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Features 10 Career Trends for Texas Master’s Level Psychology Graduates
TPA BOARD OF TRUSTEES
Emily Sutter, PhD; Howard Eisner, PhD; and Leslye Mize, PhD, University of Houston - Clear Lake
Deanna Yates, PhD President C. Alan Hopewell, PhD President-Elect
VOLUME 54, ISSUE 4
18 The Empirically Validated Treatments Movement: A Practitioner Perspective Ronald F. Levant, EdD, ABPP
Paul Burney, PhD President-Elect Designate
22 Challenging Issues for Women at Midlife Walter Cubberly, PhD Past-President Board Members Ron Cohorn, PhD Patrick Ellis, PhD Richard Fulbright, PhD Charlotte Kimmel, PhD Joseph C. Kobos, PhD Suzanne Mouton-Odum, PhD Roberta L. Nutt, PhD Dean Paret, PhD Elizabeth L. Richeson, PhD Ollie Seay, PhD Jarvis Wright, PhD
Donna Davenport, PhD, Robert L. Nutt, PhD, Robbie N. Sharp, PhD, and Melb J.T.Vasquez, PhD
Departments 2
FROM THE PRESIDENT Deanna Yates, PhD, TPA President
4
FROM TPA HEADQUARTERS: Success Before Work
EX-OFFICIO BOARD MEMBERS
David White, CAE, TPA Executive Director Richard M. McGraw, PhD Federal Advocacy Coordinator
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Texas Psychological Foundation Contributors
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Council of Representatives
Melba J. T. Vasquez, PhD CAPP Representative Jerry R. Grammer, PhD Texas Psychology Foundation President Mary Martin Student Division Director
Joseph C. Kobos, PhD
9
LAS News from Houston Psychological Association Julie Landis, PhD, HPA President
PUBLISHER Rector Duncan & Associates P.O. Box 14667 Austin, Texas 78761 512-454-5262
21 Texas Psychological Association Convention Sponsors 29 Sunrise Fund Contributors
Stephanie Shaw Managing Editor Jared Hensley Advertising Sales Julie Mangano Art Director 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
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29 PSY-PAC Contributors 30 PSY-PAC Update 30 New Members 33 Classified Advertising 33 Advertisers’ Index
Texas Psychologist
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FROM THE PRESIDENT
I suppose it is inevitable that as I write my last president’s column I would reflect on the happenings of the year. It does not seem like long ago I was writing my first column and looking forward to my year as president. Being a legislative year, it was expected to be a very busy and challenging year. Legislative years typically add so much to our agenda, and it was this year’s legislative agenda that took center stage for several months.
Deanna F. Yates, PhD T PA P r e s i d e n t
O
ur legislative goal was to pass prescriptive authority legislation in 2003. We did not succeed this year; however, it is inevitable that Texas will eventually get prescriptive authority just as New Mexico has. I have personally been committed to prescriptive authority for psychologists for many years, and I will continue working with TPA and APA on this issue until I see it become a reality in Texas. APA’s Division 55 is committed to the advancement of psychopharmacology and I will be working with a committee whose goal is specifically to help states move forward with this legislation. It may take a few more years, but we will succeed because it is the right thing for our patients and it is the natural evolution of the practice of psychology.
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Another goal that I had for the year was to establish two new TPA committees: one to interact with third party payers and one to focus on public policy. Both committees were formed and have worked exceptionally hard this first year. In the area of public policy, TPA has begun to develop relationships with many consumer groups and hopes to continue to nurture these relationships. Psychology needs to be involved in setting mental health public policy and forming alliances with consumer groups is a step in that direction. With the cuts in Medicaid that occurred at the end of the regular legislative session, the third party payers committee has been very active in Austin, working to help get these services restored. As I write this article, our legislators are going into the third special session, so it is still possible to get optional services funded. Another goal was to continue preparing and positioning TPA to begin the Sunset process. The Sunset Committee has met several times and has prepared changes in our licensing act that we feel need to be made. With the help of our lobbyists we are now working out our strategy, as we could be in hearings before the Convention begins. We have also continued to build the funds to help with the Sunset effort. I would like to ask every psychologist who has not yet sent in the $100.00 to please make that contribution to the fund now. Over the past several years, the leaders of TPA have been working to make TPA an organization that is run more efficiently and an organization that is more politically
sophisticated and influential in Austin. My goal was to continue this process by tightening some of our organizational procedures this year. In running a volunteer organization such as TPA, policies can sometimes subtly change from year to year. In the orientation for the new board members this year, we discovered that the bylaws and the policies and procedures were not always in agreement with one another. Also, with the yearly change in leadership, some procedures are inadvertently altered. To rectify this situation, I asked the Bylaws Committee to review the bylaws and the policies and procedures and to recommend changes that would align them and also reflect what actually takes place in the running of TPA. The Bylaws Committee, a committee of one, Dr. Ron Cohorn, worked long and hard to find discrepancies and to recommend changes. An example of a change that streamlined procedures was the policy for nominating individuals for the annual TPA awards. This process was so complex that people frequently complained that it was just too difficult and too lengthy to take the time to make a nomination. Due to streamlining the nomination process, we had more people willing to make nominations this year and we received many strong nominations. Dr. Roberta Nutt, Awards Committee chair, did a great deal of work on these procedures for the Bylaws Committee. On a personal note, my work on the President’s New Freedom Commission on Mental Health ended. The report was WINTER 2003
published and finally made public in July. Some commisioners feared that the report would not be well received by many of the stakeholders or that it would sit on a shelf gathering dust somewhere rather than being implemented. So far we have been very happy with the response. I have not heard anything negative about the report and providers and consumer groups alike have given us very positive feedback. Now the implementation is being planned. While we hope that Texas is a demonstration state for the implementation of the Commission’s recommendations, Mr. Charles Curie, the administrator of SAMHSA, has been given the task of evaluating the report and implementing recommendations at the federal level. It is an honor for me to be able to bring Mr. Curie to Dallas to be the keynote speaker at this year’s Convention. He will have the most up to date information on the implementation of the Commission’s recommendations and I hope that many of you will be there to hear him. In addition to Mr. Curie’s address, our Program Committee, chaired by Dr. Pat Ellis, has put together a superb lineup of presentations for this year’s convention which is just around the corner. There should be something for everyone so I hope to see you in Dallas. This has been a year fraught with excitement, challenge, and frustration. Nevertheless, I believe TPA is on its way to being even better prepared to face the challenges that lie ahead. I leave TPA in capable hands and expect to see the organization continue to grow stronger and wiser. I am happy to have had the opportunity to serve as your president this year and look forward to a successful future for TPA and the practice of psychology. ✯
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Then when paying, $27 will be deducted from any program you select, including our $27 courses! (One use per customer • Good through November 15, 2003)
Special Thanks No event of the magnitude of the TPA Annual Convention can be possible without the dedicated and often unappreciated work of volunteer members. They are committed to insuring that your annual convention will be the best educational experience possible. Their loyalty and dedication to this endeavor are vital contributions that add value to memberhip in TPA. Should you bump into any of the committee members listed here, please take a moment to thank them.
Patrick J. Ellis PhD (Chair) — Houston Sharon Brown, PhD — Houston Stacey Bourland, PhD — Houston Michael Flynn, PhD — Denton Tom Gray, PhD — Vernon Stephen McCauley, PhD — Houston Suzanne Mouton-Odum, PhD — Houston Dean Paret, PhD — Burleson
Texas Psychologist
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FROM TPA HEADQUARTERS
Success Before Work . . . David White, CAE TPA Executive Director
I want you to imagine getting up this morning and not having to go to work. In essence, you are able to get up and provide a very comfortable living without doing much work at all. You might have invested wisely in the past and are currently reaping the benefits of your past successes, but during that initial time you did have to work. Think of what it would be like NEVER to have to work and have everything provided for you…
T
hat is what many of our members think about the future of this profession. They think that they can just get up and go on about their normal activities and everything will be provided for them. Over the last several issues, I have reported the importance of our Sunset review, which will take place in 2005. I have told you about the committee and the members who will be leading this effort. We are not only focusing our efforts on Sunset, we are also revising TPA bylaws and the policy and procedures manual, discussing with consultants how to position TPA for the future, and learning how to gain a group health insurance program for our members. Needless to say, we have LOTS happening. So who exactly is doing all the work for TPA during this monumental time? Well, only 2.6 percent of the entire membership serves on committees, task forces and TPA’s Board of Trustees. So, out of 1,473 members we have only 39 working to advance TPA’s initiatives. Those 2.6 percent active members are from: Active Members Serving on Committees/Boards Houston . . . . . . . . . . . . . .25% Austin . . . . . . . . . . . . . . . .17% Denton . . . . . . . . . . . . . . .10% 4
Texas Psychologist
Dallas . . . . . . . . . . . . . . . . .5% San Angelo . . . . . . . . . . . . .5% San Antonio . . . . . . . . . . . .5% Beaumont . . . . . . . . . . . . . .5% Ft. Worth . . . . . . . . . . . . . .3% Conroe . . . . . . . . . . . . . . . .3% Big Spring . . . . . . . . . . . . .3% Sugarland . . . . . . . . . . . . . .3% Burleson . . . . . . . . . . . . . . .3% El Paso . . . . . . . . . . . . . . . .3% Lubbock . . . . . . . . . . . . . . .3% Vernon . . . . . . . . . . . . . . . .3% Huntsville . . . . . . . . . . . . . .3% Waco . . . . . . . . . . . . . . . . .3% Compare this involvement with the overall demographics of TPA. Out of our entire membership, 25 percent are from Houston, while 16 percent are from Dallas, 15 percent from Austin and 10 percent from San Antonio. 2003 Demographics Houston . . . . .367 . . . . . .25% Dallas . . . . . .238 . . . . . .16% Austin . . . . . .220 . . . . . .15% San Antonio . .144 . . . . . .10% Ft. Worth . . . . .54 . . . . . . .4% Other . . . . . . .450 . . . . . .30% So it becomes clear that a majority of active members come from the larger cities, but we also know that you can participate
in TPA in another way—your financial support. Out of all the dues and PAC revenue we received this year, 50 percent came from members in Houston, Dallas, San Antonio or Austin. TOTAL DUES/PAC REVENUE Houston . . . . . . . . . . . . . . . .19% Dallas . . . . . . . . . . . . . . . . . .10% Austin . . . . . . . . . . . . . . . . . .13% San Antonio . . . . . . . . . . . . . .8% As TPA continues to position itself as a political force in the state legislature, one factor that keeps us “politically involved” is the PSY-PAC contributions. I want to provide a few more statistics for you to consider. Out of all the contributors for this year, 63 percent came from the five major Texas cities, yet only 36 percent of the total dollars collected came from these folks. What that indicates is that members outside of the large cities are being active with their contributions. Another form of active participation in TPA is your attendance at the TPA Annual Convention. Out of the total convention attendees, members from the rural areas of the state represent the larger turnout, with members from Houston representing the largest number of attendees from the larger cities. Continued on page 6 WINTER 2003
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Texas Psychologist
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Continued from page 4
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Council of Representatives Joseph C. Kobos, PhD
As Roseanne Roseanna Danna would say, “If it’s not one thing, it’s another.” At the last Council meeting, we struggled in the snow and many were stranded. In August, we worried about how many would come to Toronto for the Council meeting and the Annual Convention. This time the culprit was SARS. When the World Health Organization declared Toronto off limits to travelers in April, all the listservs were concerned about whether to cancel the convention and if individual members would attend even if the convention were held.
E
ventually, Toronto was taken off the WHO list and APA decided to hold the meeting. Canceling the meeting would be very costly because of contract penalties and moving the convention was impossible on such short notice. The decision to go forward was wise. While attendance revenues were down, the drop was nowhere near as grim as anyone predicted. APA leadership, which included our new CEO Norman Anderson and his team, and everyone in convention planning all deserve kudos. After thoughtful deliberation and a review of the data, they followed the advice of that old philosopher, Yogi Berra, “When you come to a fork in the road, take it.” In the end, perhaps a dozen or more did not attend Council and either left an empty seat or found replacements. Norm Anderson continues to settle in as CEO. He gave an excellent chronology of the issues involved in making a difficult decision and described the very human and scientific process of making the decision to go ahead with the convention. In addition to talking about APA finances, he laid out his capital hill agenda, which included mental health parity, graduate psychology education, and supporting NIH and other funding for psychosocial research. He described one legislator’s efforts to use a line item approach to delete funding for sexual behavior research. In an unprecedented maneuver, the specific research and its funding ID number were listed in a funding bill. This process would remove review and funding authority from the NIH. APA’s efforts were successful in turning back the tide, but it was a close vote and similar efforts are anticipated in the future. The big news was the budget and
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APA finances. Under the very able leadership of CFO Jack McKay, APA refinanced its two buildings. This freed up money so we will no longer have cash flow difficulties. The Finance Committee continues to recommend a conservative budgeting process and the Board of Directors and Council affirmed the process, with one exception — Council
Texas Psychologist
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recommended and voted the resumption of a combined Board/Committee, which means an expenditure of $200K. APA is poised to be $400K in the black in 2004 — a remarkable turnaround from the past several years. Kurt Salzinger has announced his intention to leave as head of the Science Directorate. We are currently looking for a new director. CRSPPP also recommended — and Council approved — the renewed recognition of clinical neuropsychology as a specialty in professional psychology. Look for an APA ballot on amending the bylaws. The issue is whether any bylaw change should be accompanied with clarifying information. Currently whenever a change in bylaws is presented to the membership, Council votes on whether pro/con statements should accompany the proposed change. Over the years, any proposed bylaws change with pro/con statement would be voted down. However, some thoughtful Council members reasoned that it is anti-democratic and anti-intellectual
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Texas Psychologist
not to include pro/con statements or information about any issue that requires a vote, because only an informed electorate can make reasoned decisions. Look for the ballot and also see whether a pro/con statement accompanies it. Much thoughtful deliberation and parliamentary consultation went into the debate and decision. In the opening memorial for deceased members, Gladys Guy Brown of Dallas was acknowledged. Dr. Brown was one of the first independent practitioners in Texas. I had the opportunity to interact with her on several occasions and she offered very positive encouragement. Dr. Brown was also one of the early Diplomates of the American Board of Professional Psychology. She represented the highest standards of our profession. Congratulations to M. David Rudd of Baylor University and TSBEP who was elected to Fellow status in Division 12, Clinical, and to Dee Yates of San Antonio who was elected to Fellow status in Division 55, Pharmacotherapy.
Welcome to Bob McPherson, our Professional Affairs Officer, who will become the Texas Representative to APA Council. Our interests are in good hands, but more hands would be better. Vote 10 for Texas, and let’s get two representatives from Texas. This is my last column as APA Representative. I have enjoyed serving you and representing Texas Psychology interests on Council. My formal tenure ends in December but I received my certificate in August, which tells you something. Working with the TPA Board of Trustees has been a fun and stimulating experience. Psychology in Texas is an exciting and vibrant profession. I urge you to get involved in your local community with your elected representatives and in your professional organization. You can make a difference. I will see you at the TPA Convention in Dallas. If all goes as planned, my son and his wife who live in Dallas will be delivering us another grandchild at that time. Happy trails. ✯
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LAS NEWS From the Houston Psychological Association Julie Landis, PhD, HPA President
Members of the Houston Psychological Association (HPA) began the new fiscal year with a bow to our past by inviting previous presidents and officers of HPA to the June luncheon meeting to celebrate the continuation of our organization as a vital network for professional psychology in Houston.
M
any of our former leaders attended and were recognized for their efforts and continued support. We were also particularly fortunate to hear Dr. Reuven Baron, an international expert on Emotional Intelligence, discuss his research and its application to practice. At the end of the meeting, Dr. Patrick Ellis presented the 2003 Media Award to television personality Jerome Gray, who was very gracious in his acceptance of the award for his work on the “My Family/Your Family” weekly program on Channel 11 (CBS). In July, HPA members and quite a few potential new members gathered together at a luncheon in the first of a series of planned talks aimed at those in our association who are in private practice or are considering it as a career option in the future. This series of talks by business professionals, attorneys, and seasoned psychologists is aimed at informing psychologists about the ins and outs of running a small business. At the July meeting, a panel composed of a certified public accountant and a business marketing specialist addressed many of the issues involved in the private practice business such as developing a marketing plan and strategy, tax issues, etc. Topics selected to be covered in future gatherings will address many of the issues psychologists never learned in graduate school but need to know about to survive and prosper in the current economic climate. The series will
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continue later this fall with a networking breakfast and a talk by a local attorney who will alert us to the legal pitfalls of private practice. Plans are also underway to address our members’ needs for meeting the new TSBEP requirement of continuing education hours in ethics. On a serious note, HPA members came together to voice their concerns during the summer after learning of actions by the Texas Legislature directly affecting the provision of mental health care here in Houston as well as all over Texas. Local psychologists working in public agencies and private practitioners who service adult clients with Medicaid and who will be affected by these changes alerted us. We contacted TPA leaders who were quick to respond to our requests for information. Armed with information gathered by TPA, many of our members organized to get the word out about the need to attend hearings in Austin. Others wrote letters of protest and contacted legislative members about the impact to the public. With the upcoming city council elections and mayor’s race, HPA is also planning to continue its political activeness and to make our voice heard with regard to mental health issues in our city. Our legislative chairs are in the process of arranging brief visits by candidates for city offices at our upcoming fall luncheons in September and October to discuss their views regarding city services affecting the mental health provider community.
As the summer comes to an end, HPA members will have an opportunity at our next luncheon in September to hear Dr. Michelle York from Baylor College of Medicine discuss her research and describe practice issues with regard to patients with Parkinson’s disease. We will also welcome back our members and greet the psychology interns who are new to the city and are beginning their internships at the five APA accredited internship sites located at school districts, hospitals, and medical schools within Houston. We have many exciting plans for this new year including efforts to expand our membership and increase our visibility within the community. Our programming chairs are working hard to develop a program of speakers who will discuss topics of interest that will entice our members to become active and regularly attend our luncheons. Plans are already underway for our holiday party and other social events that will provide networking opportunities and camaraderie. In addition, HPA committees are developing continuing education workshops of interest to local psychologists and the mental health community. We are also working to bring in a nationally-recognized speaker for the Annual Spring Conference scheduled for May of 2004. To stay in the know, be sure and check out our web site www.hpaonline.org and our monthly newsletter filled with the latest about what is happening here in Houston. ✯
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Career Trends for Texas Master’s Level Psychology Graduates Emily Sutter, PhD; Howard Eisner, PhD; and Leslye Mize, PhD University of Houston — Clear Lake
ABSTRACT Texas produces hundreds of master’s level psychology graduates each year. What have their career experiences been? Since 1981, the authors have periodically surveyed all graduates of the professional psychology master’s level programs at the University of Houston-Clear Lake to determine the graduates’ career experiences. In the spring of 2003, surveys were mailed to 669 graduates. Survey questions investigated licensure, employment, salary, and the perceived effects of managed care on the graduates’ work. The survey produced a 48% return rate. Results suggest that basic mental health service activities have not changed much over the past 20 years but have adapted to job market conditions. Diagnostic work for school psychology graduates in school districts remains a staple, as does psychotherapy in private practice and outpatient settings for graduates of the clinical and family therapy programs. As a group, the school psychology graduates tended to be better paid, although respondents earning the highest incomes were psychotherapists in long-term private practice. Licensure has become essential over the decades, with the professional counselors license (LPC) the most popular credential. Managed care has affected the psychotherapists much more than those doing research or working in school districts, but not enough to drive practitioners out of the field. Overall, the employment rate for master’s level graduates remains very high.
According to the Texas Higher Education Coordinating Board figures (THECB, 2003), Texas public institutions of higher education award over 600 master’s degrees in psychology every year. When added to the psychology master’s degrees awarded by Texas private institutions of higher education, Texas clearly is a major producer of master’s level psychology graduates. Also, according to the THECB, over the past five years more than twothirds of the psychology master’s graduates of Texas public universities obtain their degrees in clinical, counseling, or school psychology programs. The Texas public institutions of higher education that award the most master’s degrees in psychology are presented in Table 1. Interestingly, counseling psychology programs produce some three times more graduates than
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Texas Psychologist
Table 1 Texas public universities granting the most psychology master’s degrees
TX Public Universities
Graduates of all Psych. Programs*
Graduates of only Clinical/Counseling/ School Programs
Prairie View A&M
172
170
Univ. of Houston-Clear Lake
50
30
Sam Houston State Univ
46
43
Southwest Texas State Univ
38
37
Stephen F. Austin
31
23
Statewide Total
633
446
Note: Figures are mean numbers of degrees awarded/year, 1998-2002. * These figures include clinical/counseling/school graduates.
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clinical and school psychology programs combined. This fact mirrors figures obtained at the national level by the American Psychological Association (APA, 1999). Clinical, counseling, and school programs are practitioner-training programs that usually lead to licensure in mental health professions. Graduates of programs other than psychology also often earn such licensure. For instance, programs in counseling and guidance, student counseling, and counseling education are frequently offered by schools of education and lead to the MEd, as opposed to the MS or MA in psychology. Over 800 of these counseling degrees are awarded each year by Texas public institutions alone (THECB, 2003). Other mental health practitioners, such as marriage and family therapists, come from even more diverse academic program areas, such as human development or home economics. In sum, Texas produces well over 1,000 potential master’s level mental health practitioners every year. Within this very large cohort of potential mental health practitioners, where do the graduates of master’s level psychology programs find their career identities? Except for the American Psychological Association data (APA, 1999) that describes career experiences of new master’s level psychology graduates at the national level, there is little recent information on this topic (Gehlmann, 1994; Lowe, 1997; MacKain, Tedeschi, and Durham, 2002; Sutter, Mize, and Eisner, 1994). One of the first mental health credentials for master’s level psychology practitioners in Texas was the certification for psychological associates, created with the Psychologists’ Licensing Act of 1969. Over the years this certification was replaced by a license for psychological associates (LPA) to practice under supervision. The 1980s and early 1990s saw the introduction of new Texas licenses for mental health practice, primarily the professional counselors’ license (LPC), the marriage and family therapists’ license (LMFT), and the chemical dependency
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counselors’ license (LCDC). The license for specialists in school psychology (LSSP) was created by the Texas legislature in 1995. It credentials individuals to practice school psychology only in Texas public schools and is not a license for private practice. What trends have occurred in the career issues of Texas master’s level psychology graduates? What licenses are the most popular? Are these graduates readily able to find employment and where do the jobs exist? What activities fill their workdays? How much do they earn? How have they been affected by managed care? And are their experiences similar to psychology master’s graduates in the rest of the nation? These career choices would seem of obvious interest to the faculties of master’s level psychology programs, to psychology students themselves, and to the profession of psychology as a whole. They are the focus of this study. To answer these questions, faculty at the University of Houston-Clear Lake (UHCL) surveyed the graduates of their three professional psychology master’s programs (clinical, school, and family therapy) in 1981, 1993, and again in 2003. Where appropriate, each new survey has been compared to the previous decade’s survey results. Because they are new, the results of the 2003 survey are presented here in more detail than the past surveys. The information concerning trends in career choices not only assists in curriculum development within academic programs, but also provides a window into the mental health profession at the master’s level. Because UHCL is one of the major producers of these professionals in Texas, the career choices of these graduates may have implications for mental health practice in the state as a whole. Method Participants The authors surveyed all graduates of the UHCL professional psychology master’s degree programs (clinical, school, and family therapy). These professional
programs are specifically designed to prepare graduates for licensure and professional mental health practice. All the professional program areas are approved/accredited by their respective accrediting agencies. The American Association for Marriage and Family Therapy (AAMFT) accredits the Family Therapy program; the National Association of School Psychologists (NASP) approves the program for School Psychology; and the Clinical Psychology program meets the standards of the Council of Applied Master’s Programs in Psychology (CAMPP). The programs all require more than 60 semester credit hours and involve extensive internships. The average age of the students is 36, and the majority are white females. Questionnaire The questionnaire contained 16 questions, mostly in multiple-choice format. Basic questions about licensure and employment experiences were the same each decade with minor updating to reflect new licenses or practice conditions. Space was available at the end of the survey for participant comments. Procedure The study was approved by the institution’s IRB and the questionnaires were mailed to all professional psychology graduates. A stamped, return-addressed envelope was included to enhance the response rate. Results were tabulated and subjected to chi square analyses. Results reported as significant employed an alpha of .01. Results Survey Return Rate The current survey was mailed in January 2003 to all 669 graduates of the Clinical Psychology, School Psychology, and Family Therapy programs at UHCL. Completed surveys were returned by 317 graduates, for a 48% response rate. Response rates were fairly consistent for the three program areas. Of those who returned
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the survey, 310 indicated their primary major. Some 115 (37%) were graduates of the Clinical Psychology program, 128 (41%) were from Family Therapy, and 67 (22%) were from School Psychology. The School Psychology program is the smallest and the newest of the programs so the smaller number responding was not unexpected. Some 10% of the respondents graduated between 1976 and 1985; 51% graduated between 1986 and 1995; and the remainder (39%) graduated between 1996 and 2002. In general, the return rate appears sufficient to draw meaningful conclusions from the responses. Acceptance into Doctoral Programs A question newly included in the current survey asked if the respondent had been accepted into a doctoral or other advanced professional degree program since graduation. Since the three programs are designed to be “terminal” professional master’s degrees, it was surprising to learn that 16% of the master’s graduates had been accepted into doctoral or other advanced professional degree programs. Clinical, counseling, and school psychology doctoral programs were the most popular. There was no significant difference among the three UHCL programs in terms of acceptance rates into doctoral programs. A chi square test did show a highly significant relationship between acceptance into doctoral programs and time of graduation: the longer the interval since receiving the professional psychology master’s degree, the more likely it was that the respondent had been accepted into an advanced professional degree program. Employment Rate The number of graduates employed outside the home for pay dropped very slightly from the survey in 1993 (90%) to the 2003 survey (87%). Only 10 individuals indicated they were looking for work, yielding a 3% unemployment figure. This is identical to APA’s findings for new master’s graduates (APA, 1999). Most
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(90%) of the employed UHCL graduates work more than 20 hours per week. This is slightly better than the American Psychological Association’s (APA) figures for master’s level employment, but the APA figures considered only recent graduates (APA, 1999). Of the 13% in the current survey who were not working, 25% indicated they were looking for work; 22% indicated they were not interested in work at this time; 28% indicated they were retired; and the rest gave various other reasons for not being employed. It is very difficult to draw unemployment rate implications from these data for master’s level graduates because of the current relatively high unemployment figures for
the nation in general (6.2% unemployment). However, if UHCL graduates are typical of the entire state, then Texas master’s level psychology graduates fare very well in using their educational training to obtain employment. Licenses Obtained Of particular interest is the information concerning the licenses obtained by the UHCL master’s graduates across the three decades. These data are presented in Table 2. Because 16% of the respondents indicated they had been accepted into doctoral programs, it is not surprising to see two new licensure categories this year, the
Table 2 Credentials obtained by UHXL professional psychology graduates Credential
1981 (N=109)
1993 (N=237)
2003 (N=317)
LPA (Psychological Assoc.)
17%
12%
7%
LPC (Professional Counselor)
NA
51%
53%
LMFT (Marriage & Family Therapist)
NA
35%
31%
LSSP (Specialist in School Psych.)
NA
NA
19%
LCDC NA (Chemical Dependency Counselor)
16%
6%
LP (Psychologist)
no data
no data
5%
MD (Medical Doctor)
no data
no data
2%
Other
no data
no data
7%
None
83%
24%
14%
Note: Percentages exceed 100 because some respondents hold multiple credentials.
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Licensed Psychologist (LP) and the Medical Doctor (MD). The responses in the “other” category generally specified a credential that was offered by a professional association as opposed to a license. Licenses were not examined in the APA national survey since licensing is done at the state level. The professional counselor’s license (LPC) remains the most popular choice (53%) of the 2003 respondents, with 31% of the 317 respondents obtaining the license for marriage and family therapists (LMFT). These figures are very similar to the results from the 1993 respondents. The UHCL practitioner programs were designed with the assumption that most graduates would become psychological associates. However, results suggest that the percent seeking licensure as an LPA continues to decline over the decades, with only 7% of the 2003 respondents possessing the LPA. New since the 1993 survey is the specialist in school psychology license (LSSP), with 19% of the respondents obtaining this license. As more types of licenses have become available and as more legal restrictions appear for individuals attempting to practice in the mental health field without a license, it is not surprising to see the percent of graduates with no license steadily declining from 83% in 1981 to 14% in 2003. Employment Settings When asked about their employment setting and work activity, only those 2003 respondents (N=219) who responded to the questions and who indicated they worked more than 20 hours per week were included in the data analyses. From the responses of these full-time employed individuals, some possible trends appear (see Table 3). Since the demise of psychiatric hospitals in the early 1990s, only 6% of the respondents work in inpatient mental health settings. Some of these were specified as prison hospitals or nursing homes. An increasing proportion of the graduates now work in public schools as well as in outpatient settings such as mental health agencies. The
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spike seen in private practice settings during the 1980s seems to have diminished somewhat by 2003. In an attempt to more
thoroughly explore the sites involved in the “other” responses, these answers were reexamined and categories for higher
Table 3 Primary employment settings of UHCL professional psychology graduates Setting
1981 (N=109)
1993 (N=237)
2003 (N=219)*
In-patient
19%
6%
6%
Out-patient agency
18%
14%
22%
Public school
13%
12%
25%
Private practice
15%
30%
24%
University
no data
no data
6%
Business/Industry
no data
no data
3%
Medical facility
no data
no data
5%
Other
35%
38%
9%
*Only data from those employed full time were considered here.
Table 4 Primary work activity of UHCL professional psychology graduates Nature of work
1981
1993
2003
Psychotherapy
29%
48%
41%
Diagnostics/assessment
14%
6%
22%
Case management
17%
6%
15%
Administration
17%
6%
9%
Teaching
12%
3%
2%
Research
no data
no data
3%
Consulting
no data
no data
3%
Other
11%
31%
5%
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education, business, and medical facilities were included in Table 3 for the 2003 respondents. It was also interesting to note that when the sites were examined in terms of the degree program of the respondent, significant differences emerged. As expected, those with school psychology degrees were employed primarily in public schools, while those with clinical or family therapy degrees were employed primarily in private practice and outpatient settings. Date of graduation also showed a significant relationship to employment setting, with those receiving degrees between 1978-1985 being employed more frequently in private practice and institutions of higher education (58% and 21% respectively) than those graduating from 1986 to 1993 (29% and 8%), or those graduating more recently from 1994-2002 (12% and 4% respectively). Work Activity When queried about the nature of their work, the current respondents reveal a slight shift away from psychotherapy and into more diagnostic jobs or case management/short term counseling roles. Again, in an attempt to provide more specific data, the “other” responses were examined. Research and consulting emerged as two additional job categories. Table 4 compares the work activities during the three different survey dates. A significant relationship was found between the license obtained and respondents’ primary work, with LSSPs doing diagnostic work while LPCs and LMFTs were more involved with psychotherapy. Further, a significant association was found between employment setting and job activity. Those employed in the schools were primarily involved with diagnostic work and those employed in private practice or outpatient settings did psychotherapy primarily. Earnings How much money do the graduates make? Because of inflation, no attempt was
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made to compare incomes across the decades. However, since income is a very important variable, it was examined in this year’s survey in a number of ways: degree obtained, length of time from graduation, license, employment setting, and work activity. Tables 5 and 6 present some of these data. As a group, those with the school psychology degree tend to be paid better. This finding was consistent with results of the APA survey at the national level (APA,
1999). Some 86% of the school psychology graduates earned above $40,000 per year. Clinical psychology graduates fared less well with 65% earning above $40,000. Family therapists came in last, with approximately 59% of their graduates earning above $40,000. Yet, it was this same practitioner group (family therapy) that had the greatest percentage of graduates earning above $70,000. As one might expect, earnings varied by date of graduation, with graduates earning more money the longer they were
Table 5 Earnings of UHCL professional psychology graduates by program area Amount
Clinical (N=75)
School (N=55)
Family Tpy. (N=87)
Total (N=217)
Under $30,000
15%
7%
18%
14%
$30,000 - $39,999
20%
7%
24%
18%
$40,000 - $49,999
32%
49%
16%
30%
$50,000 - $59,999
11%
22%
16%
16%
$60,000 - $69,999
9%
9%
9%
9%
Over $70,000
13%
6%
17%
13%
Table 6 Employment of UHCL professional psychology graduates earning over $70,000 Setting
%
Work activity
%
In-patient
0%
Psychotherapy
63%
Out-patient agency
7%
Diagnostics
7%
Public school Private practice University Business/Industry Medical facility
7% 48% 15% 7% 4%
Case Management Administration Teaching Research Consulting
0% 7% 4% 4% 4%
Other
12%
Other
11%
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in the field (i.e., the further out their graduation date). As a group, LSSPs (school psychology) earned more than LPCs and LMFTs (clinical and family therapy). This is particularly noteworthy since the school psychology yearly incomes are normally based on a 10-month academic year as opposed to clinician and family therapy incomes that are normally based on a 12month calendar year. A separate analysis was done on graduates earning over $70,000 (see Table 6). A substantial number of these individuals were involved in the private practice of psychotherapy (and were LPCs or LMFTs who had been in the profession for a long time since graduation). Managed Care Finally, the 2003 survey queried the respondents about the effects of managed care on their work. Since the managed care phenomenon arose in Texas after the 1993 survey was conducted, no comparison across decades was possible. Graduates were asked how much managed care currently affected their work and what they anticipated the effects would be in another five years. Results are presented in Table 7. The school psychology graduates report being affected little or not at all by managed care, while the clinical and family therapy graduates report being much more affected. The differences among these three groups were highly significant. This difference is equally apparent when the professions were asked to predict how much managed care would affect them five years hence. When these responses to managed care were examined by types of licenses possessed, it came as no surprise that the LSSPs were negligibly affected, but the LPCs and the LMFTs were much more affected. The difference was again highly significant. Similarly, those reporting being least affected by managed care worked in school settings (only 2% reported being very much affected by managed care) and did diagnostic work (54% reported not being affected at all). Some 83% of researchers
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also reported not being affected at all by managed care. Those working in private practice or business reported being very much affected by managed care (64% and 67% respectively). Some 52% of psychotherapists reported being very much affected by managed care. When asked in what specific ways managed care affected their work, respondents gave multiple responses. Table 8 shows that for those indicating they were affected, increased paperwork was the main complaint. Other concerns were a decrease in length or amount of services provided to clients and a decrease in fees charged. Interestingly, more respondents reported that managed care increased their caseload rather than decreasing their number of clients.
Discussion The present survey data, when compared with data collected over the past two decades, suggest that graduates of professional psychology master’s level programs are increasingly seeking licensure and seem to be increasingly diversifying and specializing to meet the needs of a constantly changing job market. Graduates tended to flock to private practice in the 1980s when liberal insurance reimbursement for services prevailed. After the advent of managed care, fewer graduates pursued the private practice of psychotherapy. Clearly employment of these master’s level graduates in the mental health field remains high. Most are employed full time with the vast majority employed in the mental health field in which they trained. Those in school psychology seem to benefit from strong job
Table 7 Perceived effects of managed care on UHCL professional psycohlogy graduates now and in five years PROGRAMS Clinical
School
Family Therapy
Very Much
39%
2%
45%
Somewhat
13%
13%
13%
Very little
23%
27%
19%
None
25%
58%
23%
Very Much
56%
4%
35%
Somewhat
14%
19%
34%
Very Little
10%
41%
17%
None
20%
36%
14%
Effects Now
Effects in 5 years
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demand, doing primarily diagnostic work, with salaries between $40,000 and $60,000. They report being affected little by managed care. Those in clinical and family therapy programs clearly prefer the LPC and LMFT licenses to the LPA, and find employment in outpatient agencies or private practice. Those in outpatient agencies generally earn less than $40,000 per year, while individuals in private practice show the widest range of incomes. However, of the respondents earning more than $70,000 per year, most are in private practice and have been there for many years. Psychotherapy is the primary activity of the clinical and family therapy graduates and managed care affects these practitioners much more than the school psychology graduates. These practitioners expect
managed care to have a similar, substantial impact on their professional activities over the next five years. The results suggest that while Texas produces large numbers of master’s level professional psychology graduates each year, these individuals continue to find employment in the mental health field with most earning over $40,000 per year. Presumably this success speaks to the quality of their work and their contributions to the lives of those seeking mental health services. ✯ References American Psychological Association Research Office (Update 1999). Auguste, R.M., Wicherski, M., and Kohout, J.L. 1996 Employment Survey: Psychology
Table 8 Ways in which managed care affects UHCL professional psychology graduates Effect
Graduates with Master’s, Specialist’s, and related Degrees. APA Online. www.apa.org. Gehlmann, S.C. (1994). Employment survey: Psychology graduates with master’s, specialist’s, and related degrees. Office of Demographic, Employment and Educational Research, Education Directorate, American Psychological Association, Washington, D.C. Lowe, R.H. (Spring, 1997). Employment realities and possibilities for master’s level psychological personnel. Journal of Psychological Practice, 3(2), 4754. MacKain, S.J., Tedeschi, R.G., & Durham, T.W. (August, 2002). So what are master’s-level psychology practitioners doing? Surveys of employers and recent graduates in North Carolina. Professional Psychology: Research & Practice, 33(4), 408412.
% (N=220)
Increases # of clients
19%
Decreases # of clients
11%
Increases paperwork
46%
Increases services provided to clients
5%
Decreases services provided to clients
29%
Increases fees charged
5%
Decreases fees charged
27%
Increases overhead expenses
18%
Decreases overhead expenses
1%
No effect
34%
Other responses
11%
Sutter, E., Mize, L., & Eisner, H. (October, 1994). Whither graduates of master’s psychology programs? The Texas Psychologist, 5-9. Texas Higher Education Coordinating Board, Degrees Awarded Data (Profile 020), Masters Degrees Awarded by Curriculum Area (Report 060), Psychology (Element 4200000000) and Coun Educ/Std Con & Guid Srvc (Element 1311010000). www.thecb.state.tx.us/netvisual/menu.htm.
Note: Percentages exceed 100 because multiple responses were allowed.
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The Empirically Validated Treatments Movement: A Practitioner Perspective 1 Ronald F. Levant, EdD, ABPP
I would like to weigh in on the issue of what has been called, sequentially, “empirically-validated treatments” (APA Division of Clinical Psychology, 1995), “empirically-supported treatments” (Kendall, 1998), and now “evidence-based practice” (Institute of Medicine, 2001).
E
mpirically validated treatments is a difficult topic for a practitioner to discuss with clinical scientists. In my attempts to discuss this informally, I have found that some clinical scientists immediately assume that I am anti-science and others emit a guffaw, asking incredulously, “What, are you for empirically-unsupported treatments?” McFall (1991, p. 76) reflects this perspective when he divides the world of clinical psychology into “scientific and pseudoscientific clinical psychology,” and rhetorically asks, “What is the alternative [to scientific clinical psychology]? Unscientific clinical psychology” (see also Lilienfeld, Lohr, & Morier, 2001). Thus, there are some ardent clinical scientists (e.g., McFall and Lilienfeld) who appear to subscribe to scientific faith and believe that the superiority of the scientific approach is so marked that other approaches should be excluded. Since this is a matter of faith rather than reason, arguments would seem to be pointless. Nonetheless, clinical psychologists have argued over it for the last eight years. Punctuating these interactions from the practitioner perspective, the controversy seems to stem from the attempts of some clinical scientists to dominate the discourse on acceptable practice and impose very narrow views of both science and practice. Let’s start with a brief recapitulation of
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the events. Division 12, under the leadership of then President David Barlow, formed a Task Force “to consider methods to educate clinical psychologists, third party payors, and the public about effective psychotherapies” (APA Division of Clinical Psychology, 1995, p. 3). The Task Force came up with lists of “Well-Established Treatments” and “Probably Efficacious Treatments.” Not surprisingly, the lists themselves emphasized short-term behavioral and cognitive-behavioral approaches, which lend themselves to manualization; longer term, more complex approaches (e.g., psychodynamic, systemic, feminist, and narrative) were not well represented. The empirically validated treatments movement has had quite an impact on practitioners. It provided ammunition to managed care and insurance companies in their efforts to control costs by restricting the practice of psychological health care (Seligman & Levant, 1998). It has also influenced many local, state, and federal funding agencies, which now require the use of empirically validated treatments. Moreover, this movement could have an even greater impact on practitioners in the future. For example, it could create additional hazards for practitioners in the courtroom if empirically validated treatments are held up as the standard of care in our field. Further, adherence to
empirically validated treatments could become a major criterion in accreditation decisions and approval of CE sponsors, as the Task Force has urged (APA Division of Clinical Psychology, 1995, p. 3). Some clinical scientists have gone so far as to call for APA and other professional organizations “to impose stiff sanctions, including expulsion if necessary,” against practitioners who do not practice empirically validated assessments and treatments (Lohr, Fowler & Lilienfeld, 2002, p. 8). Given all of this fallout, it should be no surprise that the Task Force report was soon steeped in controversy. Critics argued first and foremost that the Task Force used a very narrow definition of empirical research. For example, Koocher (personal communication, 7/20/03) observed that “‘empirical’ is in the eye of the beholder, and sadly many beholders have very narrow lens slits. That is to say, qualitative research [and] case studies…have long been a valuable part of the empirical foundation for psychotherapy, but are demeaned or ignored by many for whom ‘empirical validation’ equates to ‘randomized clinical trial’ [RCT]. In addition, a randomized clinical trial demands a treatment manual to assure fidelity and integrity of the intervention; however, the real world of patient care demands that the therapist (outside of the research arena) constantly
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modify approaches to meet the idiopathic needs of the client…Slavish attention to ‘the manual’ assures empathic failure and poor outcome for many patients.” Furthermore, Seligman and Levant (1998) argued that, whereas efficacy research programs based on RCT’s may have high internal validity, they lack external or ecological validity. On the other hand, effectiveness research, such as the Consumer Reports study (Seligman, 1995), has much higher external validity and fidelity to the actual treatment situation as it exists in the community. Additional effectiveness studies are needed and could be conducted by the Practice-Research Networks that have recently appeared (Borkovec, Echemendia, Ragusea, & Ruiz, 2001). Finally, others have pointed out that many treatments have not been studied empirically. There is a big difference between a treatment that has not been tested empirically and one that has not been supported by the empirical evidence. A few years later, John Norcross, thenPresident of Division 29 (Psychotherapy), countered by establishing a Task Force on Empirically Supported Therapy Relationships in 1999, which emphasized the person of the therapist, the therapy relationship, and the non-diagnostic characteristics of the patient (Norcross, 2001). Lambert and Barley (2001) summarized this research literature, pointing out that specific techniques (namely those that were the focus of the studies underlying the Division 12 Task Force report) accounted for no more than 15 percent of the variance in therapy outcomes. On the other hand, the therapy relationship and factors common to different therapies accounted for 30 percent, patient qualities and extra therapeutic change accounted for 40 percent, and expectancy and the placebo effect accounted for the remaining 15 percent. Westen and Morrison (2001) reported a multidimensional meta-analysis of treatments for depression, panic disorder,
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and GAD, in which they found that “the majority of patients were excluded from participating in the average study,” due to the presence of comorbid conditions (p. 880). Approximately two-thirds of the patients in the studies they reviewed were excluded, which seems like a high percentage, but is actually a bit lower than national figures for comorbidity. Meichenbaum (2003) noted that fewer than 20 percent of mental health patients have only one clearly definable Axis I diagnosis. Thus, the vast majority of cases seen by practitioners do not meet the exact diagnostic criteria used in the RCT’s that established efficacy for various treatments. Furthermore, the empirically validated treatments on these lists have typically been studied using homogeneous samples of white, middle-class clients, and therefore have not often been shown to be efficacious with ethnic minority clients.
So what does this all mean? Suppose we had lists of empirically validated manualized treatments for all DSM Axis I diagnoses (which we are actually a long ways away from). We would then have treatments for only 20 percent of the white, middle class patients who come to our doors—namely those who meet the diagnostic criteria used in studies that validated these treatments. That’s bad enough, but that’s not all. In order to limit services to only the 20 percent of white, middle class patients who come to us, the average practitioner would have to spend many hours, perhaps years, in training to learn these manualized treatments. If we restricted ourselves to use only manualized treatments, we would be limiting our role to that of a technician. In the end, these treatments would only account for 15 percent of the variance in therapy outcomes of these patients. One can readily see why
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few practitioners embraced the empirically validated treatments movement. My view is that although one of psychology’s strengths is its scientific foundation, the present body of scientific evidence is not sufficiently developed to serve as the sole foundation for practice. Practitioners must be prepared to assess and treat those who seek our services. To be sure, we all get referrals of clients that we decide to refer to others because we don’t think that we are the best clinician for that case, but those who are in general practice have to work with the clients that come to them. Whether we operate from a single theoretical or a more eclectic perspective, we bring to bear all that we know from the empirical literature, the clinical case studies literature, and prior experience, as well as our clinical skills and attitudes, to help the client that is sitting in front of us. This is what is often referred to as clinical judgement. Some condemn clinical judgement as subjective. To them I say that
clinical judgement is simply the sum total of the empirical and clinical knowledge and practical experience and skill that clinicians bring to bear when it is our job to understand and treat a particular and very unique person. Fox (2003) goes even further, pointing out that in many learned fields, science and practice are often separate endeavors, and that practice often has to precede science. Physicians were treating cancer long before they had much of an idea of what it was and were using pharmaceutical agents like aspirin long before the pharmacodynamics were known. To quote Fox (2003): The fact of the matter is that if clinicians restrict themselves to applying only narrowly validated or known techniques, they will never be of much value to society. Lest you think that statement is an invitation to charlatanism, remember that clinicians do not
have the luxury to start from what is. They must start with the needs of the people who come to them and then apply all the knowledge, information and skill they have to help resolve those problems. On the other hand, we do have a problem of accountability in health care, one that will surely affect psychology. For example, the current lag between the discovery of more effective forms of treatment in health care and their incorporation into routine patient care is on the average 17 years. DeLeon (2003) predicts that health care in the 21st century, abetted by technology, will be characterized by even greater accountability for practitioners, due to the combined effects of the increasingly well-informed health care consumer, who gathers relevant health care information from the Internet; the increasingly well-informed practitioner,
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who will be able to obtain best practice information from a PDA; and increased monitoring of health care practices to flush out variation in treatment for specific diagnoses. In this environment we are going to need betters ways to evaluate practice. I would suggest that we consider using the broad and inclusive definition of evidence-based practice adopted by the Institute of Medicine (2001). This definition consists of three components: best research evidence, clinical expertise, and patient values. This definition makes all components equal, provides a broad perspective that allows the integration of the research (including that on empirically validated treatments and that on empirically supported therapy relationships) with clinical expertise, and brings the topic of patient values into the equation. Such a model that equally values all three components will better advance knowledge related to best treatment and provide better accountability. As always, I welcome your thoughts on this column. You can most easily contact me via e-mail at Rlevant@aol.com. âœŻ References American Psychological Association Division of Clinical Psychology (1995). Training in and dissemination of empirically-validated psychological treatments: Report and recommendations. The Clinical Psychologist, 48, 3-27. Borkovec, T. D., Echemendia, R. J., Ragusea, S. A., and Ruiz, M. (2001). The Pennsylvania Practice Research Network and possibilities for clinically meaningful and scientifically rigorous psychotherapy effectiveness research. Clinical Psychology: Science and Practice, 8, 155-167. DeLeon, P.H. (2003). Remembering our fundamental societal mission. Public Service Psychology, 28, 8, 13. Fox, R. E. (2003, August). Toward creating a real profession of psychology. Paper presented at the Annual Meeting of the American Psychological Association, Toronto, Ontario, Canada.
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Gonzales, J.J., Rngeisen, H. L., & Chambers, D. A. (2002). Clinical Psychology: Science and Practice, 9, 204-220. Institute of Medicine (2001). Crossing the Quality Chasm: A new Health System for the 21st Century. (2001). Institute of Medicine: Washington, DC. Kendall, P. C. (1998). Empirically supported psychological therapies. Journal of Consulting and Clinical Psychology, 66, 3-6. Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory/Research/ Practice/ Training, 38, 357-361. Lilienfeld, S.O., Lohr, J. M., & Morier, D.(2001). The teaching of courses in the science and pseudoscience of psychology: Useful resources. Teaching of Psychology, 28, 182-191 Lohr, J. M., Fowler, K. A., & Lilienfeld, S. O. (2002).The dissemination and promotion of pseudoscience in clinical psychology: The challenge to legitimate clinical science. The Clinical Psychologist, 55, 4-10 McFall, R. M. (1996). Manifesto for a science of clinical psychology. The Clinical Psychologist, 44, 75-88. Meichenbaum, D. (2003, May). Treating Individuals with Angry and Aggressive Behaviors: A Life-Span Cultural Perspective. Paper presented at the Annual Meeting of the Georgia Psychological Association, Atlanta, GA. Norcross, J. C. (2001). Purposes, processes, and products of the Task Force on Empirically Supported Therapy Relationships. Psychotherapy: Theory/ Research/ Practice/Training, 38, 345-356 Seligman, M.E.P. (1995). The effectiveness of psychotherapy. American Psychologist, 50, 965-974. Seligman, M. E. P., & Levant, R. (1998). Managed care policies rely on inadequate science. Professional Psychology: Research and Practice, 29, 211-212. Westen, D. and Morrison, K. ( 2001). A multidimensional meta-analysis of treatments for depression, panic, and
generalized anxiety disorder: An empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology, 60, 875-899. Biographical Sketch Ronald F. Levant, EdD, ABPP, is a fellow of Division 39 and a candidate for APA President. He is in his second term as Recording Secretary of the American Psychological Association. He was the Chair of the APA Committee for the Advancement of Professional Practice (CAPP) from 1993-95, a member at large of the APA Board of Directors (1995-97), and APA Recording Secretary (19982000). He is Dean of the Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, FL. Footnote 1 Adapted from Levant, R. (in press). The empirically validated treatments movement: A practitioner/educator perspective. Clinical Psychology: Science and Practice.
TEXAS PSYCHOLOGICAL ASSOCIATION ANNUAL CONVENTION SPONSORS Please take a moment to thank these sponsors should you meet them at the convention. We could not host such a magnificent program without their support.
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Challenging Issues for Women at Midlife Donna Davenport, PhD; Roberta L. Nutt, PhD; Robbie N. Sharp, PhD; and Melba J.T. Vasquez, PhD
The following papers were written for a symposium sponsored by the Psychology of Women Special Interest Group at the Texas Psychological Association’s Annual Convention in 2002. The authors are all psychologists who have been involved in professional societies, academia, clinical practice, and friendship, and who have shared the journey into midlife. We, as women and psychologists, wanted to address important issues at this point in our experiences, so that we might learn from our reflections and those of others.
Although each of these papers deals with loss in some way, each one addresses a different perspective and a different life lesson. Dr. Davenport shares her thoughts about anticipatory grief, drawing from her experiences of losing her own mother. She discusses what remains after the death of a loved one and emphasizes the importance of ritual and symbol. Dr. Nutt entertains us by debunking the stereotype of the middleaged woman being over the hill. She examines the research about the feminine role and dwells on the positive aspects of aging. Dr. Sharp discusses her work in grief recovery. She presents a model of growing through the grief process by looking at spiritual, psychological, and sociological issues. Dr. Vasquez describes the importance of our mentors in our professional growth. She examines how their losses impact our thoughts about our career goals and challenge us to look to ourselves as mentors for those who can profit from our experiences.
Part I: Midlife Loss of a Parent For those of us who are lucky, our parents did not die when we were young and still quite dependent. Instead, we dealt with their deaths when we were adults and often after a significant period of caregiving and anticipatory grief during their decline.
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Women typically carry the brunt of the responsibility for caregiving of elderly parents (Davenport, 1998). Accordingly, they are often in more physical and psychological contact with their parents in the months or years preceding their deaths than they had been heretofore, and the ensuing sense of loss after death can be especially acute. Further, as the Stone Center’s Cultural/Relational theory suggests, the connection between mother and daughter can be especially close (Jordan1997), which suggests that part of the bereaved daughter’s identity may feel in jeopardy as she attempts to come to terms with what the loss means to her. The Experience of Loss There is often a sense of generational shift after a parent dies, especially after the death of the second parent (Donnelly, 2000; Myers 1997). Some authors (e.g. Bartocci, 2000; Brooks, 1999; Levy, 2000) of popular books on loss of parents additionally suggest that it is inevitable for the adult child survivor to feel like an orphan; there is no longer any one to turn to for guidance, to share memories, or to serve as a buffer between herself and death. The longest lasting familial bond has been severed. Classical theories of bereavement would support this contention, with decathexis considered the goal of healthy
resolution of grief (Freud, 1917/1957). Other writers (e.g., Davenport, 2002) however, point out that while death ends life, it does not end the relationship. For many bereaved persons, the presence of the deceased loved one may still be accessible. Recent research (Francis, Kellaher, & Lee, 1997; Klass & Walter, 2001; Rees, 1979) confirms that large numbers of apparently healthy survivors report some sense of ongoing connection with the deceased. Sometimes this takes the form of actually talking to the lost loved one. For women, this is usually done in the home; men often talk with their deceased fathers at cemeteries. One study (Marwit & Klass, 1995) examined the function of the bond that seems to transcend death and found that it was often maintained to provide moral guidance during difficult life situations or to offer solace by claiming the legacy imparted from the deceased. Sometimes the conversation is audible or within the bereaved person’s mind, sometimes the parent’s memory is invoked, and sometimes the past relationship is used as a way to clarify values. Another qualitative study of psychologists (Davenport, et al., 2002) indicated that a large majority of those interviewed said that they also sometimes felt the presence of their deceased parent— sometimes through dreams, sometimes by
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doing an activity their parent used to do, and sometimes by deliberately invoking their memory. It seems clear that such experiences cannot be written off as a symptom of some psychopathology. Spiritual/religious beliefs may be helpful but are not requisite for survivors to claim this sense of ongoing connection. For psychologists who need psychological explanations of the phenomenon, understanding it as accessing the internalized love object works well (Baker, 2001). Whether the continuing relationship is conceptualized as transcendent or merely psychological, the experience of it is often undeniable for many bereaved persons. Memorials Specific activities or rituals are often helpful for bereaved individuals (Combs & Friedman, 1990) but perhaps especially so for adult children who have lost their parents. Creative expression, designed not only to facilitate grief but also to honor the deceased, can provide tangible memorials that evoke the quality of the parent/child relationship. One client of mine is collecting all the pithy pieces of advice her father was noted for dispensing and is making a scrapbook for his grandchildren. Another artist client painted a landscape that her father was especially fond of and said, “It’s like I’m shouting into the void— See, I still love him! You can’t take him away!” In writing the memoir after my own mom’s death (Davenport, 2002), I found that recollecting stories about her and about her/our ancestors that she had told me over the years provided an ongoing sense of legacy we are both part of. During the process, I wrote a poem in tribute to her and our relationship. Now, four years almost to the day since she died, it is what seems to best capture my resolve to maintain her importance in my life: There is evil, I now know. I see it. Destruction that attacks you,
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That deprives you of choice, That undermines your every effort. It feeds on our despair. My mother, it shall not win. This battle is not the last. So when you die, When it has taken you away— Piece by piece until finally gone— I will remember your love, your colors, The melody that is you. In some shining part of me, Your song will still be sung. More: Nothing can touch what I prize the most. Far past these indignities, Past your death, past mine also, Through all the eons yet to come, I will always be your daughter.
Part II: Confronting Cultural Stereotypes: Midlife as Liberation As is true in many contexts, there has been too much emphasis on the negatives associated with midlife—particularly losses. Losses are only one part of the story. Media and Cultural Assumptions One of the biggest challenges of midlife for women is confronting cultural stereotypes routinely presented in media, movies, television, magazines, etc. Middleage and older women are presented as sweet little old ladies, hags, old bats, evil witches (ever see any evil old man costumes at Halloween? [Matlin, 1993]), and crones. Aging is described as a scary process generally leading to depression. Culture assumes that aging is paired with increasingly rigid ideas, loss of hearing, and general ugliness—white hair, wrinkles, and stooped posture. Advertising in the media spends millions pushing cover-up makeup and a variety of lotions and creams to fight the effects of aging (Friedan, 1993). Even dishwashing detergents claim to soften hands and make them appear more youthful (Matlin, 1993).
Women are encouraged to seek cosmetic surgery to change their natural looks and lie about their age. Double Standard of Aging Many experts on the aging process describe a double standard of aging (Etaugh, 1993; Sontag, 1979). As men age, it is assumed that wrinkles give them character and grey hair represents wisdom (Deutsch, Zolenski, & Clark, 1986). With maturity come increased competencies, respect, and financial security. Old men are seen as distinguished. The opposite is typically true for women. As their appearance ages, they are less valued or even noticed (Bazzini, McIntosh, Smith, Cook, & Harris, 1997; Fodor & Franks, 1990). They do not gain in perceptions of wisdom or distinction. For women, aging is viewed as a problem to be overcome, denied, or avoided. Old women may be criticized for using up resources and being a burden on society and their families. Aging equals deterioration, helplessness, frailty, and confusion. Culture assumes all elderly persons are incompetent and living in nursing homes (Friedan, 1993; Matlin, 1993). They are isolated and hidden. Well-Kept Secret In reality, the advantages of midlife and older for women are a well-kept secret. There is no denying the bodily changes and increases in aches and pains and health risks (Bee, 1996; Etaugh, 1993). However, these changes are well balanced by the positive and dynamic increases in freedom and selfdefinition. Women’s roles change, many earlier obligations drop away, and women have a greater number of role choices and feel less concern for the outside opinions and criticisms of others. There was a recent Oprah interview on television with Susan Sarandon and Goldie Hawn, who had both passed 50. Both interviewees reported feeling freer, sexier, and more joyous after passing 50.
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Psychological research has supported this positive view of aging for women for decades. In today’s U.S. society, young adulthood is often protracted, marriage is delayed and overall health has improved (Matlin, 1993). The life span has grown longer. Even the definition of midlife has shifted upward. In 1900, the life expectancy for women was less than 50; now it is closer to 80 (U.S. Bureau of the Census, 1993). The quality of life is also better, barring illness. Nutrition is better, people exercise more, and new role possibilities have increased. Contradicting Cultural Assumptions Research studies going back to the 1960s and 1970s (Hyde, Krajnik, & Skuldt-Niederberger, 1991; Neugarten, 1968) found that women and men grow closer together in personality characteristics as they age. Women become more assertive and independent, and men grow more emotional, nurturing, and interpersonally connected. A repeated midtown Manhattan Longitudinal study assumed women’s mental health deteriorates with age for every decade after 20, but found drastic improvement after 40. Later, the National Center for Health Statistics found women in their 40s, 50s, and 60s to be in as good as or better mental health than women in their 20s and 30s (Friedan, 1993). They concluded there is more stress in the lives of younger women. Few women have been shown to suffer seriously with the stereotyped empty-nest syndrome when children leave home (Bart, 1971; Grambs, 1989; Rubin, 1979). Mitchell and Helson (1990) went so far as to suggest that the early 50s are the prime of life for women. Freed from parenting responsibilities, women have new energy to pursue other interests (Brown & Kerns, 1985). They demonstrate a joy in living and liberation from monthly cycles, a high interest in sex, an increased sense of autonomy, and an ongoing interest in friends, family, and careers (Jackson, Chatters, & Taylor, 1993; Mitchell & Helson, 1990). Connectedness has been 24
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shown to have a direct effect on positive mental health and mortality. Research that has emphasized negative aspects of aging has been criticized for using the institutionalized elderly while generalizing to the total population. These samples were convenient but did not represent reality. It has also been suggested that the personal fear of aging in researchers may have caused bias in their research. For example, the assumed decline in intelligence for aging adults has been tied to test bias rather than any actual decline for active individuals. Suicide rates, another measure of mental health, is significantly higher in males over 65 (45.6 per 100,000) than women over 65 (7.5 per 100,000). Studies based upon European-American, middle-class, educated women has shown them to be independent, in charge of their lives, adventurous, hard-headed, unconventional, opinionated, individualistic, self-confident, complex, and demonstrating high selfesteem. They were reflective and contemplative, demonstrated integrity, gave high priority to instrumental functions, were positive about menopause, and welcomed new experiences. They were interested in politics, social issues, and were joyfully engaged in the present. Career-oriented women at midlife demonstrate more internal locus of control. Women in leadership roles are confident, sure of their own opinions, conscientious, serious, assertive, determined, and creative. They value mentoring and empowering others. Positive mental health of midlife and older women is even more obvious in cultures that revere older women (Grambs, 1989). Many Native American tribes valued wisdom in older women. Aboriginal women in Australia are respected—their advice is sought on matters of importance and they are involved in spiritual ritual and community decision making. Among the Kung people of southern Africa, status increases with age, as do spiritual powers. Older women can handle taboo and ritual substances that are considered too powerful
for women still involved in bearing and caring for children. Midlife is viewed as a new beginning. It is time to change our cultural stereotypes. Midlife for women needs to be viewed in balance, describing both its inherent changes and exciting opportunities.
Part III: Grieving and Helping Others To Do One of the most gratifying and painful tasks I have encountered in professional life was finding a healthy way of addressing my own losses and helping patients and students to do the same. As a developmental psychologist, I understand and embrace the concept of change, letting go of what was and making what is now a part of my life. Too often we make these transitions without allowing ourselves time and energy to experience the feelings, explore them, and say goodbye. In our busy professional and personal lives, many of us have adapted by rushing through this process again and again. We lose so much by not treating our losses as an important component of our development — one that teaches profound lessons. What I found and continue to find in the lives of others is how loss changes all the relationships in our lives and how each of these relationships must be examined and renegotiated, at a time when emotions and experiences are askew and structure seems to be missing. Finding ways of grieving that link the intellectual self with the emotional and the spiritual self sustains us through losses by integrating the past with the present. Across the past six years, my colleague, the Reverend Dr. Peter Thomas, and I have developed our thinking about how to help persons grow through their grief process. What began as a way to help structure and organize those in our churchbased grief recovery groups has evolved as we have incorporated information from participants and as we have discussed our thoughts about grief as a developmental process. WINTER 2003
Our Philosophy Grief occurs when persons experience the loss of dreams, loved ones, jobs, homes, businesses, way of life, and health. Rather than passing through a series of stages that compartmentalize our emotional reactions to these losses (e.g., Kuebler-Ross, 1969), we see people who are encompassed in an amalgam of spiritual, sociological, and psychological changes that are interactive, in a constant state of flux, and command attention. If these emotions, attitudes, behaviors, and thoughts can be structured and organized within these dimensions (spiritual, sociological, and psychological), we find that healing can begin to take place. We see the loss as a crisis event, a lifechanging incident, and the crisis experience as the amalgam of changes that are set in motion by the crisis event. Spiritual Processes Using the twenty-third Psalms as a metaphor for the experience of grief and
loss, Dr. Thomas describes a spiritual journey from: 1) orientation — life that is going along in the expected manner, 2) to a crisis event, 3) to disorientation — the crisis experience in the valley of the shadow of death, and finally 4) to re-orientation — learning to incorporate the loss and to cope in the new life. As an Episcopalian priest, Dr. Thomas is able to address many of the religious belief systems that are shaken during the crisis experience. He weaves this into the same developmental model of change, change experience, and integration (death, resurrection, and new life). Psychological Processes Using the familiar psychosexual stages set out by Erik Erikson (1968), those who are grieving can be reminded that they have experienced this developmental sequence time and again as they have progressed from one stage of life to another. We have also used this model to demonstrate how each person has gained patterns of strength and
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these relationships are only slightly impacted. We believe that much of the work of grief is in reconciling one’s loss in each of these relationships. The Work Dr. Thomas and I find that discussing ways of letting go, how old habits inhibit new habits, the use and importance of rituals, ways to acknowledge the reality of the past, and a format to plan for the future and evaluate the present helps orient those in grief. We have structured our Grief Recovery Course to be a psychoeducational group rather than a therapy group. We believe that the group setting and group process is an integral part of the healing process, although we emphasize that each person experiences grief in his or her own way and at his or her own pace. The midlife challenge for me has been to find a means of coping with inevitable losses and changes. By incorporating written materials, conducting groups, encountering examples in my clinical work, and formulating my ideas and perspectives on how I see loss, change, and coping, a framework has evolved that allows me to help structure and organize the overwhelming experience of grief. As we complete our book, both Dr. Thomas and I have found ways of communicating these ideas to others, thus allowing them to grow through their own grieving.
Part IV: Mentoring at Midlife: Losses, Gains and Challenges One of the most important difficulties faced by women graduate students and young professionals has to do with obtaining mentors. Worell and Johnson (1997) describe the reasons as the lack of female faculty, and the tendency for male faculty to have less identification and contact with female students than they do with male students. Women of color have even less access to informal contact with
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advisors, especially with mentors who are familiar with ethnic as well as gender issues. Often, women, and women of color, obtain “situational mentoring” from various sources and persons. I am one of many who has obtained rich and diverse mentoring from a number of sources, including from some of the few women of color psychologists who came before me. I am now at the age, chronologically and professionally, when those mentors are retiring or dying. At midlife, one of the developmental issues is the loss of mentors through retirement, disability and/or death. The loss of a couple of my mentors has had a major impact, and I’d like to share the experience of one of those losses. Dr. Martha Bernal contributed significantly to the advancement of ethnic minority psychology. She unfortunately suffered from three different bouts of cancer, including the final one that took her life prematurely on September 28, 2001 in Black Canyon City, Arizona. Martha was the first Latina in the United States of America to receive a PhD in Psychology; she received it at Indiana University at Bloomington. The focus of her research during the first part of her career was on parent-training approaches for behaviorally deviant children. For the last 20 years of her career, her research focused on the ethnic identity of Mexican American children. Dr. Bernal published about 60 articles and book chapters, several books, was guest editor of journals, and presented numerous papers. In the early 1970s, she dedicated herself to the goal of ensuring that more Latinas and Latinos had the opportunity to receive graduate training. She applied much of her research to increase the status of ethnic minority recruitment, retention and training. Her social action research was designed to focus attention on the dearth of Latino/a psychologists and to recommend steps for addressing that problem. She published seminal articles in the American Psychologist (Bernal and Castro, 1994; Bernal & Padilla, 1982) and The Counseling Psychologist
(Quintana & Bernal, 1995) that documented the dearth of minority graduate students and faculty members in psychology departments throughout the United States. James Jones, another mentor, said: I have known Martha since the mid-1970s. She has always been a focused advocate for people of color in psychology, and for Latinas in particular. She was a leader at the Dulles Conference that established the foundation for so many of the ethnic/racial minority programs, organizations we are involved in today. She was always tough-minded, but equally tender-hearted. She was creative as a scientist, administrator, teacher and advocate, and compassionate as a friend and colleague. Martha was a giant in our field, a first among many, and a gift to us all. I was privileged to count her as a friend, and I will miss her. When I first met Dr. Bernal at a California symposium on Chicano psychology, I was a graduate student. My peers and I were enthralled to see her—we could not believe that she was only five feet tall! Yet, she stood very tall to many of us. She was such an important symbol of success, achievement, persistence, and spunkiness. She could push and challenge us. She could be tender, gentle and supportive. She was a treasure. People assumed that I was one of her students. I never was. She was willing to be a “situational mentor” at times, serving as Chair of Symposia at APA, and otherwise providing consultation for various professional situations. She directly and indirectly provided guidance and inspiration to a wide range and number of psychologists of color, men and women. Those who knew her perceived her as an exceptional and phenomenal woman. She blazed a trail that allowed many of us to be here. I realize with relief that I had a couple of
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opportunities to honor Dr. Bernal before she died. Steve Lopez and I organized her nomination for a major APA award the year before she died, and she was awarded the honor! That is partly the reason that he and I worked together to publish her obituary in the American Psychologist; we had the material and the emotional motivation. In addition, the National Latino Psychology Conference held in San Antonio in 2000 was in her honor, and as a keynote speaker, I focused much of the talk on her and her work (Vasquez, 2000). All of this was before we knew she was ill. At APA in Chicago 2002, my talk for an award which I received was also in her honor (Vasquez, 2002). A version of that talk is published in the American Psychologist. This realization leads me to underscore what we know: demonstrating care before and after the death of someone helps the grief process. She knew we cared about and honored her. In 1999, the first National Multicultural Conference and Summit was held in Newport Beach, California. Four psychologists of color, including myself, devoted our APA divisional presidential year to cohosting this conference. One of my projects was a panel, “Honoring Senior Women of Color.” Reiko True, Carolyn Payton, Martha Bernal, and Carolyn Attneave (posthumously) were honored and asked to speak about their experiences with racism and sexism (Sue, Bingham, PorcheBurke & Vasquez, 1999). It was a powerful, funny, poignant and unforgettable event! Three of the four pioneer women of color honored at the first National Multicultural Conference and Summit in 1998 have now died, meaning that the numerous professionals whom they mentored have experienced a significant loss of mentors. Consequently, women of color who are developmentally, professionally and chronologically at midlife may be finding themselves the “senior” mentors available to graduate students and young professionals. This position can be terrifying as well as an honor. Most of us do not feel ready to be in the role in which we find ourselves.
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Developmental models describe transition periods as both a challenge and an opportunity. Challenges include the expectations and requests from various sources, which can be overwhelming. Stress management models seem inadequate when I find myself with requests from so many graduate students and young professionals. Even those of us not in academia get called upon to review the credentials of young multicultural professionals up for tenure, to be interviewed by students for a class on multiculturalism, to give talks at universities for programs attempting to provide multicultural psychologists role models, etc. Setting boundaries and providing referrals to colleagues are of course important strategies, but every time I do so, I am aware of the missed opportunity to provide someone with the experiences that I so treasured from others. Yet the opportunity to give in these ways also provides meaning to my professional life and allows me to experience the basic need to make contributions and to be productive. According to Gelso and Lent (2000) in their chapter on research in the Handbook on Counseling Psychology, research on mentoring relationships underscores the major importance of this relationship in the professional’s life. Professionals who recollect their graduate school experience comment on the centrality of the relationships and the negative impact of lack of mentoring. Despite the research that is out there, there is now no formal theory of the mentoring relationship, although informal observations such as mine exist. This is an area of inquiry in its early stages. However, I hope that theory development includes the aspects of the transition from student to mentor, and the losses, gains and challenges involved in that process. Conclusion The challenges at midlife include various kinds of losses, the literal loss of parents and mentors, changes in roles, and
increased risk of health and bodily aches and pains! Loss changes every relationship in our lives. Each of these relationships and their impact must be examined and renegotiated at a time when emotions and experiences are askew and structure seems to be missing. These challenges, however, are also opportunities for life-enhancing transformation. Indeed, the pain of loss may be conceptualized as simply a part of the process of developmental transformation. Midlife is a time when we are all struggling with losses, but these changes are well balanced by the positive and dynamic increases in freedom and self-definition. This paper identifies ways to transform and benefit from the challenges of loss, and enjoy the opportunity for increased contribution, productivity, and a sense of well-being. Our profession as well as our society must that emphasize and appreciate this perspective. ✯ References Baker, J. (2001). Mourning and the transformation of object relationships. Psychoanalytic Psychology, 18, 55-73. Bart, P. B. (1971). Depression in middle-aged women. In V. G. Gornick & B. K. Moran (Eds), Women in sexist society. New York: Basic Books. Bartocci, B. (2000). Nobody’s child anymore. IN: Sorin Books. Bazzini, D. G., McIntosh, W., Smith, S., Cook, S., & Harris, C. (1997). The aging woman in popular film: Underrepresented, unattractive, unfriendly, and unintelligent. Sex Roles, 36, 531-543. Bee, H. (1996). The journey of adulthood. Upper Saddle River, NJ: Prentice Hall. Bernal, M. E. & Castro, F. G. (1994). Are clinical psychologists prepared for service and research with ethnic minorities? Report of a decade of progress. American Psychologist, 49, 797-805. Bernal, M. E. & Padilla, A. M. (1982). Status of minority curricula and training in clinical psychology. American Psychologist, 37, 780-787.
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Brown, J. K., & Kerns, V. (Eds.) (1985). In her prime: A new view of middle-aged women. South Hadley, MA: Bergin & Garvey. Combs, G. & Friedman, J. (1999). Symbol, story, & ceremony. NY: Norton. Davenport, D.S. (2002). Singing mother home: A psychologist’s journey through anticipatory grief. Denton: UNT Press. Davenport, D.S. (1999). Dynamics and treatment of middle-generation women. In M. Duffy, Ed. Handbook of counseling and psychotherapy with older adults. NY: John Wiley. Denmark & M. A. Paludi (Eds.), Psychology of women: A handbook of issues and theories. Westport, CT: Greenwood Press. Deutsch, F. M., Zalenski, C. M., & Clark, M. E. (1986). Is there a double standard of aging? Journal of Applied Social Psychology, 16, 771-785. Donnelly, K (2000). Recovering from the loss of a parent. NE: iUniverse. Erikson, Erik. (1968). Identity: Youth and Crisis. New York: W. W. Norton & Co. Etaugh, C. (1993). Psychology of women: Middle and older adulthood. In F. L. Denmark & M. A. Paludi (Eds.), Psychology of women: A handbook of issues and theories. Westport, CT: Greenwood Press. Fodor, I. G., & Franks, V. (1990). Women in midlife and beyond: The new prime of life. Psychology of Women Quarterly, 14, 445-450. Francis, D., Kellaher, L. & Lee, C. (1997). Talking to people in cemeteries. Journal of the Institute of Burial and Cremation Administration, 65, 14-25. Freud, S. (1917/1957). Mourning and melancholia. In J. Strachey (Ed.), The standard edition of the complete works of Sigmund Freud, 14. London: Hogarth. Friedan, B. (1993). The fountain of age. New York: Simon & Schuster. Gerkin, Charles V. (1989). Crisis Experience in Modern Life :Theory and theology for pastoral care. CA: Abigon Press. Grambs, J. D. (1989). Women over forty:
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Visions and realities, (rev. ed.). New York: Springer. Hyde, J. S., Krajnik, M., & SkuldtNiederberger, K. (1991). Androgyny across the life span: A replication and longitudinal follow-up. Developmental Psychology, 27, 516-519. Jackson, J. S., Chatters, L. M., & Taylor, R. J. (Eds) (1993). Aging in Black America. Newbury Park, CA: Sage. Jones, J. (2001, December 2). Personal communication. Klass, D. & Walter, T. (2001). Process of grieving: How bonds are continued. In Stroebe, M.S., Hansson, R.O., Stroebe, W., & Schut, H. (Eds.), Handbook of bereavement research. Washington D.C.: American Psychological Association. Kuebler-Ross, E. (1969). On Death and Dying: What the dying have to teach doctors, nurses, clergy and their own families. N.Y., N.Y.: Macmillan Levy, A. (2001). The orphaned adult. NY: Perseus. Marwit, S.J. & Klass, D. (1995). Grief and the role of the inner representation of the deceased. Omega, 30, 283-298. Matlin, M. W. (1993). The psychology of women. Fort Worth, TX: Harcourt Brace Jovanovich. Mitchell, V., & Helson, R. (1990). Women’s prime of life: Is it the 50s? Psychology of Women Quarterly, 14, 451470. Myers, E. (1997). When parents die. NJ: Penguin Putnam. Neugarten, B. L. (Ed.). (1968). Middle age and aging: A reader in social psychology. Chicago: University of Chicago Press. Quintana, S. M. & Bernal, M. E. (1995). Ethnic minority training in counseling psycology: Comparisons with clinical psychology and proposed standards. The Counseling Psychologist. 23, 102-121. Rees, W.D. (1997). Death and bereavement. London: Whurr. Rubin, L. (1979). Women of a certain age. New York: Harper & Row. Sontag, S. (1979). The double standard of aging. In J. H. Williams (Ed.), Psychology
of women: Selected readings (pp. 462-478). New York: Norton. Sue, D. W., Bingham, Rosie P., PorcheBurke, L., Vasquez, M. J. T. (1999). The Diversification of Psychology: A Multicultural Revolution. Report of the National Multicultural Conference and Summit. American Psychologist. 54, 10611069. Thomas, Peter G. and Sharp, Robbie N. (2001). Grief Recovery Course. Unpublished manuscript. U. S. Bureau of the Census (1993). Statistical abstract of the United States: 1993. Washington, DC: U.S. Government Printing Office. Vasquez, M. J. T. (2000, November). The Amazing Challenges and Achievements of Latino Psychologists: A Tribute to Martha Bernal, PhD Invited Keynote Address presented at the Conference, Latino Psychology 2000: Bridging Our Diversity. San Antonio, Texas. Vasquez, M. J. T. (2002). Complexities of the Latina Experience: A tribute to Martha Bernal. American Psychologist, 57, 878-888. Worell, J. & Johnson, N. G. (1997). Introduction: Creating the future: Process and promise in feminist practice. In J. Worell and N. G. Johnson (eds.). Shaping the future of feminist Psychology: Education, research and practice. Washington, D. C.: American Psychological Association. Pp 114.
WINTER 2003
Sunrise Fund Contributors Ramona Aarsvold PhD Marcia Abbott PhD Marianna Adler PhD Joan Anderson PhD Carolyn Anderson PhD Judith Norwood Andrews PhD Larry Aniol PhD Richard Austin, Jr. PhD Laurie Baldwin PhD Eileen Barbella PhD Elizabeth Barry PhD Patricia Barth PhD Deborah Barton PhD Julie Bates PhD James L. Baxter MA Karen Belter PhD Robert Blake PhD Bonnie Blankmeyer PhD Deborah Boelter PhD Hautina Bollinger PhD Rosie Bostick PhD Joy Breckenridge PhD Bonnie Brookshire PhD Stacy Broun PhD J. Martin Brown PhD Timothy Brown PhD Joan Bruchas PhD Erica Burden PhD Robin Burks PhD Roger Burns PhD Mary Burnside PhD Sam Buser PhD Kay Campbell PsyD Bob L. Carpenter Ralph Casazza PhD Joseph M. Casciani Mercy Chieza PsyD Gloria Chriss PhD Antoinette R. Cicerello PhD Pauline Clansy EdD Donna Copeland PhD Carol Cossum EdD Ray Coxe PhD Harold Crasilneck PhD Rosalie Cripps PhD Maria Concepcion Cruz PhD Walter Cubberly PhD Jack Deines PhD Anitra DeMoss PhD Alexandria H. Doyle PhD Patricia Driskill PhD Michael Duffy PhD, ABPP Melody A. Dunbar MS Dianne Dunn PsyD Ann L. Dunnewold PhD WINTER 2003
Richard E. Eckert PhD Anette T. Edens PhD Richard R. Eiles PhD Virginia (Ginger) Enrico PhD Richard Ermalinski PhD Robert Federman EdD Stephen E. Finn PhD Alan T. Fisher PhD Joseph E. Fogle PhD Duncan L. Forest PhD Edward Framer PhD Eric Frey PhD Lois C. Friedman PhD Shirley Friedman EdD Lois C. Friedman PhD Cheryl Fuller PhD Marsha T. Gabriel PhD Ronald Garber PhD Lauren M. Gaspar Michael Gaubatz Michael R. Ghormley BS Martin Gieda PhD Penny M. Goffman PhD Rolf W. Gordhamer PhD Addison Gradel EdD Melissa Graham MEd Dennis Grill PhD Pamela B. Grossman PhD Carol A. Grothues PhD Gerald (Jerry) Grubbs EdD, MSCP William B. Gumm PhD Ranee B. Gumm PhD Michele GuzmĂ&#x;n PhD Cheryl L. Hall PhD Lester E. Harrell PhD Michelle T. Hart PhD Sophia K. Havasy PhD Marian H. Higgins PhD Robin Hilsabeck PhD Clifford L. Hirsch PhD Tamara Hodges C. Alan Hopewell PhD David Hopkinson PhD Melanie L. Horn PhD Sandra L. Hotz PhD Donna Hughes PhD Cheryl F. Hughes PhD Mary A. Gordon Hurd PhD Adele H. Hurst PhD C. Robert Ingram Daniel W. Jackson PhD Linda J. Jackson PhD A. Jack Jernigan PhD Thomas Johnson A. Michael Johnson PhD
William Jones PhD Krista D. Jordan PhD Frances H. Kimbrough PhD Burton A. Kittay PhD Christopher L. Klaas PhD Joseph C. Kobos PhD Kenneth Kopel PhD Bruce Kruger PhD Richard P. Krummel PhD Tom Kubiszyn PhD Angela Ladogana PhD John W. Largen PhD Sarah Lederer Snow Mark Lehman PhD Bert D. Levine PhD Franklin D. Lewis PhD Mary A. Little PhD David S. Litton PhD Daniel L. Logan PhD Dwayne D. Marrott PhD Xavier Martinez PhD Lynn M. Matherne PhD Patricia McBride-Houtz PhD James C. McCabe PhD Donald C. McCann PhD David G. McCarley PhD Joyzelle H. McCreary PhD Robert F. Mehl PhD Muriel Meicler PhD Maritza Milan PhD Robert W. Moats PhD William Montgomery PhD Leon Morris EdD Gary Neal PhD Naomi D. Nelson PhD Walter Newsom PhD Norma Ngo PsyD Christopher G. Nikolaidis Margaret P. Norris PhD Gina R. Novellino PhD Roberta L. Nutt PhD Frank D. Ohler PhD George Parker PhD Carole G. Pentony PhD Harold Perry PhD P. Caren Phelan PhD Kim Praderas PhD John Price PhD Lynn Aikin Price PhD Jayne M. Raquepaw PhD Karen Rasile PhD John K. Reid PhD Herbert Reynolds PhD Elizabeth L. Richeson PhD Dan Roberts PhD
Richard Rogers PhD Olga Ruiz de Arana EdD Earl S. Saltzman PhD Barbara Sanford PhD Gordon C. Sauer, Jr. PhD John Savell PhD Lawrence Schneider PhD R. Gaston Scott EdD John Sell PhD Cristina Serrano PhD Verlis L. Setne PhD Theresa Sharpe PhD Huntly Shelton PhD Jeffrey C. Siegel PhD Tana Slay PhD W. Truett Smith PhD Nanette Stephens PhD Jana Swart PhD Arthur R. Tarbox PhD Daniel J. Thompson PhD Thomas J. Tully EdD Dana B. Turnbull M.A. Thomas A. Van Hoose PhD Nancy D. Van Morkhoven Dr PH Jessica Varnado PhD Melba J. T. Vasquez PhD Laurel Bass Wagner PhD Belinda Walker PhD Michael Walker EdD David J. Welsh PhD Joan Weltzien EdD Peggy Wheaton PhD Thomas L. Whiddon MS Jim C. Whitley EdD Christina Williams PhD Alison Wilson PhD Nancy E. Wilson PhD James R. Womack PhD Murray E. Worsham PhD Mimi Wright PhD Jarvis A. Wright, Jr. PhD Sara Young PsyD Robert Zachary PhD Carol Zuccone EdD Burton J. Zung PhD
Texas Psychologist
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PSY-PAC UPDATE J. Paul Burney, PhD
I want to personally thank all TPA members who have contributed to PSY-PAC this year, our PSY-PAC Board of Directors, and Dr. Ron Cohorn, PSY-PAC Past President, for his advice, insight, and wisdom. PSY-PAC had an excellent year in spite of the Texas and national economy. From January to August of 2002, 95 PSY-PAC members donated $29,085.29, including funds for RxP. During the same period this year; 204 PSY-PAC members contributed $35,583.13, including RxP. This represents a 22 percent increase of $6,497.84 in donations and a 115 percent increase of 109
additional members. In January through August of 2002, we received 12 donations of $1000, one donation of $2000, and one donation of $4000. For the same time period this year, we also received six donations of $1000. The year 2004 will be an important year for TPA and PSY-PAC as we begin preparation for the 2005 Sunset Review of our Psychology License and Practice Act. We will need to be present at legislative events, fundraisers, and receptions to educate our legislators about the importance of psychology as a profession and the benefits we provide to society.
TPA’s legislative success requires effective grassroots activism, personal contact with legislators, solid lobbying, and generous financial contributions. If you are not currently a member of PSY-PAC, take the opportunity to join and contribute at TPA’s Annual Convention in Dallas on November 6-8. PSY-PAC’s Annual Board Meeting will be 8 a.m. - 9 a.m., Saturday, November 8 and all members are encouraged to attend. All members who have contributed $100 or more are eligible to vote on all PSY-PAC matters. Thank you for your current and continued support and for making this a very successful PSY-PAC year.
New Members The following individuals joined TPA between June 26, 2003 and August 20, 2003. TPA welcomes all of our new members. Doctoral Members Sheryl Gordon Beatty, PhD Joan Biever, PhD Kier Bison, PhD William Brown, PhD Lyle Cadenhead, PhD Mimi Cotellesse, PhD Mary Damkroger, PhD Josephine De Los Santos, PhD Sid Dickson, PhD Marie-Elise DuBuisson, PhD Philip Dunbar, PhD Kelly Goodness, PhD Henry Hanna, PhD Margaret Jordan, PhD Jon Lasser, PhD Lisa Lind, PhD Alice Lottes, PhD
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Texas Psychologist
Gloria Miller, PsyD Monte Miller, PsyD Frankie Paulson-Lee, PhD Joellen Peters, PhD Adam Saenz, PhD Charles Scherzer, PhD Theresa Sharpe, PhD Sonia Simon, PsyD Gregroy Simonsen, PhD Victoria Sloan, PhD
Associate Members Manuel Dominguez, MA Dana Truman-Schram, MA Stephanie Tong, MA
Trisha Bement, MS Catherine Callender, MS, MEd Lisa Cepeda, BA Rachel Chauncey Melissa Graham, MEd Melenie Hohensee, MEd William Jarrold, MA Marie Lamothe-Francois, BA Julie Maggard, BA Ivana Radovancevic Nora Resendez, BA Jack Tsan, BA Susana Verdinelli, MEd Alicia Valle, BS Kenneth Whitton, Jr. Mickie Wong
Students Daniel Altman, MS
WINTER 2003
2003 PSY-PAC Contributors April 1, 2003 – June 25, 2003 $2000
Paul Chafetz, PhD
Nancy Leslie, PhD
Michael Walker, PhD
George Faibish, PhD
Edward Davidson, PhD
Gloria Chriss, PhD
Alaire Lowry, PhD
David Welsh, PhD
Elizabeth Fowler, EdD
Pauline Clansy, EdD
Tom Lowry, PhD
Joan Weltzien, EdD
Alan Frol, PhD
$1,000 - $1,999
Karen Claridge, PhD
Janna Magee, PhD
Richard Wheatley, PhD
Adrienne (Ann) Gardner, PhD
Walter Bordages, PhD
Ron Cohorn, PhD
Patricia Martinez, EdD
Michael Whitley, PhD
Sylvia Gearing, PhD
Tim Branaman, PhD
Maria Concepcion Cruz, PhD
Xavier Martinez, PhD
M. Wright Williams, PhD
Jayne Gordon, PhD
Paul Burney, PhD
Sean Connolly, PhD
Donald McCann, PhD
Shirely Willis, PhD
Lois Graham, PhD
Cheryl Hall, PhD
Raye Coxe, PhD
Glen McClure, PhD
Connie Wilson, PhD
Pamela Grossman, PhD
Ethel Hetrick, PhD
Jim Cox, PhD
Joseph McCoy, PhD
James Womack, PhD
Carol Grothues, PhD
Alan Hopewell, PhD
Robert Cross, PhD
Jerry McGill, PhD
Eirene Wong-Liang, PhD
Barbara Hall, PhD
Kenneth Huff, PhD
Walter Cubberly, PhD
Richard McGraw, PhD
Kathryn Wortz, PhD
Jo Beth Hawkins, PhD
James Quinn, PhD
Caryl Dalton, PhD
Robert McKenzie, PhD
John Worsham, PhD
Annette Helmcamp, PhD
Deanna Yates, PhD
Patricia Driskill, PhD
Robert McLaughlin, PhD
Jarvis Wright, PhD
David Hensley, PhD
Michael Duffy, PhD, ABPP
Robert Mehl, PhD
$500 - $999
Annette Edens, PhD
Muriel Meicler, PhD
Under $100
Carola Hundrich-Souris, PhD
Frankie Clark, PhD.
Wayne Ehrisman, PhD
James Meredith, PhD
Elizabeth Abbott, PhD
Adele Hurst, PhD
Richard Fulbright, PhD
Raymon Finn, PhD
Brad Michael, PhD
Lynn Aiken Price, PhD
Sarah Kramer, PhD
Morton Katz, PhD
Alan Fisher, PhD
Charles Middleton, PhD
Bruce Allen, PhD
Richard Krummell, PhD
Lane Ogden, PhD
Joseph Fogle, PhD
Robert Mims, PhD
Martin Ancona
Wanda Kuehr, PsyD
Dean Paret, PhD
Ann Friedman, PhD
Lee Morrisson, PhD
Carolyn Anderson, PhD
Betty Lanier, EdD
Mimi Wright, PhD
Michael Gottlieb, PhD
Leon Morris, EdD
Karen Belter, PhD
Rebecca LeBlanc, PhD
Steven Gray, PhD
Suzanne-Mouton-Odom, PhD
Karen Berkowitz, PhD
Rochelle Levit, PhD
$100 - $499
Susan Gifford, PhD
Joanne Murphey, PhD
Ronald Boney, PhD
Stephen Loughhead, PhD
Barbara Abrams, EdD
Jerry Grammer, PhD
Frank Ohler, PhD
Bonnie Brookshire, PhD
Marilyn Maas, PhD
Laurence Abrams, PhD
Chuck Gray, PhD
Michael Pelfrey, PhD
Stacy Broun, PhD
Patricia Mahlstedt, EdD
Joan Anderson, PhD
Josue Gonzalez, PhD
Laurence Perotti, PhD
Timothy Brown, PhD
Dwayne Marrot, PhD
Kyle Babick, PhD
T. Walter Harrell, PhD
Sally Porter, EdD
Amos Bruce, PhD
Charles McDonald, PhD
Elizabeth Barry, PhD
Charles Haskovec, PhD
Shelly Probber, PsyD
Sam Buser, PhD
Stuart Nathan, PhD
Patricia Barth, PhD
Sophia Havasy, PhD
Walter Quijano, PhD
L.Carol Butler, PsyD
Dorothy Pettigrew, PsyD
Barbara Beckham, PhD
Swen Helge, PhD
Lynn Rehm, PhD
Jane Carr, MA
Aurelio Prifitera, PhD
Connie Benfield, PhD, ABPP
Scott Hickey, PhD
John Reid, PhD
Ralph Casazza, PhD
Janet Rexroad, EdD
Joan Berger, PhD
David Hopkinson, PhD
Elizabeth Richeson, PhD
Terri Chadwick, PhD
Harriet T. Schultz, PhD
Lee Berryman-Tedman, PhD
Robert Hughes, PhD
Laurie Robinson, PsyD
C. Munro Cullum, PhD
Norman Shulman, EdD
Malcom Bonnheim, PhD
Sheila Jenkins, PhD
Leigh Scott, PhD
Kenneth Cyr, PhD
Gregory Simonsen, PhD
Peggy Bradley, PhD
Kevin Jones, PhD
Robbie Sharp, PhD
Dana Davies, PhD
Jana Swart, PhD
Ray Brown, PhD
Charles Keller, PhD
Jev Sikes, PhD
Sally Davis, PhD
Thomas Tully, EdD
Bradford Brunson, PhD
Burton Kittay, PhD
Laura Spiller, PhD
Sharon Davis, PhD
Patricia Weger, PhD
Erica Burden, PhD
Christopher Klaas, PhD
Nannete Stephens, PhD
John Deines, PhD
Mark Wernick, PhD
Robin Burks, PhD
Harry Klinefelter, III, PhD
Alan Stephenson, PhD
Alfred Dooley, EdD
Deborah Gleaves, PhD
Lyle Cadenhead, PhD
Kenneth Kopel, PhD
Thomas Van Hoose, PhD
Alexandria Doyle, PhD
Alison Wilson, PhD
Linda Calvert, PhD
Angela Ladogana, PhD
Mark Voeller, PhD
Jean Ehrenberg, PhD
Elaine Calaway, PhD
Mark Lehman, PhD
David Wachtel, PhD
William Erwin, PhD
WINTER 2003
Victor Hirsch, PhD
Texas Psychologist
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Training Workshops presented by Dr. Donna Smith The Psychological Corporation ESC Region 1 ESC Region 2 ESC Region 3 ESC Region 4 ESC Region 5 ESC Region 6 ESC Region 7 ESC Region 8 ESC Region 9 ESC Region 10 ESC Region 11 ESC Region 12 ESC Region 13 ESC Region 14 ESC Region 15 ESC Region 16 ESC Region 17 ESC Region 20
Edinburg Corpus Christi Victoria Houston Silsbee Huntsville Kilgore Mt. Pleasant Wichita Falls Richardson Fort Worth Waco Austin Abilene San Angelo Amarillo Lubbock San Antonio
10-Nov 18-Nov 4-Sep 9-Dec 10-Dec 23-Oct 30-Oct 5-Dec 2-Dec 25-Sep 23-Sep 20-Oct 17-Sep 21-Oct 15-Sep 21-Aug 8-Sep 30-Sep
11-Nov 1-Oct 15-Jan
4-Mar
3-Jun
26-Sep 28-Oct
3-Nov
4-Nov
17-Oct
27-Oct
Contact the Special Education Assessment Specialist at your Regional Service Center to register or for more information. 14-Oct
A workshop fee may be charged at some centers.
E-mail Updates
Does TPA have your e-mail address? If not, you could be missing out on
@
important announcements about upcoming CE opportunities and
numerous other important updates. If you have not been receiving
announcements from us via e-mail, then we don’t have your current
address. To have your e-mail address added, send your updated address to admin@texaspsyc.org.
WINTER 2003
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Texas Psychologist
CLASSIFIEDS
ADVER TISERS INDEX American Professional Agency
Child therapy toys, games, books, My First Therapy Game. www.childtherapytoys.com.
inside front cover
CE-credit.com
3
Center for Anger Resolution
6
EMDR
17
Hazelden
25
K-MED
17
Professional EDU, LLC
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established professionals. This is a wonderful opportunity to
The Psychological Corporation
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establish or expand a practice in Austin with the possibility for
ProfessionalCharges.com
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immediate referrals. (512) 454-3685.
Remuda Ranch
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Rockport Insurance Associates
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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-
Psychologist. Expanding interdisciplinary private group practice
Senior Connections, Inc.
17
seeks a Texas licensed Psychologist, must have experience in working
Systems-Centered Training
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with children school age to adolescents. Located in a prominent part
Therapist Helper / Vantage
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of Houston, the office has a very attractive setting. Very little managed care/emergency work. Forward resumes by fax to 713.621.7015. www.tarnowcenter.com.
NeuroPsychologist. Expanding interdisciplinary private group practice seeks a Texas licensed NeuroPsychologist, must have experience in working with children school age to adolescents.
Systems-Centered· Training: January, 2004 Austin Workshops An innovative method for: Group and Individual Therapy Couples and Family Therapy Organizational Change
Located in a prominent part of Houston, the office has a very attractive setting. Very little managed care/emergency work. Forward resumes by fax to 713.621.7015. www.tarnowcenter.com.
PSYCHOLOGISTS needed P/T (weekdays—at least 6-8 hours per week) to do assessment and treatment in nursing homes. We have 400 contracted facilities in Texas we serve, throughout the state. Visit our web site: www.vericare.com. Please send your C.V./resume to Vericare (Formerly Senior Psych Services): Email: lvanderveen@vericare.com, FAX: (800) 503-3842, PHONE: (800) 5085151.
Learn about Systems-Centered® methods for change: participate in the weekend Foundational and Intermediate training workshop on January 23-25, and/or attend the SCT® Organizational Development training on January 26-27. Developed by Yvonne M. Agazarian, Systems-Centeredº Training (SCT) is a method that reduces unproductive and defensive patterns blocking the inherent driving forces in human systems toward healthy change. Defensive and unproductive patterns are modified in a systematic order. Learning to undo defenses at one level provides a foundation set of skills for undoing defenses at the next level. Modifying the defenses reduces the symptoms that people enter therapy to manage (anxiety, tension, depression and hostile acting out) and increases the capacity to use one’s emotional and cognitive intelligence. Undoing unproductive patterns in organizations, allows the organization to direct its energy towards productive work and toward the goal for which the organization was developed. For information contact Rich Armington at (512) 306-0166. SCTº, Systems-Centeredº and Systems-Centered Therapyº are registered trademarks of Dr. Yvonne M. Agazarian and the Systems Centered Training & Research Institute.
WINTER 2003 Texas Psychologist
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TEXAS PSYCHOLOGICAL ASSOCIATION 2003 ANNUAL CONVENTION
NOVEMBER 6 - 8 DALLAS, TEXAS THE WESTIN GALLERIA For more information, call
888.872.3435 512.280.4099 or visit www.texaspsyc.org.