxP legislation. CPAGS, which represents our profession’s future, was visually present with Zara Ashikyan as chair. For those who attended this year’s SLC event hosted by Russ Newman and Mike Sullivan, the panel, “How Prescribing Has Changed Our Clinical Practice: Experiences Of The [DoD] Prescribing Psychologists,” clearly demonstrated that RxP is the future. John Sexton, for example, noted that at both events RxP has been a prominent part of SLC since 1995. According to the 2003 SUMMER 2004
accessibility,” and 75 percent of all visits to
we continue to passively accept reports that general physicians (with minimal mental health training) provide 75 percent of the psychotropic medications or that the Food and Drug Administration felt it was necessary to issue a public health advisory urging doctors to be especially careful in prescribing antidepressants to children and adolescents due to a possible association between the drugs and suicide? Psychology must provide proactive leadership in this area—it is our societal responsibility. For those (e.g., our colleagues in Florida) who are particularly concerned about the quality of care for women, one should seriously reflect upon John Preston’s report that they receive only 58 percent of all psychiatric services but 73 percent of psychotropic prescriptions. Is this really what we believe our daughters or loved ones deserve? Sally’s focus on change fits very nicely with the realities of the health care environment of the 21st Century and SLC’s Strategic Resilience For The Profession: Getting A Jump On Change. In his keynote address, Russ Newman was enthusiastic about the future of RxP and professional psychology: “It seems rather clear that psychiatrists have a financial incentive to keep psychologists from serving as attending clinicians in [California’s] state hospitals. In fact, this was something I discussed with
the Federal Trade Commission and Department of Justice Antitrust Division in June when we had the opportunity to testify at the Joint Hearing on Health Care and Competition Law and Policy. In addition to detailing a number of instances of what we believe are organized psychiatry’s efforts to restrain trade in hospitals, we also alerted the FTC to what we expect will happen as more states come on line with prescriptive authority statutes. After all, who better than psychologists to explain to the FTC that the best predictor of future behavior is past behavior? Attempts to undermine regulatory implementation of prescriptive authority laws and potential boycott activity by psychiatrists against pharmaceutical Texas Psychologist
25
companies who support psychologists are a couple of the future behaviors we thought the FTC could expect from organized
authority law. Although the process has been slow going for sure, recent developments have provided reason to smile. At the end of
psychiatry based on its past behavior. “Speaking of prescription privileges for
February, the state’s Board of Medicine voted
psychologists, the past year witnessed
The Board of Psychology recently approved the regulations as well...The regulations face
considerable continuing activity on this
unanimously to accept the draft regulations.
front. Nine states introduced RxP legislation in 2003—Florida, Georgia,
their next major hurdle during a 30-day
Hawaii, Illinois, New Hampshire, Oregon,
hearing where organized psychiatry will undoubtedly try, once again, to derail the
Tennessee, [the Great State of ] Texas and Wyoming. Six of these states had committee hearings on their bills, the largest number ever in one year. And Wyoming had its first-
public comment period followed by a public
process.
Thank
you,
New
Mexico
psychologists, for staying the course.” Finally, I would like to take this
LAW
Should I Warn My Patients of the Possible Side Effects of Medications They Are Taking? Sam A. Houston
A
s you have probably read, the Food and Drug Administration recently released a statement
time bill not only pass out of a senate
opportunity to personally commend TPA’s
warning of a possible link between
committee but also go to a floor vote. Bills in 2004 so far include Georgia, Hawaii,
Past-President Dee Yates on her service to our
antidepressants and suicide. It is likely that many of your clients take antidepressants.
Illinois, Louisiana, Maine, New Hampshire, Oklahoma and Tennessee. And Guam continues to work to implement its law. “Importantly, the New Mexico Psychological Association remains hard at work implementing their prescriptive
nation as a member of the President’s New Freedom Commission on Mental Health. Because of Dee, psychology’s voice was heard at the highest levels. Too many colleagues simply do not appreciate the importance of being personally involved in the public policy process. Aloha.
Although such medications are probably prescribed by psychiatrists (to whom you may have referred your patients) or other medical doctors, you should still be aware of possible litigation arising from some of these recent reports. Litigation against major pharmaceutical companies is common. Many times the prescribing physician or treating doctor is sued along with the manufacturer. In some cases, suit is brought against only the physician. However in other cases, the litigation net is cast wide to bring in more distant defendants. Because of this potential for inclusion, you should be aware of the questions concerning the duties and roles of psychologists in cases involving patient suicide or harm while taking antidepressants. The general rule is that a psychologist is not included in the legal definition of a “health care provider.” Texas statutory law indicates that duty to warn and provide “informed consent” falls on the health care provider prescribing the drug. Since the psychologist is typically not the prescribing physician, the duty to provide informed consent or warn would probably fall on the psychiatrist or other prescribing doctor. However, I looked and could not find any cases specifically involving whether or not a psychologist had to warn a patient of the
26
Texas Psychologist
SUMMER 2004
alleged dangers associated with a particular drug. Thus, while it is fairly clear that the psychologist has no statutory obligation to warn the patient of the risk associated with the drug, it is not clear that a psychologist is completely immune from liability. Texas law places a duty on a psychologist to act as a reasonably prudent person under the same or similar circumstances with regard to the treatment of a patient. This would
are taking antidepressant medications:
them and that you have advised them to
Familiarize yourself with all potential side effects and go over them with your client. I
follow up with their physician if they are feeling any untoward effects.
think this is particularly important in cases
Careful documentation and practice
where you have referred a patient to a psychiatrist for drug treatment medication in
will help keep you out of any litigation. FDA warnings have prompted mass tort
addition to your therapy. Many times an
litigation in the past.
arrangement is made where psychiatrists will see a patient on a fairly infrequent basis and
Phen-Fen, Baycol and other medications have fallen under close scrutiny. It is
Breasts implants,
the patient will see the psychologist even while
unlikely that you would be included in the
and
taking such medication. In such a situation, it
event such litigation proceeds against the
knowledge of the potential side effects of medications and the tell-tale signs exhibited
is especially important to warn and keep watch
antidepressant manufacturers; however, it is
by patients with suicidal behavior. An
for telltale signs. Document that you warned the patient, and discuss with him or her any
better to be safe than sorry, and these simple steps will help keep you away from
argument could be made that you would have
possible new feelings on each visit.
the lawyers and the courtroom.
a duty to warn a patient or, at minimum, recognize and take action to prevent suicide of patients who are taking such medications
Pay special attention to your referral sources and make certain they are reputable
I continue to receive numerous telephone requests for the telephone
physicians who will fully discuss the side
consultation program established through
even if you did not have a statutory duty to
effects of the medications with their patients. While treating patients who began antidepressant medications prior to seeing
my office and the Texas Psychological Association several years ago. If you have any questions about the program, please
you, make sure you document that you
call me at 713-650-6600.
include
a
heightened
awareness
warn them of the potential side effects. In light of the fact that the law is unclear, I recommend that you take the following steps on all of your patients who
have discussed possible side effects with
PSY-PAC Contributors January 1 - March 31 $1000-1999 Paul Burney, PhD $100-499 Laurence Abrams, PhD Barbara Abrams, EdD Barbara Alford, PhD Judith Norwood, Andrews, PhD Elizabeth Barry, PhD Patricia Barth, PhD Connie Benfield, PhD, ABPP Joan Berger, PhD Malcolm Bonnheim, PhD Peggy Bradley, PhD Tim Branaman. PhD Glenn Bricken, PsyD Stacy Broun, PhD Ray H. Brown, PhD Timothy Brown, PhD Joan Bruchas, PhD King Buchanan, PhD SUMMER 2004
Barry Bullard, PsyD Erica Burden, PhD Linda Calvert, PhD Kay Ransom Carey, PhD Betty Cartmell, PhD Gloria Chriss, PhD Ron Cohorn, PhD Donna Copeland, PhD Walter Cubberly, PhD Caryl Dalton, PhD Philip Davis, PhD Michael Duffy, PhD, ABPP James Duncan, PhD Patrick Ellis, PhD Richard Ermalinski, PhD Raymond Finn, PhD Alan Fisher, PhD Lynn Fisher-Kittay, PhD Alan Frol, PhD Richard Fulbright, PhD Ray Gilbert, PhD Jerry Grammer, PhD
Charles Haskovec, PhD JoBeth Hawkins, PhD Annette Helmcamp, PhD William Helton, PhD David Hensley, PhD Ethel Hetrick, PhD Robert Hochschild, PhD Alan Hopewell, PhD David Hopkinson, PhD Robert Hughes, PhD Jerry Hutton, PhD Sheila Jenkins, PhD Johnny Johnson, PhD Morton Katz, PhD Gilda Kessner, PsyD Charlotte Kimmel, PhD Burton Kittay, PhD Amelia Kornfeld, PhD Richard Kownacki, PhD Tom Kubiszyn, PhD Angela Ladogana, PhD John Largen, PhD
Nancy Leslie, PhD Rochelle Levit, PhD Franklin Lewis, PhD David Litton, PhD Alaire Lowry, PhD Marilyn Maas, PhD Jerry Mabli, PhD Ann Matt Maddrey, PhD Perry Marchioni, PhD Raul Martinez, PhD Denise McCallon, PhD Donald McCann, PhD Richard McGraw, PhD Sherry McKinney, PhD Robert McLaughlin, PhD Robert McPherson, PhD Donald McRee, PhD F. Gary Mears, PhD, PsyD Brenda Meeks, PhD Robert Mehl, PhD Robert Mims, PhD Lee Morrison, PhD Texas Psychologist
27
Dean Paret, PhD Randy Phelps, PhD Barry Rath, PhD Lynn Rehm, PhD John Reid, PhD Laurie Robinson, PsyD Gordon Sauer, Jr, PhD Verlis Setne, PhD Robbie Sharp, PhD Joyce Sichel, PhD Jill Squyres, PhD David Steinman, PhD Thomas Tully, EdD Thomas Van Hoose, PhD Nancy Van Morkhoven, PhD Beverly Walsh, PhD David Welsh, PhD Mark Wernick, PhD Richard Wheatley, PhD M. Wright Williams, PhD Connie Wilson, PhD Constance Wood, PhD Kathryn Wortz, PhD Robert Zachary, PhD Under $100 Mary Alvarez-del-Pino, PhD Paul Andrews, PhD Juana Antokoletz, PhD Charles Cleland, PhD John Elwood, PsyD Jeanne Field, MS Sylvia Gearing, PhD Carol Grothues, PhD M.P. Hewitt, EdD Pamela Horton, PhD Ronald Jereb, PhD Arthur Linskey, PhD Dwayne Marrott, PhD Muriel Meicler, PhD Kavita Murthy, PhD Carole Pentony, PhD Dorothy Pettigrew, PsyD Manuel Ramirez, PhD Anna Satterfield, PhD Laura Spiller, PhD Jessica Varnado, PhD Patricia Weger, PhD
28
Texas Psychologist
Texas Psychological Foundation Contributors January 1 - March 31, 2004 $500 +
Under $100
Manuel Ramirez, PhD
Connie Benfield, PhD, ABPP Tim Branaman, PhD
$100-499
Stacy Broun, PhD
Gloria Chriss, PhD
Alan Frol, PhD
Jerry Grammer, PhD Ronald Jereb, PhD
Ray Gilbert, PhD M.P. Hewitt, EdD
Burton Kittay, PhD
Arthur Linskey, PhD
Kimberly McClanahan, PhD Robert McLaughlin, PhD
Marilyn Maas, PhD Laurie Robinson, PsyD
Robbie Sharp, PhD
Donald Trahan, PhD Thomas Van Hoose, PhD Richard Wheatley, PhD
Sunrise Fund Contributors January 1 - March 31, 2004 Anthony Arden, PhD
Richard Holt
Joan Berger, PhD Robin Binnig, MS
Alan Hopewell, PhD Thomas Johnson, PhD
Timothy Daheim, PhD Mary De Ferreire, PhD
Morton Katz, PhD Amelia Kornfeld, PhD
El Paso County Psychological Society Cynthia Fincher, PhD
James Gary Marsh, PhD Robert McLaughlin, PhD
Cynthia Galt, PhD Alan Griffin, PhD Terence Hannigan, PhD
Randy Phelps, PhD Nell Schwartz, PhD Richard Wheatley, PhD
New Members TPA welcomes all of our new members. Doctoral Members Rhonda Akkerman, PhD Marilu Berry, PhD Nicole Bodor, PhD Denise Boyd, EdD Kevin Correi, PhD Paul Damin, PhD Michael Hand, PhD Lisa Lewis, PhD Ramona Noland, PhD Evelyn Parker-Gaspard, PhD T. Kevin Roberts, PhD
Bridget Sonnier-Hillis, PhD Student Members Diane Antonvich, BA Miriam Arnold, MA Deborah Horn, MS Jodie Lane, MS Barbara McGowan Jamie McNichol, PsyD Michael Morris, MSSW Alexia Tran, BA
SUMMER 2004
CLASSIFIEDS Employment Opportunity Dallas County, the second most populated county in Texas, is currently seeking: PSYCHOLOGIST (Salary Commensurate w/ experience) Psy.D. or Ph.D. in clinical or counseling psychology. One year supervised clinical experience in psychology service. Must be licensed by Texas Board of Examiners. Must be willing to relocate to Dallas County. Visit www.dallascounty.org or call our office at (214) 653-7638. Equal Opportunity Employer Austin group looking for a colleague! Come join an existing group of solo practitioners each with a minimum of 10 years in private practice. Very nice office in central Austin with support staff. Pleasant atmosphere with well-established professionals. This is a wonderful opportunity to establish or expand a practice in Austin with the possibility for immediate referrals. (512) 454-3685. Licensed Psychologist Needed. Expanding interdisciplinary private group practice seeks a Texas licensed psychologist. Must have experience in working with children school age to adolescents. Located in a prominent part of Houston, the office has a very attractive setting. Very little managed care/emergency work. Excellent benefits. E-mail resumes to John@tarnowcenter.com or fax to 713-621-7015. STAFF PSYCHOLOGIST NEEDED. The Callier Center for Communication Disorders is a nationally recognized research, diagnostic and treatment facility that has been part of the University of Texas at Dallas since 1975. We seek a full-time PhD level clinical psychologist to join the multidisciplinary clinical staff serving individuals with communication impairments. The psychologist will work with speech-language pathologists, audiologists and educators serving individuals with mental health concerns and coexisting communication disorders related to developmental delay, hearing impairment, language disorder, autistic spectrum disorder and/or brain injury. Patients range in age from 6 months - elderly. Minimum Professional Qualifications include a PhD or PsyD in Clinical Psychology from an APA approved training program and a Texas Psychology License. Necessary experience includes: administration of nonverbal IQ tests, diagnosis of PDD, mood/anxiety disorders, etc in early childhood, skill in use of parent guidance and coaching, crisis management with suicide and child abuse. Prefer ABPP in Neuropsychology, Texas LSSP, Fluency in Spanish and/or Sign Language may be eligible for a one-time hiring bonus. Contact Dr. Teresa Nezworski, Search Committee Chair at 214-905-3040 or nezworsk@utdallas.edu. SUMMER 2004
ADVER TISERS INDEX
American Professional Services
Inside Front Cover
CE-credit.com
26
Center for Anger Resolution
5
Hazelden
10
Remuda Ranch
10
Rockport Insurance Associates
3
Senior Connections, Inc.
14
Nova Southeastern University
17
UT MD Anderson Cancer Center
29
ASSISTANT PROFESSOR The University of Texas M. D. Anderson Cancer Center, Department of Behavioral Science, is accepting applications for a nontenure track clinical faculty position. The individual filling this position will have a central programmatic and educational role in the institutional faculty health program, and may hold a joint appointment in the Department of Neuro-Oncology in the Division of Cancer Medicine. Candidates must have a minimum of 5 years’ experience in mental health, strong background in organizational health programs, counseling and program development. Previous experience in an academic setting and with a faculty health or professional assistance program is very desirable. Qualifications include a doctoral degree from an accredited college or university in clinical psychology, counseling psychology, organizational psychology, educational psychology or related field or a medical degree in related field. Both salary and benefits are very competitive, and salary is commensurate with experience. The University of Texas M. D. Anderson is located within the Texas Medical Center, the largest medical center in the world. Houston is a dynamic, multicultural city with a very affordable cost of living. Applications will be accepted and reviewed until the position is filled. Application procedures: Mail cover letter, curriculum vitae and professional reference list to: Ellen R. Gritz, Ph.D., Professor and Chair, The University of Texas M. D. Anderson Cancer Center, Department of Behavioral Science - 243, 1515 Holcombe Blvd., Houston, Texas 770304009, or by courier, Department of Behavioral Science - HMB 7.100, 1100 Holcombe Blvd., Houston, Texas 77030.
M. D. Anderson Cancer Center is an EOE employer and does not discriminate on the basis of race, color, national origin, gender, sexual orientation, age, religion, disability or veteran status, except where such distinction is required by law. All positions at M. D. Anderson are considered security sensitive; drug screening and thorough background checks will be conducted. The University of Texas M. D. Anderson Cancer Center values diversity in its broadest sense. Diversity works at M. D. Anderson. Smoke-free environment.
Texas Psychologist
29
Calling TPA Psychologists to Disaster Response:
F
ollowing September 11, the American Psychological Association asked each of the 50 states’ psychological associations to create a network of psychologists who are trained in disaster or
crisis response. Drs. Rita Justice and Judith Andrews were asked by TPA to chair the Texas Psychological Association Disaster Response Network. Since then, the TPA Disaster Response Network chairs and committee have attempted to educate psychologists regarding specialty training and to identify those licensed psychologists in the state of Texas who have had crisis response training or would like to have such training. As a group of crisis response trained psychologists, the TPA DRN does not act as an independent team but may respond through various venues such as Red Cross, NOVA, or CISM teams. Our purpose includes encouraging psychologists to become trained in crisis response and to obtain local practice before being asked to respond to a statewide or nationwide disaster. The purpose of this notice is to reach TPA members who are crisis trained and are not part of our database. If you would like to become a part of our TPA DRN, please e-mail Judith Andrews at judithphdjudith@yahoo.com. We will then e-mail you a database form and current information about the business of the Disaster Response Network here in Texas.
Sincerely, Judith Andrews, PhD Rita Justice, PhD TPA DRN Coordinators