PSYCHOTHERAPY

President's Message 3

Editor's Column 4

Media, Marketing & Psychology

The Medicare Market 5

Feature Article

Helping to Value the Self and Others in

Group Psychotherapy 6

Feature Article

Reflections On Disaster 8

Washington Scene

Prescription Privileges: The Evolution Continues 10

Feature Article

The Opportunities and Perils of Clinton's

First Hundred Days: You Choose 13

Citation Nominees Sought By CWP 19

Feature Article

In Honor of Bernie Kalinkowitz Friend & Mentor 21

Substance Abuse

More Federal Agency Alphabet Soup

as ADAMHA Becomes SAMHSA 21

Medical Psychology

Medical & Surgical Referral Interface:

Problems with Philosophy and Nosology 23

Feature Article

Documentation of Services and Exclusions:

Can Big Brother Be Far Behind 2S

Feature Article

Our APA Super-Celebration 26

VOL.27. NO.4

OFFICIAL PUBLICATION OF DIVISION 29 OF THE

AMERICAN PSYCHOLOGICAL ASSOCIATION WINTER 1992-1993

MEMBERS·AT·LARGE Ernst Beier, Ph.D., 1991-1993 44 West Third Sooth,

ApI. 11607 South

Sail Lake Chy, UT 8410 1 Office: 801-581-7390

Division of Psychotherapy of the American Psychological Association 1993 Officers

OFFICERS

President

Gerald P. Koocher, Ph.D. Dept. of Psychiatry Children's Hospital

300 Long ..... ood Ave. Boston, MA 02115·5737 Office: 617-735-6699 FAX: 617-730·04575

....

Past President Reuben Silver, Ph.D. 510 Huron Rd. Delmar, NY 12054 Office: 518-439-9413 PAX: 518·439-9413

Presld ent Elect

Tommy T. Stigall, Ph.D. The Psycholgy Group

701 S. Acadian Thruway Baton Rouge, LA 70806 Office: 504·387-3325 fAX: 504-387·0140

Treasurer 1992-1994 Alice Rubenstein, Ed.D. Monroe Psychotherapy Or. 59-E Monroe Ave.

Pimf ord, NY 14534 Office: 716·586-04 \0 fAX: 716-586-2029

Secretary 1991.1993

Pat rieia S. Han nigan-Farley, Ph. D., 24600 Center Ridge Rd., Ste .. 420 Westlake, OH 44145

Office: 216-871-6800, Ext 19 FAX: 216·871-1159

Wade Silverman, Ph.D., 1993-1995 1514 San Ign acio, Suite 150

Coral Gables, PL 33146

Office: 305 ·661-7844

FAX: 305·666·8888

Morris Goodman, Ph.D., 1993-1995 One Cypress SL.

Maplewood, NJ 07040

Office: 201-763-3350

Suzanne [I. Sobel, PIl.D., 1993-1995 1680 Highway A lA, Suite 5

Satellite Beach, FL 32937

Office: 407-773·5944

Sandra Haber, Ph.D. , 1991·1993 211 W 56lh St.,1I21H

New York, NY 10019

Office: 212·246-6057

FAX: 718-768-4851

Carl Zimet, Ph.D., 1992-1994 4200 E. 9lh Ave.

Univ, of Colorado Medical School Denver, CO 80262

Office: 303·270-8611

PAX: 303·270·8611

Norine G. Johnson, Ph.n~ 1992·,]994 110 W. Squanturn.jt l?

Quincy, MA 02171

Office: 617-471-2268

FAX: 617-323-2109

REPRESENTA TIVES TO APA COUNCIL

Donald K. Freedhoim, Ph.D. 1993-Feb 1996

Dept, of Psychology

Mather Memorial Bldg.

Case Western Reserve Univcrsuy, Cleveland, OIl 44106

Office: 216-368·2841

FAX: 216-368-4891

Ronald F. Levant, Ed.D., 1991-1993 1093 Beacon SI., 113C

Brookline, MA 02146

Office: 617·566-4479

FAX: 617-484-1902

Lisa M. Porche- Burke, Ph.D. /992-1994 CSPP-LA

lCXXl S. Freemont Ave. Alharn bra, CA 91803- 1360 Office: 818-284 ·2777

Carol D. Goodheart, Ed.D., 1991. Feb. 1994

21 Harper Rd.

Monmouth Jct., NJ 08852 Office: 908·246-4224

LIAISONS/MONITORS Administrative Liaison Mathilda Canter, Ph.D, 4{)3S E. MeDooald Dr. Phoenix, AZ 85018

Office: 602 .g4{). 2834

BAI'l'I MonilOr Irene Deitch, Ph.D. 57 Butterworth Ave.

Staten Island, r-.ty 10301-4543 Office: 718·390-7744

CEMA Monitor

Lisa M. Porche-Burke, Ph,D, CSPP·LA

1000 S, Premont Ave. Alhambra, CA 91803-1360 Office: 818-284·2777

Unison to APA International Committee Ernst Beier, I'h,D,

44 '. Thi rd South, 11607 South Sail Lake City, UT 84101 Office: 801·581·7390

EDITORS OF PUBLICA nONS

Obsen'tr /0 APA & CA PP Practice Directorate

Ellen McGrath, Ph.D. 1938 Del Mar

Laguna Beach, CA 92651 Office: 714-497·5003

Psychotherapy Journal

Donald K. Freedhclm, Ph, D, Editor Dept of Psychology

Mather Memorial Bldg.

Case Western Reserve University Cleveland, OH 44106

Office: 216·368-2841

REPRESENTA TlVES TO JCPEP Tommy T. Stigall, Ph.D.

The Psychology Group

701 S. Acadian Thruway

Baton Rouge, LA 70806

Office: 504-387-3325

Psychotherapy J o urna 1

Wade H. Silverman, Ph.D~ Editor· Elect 1514 San Ignacio, Stc. 150

Coral Gables, PL 33146

ornee. 305-66\-7 44

Psychoth erapy B ulletin

Linda Campbell, Ph.D., F:dilur Inivcrsity of Georgia

402 Aderhold IlaU

Athens, GA 30602-7142

Office: 404-542-8508

fAX: 4{)4·542-4130

Arthur Wiens, Ph.D.

Oregon [Ieahh Services University 3181 SW Sam Jackson Park Rd. Portland, OR 972DI

Office: 503-279·8594

MID·WINTER MARCH 9-13, 1994

Convention Coordinator Program Chair

William Fishburn, Ed,D. Louise Silverstein, Ph.D

Associate Coordinator Leon VandeCreck, Ph.D.

Continuing Education Chair Barry Schlosser, Ph.D

1993 will be a year of significant new initiatives for the Division of Psychotherapy. These will fall into three general categories: program themes, membership growth and services, and a strong focus on the future of the Division. I invite each reader to think about ways you might be able to join with the Division leadership in advancing these goals.

First, with respect to program, I have advocated with both our Mid-Winter and AP A Convention program planners a dual thematic focus on psychotherapy, diversity, and child/adolescent work. Dr. Vera Paster, on the Mid-Winter program, and Dr. Norine Johnson, on the APA program, have taken up this challenge well. Significant content d~ng with the full range of potential client populations across diverse racial and cultural lines will be a part of our programs this year. In addition, there will be a renewed focus on psychotherapy with children and adolescents, groups overlooked in our programs over the past few years.

Second, with respect to membership, we are planning a major new membership recruitment campaign as well as some new membership benefits. Under the leadership of Membership Chair Dick Mikesell, we shall undertake a significant direct-mail membership drive utilizing a streamlined process for bringing interested colleagues on board. This will be paired with a plan to offer continuing education credits to our members who attend specifically designated portions of the Division's programs at the APA convention. We will allow non-members to join "on the spot" to

PRESIDENT'S MESSAGE

Gerald Koocher

earn continuing education credit, as a membership enhancement strategy. Watch for details in future issues of the Bulletin regarding which symposia and other presentations will be offered with continuing education credits at the August meeting in Toronto.

The third focus of my administration will be undertaking a self-study of the Division, looking toward our role in the next 100 years of American psychology. The Board of Directors will be holding a special retreat session in connection with our meeting at the Mid-Winter convention. I encourage readers to drop me a note with any topics related to our Division's future that you would like to have addressed as we consider future activities and our role within APA.

PSYCHOTHERAPY BULLETIN Published by the

DIVISION OF PSYCHarHERAPY AMERICAN PSYCHOLOGICAL ASSOCIATION

3875 N_ 44th Street • Suite 102 • Pboenix. ArizcQa 85018 • (fm) 952·8656

WADE SIL YERMAN. Ph.D .• Editor

CONfRIBlITING EDITORS

Medical Psychology ._._,_ David B. Adams, Ph.D.

PSYCOhmm .• • __ ._._ Mathilda Canter, Ph.D.

W!!Shingmn Scene. Edinr __ Patrick Del.eon, Ph.D.

Media. • -1a:rteting &: Psychology __ ._ _._ Bruce Ferman, Ph.D.

ProfessianalLiability ._. __ Leon VandeCreek, Ph.D.

F'inance - Jack Wiggins, Ph.D.

Group ~ ~_ •• __ ._._ _ Morris Goodman, Ph.D.

Substance AOOse . __ •• _ Harry Wexler, Ph.D.

STAFF

Ceni:ra.l Office Administrator Pauline Wampler

Associate Adminis1J'alOr Norma K. Files

3

In closing, I urge all of you to support the recent call from AP A for contributions of"$1 00 for 1 00 Days" to boost APA's drive for inclusion of psychologists under any future national health insurance plans. The Division will be making a substantial contribution to

this cause, as your Executive Board sees success of this initiave as an absolute necessity if we are to assure the public interest and survive as a profession. Please sign on to this initiative with your contributions.

EDITOR'S COLUMN

Wade Silverman

This is my last issue as your editor. It has been a wonderful six years in which I had the opportunity to become friends with so many good people. The Publication Board nominated and the Board of Directors approved the appointment of Linda CampbeU as your new editor. We had the oJ'lportunity to meet over several: hours to discuss the transition and to make acquaintance. The Bulletin will be in great hands.

I want to thank each and every one of mycontributing editors for a job well done. Norma Files and Pauline Wampler made my jobso much easier .. Though I never did get to use the camera effectively, I do remem ber so many of your smiling faces at the various Mid-Winter and APA Conventions.

Several weeks ago I received a gift from colleagues to ease the pain of our hurricane loss. Thank goodness, our insurance has handled our financial concerns so it was not needed for food or housing. However, it was deeply appreciated, I used that gift to get away from architects. contractors, insurance adjustors, and building inspectors to take a brief vacation with the entire family. I know who organized that effort to give the Silverman's this time together and it is deeply appreciated, We all thank you and we are all deeply touched by your caring,

In this issue are two featured articles by Art Kovacs and Bob Resnick about the assaults on our profession. 1 am particularly aware of their warnings following two different events that have taken place in my own practice in the last two weeks. First, I received a registered letter from a major insurance carrier informing me that due to business considerations, I was being dropped from the provider list This would

happen within the next four weeks .. The vast majority of my colleagues were also dropped from the list. In one large group practice. 27 of 30 practitioners were dropped.

The second incident was with a managed care company 3000 miles from my office. They were not in agreement with my treatment plan for a hospitalized teenager. He had been hospitalized because he hadfelt suicidal for three days. The master's level case manager wanted me to see the client every day he was in the hospital and was opposed to my not wanting to do family therapy immediately. In conversation with her, 1 explained that the family needed a cooling-off period and that I wanted to see theclienton a three-day -a-week basis. The managed care company then denied further hospitalization. Fortunately for the client, the secondary insurance company authorized more days. I called the clinical supervisor to find out if it was now policy for their case manager to dictate forms of treatment. I also asked to seethe data that the clinical director had that showed that three visits per week was less effective than five visits per week. This was the first time in my experience !hat a carrier told me how and when to treat. Once again in discussion with colleagues, I found that this was not unusual.

There are a variety of methods to accomplish treatment goals. I have no difficulty in being examined by quality assurance and utilization reviewers. However, when a clinician has an acceptable rationale to employ generally accepted treatment procedures and is denied the right to use them, then we have surely lostcontrol over the practice of our profession. This is happening today, right now. Alert your state associations and prepare for the worst

MEDIA, MARKETING & PSYCHO LOG Y !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

The Medicare Market

Bruce D. Forman

Changes in the Medicare law which went into effect in July of 1990 were hailed as a watershed ofopportunity for psychologists. While a new market ofbeneficiaries has been available to us not many psychologists have taken advantage. I've spent the better part of the past two years managing psychological services of elderly residents of nursing homes and consequently I've had to become acquainted with some of the problems we must face in dealing with Medicare reimbursement.

One of the most interesting things I've noticed is that many psychologist are afraid of Medicare because they don't understand the regulations. One of the first things to understand is that while the regulations come from the Health Care Financing Administration (HCFA) interpretations are made by the Medicare authority in each state. Thus, you must rely on the local carrier to provide you with information regarding how and where claims fu-e processed along with the reimbursement rates and anything that will affect those rates. Secondly, it is not sufficient to get information once and assume you know everything you need. The rules change periodically and you must keep current. Sometimes providers miss a bit of information and might not find out until the Explanation of Benefits indicate a smaller than expected payment or denial of the claim. If questions come up it's best to call your carrier and get the most current information. Most carriers will gladly give you a written response if requested.

Psychological services are new for the Medicare carriers and they do not understand our industry very well. In their system we are "physicians" and the work we perform is viewed in the same way physicians render their services. Diagnostic tests, for example, can be performed by an assistant To be reimbursable testing must be done within the context of a treatment regimen. If psychological testing is performed and there is no subsequent treatment, it is not reim bmsable because it is considered "screening," a non-covered service. If you've been accustomed to baving an assistant administer tests for yon and then yon score and interpret the results or even snpervise and co-sign a report completed by a psychometrician. yon must play by different rules, While yo may have an assistant work with you their WCHk must be "'incident

to" services you personally render. That means you must by physically present in the same suite of offices or at the facility at the time the services are rendered and be immediately available in the case a question or issue arises pertaining to the overall management of the case. This way of working may be a little unusual for psychologists who supervise testing, but until the regulations are changed we must comply or face the consequences of filing fraudulent claims.

I've spoken with a number of psychologist who have given up in disgust and refuse to participate in the Medicare system. This is unfortunate. Although frustrating, navigating through the sea of red tape can be accomplished. There is a vast market available to us as a result of both the changed law and by the fact that the elderly are rapidly becoming a larger segment of the U.S. population. In fact, people over 100 are the fastest growing group! In the language of the 1988 Omnibus Budget Reconciliation Act chemical restraints (i.e., psychotropics) are less desirable than psychological interventions. because of a long history of overuse and abuse.

In addition to psychotherapy, we can develop al ternative or indirect models of psychological services that emphasize consultation and training in much the same way psychologists have done in other settings, such as schools. Our next challenge is use our expertise to develop psychological services for severely regressed and end stage Alzheimer's patients, their families, and their caregivers.

My experience in working with this population is that they are usually open to treatment and deal with some major issues in living. One of the challenges we face as therapists is dealing with our own concerns over death, loss of loved ones, debilitating illness, and declining autonomy. I've discovered that elderly patients bond very quickly and express their appreciation of the chance to experience personal growth in just a few sessions. Given that the incidence of treatable emotional disorders among the elderly is so high and other market segments are eroding I recommend consideration be given to getting involved in providing services to the elderly.

5

FEAlU RE A aneta !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Helping to Value the Self and Others in Group Psychotherapy

Michcu;/ P. Andronico

The Group As A System

The perception of the psychotherapy group as a system is another crucial aspect in the furthering of appreciation of self and others. When the group therapist points out that people tend to play roles in a group, the group members begin to learn which roles they tend to play and why. These discoveries and explorations help the individual members to more clearly see that the group contains an entire range of feelings and viewpoints, with certain members emphasizing particular views and other members highlighting other views. The realization that one is speaking for a point of view helps individual mem bers to see that it is helpful for the rest of the group to have that viewpoint represented in order for the group to be able to explore a wide range of feelings. This makes it easier for individuals in the group to express unpopular feelings and points of view. It also allows for many opportunities for conflict resolution since many different opinions are offered.

In the summer 1992 issue of The Psychotherapy conflict. The opportunity and pressure to resolve Bulletin, Morrie Goodman (p.26) addresses the cen- conflicts in the group helps those with poor conflict trality of the "others" in the group psychotherapy resolution skills to develop these skills through obmilieu. He states that "cooperativeness, transparency, serving others and gradually participating in these congeniali ty, warm th, respect and acceptance are re- discussions and interactions. As these people increase warded in the group therapy context." These charac- their participation and voice their own reactions and teristics are indeed rewarded, but at a dual price. The distortions, they can begin to see that their opinions are initial price is running a high risk of vulnerability. In usually valued by others in the group, thus increasing individual psychotherapy, a client certainly encoun- their own feelings of self worth. In those situations ters the vulnerability of their own fears of humiliation, where their own distortions lead their opinions far shame and other negatives which go along with the from the point, they can learn to accept that their exposure and discussion of their deeper feelings. Doing _ opinions are not always correct and that these distorso in the exclusive company of an individual therapist tions can lead them to relevant personal material, however, substantially reduces th~ risk on a reality rather than angry self-recriminations or excessive level, especially since one is paying this therapist! defensiveness. This type of acceptance by the group encourages group members to express and deal with their shortcomings.

In group psychotherapy however, the client risks much more in the presence of their peers who are not paid and have many more opportunities to be spontaneous and directly critical (as well as supportive). The second price which members of a group pay is leaming to recognize and modify how they interact with others in ways that are negative and work against themselves. This recognition is often painful and difficult. The payoff to all of this is that once a group member begins to see their negati ve traits and experience the other group members as still accepting him or her as a person despite their "warts", then the process of change and self acceptance becomes accelerated. During this process the group members also accept and value others as well.

In group psychotherapy "intro group transferences" are often more intense than transference in individual therapy because there are more people in a group who more realistic all y resemble transferential figures, than a therapist does. For example, it is much easier to get angry at a whining, complaining female member in a group who resembles one's mother, than a passive supportive male therapist.

When group members realize that they are vulnerable to criticism and verbal attack from other group members and that this rarely happens without offsetting support and opportunities for resolutions of conflict, the individual begins to gain more confidence in their ability to constructi vely respond to criticism and

This perception of the group as a system which needs to explore many facets and feelings, readily leads to insights into other systems such as, what role do the individual group mem bers play in their present families, their families of origin. their jobs. and other places. A further extension of systems thinking is that individual members begin to see themselves as a

6

system, with many conflicting needs and desires which figure for the acceptance of differences. The group need exploration and appropriate expression. This psychotherapist points out where and when the group insight leads to a deepening appreciation of one's self gets "stuck" and facilities the exploration of, and and recognition of the value and necessity of movingbeyond,thesestuckpoints. The therapist also becoming a more rounded person with more points out avoidances of issues when they arise. adaptive abilities.

The therapist's willingness to confront conflict is

The Therapist's Role crucial to the group. The acceptance of conflict and

E th h th diff t h I the continual pointing out of opportunities to resol ve

ven aug erearem~y,~any, eren ,sc oo.s conflicts among group members sets the stage for

of group psychotherapy With different theoretical on- I . th '. rta t kill A' I tate t

. th b . th ., I' , 'tar' alm . earnmg ese Impo n s . s. sunp e s men

entatrons, e asic erapist s ro e IS Simi . 10 ost h "Y f t be t h th ' thr ts f

all. Even those group therapists who claim that they do sue as au our seem 0 a eae o. er s roa ~r

". divid I th " . .. " all kn I the past few weeks. How are you gomg to work this : I~ ~:;:y ~ ~ group usu J a~. ow ~ out?" gives the message that it is possible to resolve

ge ~ unPO. ce 0 t e group as a mo va IDg an this in the group, and that the therapist is not taking

suppo ve environrnen . sides. By not siding with either party, the therapist avoids encouraging scapegoating. By preventing scapegoating the therapist's attitude of valuing each member of the group is communicated and helps the group members to value themselves and others to a greater degree.

The most important aspect of the group psychotherapist's role is to establish and maintain a safe environment in which group members can interact and explore their feelings. The group leader points out the commonalities and differences among members, with an attitude of value and appreciation of differing points of view, Here the group psychotherapist serves as a role model and transferential authority

And to society!?!

"Treatment of Addictive Dlsorders"

Nineteenth Annual Advanced International Winter Symposium

January 31 - February 5, 1993 Colorado Springs, CO

Contact: Dr. Gary G. Forrest Psychotherapy Associates, P .C. 3208 N. Academy Blvd., Suite 160 Colorado Springs. CO 80917 (719) 594-9304 or (719) 597-5959

Correction

Bulletin 27:3, FaIl Issue: David B. Adams' article «Factitious Disorders and Malingering: Choosing the Appropriate Role for the Psychologist". On page 11 Dr. Adams lists the diagnostic criteria for antisocialpersona1itydisorder; indicatingitemJ' deliberately engaged in fire fighting," Dr. Adams meant to say "deliberate engaged in fire setting!

7

FEAT U REA anc L E !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Reflections On Disaster Beth Wheeling

On August 24, 1992 South Florida experienced the largest natural disaster in American history in the form of Hurricane Andrew. While most psychologists get training in working with trauma, very seldom is there an opportunity to see what works and what doesn't on such a grand scale. This was one such opportunity.

Although disaster plans were in place. I don't think that anyone could really have imagined or planned for the profound needs of a large population that was so thoroughly devastated. Many major corporations manned relief efforts and sent staff to assist in providing people with the basic necessities. Typically, most efforts are organized in terms of "teams." people who work together to get the needs of the people who are affected met.

I was called in by several large local corporations to assist their employees and relief teams. The therapeutic teams brought in by the company were overwhelmed by the level of loss they encountered. It takes a lot of energy to hear over and over again people discussing nightmarish scenarios of their attempts to survive. In a few short hours South Florida was transformed from a sophisticated city to the frontier. One loss piled upon another as people searched for lost family members and pets. Looters pegged nice neighborhoods as targets. People stayed at their demolished houses with guns to protect what little they had left.

Part of the stress of a disaster is that most people have no frame of reference for how to deal with the demands of the situation. We were constantly challenged to be resourceful while trying not to identify with clients and wonder how well we might cope if faced with similar situations. The biggest challenge to remaining an effective helper was to be able to avoid over identifying with the people we were trying to help. After awhile, numbness set in for most of the therapists. It became very clear at the outset that some part of the relief team needed to stay away from the disaster sites to provide a balance for the other team members who became traumatized by constant exposure to the disaster victims.

I came to understand Maslow's "Hierarchy of Needs." People weren't discussing emotions, they were too busy managing shelter and safety. The

luxury of depression would come later. The biggest psychological need of the survivors was support for structuring the meeting of their basic needs. Most people were dazed. Because there was no power, therefore no communication. no one knew where to get food or ice. There was no way of knowing the condition of the roads until you got to them, or whether the stores they would lead you to had supplies.

The most useful commodities were supplies and information. When we could supply these, people did not have to waste their energy.

Part of the fatigue on the part of the teams was the fact that everyone had to go through a cognitive restructuring. Imagine a world in which there are no working traffic lights. Imagine not being able to get in your car to go out. Imagine a swat team outside your local supermarket to prevent riots by people who had driven miles to get ice.

Take that one step further. Imagine trying to conduct your business without hot showers. electricity and clean water. Many simple acts became enormously complicated. In the early weeks after the storm I began to see people in my office who were experiencing marital and famil y discord. Many people lost jobs as well as houses and their emotional resources were stretched to capacity. Parents whose children could not sleep called to get help in discerning what was normal behavior in the midst of such abnormal circumstances.

Within the companies I was working with, services were set up so that psychological support was provided for any employee or family member who wanted it Educational materials dealing with emotional responses to disaster were circulated among employees.

My gut feeling was that the best way to assist employees of the company that I served was to go OUl into the field and do some educational programs. We were able to implement such a program about two months post hurricaine and it seemed to create a good bridge between employees and their EAP programs.

Four weeks after the storm I was asked to take over a program at another large local employer who had

8

hired another psychologist from a national company that specializes in disaster relief.

He supervised disaster relief, set up day care so employees could leave small children while they attended to their recovery and rebuilding, and provided education regarding psychological aspects of disaster to management and staff.

By the fourth week, everyone in the company had been debriefed in groups when they returned to work. Parents were given classes and handouts on how to deal with traumatized children. Managers were educated about the effects of trauma on employees and how to manage emotional issues in the workplace. By the time I arrived this consultant was accepted as a trusted friend.

,.,

Now that some time has passed and I have regained much of my pre-hurricane emotional balance I have tried to evaluate the victories and pitfalls of my EAP efforts. These are the things that I have concluded:

1. It is helpful to have a disaster plan in place.

2. It is naive to think that initially people will need psychological support. Most people focus on survival and need information and supplies. Therapists are valuable insofar as they can listen and validate the trauma.

3. It is nice to blend local and national support When I heard that one of our large local corporations had flown in experts from other cities I was initially angry that they were not using local people. It was weeks later when I realized that people who did not personally experience the traumas and losses had a lot more to give. A great deal of my energy was going to just reorienting m yself or deaIing with daily struggles of living with no power and contaminated water. Most people who were brought in to help could at least go back to an air cond.itioned hotel room and a bot shower.

4. It is probably better to take tbe in:iriatire and se

up educa1ional programs. ratba then - fel'

people to take advantage of services. The kind of education that parents got abom traumatized

children helped to spare them from additional feelings of stress and helplessness.

S. Having one constant person "in-house" offers people a sense of constancy and a comforting resource during the time after a disaster.

6. If work settings are too spread out for one "in-house" person, then regular debriefing and update sessions should be scheduled in those work settings at a minimum of four week intervals to monitor progress, normalize reactions, provide support and identify employees at risk.

7. The need for ed ucation doesn't stop as time passes. A large part of the difficulty businesses . are facing now is because of the different pace of each employee's recovery. People who are ready to move on from the trauma are losing patience for people who are still struggling with the effects of the disaster. Our efforts now need to focus on additional emotional support and building tolerance.

8. Be prepared for the people with marginal coping skills to need psychological services early on. People for whom emotional coping is a daily challenge will be the least prepared to deal with the trauma. You can count on marital discord, domestic violence. increased reliance on drugs and alcohol.

In the last two months I ha ve come to understand the process that Don Catheral refers to as "staggering in sync." It has been very interesting to trytobeahelping professional to disaster victims while being one myself. The biggest difficulty ahead of us is finding a way to move forward while continuing to support those who are still in the early stages ofrecovery. Because so many pans of Miami seem normal. it has been easy to put people who are not so fortunate out of our minds.

J a fe miles from my house people are only now starting to rebuild, Their lives will not be normal for many more months. As much as South Florida may want to put the hurricane behind it, the reality is that recovery will not be complete until we can all move forward together.

9

...

WASHINGTON SCENE !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Prescrlptlon Privileges: The Evolution Continues

Pat DeLeon

This year during its deliberations on the Fiscal Year 1993 Appropriations bill for the Department of Defense (DoD)., the House of Representatives did not express any objections to the psychology prescription privilege training program. The only modification which the House proposed was to eliminate the specific directive that the training was to be exclusively conducted at the Walter Reed Army Medical Center, thus providing DoD with greater administrative flexibility. The House-Senate conferees subsequently agreed that ''The conferees are pleased. with the progress being made on the psychology prescription training program and especially the efforts to develop relevant training modules which complement the trainees' expertise ... Ongoing external evaluation and selection of the next class are expected to proceed." PresidentB ush has now signed this bill into public law (p.L. 102-396), and we continue to be assured by Lt. Col. Scott Fairchild, one of the psychology trainees, that "the piglets" (as "Dr. Bob" Resnick continues to call them) are doing just fine,

On the state level there have been some very interesting developments. Ruth Paige, of the State of Washington recently reported on the activities of their Association's Prescription Privileges wk force: In general, we have spent the past year building support by offering presentations and having open discussions at our Spring and Fall statewide meetings and at regional meetings as well. We have presented at two of the six regional chapters so far. We plan to have one or two of our members present to all of the chapters in the state. While the activity is somewhat repetitive, we have found that people who attend chapter meetings may not be the sarneas those who attend the statewide meetings and vice versa. We're trying to speak. 10 as many people as we can because we've realized that, after exposure to the topic of prescription privileges and after having the chance to ask many questions, people feel more involved, positive, and reassured. We include known opponents of the idea on the panel, and they, of course, raise as many of their concerns as they wish. Most of the concerns focus on educational. preparation and training .. Many are concerned that psychologists will be moving into something that is much more complicated than we imagine, and that our current training has not prepared us for the task at all, Usually when questioners learn about the

training offered at Wright State, the Division 28 ePE proposals.etc., theyappear to be reassured.

We have also met with representatives from the University of Washington and Washington State University, the two doctoral training institutions in oUI state. The representatives are task force members and they are beginning to advocate for the development of predoctoral training in psychopharmacology for entering clinical psychology doctoral students.

A representative of our task force will, when she goes to Hawaii next month, meet with Ray Folen ani! learn about Hawaii's demonstration project. We are considering the notion of establishing a demonstratioc project in this state.

At our most recent meeting. we planned our 1993 activities. These will be primarily educational. Wr. plan to work more closely with faculty from the University of Washington and Washington State University. Also, we're planning to ha ve a series of CPE events on psychopharmacology for licensed psychologists at our two statewide conventions, at our regional meetings. and possibly even a mini-convention onjusi that topic. The goals of the CPE presentations will be 10 better prepare Washington psychologists to understand and assess impact of medications their patients are receiving and to consult with prescribing physicians more knowledgeably.

Working with the task force members is fun and exciting. We continue 10 look forward to meeting the chaUengeofinforming and in volving psychologists iL. this state ..

At the Centennial Convention in Washington, DC the APA Practice Directorate convened a meeting of the leadership of those State Psychological Associations which had expressed interest in the prescription privilege agenda. Representatives were invited. from 11 states and approximately 50 psychologists attended, The most exciting development was the decision by the leadership of the California State Psychological Association, under the leadership of President Arlo Thomas, to seriously pursue relevant legislation, pursuant to deliberations held by their 40+ member Board of Directors earlier this year. The California "game

10

Under Russ's leadership the Practice Directorate has also been performing an analysis of non -physician provider prescription privilege laws across the nation to identify various models, structures and issues accounted for in other professions' endeavors so as to facilitate the development of proposed modellegislation for psychologists. One component of this effort will be close collaboration with relevant policy staff of the American Nurses' Association - who are in the midstof developing a nationwide nursing prescription strategy. A survey of public perceptions regarding the underlying issue of psychology prescribing .as well as the utilization of outside consultants to develop a strategic "action plan" that would address training and education issues are also progressing. These efforts are extraordinarily consistent with the recent policy position taken by the Committee for the Advancement of Professional Practice (CAPP). under the leadership of Pierre Ritchie, that: "CAPPreviewed current developments both internal and external to the field of psychology including: information regarding some of the contents of the draft report of the AP A Task Force on Psychopharmacology, the status of the DoD training program, the expressed interest of the Board of the California Psychological Association in moving to seek privileges from the California legislature, developments in the Hawaii mental health system. and the outline of a preliminary proposal from Consultants in Health Care Projects. After revisiting the matrer again, as CAPP has done for the past se reral years, and

after a careful revie of the re1evaru - the me ~

bers of the Committee oted unanim Ie support

reasoned efforts to secure presen . g ges for

those groups of psychologists ..... bodesire to utilize this treatment modality and '0\110 demonstrate appropriare. training.

plan" includes such activities as planning and effectuating a strategy which will endure over perhaps ten years, but will begin strong with introduction of legislation in 1993. This will include regional presentations to the various chapters. a "training of trainers" workshop, and comprehensive public information campaign - including educating legislators, California psychologists, and consumers. Interim goals include the establishment of several psychology prescription demonstration pilot projects and the active involvement of psychology's training programs. As one might well imagine, Russ Newman of the Practice Directorate is working closely with CSPA.

In order to respond in a measured fashion, CAPP is now prepared to participate with those states who both wish and are positioned to move forward with legislative and! or regulatory initiatives and to facilitate the implementation of appropriate training sequences designed to achieve this outcome .... " This is, indeed. a most important polk y development within the AP A governance.

For those who may continue to believe that these efforts are occurring wi thin a policy vacuum, a recent development within the U.S. Department of Justice Drug Enforcement Administration (DEA) may be informative, Earlier this year the DEA proposed that a new category of registration be established, to be called Mid-Level Practitioner (MLP), under which advanced practice nurses, physician assistants, and others will receive individual DEA registrations granting controlled substances privileges, consistent with the authority granted to them by the various states. The Administration commented in the Federal Register that: "When the CSA (Controlled Substances Act) was enacted state authority to dispense controlled substances was granted only to selected traditional medical disciplines which had broad authority to diagnose and determine treatment.... The evolution of advanced practice nurses and physician assistants as primary health care providers authorized to dispense controlled substances, makes the historical, operational process of the DEA registration system inconsistent wi th current authorized practices. The original system of practitioner registration did not anticipate a class of practitioners with such widely disparate authority. Some states have granted MLPs authority to dispense controlled substances without the oversight and approval of a traditional practitioner, while other states bave granted a more restricted controlled substance dispensing authority .... DEA now proposes to .... define MLP as an individual practitioner other than a physician. dentist, osteopath. veterinarian. ophthalmologist, or podiatrist, who is licensed, registered or orherwise permitted in the United States or the jurisdiction in which hel she practices to dispense a comrolled substance in the course of professional practice as a primary health care provider. Based on the new definition, DEA will create a separate registrationcategory for :MLPs. The procedures used under this system will parallel those which have been used "lith traditional practitioner registrations .... It should be noted that practitioners in institutional settings who

11

issue orders formedication for direct adminis tration to a patient ... are not prescribing within the meaning (of this section) and would be exempt from registration.

The Final Report of the AP A Task Force on Psychopharmacology, under the chairmanship of Mitch Smyer, was received by the Board of Directors at its August meeting and has now been forwarded throughout the AP A, Divisional, and State and Provincial Association governance for review and comment. Those wishing a copy of the impressive 120 page document should contact Sheila Forsyth of the Practice Directorate.

The Task Force report Executive Summary notes: " ... The Task Force approached the issue within the tradition of psychology's scientist! practitioner modef basing its review and recommendations as much as possible on data and on an assessment of public health needs. A clear overriding theme that emerged is that psychology, as a major provider of mental health services, must train its personnel to recognize the effects of psychotropic medications on behavior, their short- and long-term consequences for behavior, and the ways in which medications facilitate and! or retard progress with various forms of psychosocial treatment.... The Task Force developed its recommendations within a framework of three levels of training and practice in psychopharmacology .... Levell: Basic Psychopharmacology Education; Level 2: Collaborati vePractice; (and) Level 3: Prescription Privileges .... "

"Competence at Levell implies a knowledge of the biological basis of neuropsychopharmacology, including the locus of action for psychoactive substances and the mechanisms by which these substances affect brain function. A second focus of training at this level involves an introduction to the psychopharmacology of classes of drugs commonly used to treat mental disorders, including their use in treatment, side effect profiles, and their abuse."

"Level 2 training requires a doctoral degree, builds on Levell, and reflects the knowledge base necessary to participate collaboratively with other health care professionals in managing medications prescribed for mental disorders and integrating these medications with psychosocial treatment. Training at this level includes more in-depth knowledge of psychoactive medications and drugs of abuse, as well as know ledge

of psychodiagnosis, physical assessment, pathophysi ology, therapeutics, emergency treatments, substan abuse treatments, developmental ogy, and psychopharmacology research. Training f Level 2 competence includes coursework, practice, and internship experiences .. "

"Level 3 training of doctoral-degree psychologisn, in similar to training in other health service

sions that have independent prescription lim ited only by scope of practice and training. ing at Level 3 includes coursework, practica, supervised experiences to assure that the psychologi knows the appropriate medication to prescribe for th! client's unique combination of physical, mental, a environmental conditions. This level of training sumes a strong undergraduate science backgroun and at least 26 graduate credits of course work . biochemistry, physiology, and various aspects of psy chopharmacology, along with significant supervi clinical training experiences .... "

"The Task Force emphasizes the importance developing a subspeciality of psychology with co prehensive knowledge and experience in psychopbar macology. Practitioners with combined training i psychopharmacology and psychosocial treatments ca: reasonably be viewed as a new form of health car professional, expected to bring to health care deliver the best of both psychological and pharmacologi knowledge. The contributions of this new form psychopharmacological intervention have the po ~ tial to dramatically improve patient care and mal.; important new advances in treatment." This is, iL deed, a most impressive document; we would sugge however, that for licensed practitioners, considerab. less didactic and "hands on" training is actually neces sary and! or appropriate.

David Nichols of Intervale, New Hampshire, ha for example, proposed a training model which clo parallels that which we continue to "hear" from se . colleagues in the field would be more appropriate. ''" my view, two or three months of intensive co work, followed by a year of telephone supervisi with an experienced psychopharmacologist, is all is necessary. As I have been saying for several yea:: 'Give me a year, and someone who is highly moti vate; and I could turn any psychologist in the country inn: highly competent clinical psychopharmacologist'."

12

"This is how I learned. except that I didn't have the advantage of a period of intensive course work, and had to do a lot of studying on my own. I did have the availability of a mentor. Dr. Alan Gruber. a psychologist in Massachusetts who was founder of Alpha Geriatrics, Inc. and a pioneer in the implementation of a psychologist staffed and run nursing home consultation program. Because of the unavailability of psychiatrists to consult in nursing homes. and because of the ignorance of physicians in the areas of psychiatric diagnoses and psychopharmacology, we were forced to develop competence in psychopharmacology very quickly, and to make decisions about medications on the spot."

"During the past seven years I've evaluated and managed the medications of over a thousand patients, mostly frail elderly in nursing homes. As you can imagine. this group is the most difficult to medicate because of medical contraindications, polyphannacy, and age related decreases in the ability to process and metabolize these medications without toxic side effects. By 'medication management' I mean advising

the attending physician as to appropriate medication and dosage, and then monitoring the patient's response to the medication. Except for actually writing the prescription. I assume full responsibility for the treatment program, including discussing the use of medications wi th the nursing staff, the patient, and the patient's family."

"I believe that this kind of supervised learning on the 'front lines' is the ideal way to not only learn psychopharmacology, but more important for psychologists, to develop confidence in making clinical decisions in this area. Otherwise, it's concei vable that many psychologists who go through the classroom part of the training program, could develop cognitive competence in the field, but lack the confidence to make clinical decisions for their patients."

Clearly, different "reasonable" persons have fundamentally different perceptions as to exactly what would be "appropriate training modules" for those of our colleagues who are interested in obtaining prescription privileges. The (r)evolution continues ....

FEATU RE ARTICLE !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

The Opportunities and Perils of Clinton's First Hundred Days:

You Choose

Arthur L. Kovacs

I am writing these words on American Airlines Flight 75, returning to Los Angeles from Washington and a meeting of AP A's Committee for the AdvancementofProfessional Practice. It is five days since the election of Bill Clinton to the nation's presidency. CAPP spent most of its 2 1/2 day meeting attempting to parse the meaning for our profession of Clinton's successful campaign. I believe our advocacy staff at work in AP A Central Office has done its homework admirably, has made initial contacts with and inter-viewed persons likely to be of great influence in the forthcoming Clinton administration, and bas been able to assemble the outlines of tendencies and elihoods for us members of CAPP '00 00 . ha e to guide them into a frenzy of forthooming advocacy efforts. I canna promise.. yo tha1 'hal I am going to describe in this article in accurate, but' represen!.S the best soundings I am able to rrovide to jQU in the firxt week after the polls have closed. But by the time you

read this, you will probably know what wisdom these observations mayor may not contain much better than can I at this early moment,

What I do know for sure this early in the change of administrations is that your devotion to our calling, your wisdom in understanding the very complex issues we must discuss together, your willingness to make contributions of your hard-earned dollars for advocacy efforts, and your availability to telephone, to visit, and to write to your congresspersons are absolu1ely going to decide what kind of profession psychology is going to be in the coming century. We are approaching a Rubicon. The political struggles we are about to encounter will be as significant to our discipline as were our efforts to achieve licensure as these played out almost a half century ago. I believe that together we can affect our own destinies positively lhroogh our own empowerment Alternatively, through

13

stinginess and sloth, we can find that our capacity to engage in independent practice has now come to an end. The choice will be each of yours to make, and I shall calion you at the end of this piece.

We now possess some reasoned estimates about what kind of health care package Clinton, if left to his own devices, would probably advocate and implement. He has been a member of the conservative Democratic caucus for some time now, a group of Democratic politicians in state and national government who have been trying to create an agenda for America that was socially responsible, politically liberal, but fiscally can serva ti ve and prudent. In addressing health policy, the caucus has leaned heavily on the efforts of the Jackson Hole Group, a collection of health policy professionals, physicians, and health economists who have been meeting for almost two decades now at that location in Wyoming. Many of its participants were quite active in the Nixon administration and will most likely be welcomed back into advisory positions in the Clinton administration.

The Jackson Hole Group has created a model for the delivery of health services that is absolutely unlike any delivery system that currently exists in the nation - or in..any other nation, to th.ebest of my knowledge. Instead of managed care, we are now being offered a system that is affectionately called "managedcompetition" by its architects, for they firmly believe that uniform products competitively priced and selected by consumer preferences in a free marketplace will effectively drive health care costs down and keep those costs responsive to income levels and inflation rates in the country. In essence, the concept is a simple one. If there are competing toothpastes or laundry detergents all of which have similar characteristics and are reasonably equivalent in their product effectiveness, their end costs on the shelf are likely to determine which are chosen and consumed. Those who have created managed competition observe that in the present patchwork delivery system, health care costs are not being driven by informed consumer decisions about the price of comparable products. Neither employers who provide insurance coverage nor consumers who use services are provided the kinds of information about efficacy, range of services, likely outcomes, alternatives, or providers capabilities that would lead to a capitalistic marketplace responsive to informed decisions. Instead, the current health care market is being driven by technology

changes and by the creati ve profit-making activities of providers, insurance companies, and managed care entities each seeking to affect only a portion of the health care delivery system.

I will describe below the uniform products Jackson Hole Group is now advocating be brought into existence in this nation. But first let me share some good news about the likely dimensions of any national health plan that would be acceptable to the Clinton administration.

The most important piece of good news is that Clinton and the congresspersons closest to him are very favorably inclined to a benefits package that would include mental health benefits. Tipper Gore has a masters degree in psychology, and both couples have spent time with marital therapists. Many of the key players in the army that will produce change also have good feelings about our profession and about the saliency of psychologists as providers of services as well. Next, any plan acceptable to the new administration will have to be structured to provide coverage foc all Americans. Further, any reforms to be brought line must show promise for reigning in the runaway inflationary rates in health costs in this nation. And finally, new legislation must end the pattern of persons falling out of insurability or being locked into bac: employment circumstances because they have accnmulated some "preexisting" condition.

With all the array of possible formats that wo . help to achieve these objectives, though, I belie Clinton in most inclined to move on the Jackson Ho Group's managedcompetition model if Congress co be persuaded to be bold enough to embrace it. Here are its most significant features:

• All health services would be delivered throu organizations each of which would be prepared deliver the total array of health services required the citizenry - medical, surgical, psychological, rehsbilitative, etc.

• A federal board would be established to design standard benefits package that would include designation of the array and extent of services and E... relevant procedures these health organizations wouz be required to offer. The benefits package would revised periodically as technology, epidemiologi data, and other scientific developments dictated.

14

o Once the benefits package was designed, hospitals, other care agencies, and providers would have to interlink on a very large scale to make certain that all required services and procedures could be provided to subscribers over a very wide catchment area. These organizations might service cities, counties, entire states, or even regions of the country. Each would compute a fee that would be charged to deliver the standard benefits packages to subscribers within its catchment area. The fee would be computed on the knowledge that each organization had to face the actuarial risk of taking in patients with preexisting conditions.

o The government would establish a fee scale for what it believed to bea reasonable charge per subscriber for enrolling in a model, basic health service organization. It would mandate that aU employers, even small ones, must contract to provide access to an organization that would provide at least the basic benefits package to each employee. Small emplcyers would be linked into a small employers' cooperative in each state and secure services through the cooperative.

o Payment of the fees required to provide basic health care to employees up to the limit specified by the government would be tax deductible to employers and non-taxable to employees.

• Employers may elect to prov ide ''Lexus'' , "B:!VIW", Mercedes", or even "Rolls Royce" plans for employees, Employees may also elect to contract privately with an organization not provided by an employer, one that provides more liberal benefits, and have his/her employer pay the "basic" cost. Any payments by employers or employees for more than that a basic benefits package would be taxed by the government.

o The taxes raised on excess benefits would be used to purchase access to health care organizatiOns for tbose who are unemployed and therefore without benefits,

• Each health org;minuion woold be required to conduct outcome studied on the viability orall of its services and collect consumer satisfaction data. It would be required to provide this data to the government, and those organizations that fell outside of some established parameters would be deceTlffied and lose the capacity to continue to be provider organizations.

In addition,each health organization would be required to provide a thorough description of its services and benefits to those interested in enrolling and to provide them as well with efficacy and consumer satisfaction data.

o In order to reduce administrative costs, providers would be required to rUe all claims electronically. Those that file paper forms will be charged a fee ($100 per form is proposed initially) as a penalty for non-compliance with the electronic requirement.

• There would be tort reform turning malpractice actions into limited matters for arbitration.

o The planned health organizations would be freed from anti-trust statutes and all state regulations governing the provisions of health care.

To convey to you how serious Clinton is about attempting these revolutionary transformations of health care, please understand that the basic provisions of this reform have already been introduced as proposed legislation into both the Senate and the House ofRepresematives by legislators that have been part. bf the conservative democratic caucus. Hearings will begin after inauguration day. What kind of "basic" mental health benefit would be written into any final form of such legislation, who would be the providers, and what their qualifications might be are all totally 'Without any specification at the present time, however. We also have no idea what kind of transition would be required to move us from our present wheezing hea1thcare system to the one described if enabling legislation should be enacted. It has alreadygiven me an initialset of profound headaches even attempting to contemplate these matters.

WeaIso know with a fair degree of certainty that Clinton is opposed to a governmental, "single payer" sysrem, expanding Medicare, say, to all who possess social security numbers and controlling costs and access by setting up co-paymencresponsibilities DRGs, treatment protocols, reimbursement rates, and other restrictive measures that would have the government, nuher then free-market economics, regulate the costs of health care, Clinton's people believe that such governmental forms of health delivery are too socialistic, too burdened with layers of potential governmental waste and bureaucracy, and not consistent with the administration's economic policies and philosophies.

1S

I

BYLAWS

BALLOT

PLEASE NOTE:

Due to an error in the printing process the By Laws Ballot included in the last issue of the Bulletin contained several misprints. therefore, we are reprinting it in-this issue.

We apologize for the inconvenience and ask you to please vote again. Tear out the entire ByLaws section, fold, staple and mail to the Division of Psychotherapy's Central Office at your earliest opportunity.

BYLAWS OF DIVISION 29

PROPOSED CHANGES TO BE PRESENTED TO THE MEMBER~HIP (That which is deleted is in brackets ... that which is added is -mderlined)

ARTICLE II: MEMBERSIDP

E. The Minimum qualifications for election to the category of Student Affiliate shall be enrollment in a doctoral program which includes training in psychotherapy and which is offered in a department of psychology or [in a professional] school of professional psychology situated in a college or university of higher learning which is regionally accredited [.] or in a regionally accreditW. free standing- school of professional psychology.

E. RATIONALE: Clarifies that doctoral students at regionally accreditedfree standing schools of Professional Psychology are eligible to become student members.

APPROVE DISAPPROVE

o 0

***

F. As described in Article XI of these bylaws, there shall be a [Committee on Fellows and a] Membership Committee. [The Committee on Fellows shall be charged with evaluating nominees for the award of Fellow status by the Division;] .. I [t]he Diyision's Membership Committee shall review new applications for Member, Associate Member, or Student Affiliate status. A two-thirds (2/3) vote of these Committees shall [be required to constitute a recommendation from either of them to the Board of Directors about the status of nominees/ applicants.] determine the membership status for each appli cant and accept new members. The Board of Directors shall be notified about such determinations.

F. RATIONALE.' Simplifies the procedurefor election of Members.

APPROVE DISAPPROVE

o 0

* * *

Q.. As described in Article XI of these bylaws. there shall be a Committee on Fellows. The Committee on Fellows shall be charged with evaluating nominees for the award of Fellow status by the Division and for recommending fellow status to [the board of directors and] APA Membership Committee.

G. RATIONALE: Codifies current procedure for election of Fellows.p Z

APPROVE DISAPPROVE

o 0

* * *

2

[GJ!!.. The Secretary shall be responsible for communicating the Actions of the Division to [nominees for Fellow status and to] applicants for the status of Member, Associate Member, or Student Affiliate in a timely fashion.

H. BATWNALE:· Division nominees/or Fellow are notified by APA, not by the Division, on the action taken.

APPROVE DISAPPROVE

o 0

***

ARTICLE V: OFFICERS

B. The President shall be the Member or Fellow of tbe Division who has just completed [his/her] i term as President-Elect. [He/She] The President shall succeed to office by declaration at the close of the year after [his/her J election as President-Elect and shall serve for one (1) year. The President shall preside at all meetings of the Division, shall be the chairperson of the Board of Directors, and shall perform all other usual and customary duties of a presiding officer. The President shall cast a vote at meetings of the Board of Directors only when [hiS/her] tlliU vote would make or break a tie.

B. RATIONALE: Changes improve sentence structure and clarify current procedures.

APPROVE DISAPPROVE

o 0

***

C. The President -Elect shall be a Member or Fellow of the Division, elected for a term of one (1) year. The President-Elect shall be a member of the Board of Directors with vote and shall perform the duties which are usual and customary for a vice president. In the event that the President fails to serve his/her term for any reason whatsoever, the President-Elect shall succeed to the unexpired remainder thereof and continue to serve through his/her own scheduled term. The President-Elect shall serve as chair of the Committee on Nominations[.) ~ assuming that post while Chair Designate.

C. RATIONALE: Codifies current procedure.

APP~OVE DISAP;;;OVE I

*"'*

D. The Past President of the Division shall be the most recently retired President of the Division. [He/she] The Past President shall serve a one year term as a member of the Board of Directors with right to vote].] ~ and serve as Chair of the Committee on Awards.

3

President or any other three (3) Officers. Upon election of a President-Elect Designate, a Secretary Designate, or a Treasurer Designate, these persons shall become members of the [Administrative] Executive Committee ex officio without vote and attend any meetings of the [Administrative) Committee which take place between their election and their assumption of office. The President may also invite any other member of the Division to attend an [Administrative] Executive Committee meeting should [he/she deem] the invitee's attendance [to] be deemed important to the purposes of a scheduled meeting.

The duties of the [Administrative] Executive Committee shall be:

1. To supervise the affairs of the Division between meetings of the Board of Directors, managing those affairs within policies set by the Board and implementing actions directed by the Board.

2. To review matters on the agendas of meetings of the Board of Directors and to make recommendations about these matters to the Board.

3. To negotiate the terms of any contract entered into by and between the Division and any external organization hired to provide administrative and/or publishing services to the Division with policies set by the Board and to [S] £Upervise and evaluate the performance of such organizations.

4. Upon majority vote of the [Administrative] Executive Committee. to declare an emergency and to hold a mail or telephone ballot of the Board of Directors upon any proposed course of action it shapes to respond to the matter which constitutes such an emergency.

G. RA TlONALE: Changes the name of "Administrative Committee" 10 "Executive Committee."

There is no change in the functioning of the Committee. Seems 10 be more appropriate name.

APPROVE DISAPPROVE

o 0

***

[H]1. Actions of the [Administrative] Executiye Committee shall be subject to the review of the Board of Directors at its Annual and Mid- Winter meetings. [Actions of the Board of Directors shall be subject to the review of the membership at the membership's Annual and Mid-Winter meetings.]

1. RA'[lONALE:

PRO: Board action should not be subject to the approval of the very few members who attend the Annual or Mid-Winter meetings. Were this Bylaw to have been used, chaos would result.

CON: Actions of a Board should always be subject to approval by the membership.

APPROVE DISAPPROVE

Q 0

***

5

ARTICLE VII: NOMINATIONS AND ELECTIONS

A. There shall be a Committee on Nominations and Elections which shall consist of the PresidentElect (as Chair] who shall assume the Chair while President-Elect Designate. and four other members, two elected by the Board of Directors from among its members and two appointed by the person who shall be President in the year that the election shall occur. [President] from among the membership at large. The latter shall not themselves be members of the Board. The Committee shall be responsible for implementing the principles set forth in these bylaws and the policies adopted by the Board of Directors which govern the holding of the elections of the Division, including the election of Officers, Representatives to AP A Council, and Members at Large. The elections of the Division. as conducted by the Committee on Nominations, shall [also be conformed] conform to the bylaws and to the policies of the American Psychological Association.

A. RATIONALE: Proposal reflects current procedure. Change clarifies the time when the President-Elect assumes the Chair of the Nominations and Elections Committee.

APPROVE DISAPPROVE

o 0

***

B. The Committee on Nominations shall distribute a nominating ballot to all Members, Fellows, and voting Associate Members of the Division. The ballot shall provide spaces to enter the names of three possible nominees for any office which is [subject of a] to be filled in the forthcoming election. The nominations ballot shall be accompanied by a statement notifying the members of the Division about the Division's eligibility criteria for standing for election. Those criteria are:

1. Candidates for office must be Members or Fellows of the Division. 2.No member may be an incumbent of more than one elective office.

3. A member may only hold the same elective office for two successive terms.

4. Incumbent members of the Board of Directors are eligible to run for some position on the Board only during their last year of service or upon resignation from their existing office prior to accepting the nomination. A letter of resignation must be sent to the President with a copy to the Nominations and Elections Chair.

B. RATIONALE: Clarifies the procedure and the time that resignation must occur by a Board member who wishes to run for office.

APPROVE DISAPPROVE

o 0

* * '"

H. The Chair of the Nominations and Elections Committee shall be responsible for submitting to AP A in a timely fashion the slate to be included in the AP A election mailing.

6

H. RATIONALE: Assigns responsibility to the Chair of Nominations and Elections Committee for submission of slate to AP A.

APPROVE DISAPPROVE

o a

***

[BU. The Officers. Representatives to APA Council, and Members-At-Large shall be elected by a preferential vote of the Members. Fellows, and voting Associate Members of the Division on a mail ballot. [Said ballot shall provide space for the voterto submit a validating signature.] The Chair of the Nominating Committee shall have responsibility for:

1. Overseeing the mailing of the nominations ballot in a fashion which is consonant with the policies of the American Psychological Association;

2. Overseeing the count of the nominations [vote]:

3. Notifying the candidates and Board of Directors of the APA results of the [election] slate of nominees;

4. Announcing the [election] nominations results at the next subsequent membership meeting.

5. Disseminating results to candidate and providing exact tally [of the vote].

I. RATIONALE: Clarifies ambiguities.

APPROVE a

DISAPPROVE o

.l

***

ARTICLE XI: COMMITTEES

B. All Committee meetings shall be open to all members of the Division except at such time as the Committee may, by majority vote, declare an executive session for the purposes of discussing a matter of personnel or a legal consultation. In the conduct of Committee business, the Chair of the Committee shall be responsible for notifying the members of the call for the meeting. for establishing the agenda therefore, and for serving as presiding officer. The Chair shall cast a vote only to make or resolve a tie. A majority of me voting members of a Committee shall constitute a quorum, and unless as specified elsewhere in these bylaws, a majority vote of those present and voting at a Committee meeting shall be sufficient to adopt any reSolution.

B. RATIONALE: Broadens the reasons/or an executive session of a Committee.

APPROVE a

***

C. While the President, [with the concurrence of the Board of Directors,] or the Committee Chair with the concurrence of the President may add other persons to the Division Committees, all persons serving as voting members of Standing Comm ittees or of Ad Hoc Committees or Task Forces must be Members or Fellows of the Division. Except as otherwise provided in these

7

Bylaws, the mem bers of the Division's Committees shall be appointed by the President [upon nomination of the Chairs of such Committees]. Committee members shall serve until their successors are appointed and seated. In the case of a vacancy occurring on a Committee due to the death, resignation, or incapacity of a Committee member such vacancy shall also be filled by the President [upon nomination of a successor by the Chair of the Committee in Question].

C. RATWNALE: Gives the President the authority to appoint members of Committees.

PRO: Current Bylaws required Board approval. The President has very little say over appointments. Since the Board only meets twice a year, there can be a delay in appointing members to the Committees and thus delay the work that should be done. Presidents probably will wish to consult with many people, including current chairs, but the President should have the authority to make appointments.

CON: Too much power would be vested in the President.

APPROVE DISAPPROVE

o . 0

***

D. The President-Elect shall appoint [, with the advice and consent of the Board of Directors, in consultation with the current chair.] a Chair-Designate who shall serve as a member of the appropriate Committee during the year preceding the one in which he or she shall serve as Chair and shall assume the duties of the Chair in the year in which the President-Elect becomes President.

D. RATlONALE: Gives the President the authority to appoint members of Committees.

PRO: Current Bylaws required Board approval. The President has very little say over appointments. Since the Board only meets twice a year, there can be a delay in appointing members to the Committees and thus delay the work that should be done. Presidents probably will wish to consult with many people, inc luding curre nt chairs, but the President should have the authority to make appointments.

CON: Too much power would be vested in the President.

APPROVE DISAPPROVE

o 0

* * *

E. The President shall appoint [wi th the advice and consent of the Board of Directors.l a Chair for each Ad Hoc Committee or Task Force he or she creates during the year of his/her presidency.

E. RAVONALE: Gives the President the authority to appoint members of Committees.

PRO: Current Bylaws required Board approval. The President has very little say over appointments. Since the Board only meets twice a year, there can be a delay in appointing members to the Committees and thus delay the work that should be done. Presidents probably willwish to cansultwithmany people, including current chairs, but the President should have the authority to make appointments.

8

CON: Too much power would be vested in the President.

APPROVE DISAPPROVE

o 0

***

F. The Standing Committees of the Division of Psychotherapy shall be:

6. The Committee [for Women] on Gender Issues, which shall consist of a minimum of three (3) members of the Division. The Committee shall be responsible for fostering awareness of gender issues in the activities ofllie Diyision and for recommending policies and programs designed to educate in this area. [the panicipation of women members in the activities of the Division and of recommending policies and programs designed to enhance such participation.]

APPROVE DISAPPROVE

o 0

***

7. The MultiCultural Affairs Committee (for Ethnic Minorities], which shall consist of minimum of three (3) members of the Division. The Committee shall be responsible for fostering the participation of ethnic minority members in the activities of the Division and of recommending of policies and programs designed to enhance such participation.

F. 6 & 7. RATWNALE: Brings the names of the 2 committees in line with their function.

APPROVE DISAPPROVE

o 0

***

8.The Committee on Professional Awards, chaired by the immediate Past President. [which] shall consist of [minimum of three (3) Past Presidents of the division] the President. President-Elect. and such other Past President whom the Olair of the Committee shall choose. The Committee shall (be responsible for recommending] recommend to the Executive Committee and the Board of Directors recipients of professional Divisional awards of such a nature as are consistent with the aims and purposes of the Division [and for nominating awardees to the Board of Directors). The bestowing of any such award by the Board shall require an affirmative vote of two-thirds (2(3) of Board members present and voting.

F. 8. RATIONALE: Clarifies the composition ofche Committee on Professional Awards.

APPROVE DISAPPROVE

a 0

***

9

ARTICLE Xll: LIAISONS

A. The President-Elect shall, in the year in which he or she serves as President-Elect, identify those external organizations and Boards and Committees of the American Psychological Association which in his or her view merit the appointtnent of a liaison. observer. or monitor from the Division ofPsychotherapy[.]; and make such appoinnnents for the yearofhis or her Presidency,

A. RATIONALE: Codifies current procedures.

APPROVE DISAPPROVE

o 0

***

ARTICLE xm. SECTIONS

D. If a Section desires to publish ajournal, such activity, according to the bylaws of the AP A, shall require approval from the Division's Publications Board and Board of Directors, and from the AP A Council of Representatives.

D. RATIONALE:· Codifies current procedures.

APPROVE DISAPPROVE

o 0

***

G. A Section may be dissolved by:

1. A finding by the Secretary that the number of Section members has declined below three percent (3%) of the membership of the Division;

2. An affirmative vote of two-thirds (2/3) of the voting members of the [Executive Committee:

Board of Directors sustaining a resolution that the purposes or activities of a previously approved Section have become inconsistent with the aims and purposes of the Division 0: with those of the American Psychological Association.

3. A vote by a majority of the members of a Section to so dissolve. Such vote shall be conductec in the same manner described for the conduct of the Division's elections as described in Article VII, Section C of these bylaws.

G. RATIONALE: Corrects a typo. There was no "Executive Committee" in the old Bylaws.

DISAPPROVE o

APPROVE o

***

10

ARTICLE XIV: PUBLICATIONS

E. The Editors of the Division's publications shall be appointed for fixed terms of five (5) years for the Editor of the Journal and three (3) years for Editor of the newsletter. Their appointments shall be made upon recommendation of the Publications Board, with the concurrence of the President and the Executivy Committee .. and ratification by a majority vote of the Board of Directors. They shall serve as members of the Board of Directors, ex officio and without vote. The Editor of the newsletter shall serve in addition, as a member of the [Administrative] Executive Committee, ex officio without vote. Editors shall be eligible to succeed themselves.

E. RATWNALE: Codifies current procedures.

APPROVE DISAPPROVE

o 0

* * *

11

810S8 ZV 'x!u~oqd lOl ~l!ns 'l~~S lllvv 'N ~L8£ (6Z) AdeJ;}qloq~Asd JO llols!A!<I

---------------------------------

• Service provision organizations must be mandated to accept all qualified psychologist providers who meet the particular requirements of the organization and are willing to accept its terms and conditions.

If we can achieve these objectives, we can aid in the creation of managed competition entities that would be livable. Ifone a psychologist hadjoined was poorly managed and non-profitable and therefore threatened with extinction, s/he could move easily to another. Each of our colleagues could make our own informed decisions about which kinds of organizations had the fee structures, competitive power, and client potentials with which s/he wanted to link. Our colleagues could affect who got referred for psychological services and for what purposes. And career possibilities for colleagues who would do the required consumer satisfaction, outcome, and effectiveness assessment could be created, for there is no better trained discipline than psychology for rising to that challenge.

What a complex set of demands we now confront these weeks before Bill Clinton's inaugurationl The members of CAPP and the advocacy personnel of AP A's Practice Directorate are prepared to hurl all of our economic resources, our passion, our energy, and our ingenuity into attempting to steer the downhill avalanche we are now riding as best as weare able. We intend to do whatever we might to protect your right to practice; we are now riding as best as we are able. We intend to do whatever we might to protect your right to practice; we intend to protect the best levels of income for you and to secure the most reasonable fee levels we can manage to secure. This will be a total advocacy effort, a holy war if you will, of a kind that psychology has never before mustered.

I call on you to help wi th a level of personal intensity never asked of you before. Our professionailives are at stake. Our families' lives are at stake. Our student' lives are at stake. And in a profound sense, our profession's future role in the fabric of the nation is at stake. If we fail, those shaping health policy can inadvertently succeed in eliminating our capacity to engagein fee-for-service practice reimbursed by third parties. can force us into bureaucratic structures domi-

nated by medicine and in which we would be minor participants, can drive our income levels down to those currently earned by various paraprofessionals, and can crush the expansiveness of future career opportunities for those currently in our graduate programs.

My colleagues on CAPP have now chosen me to be their Chair-Designate for the coming year and to lead them, our APA staff, and you into this fray. I keenly feel both the challenge and the responsibility. I am making a personal request to you for your solidarity and your devotion to this effort. I need both so very deeply. I also need your dollars, and I need your readiness and availability to make telephone calls and to write letters at the critical points we will be attempting to steer one or another of the bills that will boil in Congress. By the time you read this, you should have received a fund raising letter. CAPP has initiated the first round of efforts to raise the needed financial resources, a strategy we call "$100 for 100 days." Yes, we estimate we are going to need $2.5 million this Spring for only the initial stages of the advocacy effort, and that comes to $100 for every one of you. I hope you have already sent your checks. But do not put your wallets away. We will come at you again - and probably over again.

J have tried to make you understand the urgency of this matter. I cannot know if I have been sufficiently eloquent. I can only pledge to you that I am making this quest to protect and to enhance our professions's role in this nation my life's work for whatever period ahead my services may be needed and may bear fruit, and I know the wonderful colleagues who are in partnership with me in this effort feel no less dedication. We are in a time both of terrible crisis and of awesome opportunity. I call to you to join with me in welding together a great brother and sisterhood of professional psychology. a collective whose energy and will can build a future worth having. I will close by paraphrasing John Kennedy. Ask not what your profession now can do for you; ask instead what you must be willing to do for your profession and for the maintenance of your own careers.

17

be asked to give some help, though so far there are no promises. Anyone interested may want to write me via the Department of Psychology, University of Utah. Salt Lake City, Utah, 84101.

Are You Interested?

Psychologists Needed for Foreign Workshops and Lectures

Ernst G. Beier

There is presently an effort made by several divisions of AP A to contact our colleagues in foreign countries. Psychologists abroad are being asked whether there is any interest in having American Psychologists come to their countries for temporary teaching positions, workshops or lectures. While questions of reimbursement are still open, I would much appreciate to hear from any psychologist in our Division who would be interested in going abroad and possibly accept an assignment Under certain circumstances, the psychologist may already have firm plans to visit a given country and would be willing to offer a lecture or workshop as a service without reimbursement other than tax advantages. At others, CIRP or the divisions could

Also: The APA Committee on international issues (CIRP) has the names of several Russian colleagues who would be interested in temporary or permanent teaching positions in our country. Anyone who knows of any such opportunities should write to Joan Buchanan, the director of CIRP, at AP A. If you are interested in being a member of the liaison committee, please write me, Ernst G. Beier, Liaison to CIRP from Division 29.

CITATION NOMINEES SOUGHT BY CWP

The APA Committee on Women in Psychology (CWP) is accepting nominations for its 1993 Leadership Citations. CWP presents up to three citations a year to individuals judged to have made outstanding leadership contributions to women in psychology. Nominees' contributions should represent CWP's goals of ensuring that women achieve equality as members of the psychological community.

There are two categories for nominations: emerging and distinguished leaders. Emerging leaders are psychologists who ha ve recei ved their doctorate within the past 10 years, have made a substantial contribution to women in psychology and show promise of an extensive, influential career. Distinguished leaders are psychologists who have worked for 10 years or more after receiving their doctorate. They should have a longstanding influence on women's issues and status and should be recognized leaders in their area of expertise.

All nominations must include a brief statement of support for the nominee (500-word maximum), six

copies of a current vita and three reference letters (6 copies of each letter). Reference letters should address the nominees' leadership activities, contributions, and scope of influence that advance knowledge, foster understanding of women's lives, and improve the status of women and underrepresented subpopulations of women in psychology and society.

Current CWP members and APA staff are not eligible. All materials must be received by April 1. Recipients selected by CWP will be announced at the AP A Convention in Taauo. Ontario, Canada in AU~L

Send nomination materials to:

CWP Awards

Women's Programs Office American Psychological Association 750 First St., N.B.

Washington, DC 20002-4242

19

be asked 10 give some help, though so far there are no promises. Anyone interested may want to write me via the Department of Psychology, University of Utah, Salt Lake City, Utah, 84101.

Are You Interested?

Psychologists Needed for Foreign Workshops and Lectures

Ernst G. Beier

There is presently an effort made by several divisions of APA 10 contact our colleagues in foreign countries. Psychologists abroad are being asked whether there is any interest in having Arnerican Psychologists come to their countries for temporary teaching positions, workshops or lectures. While questions of reimbursement are still open, I would much appreciate 10 hear from any psychologist in our Division who would be interested in going abroad and possibly accept an assignment. Under certain circumstances, the psychologist may already have firm plans 10 visit a given country and would be willing 10 offer a lecture or workshop as a service without reimbursement other than tax advantages. At others, CIRP or the divisions could

Also: The APA Committee on international issues (CIRP) has the names of several Russian colleagues who would be interested in temporary or permanent teaching positions in our COWl try . Anyone who knows of any such opportunities should write to Joan Buchanan, the director of CIRP, at AP A. If you are interested in being a mem ber of the liaison committee, please write me, Ernst G. Beier, Liaison to CIRP from Division 29.

CITATION NOMINE.ES SOUGHT .BY CWP

The APA Committee on Women in Psychology (CWP) is accepting nominations for its 1993 Leadership Citations. CWP presents up to three citations a year to individuals judged to have made outstanding leadership contributions to women in psychology. Nominees' contributions should represent CWP's goals of ensuring that women achieve equality as members of the psychological community.

There are two categories for nominations: emerging and distinguished leaders. Emerging leaders are psychologists who have received their doctorate within the past 10 years, have made a substantial contribution to women in psychology and show promise of an extensive, influential career. Distinguished leaders are psychologists who have worked for 10 years or more after receiving their doctorate. They should have a longstanding influence on women's issues and status and should be recognized leaders in their area of expertise.

All nominations must include a brief statement of support for the nominee (500-word maximum), six

copies of a current vita and three reference letters (6 copies of each letter). Reference letters should address the nominees' leadership activities, contributions, and scope of influence that advance knowledge, foster understanding of women's lives, and improve the status of women and underrepresented subpopulations of women in psychology and society ..

Current CWP members and APA staff are not eligible. All materials must be received by April L Recipients seIecred byCWP will1:eannOWlced at the AP A Convention in Toronto, Ontario, Canada in August

Send nomination materials to:

CWP Awards

Women's Programs Office American Psychological Association 750 First St., N.B.

Washington, DC 20002-4242

19

Name

SECOND REQUEST

Please Ignore If you have previously responded.

1992 Division Membership Survey

(Please Print Clearly)

----------------- __ Phone _

Mailing Address

City/State/Zip

Would you like to be included in a Directory of Service Providers? 0 Yes 0 No

Full-Time Work Setting: Check only one.

o University or Medical School/Teaching

o University of Medical/Student Services

o Private Practice/Individual

o Private Practice/Group

Managed Care Organization: Specify:

o Community Agency/Public

o Community Agency/Private

o Hospital

o Research Setting

o Other: Specify:

Part-Time Work Setting: Put a number 2 next to appropriate setting above, if applicable.

If you are in practice in any setting, what managed care networks do you belong to: Please list by name; additional sheets if necessary.

1.

2.

3.

What do you charge for the following services?

Individual Psychotherapy

(50 Min) $ _

(75 Min) $ .

Group Psychotherapy:

Fee: $

Time Frame:

Family Therapy:

Time Frame:

Fee: $

Psychological Evaluation:

Other: Specify

Return to:

Division 29 Central Office

3875 N. 44th Street, Suite 102. Phoenix, AZ 85018·

20

FEATU REA RTIC LE !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!~ In Honor of Bernie Kalinkowitz

Friend & Mentor

Leonard Blank

The first time I significantly encountered Bernie Kalinkowitz was the summer of 1949. He was playing second base at an NYU Psychology picnic. He was good.

At that time. Bernie was a newly minted Ph.D., but for me he immediately assumed the icon of a father figure. So much so that from that point on I was determined to be a Clinical Psychologist, and Bernie was my role model ever after (and for literally hundreds of others).

Before my meeting with Bernie, every professor I had known was addressed by title. Bernie was always Bernie for everybody. There was no question for me that when I became a professor. Chief of Services, and other titled positions that I would emulate Bernieand be addressed by my first name by students and clients.

In 1949. Bernie and a small contingent of psychologists who returned from World War II received their Ph.D. (mostly on the G.I. Bill). They became the Chiefs of Psychology in the V A, US Public Health Service, State Hospitals, and Coordinators of Clinical

Training Programs. Clinical Psychology became a viable and exciting profession because of Bernie and his small band of colleagues.

This very same band, and Bernie, a leader among leaders, fought successfully for psychotherapy as a role for psychologists. In 1961, Bernie launched the NYU Post Doctoral Program in Psychotherapy and Psychoanalysis. With eleven other candidates. I eagerly joined the first university based training program in psychoanalysis. We were not exactly apostles like an earlier group of twelve but Bernie, our leader. was virtually a prophet.

When you talk about Bernie. you can never stop with his brilliant leadership, command of the field, and focus, He was a stand-up comic; the life of the party; a passionate devotee of union, mining, and railroad causes and songs; absolutely humane, and tolerant; and warm - very warm.

To paraphrase Shakespeare, the elements were so mixed in him that nature might stand up and say to all the world, "This was a menstch."

SUBSTANCE ABUSE

More Federal Agency Alphabet Soup as ADAMHA Becomes SAMHSA

Harry K. Wexler

The federal government is at it again, they have reorganized the agencies that fund AOD prevention and treatment programs and research adding to the alphabet confusion that has already confused most of us. In brief. the Public Health Service's Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) has been reorganized into the Substance Abuse and Mental Health Services Administration, "SAMHSA," which became effective October 1, 1992. (At least one could easily pronounce ADAMHA). The new super agency will administer the substance abuse and mental health treatment and prevention programs. The three research Institutes that were in ADAMHA (National

Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Institute of Mental Health) will be transferred to the National Institutes of Health.

There were major debates on the advantages and disadvantages for the reorganization but most workers in the field remain unconvinced this enormous and expensive bureaucratic change was necessary. I have summarized the organizational changes and funding areas for the three new "Centers." The new leadership of these Centers will probably remain unclear for awhile until the Clinton administration takes control.

21

The Center for Substance Abuse Treatment (CSA T) is the successor to the Office for Treatment Improvement (OT!) and is authorized to fund programs in the following areas:

• Residential and outpatient treatment programs for pregnant and postpartum women and their children;

• "Capacity expansion" grants to States for the support of additional substance abuse treatment programs.

• Training of substance abuse counselors;

• Substance abuse treatment in State and local criminal justice systems;

• Demonstration projects to improve services for populations in critical need such as adolescents and racial/ethnic groups; and

• Substance abuse Block Grant program which distributes $1.5 billion for substance abuse services.

The Center for Substance Abuse Prevention (CSAP) is the successor to the Office for Substance Abuse Prevention (OSAP). ThisCenteris authorized to fund programs in the following areas:

• Funding for the Community Partnership program which helps community coalitions plan substance abuse local efforts will continue;

• The High-Risk prevention demonstration grant program aimed at youngsters who are at risk will also be continued and expanded to include tobacco as well as alcohol and other drugs;

• Authorization of grants to public and nonprofit groups for Employee Assistance Programs aimed at small businesses who cannot afford them;

• Establishmentof a National Data Base on Prevention on provide information about successful treatment programs; and

• Continuation of the National Clearinghouse for Alcohol and Substance Abuse.

The Center of Mental Health Services (CMHS new agency. is designed to identify and facili needed changes in mental health service delivesystems at the State and local levels. Specific p:grams that ClVD-IS will administer are:

• The Community Support and the Child aAdolescent Service System demonstratic grant programs;

• A separate grant program designed to improv. systems of care for the seriously emotionally disturbed children;

• A demonstration grant program for the horr less with mental health and substance abc problems;

• Grants to support training of professional ant paraprofessional mental health workers, Stale human resources development, and AIDS hes., care providers; and

• Mental Health Services Block Grant prograrr. which distributesS450 billion for substance ab services.

Hopefully the official line as expressed by Secret, Sullivan will prove true: ..... the administration S8: as leading both to more effective treatment and r vention of substance abuse and mental disorders ;. to enhanced research accomplishments to speed _ velopment of solutions to these health problerr However, many behavioral scientists and practi; ners worry that the reorganization will gi ve far gree, power to the medical establishment and neuroscie: and reduce the support for behavioral research.

In an attempt to provide a smooth transition.

ADAMHA Reorganization ACT of 1992 prohibits merger ofNIAAA. NIDA,andNIMH either withes, other or with any other NIH Institute for 5 years. addition, the Institutes will retain their peer reviewadvisory council systems for four years. The 1- funding levels for the Centers and Institutes are --; sented on page 23.

22

Overall Federal Funding Levels for 1993 (Numbers in millions):

Center for Substance Abuse Treatment (CSAT) $1,320.8

Center for Substance Abuse Prevention (CSAP) 246.5

Center for Mental Health Services (CMHS) 384.9

National Institute on Alcoholism (NlAAA) 177.3

National Institute on Drug Abuse (NIDA) 405.7

National Institute on Mental Health (NIMJI) 585.7

The National Clearinghouse for Alcohol and Drug published by the Centers and Institutes. They will Information provides a hotline (301) 468-2600, for send you a catalogue of all their services upon your requesting funding information and other documents request.

MEDICAL PSYCHOLOGY

Medical & Surgical Referral Interface:

Problems with Philosophy and Nosology

David B. Adams

Atlanta Medical & Neurological Psychology

A patient was referred by a neurosurgeon prior to performing, with assistance from an orthopaedic surgeon, a spinal fusion. The neurosurgeon made a generic psychological referral to the effect that "what is needed here is a psychological profile on this surgical candidate." The patient was examined, a report was written and sent via FAX to the referring surgeon. The surgeon stated: "This is a fine report, but I am calling to find out what is going on with the patient...I need you to tell me what you have not included in your report."

Upon fwther discussion, it became clear that he felt psychologists would be able to tell him the underlying needs and drives operating the patient, predict probable response to surgery, project the patient's response to narcotics, recommend a viable regimen for medication management, and determine the patient's surgical expectations. As the surgeon noted: "You guys are in the business of predicting behavior ... so tell me what makes him tick and what I need to do."

Finally, the surgeon was of the conviction that reports may say one thing but doctors feel things that do not appear in their reports.

There are two significant obstacles to providing meaningful (i.e, productive) psychological information to physician providers: a. the terminology used in psychology is not substantially different from that used in surgery (at times, equally as obscure), but

surgeons are simply not exposed to words like somatizauon, dyslhymia, and parasomnia. b. they conceive their work as being mechanical in terms of dealing with specific structures rather than the psychologist's abstraction and dealing with concepts.

Complicating this further is that while a surgeon would never conceive of creating a new name for an existing anatomical structure, some psychologists have created neologisms in order to communicate a concept. This obfuscation of scientific psychology has resul ted in poor physician-psychologist interface. The physician must rely upon th.e 6 week psychiatry rotation, ten years ago in medical school in which he/she was assigned to the back wards of a V A Hospital dealing with chronic drug dependent veterans.

Unless the surgeon has been in personal psychotherapy with a psychologist, the terminology may be obscure. If they want their patients medicated, they would prefer to do that themselves although they may ask for recommendations on "what works with these patients."

(It should also be noted that interface between the physician and the psychiatrist is complicated to an equal or greater extent by the attempts of psychiatry to define all of human behavior in terms of known biochemical substrates. The result is that the psychiatrist often uses psychoactive medications as a novice gour-

23

-=

met uses spices, unable to account for, or insure, the end product, but allowing the patient to serve as a means of determining the efficacy of the regimen. This is anti-science to the surgeon, accounting for the rapidly expanding surgeon-psychologist interface).

Many psychologists fail to realize that the physician often needs a concise and meaningful explanation of the clinical entity presenting in the office or operating room. This physician-education program occurs in a brief telephone contact between two doctors with a patient who visits, or is going to visit, both offices. The communication must be as brief as the physical medicine specialist would use in communicating with the orthopaedist: (Eg.) "We have a patient here with cervical osteophytes and dehydration at C5/6, degenerati ve disc disease complicated by an HNP at L5/S 1 for which a laminectomy appears necessary. This is confirmed by myelogram, CT scan and MRI. When can you see him?"

The psychologist should be able, in tum, to say:

"We have a patient with borderline personality disorder, a developmental condition, in which we are seeing impulsivity, emotional dysregulation, instability, recurrent suicidal attempts and rage responses. The patient falsely imputes that all of his symptoms are proximately related to a recent fall, but, in fact, these symptoms have been with him since adolescence. He needs psychopharmacologic stabilization and, for now, would be a poor candidate for post-surgical pain management programs."

The psychologist is more likely to send a laboriously lengthy report discussing results of tests which are obscure to the surgeon and answer questions that are not asked but fail to answer those which are obvious. The psychologist begins a report with lengthy introductions, pages of test results and related materials that are either meaningless to the surgeon at best or not germane to the questions asked. Preferably, there would be a report that begins with a direct and concise answer to the restated referral question followed by data to support that answer. If the surgeon wished to "read all of that," he/she may do so, but if a direct answer needs to be scanned before walking into an exam room, the cover sheet should, where possible, provide such a direct answer.

Similarly, a surgeon's concept of psychotherapy, even personal psychotherapy for a surgeon, entails a

direct presentation of a problem and securing a solution. Analytically, this impatience is ad against more anxiety provoking data. Advice protect the patient, whether it be a surgeon _ non-heath care provider. Nonetheless, the reques

a rapid and effective intervention is not in appro

While there may be countless traumata to whi patient has been exposed, such data are not al related to the patient's response to an invasive p dure. The patient may simply have heard of procedure performed upon others with negative come. The patient may have a previous life threE:: ing response to anesthetic or, simply, the patient be frightened of the unknown. Surgery, after requires that you relinquish control, in a sterile ( ity of meaning) environment in which everyo robed, masked, talking to almost anyone but the tient and expected to trust that someone in that is invested in patient-survival, (A patient reces, stated that he had sore knees after spinal surgery. when he complained of that several days after procedure, he was told "well, of course you do, we you up on your knees for part of the procedure." - patient, failing to understand the need for alignm structures, felt demeaned that he was "worked 1 puppet in front of all those people.")

The psychologist can teach a surgeon approp terminology to understand patient behavior. Sur will offer that the patient is an hysteric or is conver but the surgeon may need to briefly have explained concept of somatizing in general, somatoform pai; particular, and the dramatic portrayals of pain also be associated with such conditions as depe personality disorder. Similarly, surgeons assume when a lesion is found that, by definition .malinger: has been ruled-out. It may be necessary to illus how some of the patient's responses are under vo tar)' control despite the documented need for sur

The core dilemma, however, is that continuity-cf-care. By choice, the surgeon has leeted a field in which the emphasis is upon an un scions patient receiving a sophisticated, yet still chanical, procedure. As a surgeon once stated. only purpose about the heart for which I would concerned would be its capacity to pump Keflex lC bones."

24

The surgeon is not most stimulated by return office appointments, after care, symptoms which continue after the procedure or other issues of continuity. The psychologist, by contrast, is trained to develop a "relationship" and to see the patient for more than a single visit and often over an extended period of time. The surgeon has DRGs which dictate the length of hospital stay, and the psychologist, until recently, has had no constraints on how long the patient was seen. The surgeon may have difficulty relating to the necessity, and certainly the appeal, of such service deli very. Their own treatment approach lends itself well to immediate gratification and often obviates dealing with patient frustration and/or disappointment. A psychologist accounting to a surgeon for treatment extending over many weeks or even months will have a "hard sell" to many surgeons. Accepting this differ-

ence in treatment emphasis and style can enable the psychologist 10 better account to the surgeon for those patient problems which need to be addressed and how best they are addressed.

Simi larly, a psychologist unfamiliar with the nature of a surgical procedure is at a distinct disadvantage. The psychologist not only cannot relate to the nature of the surgeon's work, but the psychologist, without such understanding, cannot relate 10 the patient's surgical experience, expectancies, fears and sequelae.

Al though a case could be made for the creation of a subspecialty area of surgical psychology, and, indeed, perhaps such an area bears consideration, more appropriately, the psychologist needs a foundation in basic services of other members of the health car delivery team.

FEATU RE A RTICLE ~!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Documentation of Services and Exclusions:.

Can Big Brother Be Far Behind

Robert J. Resnick

Armed with the battle cry of cost containment, insurance and managed care companies have seized this opportunity to become not only more exclusionary in services provided but also quite demanding about the documentation of services. Indeed, in some states the consumers essentially waive their right to confidentiality, and must permit, in order to receive reimbursement, their managed care company to review their entire record. "Program integrity," is the vehicle for such invasiveness.

A Blue Cross plan recently promulgated both inpatient and outpatient documentation guidelines. In the initial outpatient clinical evaluation there must be sufficient information so that the insurance carrier can, "determine medical necessity, quality of care, appropriateness of treatment and the goals of treatment." There must, also, be an indication of the estimated number of treatment sessions to achieve the goals. This document must then be signed along with an indication of the provider's credentials.

Each psychotherapy note must have not only the patient's name and date of service, but the type and length of session and the names of all individuals present during the session. A therapeutic note must

include an update of the treatment plan after six sessions as well as a description of the method of treatment, and a progress report. The note must include an estimate of the number of treatment sessions after six visits and the type of therapy must be clearly identified. It has been determined that the carrier prefers, at the top of each therapy note, the name of the patient and date be typed and include a diagnosis.

Practitioners have, already, had their records reviewed in an adversarial atmosphere. In almost every instance the carrier has determined that there are overcharges or inappropriate charges that must be repaid 10 the insurance carrier. The atmosphere, in many instances, is so hostile that psychologists have hired attorneys.

If this adversarial behavior weren't enough, the insurance plan enumerates some fifty exclusions to coverage. For example, the carrier can determine at its' sole discretion that a service is not "medically necessary" and refuse reimbursement. Marital and family counseling, behavior therapy, have also been excluded by carriers. Services for certain diagnoses such as Mental Retardation, Antisocial Personality, or

2S

Inadequate Personality are not covered. Similady, Oppositional and Conduct Disorders are not reimbursable.

Standards such as these are exempt, apparently, in most states from regulation, and can be imposed, without recourse, on both the providers andconsamers of services. For example, the need to document the provider's credentials on each psychotherapy note seems ludicrous and there is anecdotal evidence that if such notes aren't typed, there tends to be even a greater adversarial relationship if records are reviewed. It is noteworthy that the persons reviewing these records have been described as "bean counters" as they simply look for certain data to be present. Indeed, there was one reported incident where a psychologist. had more difficulty with one of these reviews because notes were signed in pencil even though the note was typed.

Such egregious behavior mandate federal and/or state regulation of managed care companies. There must be appropriate legislation to require that managed care companies are as accountable for their behavior as providers are accountable for their services. Such legislation would also provide more appropriate parameters for reccrd keeping purposes and just as importantly, should mandate a single format for all insurance carriers to use for reimbursement, as well as treatment planning documentation. The time to act is now. We cannot wait, for the more entrenched such abusive mandates become, the more difficult it will be to effect change. The first step often hasappeal to all state legislators; a joint study commission where providers, consumers, and insurers can meet and prom ulgate guidelines suitable to all parties tempering the need to know with the right to privacy.

FEATU RE ARTICLE. "!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Our APA Super-Celebration

Gloria Behar Gottsegen

Member. Task Force on Centennial Celebrations

Special vignettes of the Centennial that will always stand out in my personal memory bank:

H seemed as if Union Station had canceled all arriving and departing trains and converted this magnificent marble and stone structure into a gigantic social and dining hall of reverberating and chaotic decibels emanating from exploding numbers of psychologists and their guests.

So numerous was this "population explosion" that any observer with the slightest propensity for delusional ideation could. believe that not only current and alive APA members were present, but also numerous re-incarnated ghosts of generations long departed - and all were celebrating, enjoying, dining, dancing, etc.

Speaking of dancing, an incredible, unforgettable and novel scene • and this is a fact - was that of a woman dancing with her man who was seated in a wheelchair, one of his arms raised to twirl her about him! Noone there could be more joyful than this loving couple.

The opening ceremony with stirring addresses by J ..

Donald Millar and C. Everett Koop, the innovative and in viting exhibit at the Smithsonian, the narcissistic but great Gold Circle Wall, the spectacular setting for the President Jack Wiggins' supper party and yes, even the Centennial cookbook-will remain with me for years tocome,

It was my pleasure to introduce Nick Cummings and Diane Willis as they gave their distinguished Centennial addresses and to chair a special symposium on Psychology in the Workplace.

Throughout, the multitude of carefully orchestrated events showed the fine skilled hands and hard work behind the scenes by Judy Strassburger, Liz Kaplinski and Mayella Valero of the APA Central Office staff.

I never thought, when I was first invited to become a member of the Task Force on Centennial Celebretions some four years ago, that it would be such ~ fascinating and enjoyable experience and that I wouk fmd myself working with such a creative, innovative imaginative and just plain fun group of people.

HAPPY BIRTHDAY, APA

26

TASK FORCE ON CHILDREN & ADOLESCENTS !!!!!!!!!!!!!!!!!!!!! Marketing Brochure for Children & Adolescent Therapy Available

It's always difficult for parents to make the decision to put a child in therapy. Now there's a brochure you can use to make it easier for parents to make the decision and to encourage them to address children's problems early with outpatient therapy rather than later when expensive hospitalization may be required.

Produced by the Division 29 Task Force on Children and Adolescents, "Psychotherapy with Children & Adolescents: A Guide for Parents" explains what child and adolescent therapy is, how to tell when your child needs therapy, what parents can expect from therapy and how to find a child/adolescent therapist. It addresses questions such as whether parents should expect the child to discuss therapy sessions or not, how to tell if child and therapist are compatible, confidentiality and parent contact with the therapist and insurance reimbursement.

Task Force Chair Dr. Alice Rubenstein and her committee have succeeded presenting this information in a clear, concise way addressing most of the questions and fears parents have about putting a child in therapy. The resulting attractive tri- fold brochure is available for you to use in educating parents in your community. The brochure is also an excellent educa-

tional piece for professionals such as pediatricians, school counselors and dentists to give to parents when referring to you.

There is space on the back page for you to personalize the brochure with your name, address and phone number so that it also becomes a marketing tool for your practice. This area can either be professionally printed on your brochures or can be left blank for personalizing with a name and address stamp or label. Prices for AP A members are as follows:

Division 29 Member Prices

Quantity 100

200

500 1000

No Imprint $22.50 37.95 68.95 128.95

Imprinted w/Name/address $40.00

50.00

80.00

150.00

Non-members may also order at these slightly higher prices:

Quantity 100

200

500 1000

Nolmprint $30.00 50.00 85.00 160.00

Imprinted w/Name/address s 50.00

65.00

100.00

185.00

1.------------------------------,

Children & Adolescent Order Form Please Print:

Name~ ___

Company __

City _

Address _

St _

Zip _

o Payment Enclosed

o VISA

Card No. __

o MasterCard

Exp. Date ~

Please return to:

Alice Rubenstein, Ph.D. DIVISION 29 - Central Office 3875 N. 44th St. - Suite 102 Phoenix, AZ 85018-5435

L Phone #602-952-8116' FAX #602-952-8230 I

______________________________ ---.J

27

Reminder:

24th Annual Mid-Winter Convention

The theme is

iversity"

"

Sponsored by

The Divisions of PSYCHOTHERAPY (29) INDEPENDENT PRACTICE (42) FA.M.IL Y PSYCHOLOGY (43)

of the

AMERICAN PSYCHOLOGICAL ASSOC.lATION

March II - 14, 1993

Hyatt Islandia Hotel on MissIon Bay San DleQo. California

Convention Coordinator ".Barbara Williams. Ph.D.

Associate Coordinator "" " WIJllam R. Fishburn, Ed.D.

Pro~ram Chair Vera S. Paster, Ph.D.

Contlnulng Education Chair Jean A. Carter. Ph.D.

Division 29: President - Gerald P. Koocher. Ph.D.

President-Elect - Tommy T. Stl~all, Ph.D.

DIvision 42: President - Karen za~er. Ph.D.

President-Elect· AJan Entin, Ph.D.

Division 43: President - Robert 1. Wellman, Ph.D.

President-Elect - Ronald Levant. Ed.D.

Division of Psychotherapy (29) Highlights

ti-= •..... : __

...... ~ ...

- -~- ----.,

~~~Edge

-

=--

- -~ ..

.. i-_ .... ~

• The Child and Adolescent Treatment Brochure has sold 57,800 copies, the best selling brochure the Division has ever produced and one of the most effective marketing tools.

o The 29 Publication Board developed articles on psychotherapy for CoUege newspapers- another marketing tool.

o The History of the Division of Psychotherapy was published and is available to all 29 members.

• The new Committee on Public information is developing a brochure explaining to the public current issues in psychotherapy.

o The research project on gender differences in depression, supported by Division 29, published the pilot study results in the summer Bulletin; data from the full study has been analyzed and is prepared for publication.

Division 29 is the APA division specifically committed to support the various components of effective psychotherapy: education, training, research and practice. The folIo wing are highlights in these arenas of unique Division activities for the past year:

o The History of Psychotherapy received excellent reviews and was made available only to 29 members for a significant discount; it has sold 1374 copies.

• The Trauma Response and Research Committee worked quite actively in the Los Angeles riots, Hurricane Andrew and Hurricane Iniki providing assistance, training and collecting research data.

• 0 The Trauma Committee is developing a Trauma Hotline with Los Angeles print and electronic media to provide psychological support and information during a disaster ..

PSYCHOTHERAPY BULLETI.N

TheBULLETIN is the official newsletter, published quarterly and sent to over 5,000 members of the Division. Please contact Editor for further information,

FREQUENCY: Quarterly CIRCULATION: 5,000 EDITORIAL OFFICE:

Division of Psychotherapy 3875 N. 44th St., Suite 102 Phoenix, AZ 85018

(602) 952-8656

Fax#: (602) 952-8230

ADVERTISING CLOSING DATES:

Sept. 1, Dec. 1, Feb 1, May 1 PREFERRED MATERIALS:

Camera Ready Copy.

RATES:

Full Page One-half Page One-Quarter Page Cover- 3

Cover - 4 (1/2)

Ix $150 90 50 175 175

4x $125 75 40 150 ISO

29

I-------------------------------j

I DIVISION 29 Change of address Form

I

I Please keep us informed of any changes in your address

I

I Name --------------------------------------

I

I Title ------------------------------

I

I Company --------------------------

: Address ~

: City St -- Zip ---

1 Phone --------- Date --------

1 Please return to:

I I I I

I or FAX #602-952-8230

L ~

DIVISION OF PSYCHOTHERAPY - Central Office 3875 N. 44th St. • Suite 102

Phoenix, AZ 85018

SAVE THE DATE !

MONDAY MAY 24, 1993

ST. JOHN'S UNIVERSITY

PRESENTS ITS THIRD ANNUAL CONFERENCE

MULTI-CULTURAL ISSUES
IN
DOMESTIC VIOLENCE
-. Conceptualization and Intervention Strategies Registration fee includes CE Credit

For further information phone (718) 380-7711 St. John's University Jamaica, New York

30

Division of Psychotherapy of the American Psychological Association 1993

STANDING COMMITTEES

Education and Training

Jeffrey Binder, Ph.D., Co-Chair 131 Ponce de Leon Ave., NE Georgia School of Prof. Psychology Atlanta, GA 30308

Office: 404-872-0707

FAX: 404-499-8358

Hans Strupp, Ph.D., Co-Chair Dept. of Psych., Vanderbilt Univ, Nashville, TN 37240

Office: 615-322-0058

Fellows

Suzanne B. Sobel, Ph.D., Chair 1680 Highway AlA, SuiteS Satellite Beach, FL 329"37

Office: 407 -773-5944

Finance

Alice Rubenstein, Ed.D., Chair Monroe Psychotherapy Or. 59-I::: Monroe Ave.

Pillsford, NY 14534

Office: 716-586-04\0

FAX: 716-586-2029

Gender Issues Committee Gary Brooks, Ph.D., Chair Psychology Service

116 B4, OE Tcaque VA Center Temple, TX 76504

Office: 817 -778·4811

Barbara Wainrlb, Ed.D~ Co-Chair R.D" Itl, Box 1290

Moretown, VT 05660

Office: 514-481-8272

FAX: 514-484-2864

Membership

Ril"hard Mikesell, Ph.D., Chair 4801 Wisconsin Avenue !>.'W Suite 1t503

Washington, D"C. 20016 Office: 202-966-7498 pAX: 202-966-3745

M uliicultura! A/fairs

Samuel S. am, III, Psy.D~Chair Corpus Christi Stare University 6300 Ocean Drive

Corpus Christi, lX 78412 Office: 512·994-2394 FAX: 818-284-0550

Nominations and Elections

Tommy T. Stigall, PIl.D., Chair The Psychology Group

701 S. Acadian Thruway

Baton Rouge, LA 70S06

Office: 504-387-3325

FAX: 504-387-0140

Professional A wards

Reuben Silver, Ph.D., Chair 510 Huron Rd.

Delmar, NY 12054

Office: 518-439 ·9413

FAX: 518-439-9413

Professional Practice

Ellen McGraLh, Ph.D~ Chair 1938 Del Mar

Laguna Beach, CA 92651 Offioc: 714 -497 -4333 FAX: 714-497-0913

1993 Program Committee Norine G. Johnson, Ph.D., Chair, 1991-1993

110 W" Squantum,ltI7 Quincy,MA 02171 Office: (617) 471-2268 FAX: 617-323-2109

Ed Bourg, Ph.D.,

Associate Chair, 1993-1995 56 Ross Circle

Oakland, CA 94618-1912 Office: 415-523-2300 FAX: 415-652-5078

William S. Pollack, Ph.D~ C.E. Chair, 1993-1994 Dept. POSt Graduate & Continuing Education 115 Mill Street

Belmont, MA 02178 Office: 617-855-2230 FAX, 617-855·2349

Publications Board Chair

Herbert J. Freudenberger, PIl.D. IS East 87th SL.

New York, NY 10128:

Office: 212·427-8500

Student Development

Michael Caritio, 1'11.0., Chair Ba IT)' Universit y

11300 Northeast 2nd Ave., Box 21 Miami Shores, FL 33161

orfice: 305-899-3275

FAX: 305-899-3279

Abraham Wolf, Ph.D., Co-Chair Metro Health Medical Cu.

2500 Metro Health Drive Cleveland, all 44109-1998 Office: 216-459-4647

FAX: 216-459-5907

DIVISIO OF PSYCHOTHERAPY (29)

Central OrCice 3875 N. 44th SLICC(, Suite 102 Phoenix, Arizona 85018 (602) 952-8656 FAX: (602) 952-8230

TASK FORCES

Task Force on Adolescents and Children Alice Rubenstein, Ed. D., Chair Monroe Psycbothcrapy Center

59 E, Monroe Avenue

Piusford, NY

Office: 716·586{)41 0

Task Force on Aging

Norman Abeles, Pn.D; Co-Chair Psychology Research Bldg. Michigan State University

East Lansing, MI 48824

Office: 517 ·355 -9564

Carl Eisdorfer, Ph.D_, Co-Chair Dept, Of Psychiatry, D-28

P.O. Box 016960

Miami, FL 33136

Office: 305-545-6319

Task Force on American Indian Mental Health

Diane Willi. s, Ph.D., Chair Child Study CtL

University of Ok lahoma 1100 N ~ 13th SI. Oklahoma City, OK 73117 Office: 405-271-6876

Task Force OIl \icn's Roles and Psychotherapy

Ronald Levant, Ed. D., Chair 1093 Beacon sc, se. 3C Brookline, MA 02146

Office: 617 -566-4479

Task Force on Trauma Response & Research

Ellin Bloch, Ph.D., Co-Chair Dept. of Family Medicine Mail Location 5M2

University of Cincinnati

Mcd. Cu.

Cincumati, 011 45227 ornee. 513-558-4020

J on Perez, Ph .D., Co-Chair Life Plus Foundat.ion

6421 Coldwater Canyon Ave" North Ilollywood, ell. 91606 Office; HI 8-769 -1000

DIVISION OF PSYCHOTHERAPY American Psychological Association 3875 N. 44th St., Suite 102

Phoenix, AZ 85018

Non-Profit Organization U.S. Postage PAID Phoenix, AZ 85018 Permit No. 311

ABRAHAM W WOLF,

METROPOLITAN BEN HOSP/DEPT OF PSYCH - 3395 SCRANTON RD

CLEVELAND OH 44109