PSYCHOTHERAPY

President's Message .•...•... ' ' 3

Editor's Colunm 4

Feature Article ..

Psychology Fights to Hold Ground Under National Health Care .4

Council of Representatives Meeting

February 26-28,1993 Washington, D.C , 6

Washington Scene

Prescription Privileges: Evolving Progress: 7

The Challenge to Psychology

The Changing Face of Psychology 10

1993 Division Leadership Conference 12

Feature Article

Record Keeping Guidelines 15

Nominees for 1993 election : .. 21

Substance Abuse

Substance Abuse Updates 28

Medical Psychology

Current Concepts of Mind-Body Interface:

Psychoneuroimmunology & Psychotherapy 30

Call For Papers 33

VOL.2B. NO.1

OFFICIAL PUBLICATION OF DIVISION 29 OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION

SPRING 1993

;

WadeSilvennan, Ph.D~ 1993-1995 1514 San Ignacio, Suite 150

Coral Gables, FL 33146

Office: 305-661-7844

FAX: 305-666-8888

Division of Psychotherapy of the American Psychological Association 1993 Officers

OFFICERS President

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

300 Longwood Ave. Boston, MA 0211S-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 FAX: 518-439·9413

President Elect

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

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 Ctr. 59-£ Monroe Ave. Pittsford, NY 14534 Office: 716-586-0410 FAX: 716-586-2029

Secretary 1991·1993

Patricia S. Hannigan-Farley, Ph.D., 24600 Center Ridge Rd., Ste, 420 Westlake, OH 44145

Office: 216-871-6800, Ext. 19 FAX; 216-871-1159

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

Apt 1#607 South

Salt Lake City. UT 84101 Office: 801-581-7390

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

Maplewood, NJ 07040

Office: 201·763-3350

HaTTY Sands, Ph.D., 1993 10 W. 83rd SI..

New York, NY 10024-5234 Office: 212-799-7777 FAX: 212-799·4676

Norine G. Johnson, Ph.D., 1992:1994 lIO W. Squanturn, #17

Quincy, MA 02171

Office: 617-471-2268

FAX: 617-323-2109

Ronald F. Levant, Ed.D., 1991·1993 1093 Beacon St., #3C

Brookline, MA 02146

Office: 617-566-4479

FAX: 617-484-1902

Lisa M. Porche-Berke, Ptt.D.1992-1994 CSPP-LA

1000 S. Freemonl Ave. Alhambra, CA 91803-1360 Office: 818-284-2177

Suzanne B. Sobel, Ph.D., J993·1995 1680 Highway A lA, Suite 5

Sate1l:ite Beach, FL 32937

Office: 407-173-5944

Carl Zimel, Ph.D., 1992-1994 4200 E. 9th Ave.

Univ. of Colorado Medical School Denver, CO 80262

Office: 303 -270-8611

FAX; 303-270-86lJ

REPRESENT A TIVES TO APA COUNCIL

Donald K. Freedheim, Ph.D. 1993·Feb 1996

Dept of Psychology

Mather Memorial Bldg.

Case Western Reserve University, Cleveland, OH 44106

Office: 216-368-2841

FAX: 216-368-4891

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

21 Harper Rd.

Monmouth Jct., NJ 08852 Office: 908·2464224

LIAISONS/MONITORS Administrati~e Liaison Mathilda Canter, Ph.D. 4035 E. McDooald Or. Phoenix, AZ 85018

Office: 602-840-2834

BAPPI Monilor Irene Deitch, PhD. 57 BuuerwO<th Ave.

Staten Island, NY 10301-4543 Office: 718·390-1744

CEMA MOIfiJor

Usa M. Pon:he-Burke, PhD. CSPp·LA

1000 S. Fremont Ave. Alhambra, CA 91803-1360 Office: 818-284-2177

LiDison to APA Ilflenuzlional CommiJte~ Ernst Beier, Ph.D.

44 N. Third South, 11607 South Salt Lake City, UT 84101 Office: 801-581-7390

----

Observer 10 APA & CAPP Practice Directorate

Ellen McGrath, Ph.D, 1938 DelMar

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

REPRESENT A TIVES TO JCPEP Tommy T. Stigall, Ph.D.

The Psychology Group

701 S. Acadian Thruway

&too Rouge, LA 708(X5

Office: 504-387-3325

Arthur Wiens, Ph.D.

Oregon Health Services University 3181 SW Sam Jackson Puk Rd. Portland, OR 97201

Office: 503-279-8594

EaTORsOFPUBUCAnONS

Psychol/umpy Iouma;

Donald K Freedheim, Ph.D., Edltor Dept eX Psychology

Mather Memorial Bldg.

Case Western Reserve University Cleveland, OH 44106

Office: 216-368-2841

Psychotherapy J oumal Wade H. SUvennan, Ph.D .. Editor·Fleet 1514 San Ignacio, Sre. 150 Coral Gables, FL 33146 Office: 305-661-7844

P:tychothflrtlpy Bulletin

Linda Campbell, Ph.D., Editor Inivershy of Georgia

402 Aderhold Hall

Athens, GA 30602-7142

Office: 706 542-1812

FAX: 706 542-4130

MID-WINTER MARCH 9-13, 1994

Convention Coordinator Program Chair

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

Associate Coordinator Continuing Education Chair

Leon VandeCreek, Ph.D. Barry Schlosser, Ph.D

As you read this column several exciting programmatic activities will be well underway. Firstand most important, will be the American Psychological Association's effort to assure that the therapeutic services of psychologists will be available as an option for Americans under any new heal th initiatives advanced by the Clinton administration. I urge all our members to contribute to the campaign of "One Hundred Dollars for One Hundred Days," to assure that our voices will be adequately heard in Washington. Several members of our leadership, including Ron Levant as Chair of CAPP will see to it that your dollars are spent well and effectively.

A second exciting activity is the initiation of a program of long-range planning to re-shape the role and mission of our Division for the next 100 years of the APA. The Board of Directors held an evening retreat meeting in San Diego and as a result we shall be refocusing our goals in the year ahead to meet the challenge that is uniquely ours within AP A: advancing the science and practice of psychotherapy. This will include a major membership expansion initiative under the leadership of Dick Mikesell.

Many new developments will also take place in the arena of member services. Under the leadership of our Program Chair, Norine Johnson, we have focused special program emphasis on population diversity and child psychotherapy this year. With the help of Bill Pollack we shall be initiating an "institute style" prevention continuing education workshop. and for the first time will be awarding continuing education

PRESIDENT'S MESSAGE

Gerald P. Koocher

credits to our members who attend designated symposia at the APA meeting in Toronto. lam also expecting exciting new ideas from our Multicultural Affairs and Student Development Committees under the leadership of Sam Hill and the team of Carifio and Wolf respectively. Watch future issues on the Bulletin too for developments in style as well as content I know that OUI new Editor. Linda Campbell has some exciting plans in mind.

I hope that readers will not be shy about suggesting new activities and initiatives. I welcome your ideas and creativity. Drop me a note or a fax at the address or phone number listed inside the Bulletin cover. I really do want to hear from you.

PSYCHOTHERAPY BULLETIN

Published by the

DIVISION OF PSYCHOTHERAPY AMERICAN PSYCHOLOGICAL ASSOCIATION

3875 N. 44th Street> Suite 102 • Phoenix, Arizona 85018 • (602) 952-8656

LINDA CAMPBELL Editor

CONTRIBUTING EDITORS

Medical Psychology David B. Adams, Ph.D.

PSYCoIUlTUl Mathilda Canter, Ph.D.

Washington Scene Editor Patrick Deleon. Ph.D.

Media, Marketing & Psychology Bruce Forman, Ph.D.

Professional Liability Leon VandeCreek, Ph.D.

Finance , Jack Wiggins, Ph.D.

Group Psychotherapy , Morris Goodman. Ph.D.

Substance Abuse Harry Wexler, Ph.D.

STAFF

Central Office Administrator Pauline Wampler

Associate Administrator Norma K. Files

3

EDITOR'S COLUMN

Linda Campbell

This issue is my introduction to you as the incoming editor of The Psychotherapy Bulletin. Wade Silverman has left big shoes to try to fill. He has elevated the Bulletin to a level of prominence and recognition among APA publications and he is deserving of our lasting appreciation for his work.

I am inviting you, our membership, to share your ideas and suggestions about topics, issues of concern, new column and feature possibilities. The contributing editors under Wade's editorship have done a superb job in representing our members' interests. They have very graciously agreed to continue as contributing editors. Because our profession is both dynamic and interactive with many variables that affect psychotherapy, we must continue to expand and renew our focus in the Bulletin. For this reason, I am also inviting each of you who have interest in writing for the Bulletin in a new or underrepresented area to come forward. The Publications Board under Dr. Herbert Freudenberger and the Board of Directors under Dr. Gerald Koocher have very clearly sent the message that Division 29 is an open, not closed system. New or previously inactive members are encouraged to get on board. Do not be deterred by uncertainty about your writing ability or your ideas. The

leadership of the Division is most genuinely supportive and encouraging of member involvement.

Several areas of focus have already been identified.

These are child and adolescent psychotherapy, racial and cultural diversity, and interventions at the community systems level including prevention and emergency care. Thereis interestaIso in an ongoing student column, a feature column of either a personal view, interview, or "think piece", and an update on members' professionaiactivities. If you have an interest in participating in any of these areas please let me know.

A second direction we - be taking in the Bulletin is a change in fonnaL Se eral ideas ilave been suggested by members and SDp)XlJted by the Publications Board. Please look f(X the changes and let us know what you think.

Psychotherapy is the bean of psychology. Division 29 above all other divisions of AP A must reflect d sustain that spirit and function. It is up to you, the membership, to help accomplish this purpose and a very visible way to do this is through our newsletter. I hope to hear from you soon.

FEATURE ARTICLE

Psychology Fights To Hold Ground Under National Health Care System

Reuben 1. Silver

Professional psychology is bracing for the most challenging development in its history=national health care reform. The new Clinton administration has promised to seek swift action on implementing a new nationwide health services delivery system. and the risks to psychology's future are real.

"With this battle, we are in the unenviable position of fighting to hold ground or cut our losses," observes BryantL. Welch,J .D.,Ph.D., APA 's Executive Director for Professional Practice. He says the legislative

debate about a national health care program touches on scope of practice, professional autonomy issues, and the availability of mental health services in all settings. Public and private sector providers alike will be affected dramatically.

According to Dr. Welch, "We need to try to blunt the force of any affront to our professional livelihood with our collective resources. Now more than ever psychologists must speak in a clear and unified voice, as we advocate for mental health care and access to

4

psychologists' services under the administration's plan."

Practitioners can't rely on the status quo, including current legislative protections. State mental health benefit mandates and current service delivery arrangements are in jeopardy of being usurped by the new scheme. And individual practitioners can't leave it to "organized psychology" to carry the banner. "Each of us must participate actively, working in concert with AP A and our state associations as professionals seeking a common ground," urges Dr. Welch.

What does the future hold? Bill Clinton continues to endorse a "managed competition" approach to national health care. In a nutshell, this is a monolithic managed care system crafted by the architects of the present managed care establishment.

The managed competition system is likely 10 be used to ratchet down health care expenditures to a level that is acceptable 10 both government and the business community. Providers and consumers may be far less likely to find the system palatable.

President Clinton has advocated cost controls by setting state-by-state caps on total health care spending. At this point. there is neither reliable information about state health expenditures nor a system on the horizon to collect the necessary data. This reality gives rise to the serious possibility of unrealistically low caps, in tum resulting in dramatic underfunding of mental health care.

Dr. Welch argues that, "With the current cost containment fervor, funds in the mental health field should be redirected from expensive inpatient psychiatric utilization to less costly and more appropriate treatment settings. However, the powerful medical and hospital lobbies are working hard 10 ensure that this logic is an early political casualty in 1993." Further aggravating the situation is the political splintering whereby certain consumer gronps advocare Ibat ooly certain diagnostic categories related to mental health should be covered under a national pIan..

With the pressing challenges at hand, the AP A Practice Directorate and the Committee for the Advancement of Professional Practice has been orchestrating a landmark legislative battle to help psychology survive the proposed changes and the influence of forces on Capitol Hill hostile to the profession's continued existence. Having invested five years' worth of special assessment monies on practitioners' behalf, the Practice Directorate has laid the necessary groundwork. Their seasoned lobbying staff in Washington, D.C., is supported by an effective grassroots network sustained by the state psychological associations. The national and state associations couldn't even begin to press psychology's cause without this crucial infrastructure firmly in place.

Allpractitioners who pay the special assessment are receiving additional details from the Practice Directorate about what's at stake for mental health as legislators drive towards a national system for health care delivery. Practitioners are being asked to lend their assistance in several ways. These include corresponding and visiting with congresspersons, sharing real life examples of the effects of inappropriate limitations on mental health benefits.

Contributions from a special APA fundraising campaign will be used to accomplish the extensive lobbying and other educational and advocacy activities within Congress on psychology's behalf. The requests for voluntary donations from practitioners reflect the daunting and urgent fiscal needs resulting from the present challenge to psychology. The AP A fundraising campaign monies will not be used for making any contributions to politicians.

If psychologists don't act quickly with the force of all their ranks, they stand to face tremendous disruption in their professional existence. Even in mustering their best effort. a realistic expectation may be simply to hold ground, "Anything shy of a large-scale, fully-funded effort is likely 10 herald our professional demise," Dr. Welch concludes.

5

Council of Representatives Meeting ~~~!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

February 26-28, 1993 Washington, D.C.

Donald K. Freedheim

It seems that the winter meetings of the AP A Council of Representatives (CfR) take on a certain mood during the two or three (as in these meetings) days. The August meetings at the convention are broken by two days of convention meetings and there is little continuity. But at these winter meetings, which ends the current term of officers, etc., an atmosphere develops mat seems to characterize the meetings.

Last year the mood was of celebration, as we were in me midst of our centennial events. This year the mood was of suspicion and frustration. At least that is the way things started. Throughout the meetings there was much catharsis and some blood-letting, and when we left, there was a greater feeling of understanding and trust.

The problem appeared to center around me PRO· CESS of communication and management between, mainly, the Board of Directors and the C/R. As a result. there was a long executive session by the C/R and a healthy exchange of feelings about the process. It is hard to capsulize the events in a brief report, but the essence of the problem lies in the role and responsibility of the C/R-which is THE legislative body of the organization-and the management responsibilities of the Board. which are to carry out the will of the C/R. Although tension in this area has been present for some time, it all came to a head with the shift in the status of Bryant Welch from Executive Director of the Practice Directorate to a consultant (although perhaps not in the traditional sense) in charge of APA advocacy in the federal health reform area. Bryant has done such a magnificent job in his advocacy for psycho 1- ogy, that many of the C/R were dismayed and confused by the changes. Although it is impossible for such a deliberative body to micro-manage the organization (and inappropriate, as well) the lines of communication between the Board and the C/R were not clear on the events leading up to such an important decision. As a result, CAPP (who oversee the activities of the Directorate funded by the special assessments) and the Board have formed a liaison committee, whose first task will be to search for a new executive director for the Directorate.

I am sure that more will be written and analyzed about these events in the next several months, so let us see how others interpret the situation.

Meanwhile. the CfR did accomplish a number of tasks with relevance to our Division membership. The meetings started on a sad note with tributes to Jeff Tanaka, whose untimely death occurred last FaIl. Art Kovacs and Dick Suinn spoke eloquently about Jeff, who was so active in AP A minority affairs and many other areas.

As usual, many procedural matters came before the C/R, including one resolution that would insure that all new business brought to Council and referred to committees would be brought back to the floor after two years. This is to insure that motions do not get buried in the board and committee structure of the organization, which was not an unusual happening. (Another source of tension between the Board and C/R.)

A new Division on Addictions was given candidate status. thanks to the tireless efforts of Herb Freudenberger. Also. the Division on Group Psychology and Group Therapy (49) was given final approval.

An important piece of legislation to all of us was the passage of the Record Keeping Guidelines. which I hope will be reprinted in this or the next issue of the Bulletin. The C/R established a task force to study. in depth, the controversial issues around early childhood memories of abuse. This is turning out to be a very controversial arena, with the formation of such groups as the False Memory Syndrome Society.

The e/R passed a $50+ million dollar budget. which covers over 400 staff at APA headquarters. On the latter. we approved the possible letting of bonds to re-finance our loan. which we used to purchase a new building. Details upon request will be supplies by my colleague and CfR neighbor. Carol Goodheart Together we try to do our homework, attend to all the business at hand. and represent you on this most fascinating body politic.

One last note, this meeting marked the end of Jack Wiggins' term as president. He has had a very busy eventful year with the centennial, et al. He did our Division proudl Especially in his courageous and sensitive handling of the tension-filled atmosphere of this C/R meeting. He let all sides be heard and never lost his composure. May I say for Carol and myself. as well as the rest of the Division, congratulations, Jack on your fine presidency. We are proud of your membership and past leadership in our Division.

6

WASHINGTON SCENE

Prescription Privileges· Evolving Progress:

Patrick Del.eon

From a public policy perspective, the prescription privilege agenda is fundamentally both a training and a State-level "scope of practice" issue. During the past several years various agencies of the federal government have clearly been "out in front" in demonstrating that (a) credible training modules can be developed (the Department of Defense (DoD)) and further, (b) that individual psychologists, even with minimal formal training, can competently perform this clinical function (the Indian Health Service (lHS». These advances have been made notwithstanding the vocal objections of organized psychiatry and their "public health hazard" arguments.

It is instructi ve to recall that when we first addressed the potential federal role within the prescription agenda evolution, it was in consultation with the then-chief Army psychologist, Brian Chermol, who had surveyed all Army psychologists and reported that 82 percent of Army clinical psychologists desired to obtain training in psychopharmacology and subsequently to obtain prescription privileges. Only a very small segment (18 percent) of his Psychology Corps did not At that time the gestalt within the civilian sector was admittedly somewhat different. The Hawaii Psychological Association (HP A). for example, reported a very strong split in views within its membership, with 34 percent fully supportive, 27 percent completely opposed, 12 percent generally positive, 18 percent generally opposed, and 9 percent neutral.

Today, the DoD training initiative, after various iterations, is doing quite well and there is every indication that the evolving two year program will henceforth begin with a one year focus on didactic courses at the Uniformed Services University of the Health Sciences, followed by a hands-on practicum at Walter Reed Army Medical Center, or a comparable military medical center, the second year. The current psychopharmacology Fellows report that they are doing fine, although one has decided to leave the program after the first year and return to being a full-time military psychologist. The program continues, and each of the three Services have been formally asked by the former-Assistant Secretary for Health to nominate, not later than 1 March 1993, at least one psychologist for a new class of trainees to start in July, 1993.

As we have indicated, the prescription movement must eventually become primarily a loca1! State issue and thus, we have been very pleased with the recent flurry of activity that is occurring in the State of Florida Previous columns have noted the substantial progress being made in the far West by Ray Folen (Hawaii) and Ruth Paige (Washington State). Now the Southeast seems to have come alive. Florida is an interesting state; it possesses the highest percentage of residents 65 years or older (i.e .• Medicare beneficiaries) of any state in the nation. Under the Florida statutes, nurse practitioners possess prescription authority. Their law requires the "collaboration" of physicians: however, they are not required to have their prescriptions co-signed. In 1986 Florida enacted legislation allowing limited prescription writing privileges for pharmacists, from a specified formulary containing approximately 30 drugs - without physician supervision, collaboration, or co-signature.

Accordingly. we were particularly pleased to recently receive a request from the staff for the Florida Board of Psychological Examiners for any available background materials on the psychology-prescription privilege issue as: "The Florida Board of Psychological Examiners will be discussing prescription privileges at their next meeting". Barry Crown had made a similar request at almost the same time, following up on discussions that he and his colleagues in the South Miami area are having with a local osteopathic medical school, which has expressed interest in developing an appropriate training module for clinicians already in practice. Even more significant, however, is the report we received from Frank DePiano, Dean of the School of Psychology at NOVA University, describing their new postdoctoral program in psychopharmacology.

Frank noted that "The postdoctoral training program at Nova University's Center for Psychological Studies (CPS) has begun its second cycle. Those completing the didactic portion from the first cycle indicated that they were pleased with what they had learned; believed that they could better understand the integration of psychotherapy and psychopharmacology; and that they could better communicate with medical staff. William J. Bums. Ph.D. who completed

7

the first didactic portion and is now in the midst of the practicum portion indicated that the practicum is an extremely interesting experience. The physician Director of Medical Services within the CPS oversees the practicum portion, and according to Dr. Bums provides an opportunity for complete patient contact. The trainee conducts medical interviews with the patient, then follows these interviews with a recommendation for medication. All of this is closely and directly supervised by the physician director. Once the patient has left, there is opportunity for one on one discussion between the trainee and the physician. In this way the trainee is provided an opportunity to learn by doing. but in a protected and guided environment".

"Nova will continue to pilot this postdoctoral training. The first cycle was open only to faculty of CPS. The second cycle was open to Licensed graduates of the Center. The next cycle will be open to clinical psychologists practicing in the local South Florida community."

"The two physicians working with the program continue to be enthusiastic about the program. They are impressed with the psychologists with whom they have worked and view them as eager learners who are highly committed to the patients they serve. Much of the initial success of this postdoctoral program is credited to this pair of physicians." Yes, as a profession we are continuing along the path of no rerum - and in our judgement, towards truly addressing society's pressing health care needs in a responsible fashion.

Substantial progress is also continuing on the educational front as a result of the work of prescription task forces in California and Illinois. Tom Marra (California) recently shared with us the most impressive slide presentation that he and his colleagues have developed, which among other topics, directly addresses psychiatry's proffered "unique medical expertise". It points out, for example, that 82 percent of all psychiatric clerkships are only 6 to 8 weeks in duration and that only 5 percent of psychiatric patients seen by general practitioners are referred to psychiatrists for care. Recall that an earlier report generated by Bruce Bennett had reported that of the 135,896,000 psychotherapeutic scripts written nationwide in 1991, only 17.3 percent were ordered by psychiatrists. And, going directly to the issue of whether "consumers" expect psychologists to prescribe, a Practice Director-

ate survey of non-psychologists found that not only did 60 percent favor allowing psychologists to prescribe medications (32 percent opposed and 8 percent "don 't know'') , but that when asked: "If you need help from a mental health professional, would you seek one who ... 7". 41 percent indicated: "could prescribe"; 37 percent "does not matter", and only 16 percent "could not prescribe". According to Ron Rozen sky , a member of the Illinois task. force, similar educational efforts targeted towards that State's psychology educators also are generating very positi ve responses. Currently, we are aware of 24 State! local or Divisional task forces addressing the Prescription Privilege agenda. Those interested in further developments at the State level should be in direct contact with Anita Brown of the AP A Practice Directorate, who has been actively involved in assisting these State efforts.

ANOTHER FIRST HAND REPORT:

Far more than most of us might realize, during times of national crises and turmoil, individual members of our profession have historically stepped forth and demonstrated psychology's ability to contribute significantly to the "national good" in ways that only in retrospect, may have seemed "logical and fitting" - this process, in our judgement, represents the gradual maturation of a true profession.

Recently we received a report from Christopher Kalkines, now of the State of Florida, who served in the U.S. Navy during Operation Desert Shield. "I was deployed very early in Operation Desert Shield and I (believe) was the first mental health practitioner to be deployed with regular forces in the Southwest Asian theater of operations. To the best of m y recollection I arrived on August 15, and was detached to "Echo" Surgical Support Company, Ist FSSG, 1st Marine Expeditionary Force. For administrative reasons the psychiatrist assigned to our area was returned to the United States and for a period of several weeks I was the sole military mental health provider in Saudi Arabia. As such, I had primary responsibility for our makeshift psychiatric unit, in what we referred to as the "Marine Corps Hospital" in Al J ubail, During this time I had sole responsibility for the assessment of patients referred for mental health reasons, the admission of patients requiring it, the treatment of these patients, and the discharge! disposition of these patients. I was also asked to conduct a number of evaluations on medical patients in the hospital with

8

regard to the mental health components of their medical illnesses."

"Because of the peculiarities of the Air Force medevac requirements at that time, psychiatric patients were not allowed to be air-evaced from Saudi Arabia unless they were medicated. When this requirement was presented to my superiors, their immediate response was that I prescribe such medication. Because I did not want to place myself in a position where I might be providing a service for which I was not credentialed in the United States, I requested that a physician sign the prescription order. The chief medical officer readily volunteered to do so and signed the prescriptions on all patients for whom I recommended them, based solely upon my judgment. Because we were a surgical support company and because we were mobilized so rapidly, the only true psychopharmacological agent we had available was diazepam. I immediately requested that we obtain a quality of haloperidol, however at that time we were purchasing many of our medical supplies on the Saudi market and apparently haloperidol is not approved for use in Saudi Arabia."

"During this same period of time I also conducted training with the physicians in our company who were largely surgeons and anesthesiologists. One of the training sessions I conducted concerned the general neurochemical effects of the neurotoxic agents we believed the Iraqis might use in combat and, similar effects from the antidote the Marines were issued, should they be exposed to it My training also focused on the possible risks of using neuroleptic agents in a desert environment and their possible interactions with the anticholinergic effects of the antidote."

"Because of a serious family illness, I was permanently transferred back to the United States after serving only two months in Saudi Arabia. However, during the time of my service there I groomed and maintained an extremely close relationship with my physician colleagues whom I believe respected my expertise, not only in the area of area of psychology, but also in areas which have typically been the sale domain of psychiatrists. I believe this was a result of a number of factors: I have had a great deal of exposure and experience in working with these medications in hospital settings and am very familiar with the common side effects and interactions with various medical conditions which might be encountered. I also was

careful to not extend my work into areas in which I did not have the requisite knowledge in my own estimation. At no time did any of my physician colleagues raise questions about my ability to interact with them on medical issues. In fact, it was suggested during one meeting of the medical staff that should dire circumstances arise in which we might be overwhelmed with casualties, that I might be utilized to assist an anesthesiologist in the triage area, assigning patients to the various triage categories. Both as a civilian and as a military psychologist, I found myself in the position of being asked by physicians to make recommendations for specific psychopharmacologic agents and dosages and have found this to be a service which non-psychiatric physicians truly appreciate when it is done well."

"I must confess that I myself have ambivalent feelings about psychologists pursuing prescription privileges, but have nonetheless closely followed the drama as it has developed. I would like to share with you that my primary area of concern in this matter is that most psychologists are not adequately prepared to prescribe these medications for patients with physical illnesses or who might be already taking other medications. The type of training which would be required for such an understanding would likely be so lengthy that there would be little benefit in pursuing it in lieu of attending formal medical education. While we might then recommend psychologists not become involved with patients in such circumstances, the ultimate decision will of course rest with each individual psychologist. Medication misadventures are to be anticipated from any professional group that prescribes drugs and yet I fear that once several such cases involving psychologists become public, the public perception of our professional image may be significantly tarnished. Nonetheless .... "

It has always been our contention that society would be well served by appropriately trained psychologists obtaining prescription privileges. as a number of our non-physician colleagues in other disciplines have already done. For those who continue to feel that there is "no role" within psychotherapy for the use of psychotropic medications, we would suggest they read an article, which was brought to our attention by Ed Nightingale and Jack Porter, entitled: "Integrating psychotherapy and pharmacotherapy". authored by Joseph Hyland, MD and published in the Bulletin of the Menninger Clinic. Our psychiatric colleague

9

concludes: "Because the efficacy of psychotropic medication has been established for a variety of psychiatric conditions, the determination of any treatment regimen should include an evaluation of the role of such medication.... A proper understanding of each modality will promote understanding and enhance the efficacy of the combination of modalities. The interface between them offers an array of opportunities for research and clinical advancement. This paper offers a clinical perspective. As the examples illustrate, a clinical vantage point captures data and information not available from a statistical study of larger numbers. Thus, although the value of combining modalities is clear, individual examples provide caveats against their joint application without adequate evaluation."

Over the years, Bob ("Dr. Bob") Resnick has become fascinated with the history of professional psy-

chology, and from time to time, he provides us with various "insights" which help put evolving events in a broader perspective and in particular, which vividly remind us that psychology must constantly strive to control its own destiny. His most recent tidbits: "In 1917. in what may be the fustpublished diatribe by psychiatry against psychology occurred. demonstrating a chronic adversarial stance against the autonomy of psychological practice (Cornell. 19l7)". And, "As early as 1925. a suggestion for the creation of the 'first' professional degree was made (Crane, 1925). He described the degree and called it a Doctor of Psychology to be written as Ps.D .... I do note in passing, Dr. Crane's comment that, ', .. With occasional noteworthy exceptions. the attitude of medical profession towards the practicing psychologists is one of tolerant condescension'." Those who forget the past are unfortunately doomed to relive it.

THE CHALlENG E TO PSYCH OLOGY ~!!!!!!!!!!!!!!!!!!!!!!!!!!!!!~ The Changing Face of Psychology

Dorothy W. Cantor

When I attended my first AP A and state association meetings almost 20 years ago, I felt like I had entered a masculine world, not unlike a white male club that had recently allowed women to be members. This summer, at the APA Centennial convention in Washington, I was struck by the fact that psychologists come in every shape, size and color, and that women and men are quite equally represented. It wasn't a surprise. It is a phenomenon with which I am familiar. But it is, as we know, one thing to recognize something in the abstract and quite another to experience it.

I have, for several years, been concerned with the changing face of psychology and, particularly, the fact that as Jessica Kohout, Ph.D., Director of the Office of Demographic Research, has projected that by the year 2004 the gender balance of the profession will have tipped to over 50% female. I was concerned enough to ask my colleagues on the Board of Directors to organize and fund a two-year Task Force on the Changing Gender Composition of Psychology, which I chair. My concern has a twofold source: a myth and a reality.

The myth is that when women enter an occupation, a decline occurs. Women have mistakenly been held responsible for the decline. Therefore, the term "feminization," with all its negative connotations. is applied to the occupation. Indeed. the first name of the aforementioned Task Force was the "Task Force on the 'Feminization' of Psychology." However, in response to communications from Division 9 (SPSSI), Division 35 (Women),. and individual members at an open forum at the Centennial convention; the Task Force informally adopted the new title. The truth, as Reslcin and Roos (1990) point out in their book, Job Queues, Gender Queues. is that external and internal forces first lead to the occupation becoming less attractive to men. As fewer men take up the available slots, women move into them, because for them the occupation is higher up on the job queue and provides opportunities that had not previously been available to them. Their increased number is a result, not a cause, of the decline in the occupation.

As Barbara Ehrenreich (1002) put it, "When women get to take over some field of human endeavor, it is usually because the field has been downgraded to the level of broom pushing." A reality is that women in

10

this country are paid less to do the same job as men do. When an occupation is male dominated, men and women are paid more than when an occupation is female dominated.

What does all this mean for Psychology? What are the internal and external forces that have led to the gender shift in the field? Using the model developed by Reskin and Roos (1990), a subcommittee of the Task Force on the Changing Gender Composition of Psychology, chaired by Martha Mednick, Ph.D., is doing a case study. The case study will have two subsections, one focused on the changes in academic settings, and the other on changes in practice. Once the data have been collected, we will have a view of what has occurred in the field since 1960, and why.

The next goal is even more formidable: to halt the decline and reestablish the status, prestige, and earning power of the field, regardless of its gender distribution. The Task Force is already looking at several avenues by which to accomplish that goal: education, advocacy, public relations, and leadership training. The content of each effort will be informed by the case study, and a long-term plan will be proposed.

Interestingly, the changing gender composition is not unique to psychology. Medicine, optometry, veterinary medicine, and law are among the many professions undergoing a shift in gender balance. (It should be noted, however, that although the number of women physicians quadrupled between 1970 and 1988, the percentage of women in psychiatry has declined from 14.4 to 10.5 percent (Moran, 1992). Here the reason seems to be that as other specialities have opened up to women, a smaller proportion of them is entering psychiatry). The Task Force members believe that if the strategies put forth in the long-term plan are adopted by the other professions, we are all more likely to experience success. Therefore, Helen Astin, Ph.D., is chairing a subcommittee to develop a grant proposal to get funding for a two-day invitational conference of the professions in the spring of 1994.

Even as professions become more female, the leadership tends to remain male. Organized psychology,

to date, has been no exception. There are only three women on the current Board of Directors, with eight men. (Our group pictures hark back to the image of the entire profession in the mid-'70's). Indeed, APA has only had six women presidents in its history. As our President-elect, Ronald Fox, Ph.D., a Task Force member pointed out, only 25% of all faculty in graduate departments of psychology are women, only 15% of chairs of departments of psychology are women, only 15% of the editors or associate editors of APA Journals are women, and only 28% of the presidents of state associations are women. He called for women to head educational programs, control the levers of power and occupy leadership roles at all levels in our professional organizations, and participate as leaders in legislative and regulatory struggles. He expressed concern that there be a large enough cadre of informed advocates to ensure our future. (Fox, 1992.)

I have no doubt that women can, and will, take a proportionate share of the responsibility and leadership ofPsycho!ogy. The changing face, the changing gender composition of Psychology can mean renewed vigor. strength, and purpose. The Task Force will set a plan in motion. Then it will be up to the psychologists themselves to run with it and make it happen.

REFERENCES

Ehrenreich, B. (June 22,1 992). "Why Women Are Finally Winning." Time, p. 82.

Fox, R. (1991). "Facts and Myths About the Feminization of Psychology," Psychotherapy Bulletin, 26, (4),29-31.

Moran, M. (May 15, 1992). "Psychiatry Losing Women to Other Specialties." Psychiatric News, 27 (10), pp. 1,22-23.

Reskin, B.F., & Roos, P.A. (1990). Job Queues.

Gender Queues: Explaining Women's Inroads into Male Occupations. Philadelphia, Temple University Press.

11

1993 0 iv i s ion Lea de rs hip Co nfe re n ce !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Tommy T. Stigall

More than 60 persons attended the Division Leadership Conference held in late January at the Washington, D.C. Capitol Hilton Hotel. Included were division officers, representatives of AP A governance, and AP A staff. The conference is organized and sponsored each year by the Committee on Division/ APA Relations (CODAPAR) and the APA Division Services Office. Division 29 was represented at this year's meeting by President-elect Tom Stigall.

Highlights of the conference included a state of the Association address by APA CEO Ray Fowler and remarks by APA President Jack Wiggins and President-elect Frank Farley. Stressing APA's fiscal soundness and successful negotiations to acquire ownershi p of the new 85 million dollar AP A headquarters building, Dr. Fowler discussed plans to refinance the 66 million dollar investment through a bond issue that would provide even more favorable terms to AP A.

On the matter of the 1992 Council of Representatives consolidated resolution, Dr. Fowler stressed that all guidelines and standards developed by divisions must be submitted for review by AP A legal counsel to insure that other constituencies are not adversely impacted and that APA is not exposed to legal liability . Divisions have been asked to submit for legal review any existing guidelines that previously may have been promulgated as policy, including copies of by laws and bylaws amendments.

A Vision for the Future

Outlining a number of initiatives planned for his tenure as president of APA, Dr. Farley stressed the theme for "a vision for the future of our discipline." A trilateral psychology commission would be composed of representatives from Canada, Mexico, and the U. S. to address common issues of concern to psychology in the western hemisphere. A quality award, analogous to the Malcom Baldridge award, could be used to recognize exceptional accomplishments in education and training or clinical service delivery. Initiatives in both educational reform and health care reform would be essential to psychology's continued social relevance and credibility.

An advisory group for Dr. Farley's "Second Century Assembly" is being established to plan for a

future gathering of visionary leaders in psychology. The goal of the assembly would be to examine the commonality across subareas of the field and promote solidarity. Division input is being solicited in the planning process. A documentary film of the proceedings is planned. The opportunity to exploit the Second Century Assembly as a media event, with significant public relations value, was emphasized by Dr. Farley.

Policy and Planning Board member, Norma P. Simon, consults with APA legal counsel Dort Bigg during the plenary session discussion of the consolidated resolution.

A Prescription ror Divisional Health

Reflecting on his presidency during AP A's centennial year, Dr. Wiggins stressed "social relevance" as the key to divisional growth and vitality. Noting that there are 17 of APA's current 49 divisions on "the endangered species list" by virtue of their small size and failure to grow,Dr. Wigginsdeclaredtwopreconditions for division success: Di visions must present a clear and consistent message that will attract the attention of potential members. Divisions must utilize convention programming as a vehicle for promoting interest in the division.

Five steps to achieving divisional success were outlined by President Wiggins.

l. A strategic plan is needed to facilitate the division's response to social need for crises. Opportunities for action can be seen in events such as Hurricane Andrew and Operation Desert Storm.

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2. Networking with other divisions and with AP A governance can strengthen a division's capacity for effective action. The AP A Division Services Office is an important point of contact.

3. Special membership recruitment efforts can be successful, if planned and carried out carefully. Division 42 recently became the largest APA division in one year by simplifying the process of joining.

4. Outside funding can be sought to augment dues income and enhance the division's ability to undercake socially relevant action, consistent with the division's strategic plan.

5. Collaboration with other disciplines and organizations outside the field of psychology is important to maximize the division's effectiveness. An example might be a joint study of drug abuse among children and adolescents that could involve both psychologists and physicians.

National Health Care Reform

Conference sessions were scheduled on a variety of topics, gi ving attendees an opportuni ty to interact with each other, as well as the presenters, in a more informal context. A session entitled, "Psychology and National Health Reform: Salvation or Armageddon," was led by AP A Executive Director for Professional Practice Bryant Welch.

Division 29 President-elect Tom Stigall (center) and Division 31 President-elect Kathleen McNamara confer with APApresidenlial candidate Robert Resnick.

Dr. Welch described the health care reform initiatives coming forward from the new Clinton administration. He noted that, under the proposed system of "managed competition," state laws mandating mental health insurance benefits or freedom of choice would be preempted. Large managed care entities would control access to care, and goverrunent limits on spending for health care would set provider fees and hospital allowable charges. Managed care entities would compete for the business of serving employee groups, and employers would be required to purchase benefits from the limited number of managed care brokers.

Commenting that "this is not a

psychology-psychiatry battle," Dr. Welch noted "it is a little bit scary that interprofessional relations (with psychiatry) have never been better."

The strategy being followed by the Practice Directorate is to advocate for an unlimited outpatient mental health benefit, inclusion of psychologists as independent providers, and reasonable reimbursement. Dr. Welch noted that mental health would fare much better under a "single-payer" plan of government reimbursement for all health care than under the managed competition alternative.

A Crossroads for Accreditation

Issues of accreditation policy, operational structure and procedures, and future plans were discussed by Paul D. Nelson, Ph.D. in a session entitled "Accreditation at a Crossroads: Perspectives, Responsibilities and Challenges." Dr. Nelson is Director of the APA Office of Accreditation and Deputy Director for the Education Directorate.

"Relatively few issues in my experience with American psychology are such a lightening rod as quality assurance and criteria for graduate and professional education," stated Dr. Nelson. Recalling that AP A has been involved with accred.itationas a "voluntary and non-governmental process of self- and peer-review."

The new AP A Committee on Accreditation was reconstituted officially this past November. As presently composed, the Committee represents the domains of training instirutions and programs, professionals who are themselves the product of the training programs, and the various publics that have a stake in

13

accreditation. The Committee is now in the process of reviewing AP A policies and procedures for accreditation. "looking ahead to the next 20 years, if not the next century," according to Dr. Nelson.

Consideration of the future scope of accreditation will encompass the range of specialties in psychology, as well as levels of education and training. A draft revision of the APA accreditation policy and procedures document is expected by summer, with a target date for final adoption and implementation in the Fall of 1994.

APA Executive Director for Professional Practice Bryant Welch (center) discusses the challenge of national health care reform with Practice Directoate staffer Michael Sullivan (left) and CODAP AR member Alan En/in.

Continuing Education

A lively discussion on continuing education was led by Barbara Hammonds, Director of the APA Continuing Education Office. Fourteen divisions now are recognized as APA-approved sponsors of CEo Approved sponsors may engage in co-sponsored arrangements with other divisions and groups, but must retain responsibility for insuring that each CE activity conforms to AP A guidelines. Clarifying AP A policy, Ms. Hammonds explained that divisions may not levy an additional charge for CE offerings scheduled during the APA annual convention, but may do so for preconvention CE activities or CE workshops offsite that are not an official part of the convention.

Some 400 approved CE sponsors are now recognized by AP A. The increased popularity ofCE may be due, in large part, to the trend of requiring documented CE for renewal of licensure. Whereas only 11 states required CE as a condi tion of license renewal 1 0 years

ago, today 27 states do so. The number of CE credits required ranges from 10 to SO hours per year. This trend is increasing across all professions and seems to reflect a public perception that CE enhances professional knowledge and skill in the interests of maintaining competency for practice.

Future models of CE delivery that already are technically feasible and may become more commonplace in the future include videoconferencing and personal computer networks. Because of the costs involved and the need for a critical mass of participants at each distributed location, videoconferencing usually is not suitable for rural settings. Co-sponsorship may be one way to amortize the increased costs associated with utilization .. of the new technology.

The Future of APA-Division Relations

On the fmal morning of the conference, Policy and Planning Board member Norma P. Simon and APA legal counsel Dort Bigg discussed recommendations from P&P's workgroup on the consolidated Council resolution and the future of APA-division relations. Three alternatives were identified and considered by the conference participants.

The alternative preferred by P&P is to maintain the current status of divisions as integral parts of APA, with legal review of division policy statements to be strictly enforced. Other alternatives could lead to either looser or tighter legal relationships between divisions and APA, with corresponding changes in policy review and control.

Both internal and external issues are involved in any consideration of this matter. Examples of the former would be divisional membership requirements, ownership of journal operations and division assets, and division organizational structure. External issues include such matters as training program accreditation and credentialing of psychologists, ethical guidelines and standards for practice, political advocacy and political campaign contributions. Divisions are prohibited from making campaign contributions to candidates for political office, since doing so wouldjeopardize APA's 501 (c3) tax-exempt status.

Discussion of these important issues led to acknowledgement by Dr. Fowler that the climate of cooperation and information-sharing between APA

14

AP A President-elect Frank Farley informs division leadership conference participants about his plans for a "Second Century Assembly" to debate the future of psychology.

and its divisions is much improved. The legal interpretation offered by attorney Dart Bigg is that divisions enjoy clear autonomy, where not precluded specifically by APA policy.

A recommendation for enhancing APA-division relations, recommended by Dr. Stigall, met with a favorable reaction from those present. This suggestion would involve AP A contracting with divisions to carry our specific projects on behalf of the entire Association in areas where the division might have clear expertise and interest. This could be a more efficient and cost-effective solution in many cases than creating a larger APA governance and bureaucracy, and would be consistent with the current standing of divisions as integral parts of APA. Dr. Fowler agreed to explore this approach with the AP ABoard of Directors.

J In August, it is expected that there will be a revised policy document from P&P for review and comment ~ by divisions. Final review and action on this matter is anticipated at the 1994 Winter meeting of APA Council.

Concluding Business

CODAP AR Chair John R. Tisdale presided over the presentation of nominees for appointment to CODAP AR. There are two vacancies to be filled for three-year terms, and one vacancy to complete the unexpired term of Dr. Jonathan Slavin. The following slate of nominees was approved: Alan D. Entin, Morris Goodman (alternate), Donald A. Dewsbury, Mark Snyder (alternate), Phyllis A. Katz, and Alice F. Healytalternate). CODAPAR member Judith P. Goggin will succeed Dr. Tisdale as chair of the committee.

During the closing session, Dr. Entin introduced an item of new business that would implement a recommendation of the AP A Board of Convention Affairs. The proposal, which calls for division program chairs to meet at the time of future division leadership conferences to coordinate program planning, was adopted. The intent of this proposal is to achieve a more coherent and organized convention program, with common themes spanning multiple division offerings.

The Moving Movie

The conference concluded on a humorous and entertaining note with the viewing of ''The Moving Movie," a documentary of the antics and heroics of AP A staff during the hectic time of moving from the buildings where various AP A operations had been housed to the new headquarters building.

F EATU RE ART I C LE !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Committee on Professional Practice & Standards A Committee of the Board of Professional Affairs

Introduction

RECORD KEEPING GUIDELINES

The guidelines that follow are based on the General Guidelines, adopted by the American Psychological Association (APA) in July 1987 (APA, 1987). The guidelines receive their inspirational guidance from specific APA Ethical Principles of Psychologists and Code of Conduct (APA, 1992).

These guidelines are aspirationaI and professional judgement must be used in specific applications. They are intended for use by providers of health care services. The language of these guidelines must be interpreted in light of their aspirational intent, advancements in psychology and the technology of record keeping, and the professional judgment of the

15

interpret such records. These guidelines assume that no record is free from disclosure all the time, regardless of the wishes of the client or the psychologist.

individual psychologist. It is important to highlight that professional judgment is not preempted by these guidelines; rather, the intent is to enhance it.

Underlying Principles and Purpose

Psychologists maintain records for a variety for reasons, the most important of which is the benefit of the client. Records allow a psychologist to document and review the delivery of psychological services. The nature and extent of the record will vary depending upon the type and purpose of psychological services.

Records can provide a history and current status in the event that a user seeks psychological services from another psychologist or mental health professional.

Conscientious record keeping may also benefit psychologists themselves, by guiding them to plan and implement an appropriate course of psychological services, to review work as a whole, and to self-monitor more precisely.

Maintenance of appropriate records may also be relevant for a variety of other institutional, financial, and legal purposes. State and federa1laws in many cases require maintenance of appropriate records of certain kinds of psychological services. Adequate records may be a requirement for receipt of third party payment for psychological services.

In addition, well-documented records may help protect psychologists from professional liability, if they become the subject of legal or ethical proceedings. In these circumstances, the principal issue will be the professional action of the psychologist, as reflected in part by the records.

At times, there may be conflicts between the federal, state or local laws governing record-keeping, the requirements of institutional rules. and these guidelines. In these circumstances, psychologists bear in mind their obligations to conform to applicable law. When laws or institutional rules appear to conflict with the principles of these guidelines, psychologists use their education, skills and training to identify the relevant issues, and to attempt to resolve it in a way that, to the maximum extent feasible, conforms both to law and to professional practice, as required by ethical principles.

Psychologists are justifiably concerned that, at times, record-keeping information will be required to be disclosed against the wishes of the psychologist or client. and may be released to persons unqualified to

1. Content of Records

a. Records include any information (including information stored in a computer) that may be used to document the nature, delivery, progress, or results of psychological services. Records can be reviewed and duplicated.

b. Records of psychological services minimally include (a) identifying data, (b) dates of services, (c) types of services, (d) fees. (e) any assessment, plan for intervention. consultation, summary reports, and/or testing reports and supporting data as rnay be appropriate, and- (0 any release of information obtained.

c. As may be required by their jurisdiction and circumstances, psychologists maintain to a reasonable degree accurate, current and pertinent records of psychological services. The detail is sufficient to permit planning for continuity in the event that another psychologist takes over deli very of services, including in the event of death, disability. and retirement. In addition, psychologists maintain records in sufficient detail for regulatory and administrative review of psychological service delivery.

d. Records kept beyond the minimum requirements are a matter of professional judgment for the psychologist. The psychologist takes into account the nature of the psychological services, the source of the information recorded, the intended use of the records. and his or her professional obligation.

e. Psychologists make reasonable efforts to protect against the misuse of records. They take into account the anticipated use by the intended or anticipated recipients when preparing records. Psychologists adequately identify impressions and tentative conclusions as such.

2. Construction and Control of Records

a. Psychologists maintain a system that protects the confidentiality of records. They must take reasonable steps to establish and maintain the confidentiality of information arising from their own delivery of psychological services. or the service s provided by others working under their supervision.

16

b. Psychologists have ultimate responsibility for the content of their records and the records of those under their supervision. When appropriate, this requires that the psychologist oversee the design and implementation of record keeping procedures, and monitor their observance.

c. Psychologists maintain control over their clients' records, taking into aocount the policies of the institutions in which they practice. In situations where psychologists have control over their clients' records where circumstances change such that it is no longer feasible to maintain control over such records, psychologists seek to make appropriate arrangements for transfer.

d. Records are organized in a manner that facilitates their use by the psychologist and other authorized persons. Psychologists strive to assure chat record entries are legible. Records are to be completed in a timely manner.

e. Records may be maintained in a variety of media, so long as their utility, confidentiality and durability are assured.

3. Retention of Records

a. The psychologist is aware of relevant federal, state and local laws and regulations governing record retention. Such laws and requirements supersede these guidelines. In the absence of such guidelines, complete records are maintained for a minimum of 3 years after the last contact with the client. Records, or a summary, are then maintained for an additional 12 years before disposal. If the client is a minor, the record period is extended until 3 years after the age of majority.

b. All records, active and inactive, are maintained safely, with properly limited access, and from which timely retrieval is possible.

4. Outdated Records

a. Psychologists are attentive to situations in which a record information has become outdated, and may therefore be invalid, particularly in circumstances where disclosure might cause adverse effects. Psychologists ensure that when disclosing such information that its outdated nature and limited utility are noted using professional judgment and complying with applicable law.

b. When records are to be disposed of, this is done in an appropriate manner that ensures nondisclosure (or preserves confidentiality) (see Section 3a).

5. Disclosure of Record Keeping Procedures

a. When appropriate, psychologists may inform their clients of the nature and extent of their record keeping procedures. This information includes a statement on the limitations of the confidentiality of the records.

b. Psychologists may charge a reasonable fee for review and reproduction of records. Psychologists do not withhold records that are needed for valid healthcare purposes solely because the client has not paid for prior services.

References

American Psychological Association. (1987). General guidelines for providers of psychological services. American Psychologist, 42, 712-723.

American Psychological Association. (1992). Ethical principles of psychologists and code of conduct. American Psychologist, 47, 1597-1611.

17

DIVISION MEMBERS ENJOY MID .. WINTER ACTIVITIES !!!!!!!!!!!!!!!

"

'f /{,

,

/ .

. -

Patricia Hannigan-Earley Wade Silverman

Three Presidents:

Reuben Silver - Past President Gerald Koocher - Present Present Tommy Stigall - President Elect

Administrative Committee

Dr. Reuben Silver

John Currie

Sandra Haber Richard Mikesell Linda Campbell Dorothy Cantor

18

DIVISION MEMBERS ENJOY MID-WINTER ACTIVITIES

Richard Mikesell Carol Goodheart Ellen McGrath

Don Freedheim

Morris Goodman & Ernst Beier

lierbFreudenberger T. Richard Saunders

19

DIVISION MEMBERS ENJOY MID-WINTER ACTIVITIES !!!!!!!!!!~

20

NOMINEES FOR 1993 ELECTION !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Candidate Statement for President-Elect Patricia S. Hannigan-Farley, Ph.D

The nature of eli visions within the governance structure of the American Psychological Association is changing for those concerned with the practice of psychology. The Division of Psychotherapy (29) is known for its unique place in A.P.A. where minds meet over the many facets of psychotherapy, i.e. training, research, theory and practice. The challenge of this period is to retain the wisdom gained from the Division's previous 2S year history while anticipating the needs of the next 2S years. This challenge needs to be addressed by a new generation of leaders. This new leadership needs to address the manner and environment in which we practice in a positive, hopeful and realistic fashion. Our leadership needs to em brace those changes which the future will demand of us since that is where we will spend the rest of our lives.

A summary of m y 18 years of service to the Division is:

Division Secretary and

Administrative Committee Member-at-Large, Board of Directors Committee for Women, Chair Committee for Women, Associate Chair Mid-Winter Convention, Program Chair Program Committee, Member

Research Committee, Member

6 Years 2 Years 2 Years

1 Year 2 Years 3 Years 2 Years

This experience reflects personal involvement in and commitment to the on-going mission of the Di vision. Respectful of the contributions of the previous leaders and their foresight, it is our responsibility to build on the strong foundation they have prepared for us. Psychotherapy, as practiced by psychologists, is a dynamic and vital force for society. We need not apologize to anyone for our efforts. Rather we need to emphasize the positive role which we perform for our publics: government, business, education, the family and the individual.

We can emphasize this positive role within A.P.A. by continuing and enhancing the high standards we have set in the areas of publications and convention programming for the annual and mid-winter meetings. Furthering the education of future and existing practitioners of psychotherapy is an area in which the Division needs to continue its leadership. We need to extend our influence to achieve fuller participation in ~tting the agenda forresearch on outcomes and pracucepatterns. It is important that this agenda be based on quality standards resulting from profound knowledge as opposed to resulting in our being economically credentialed as providers of psychotherapy. As a Division, we need to better communicate the efficacy of psychotherapy, as provided by psychologists, to the public and take our rightful place in the ever continuing process of health care reform.

I propose to provide leadership geared toward a hopeful future containing opportunity and requiring creativity which I know we are capable of as a Division.

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Candidate Statement for President-Elect Stanley R. Graham

Candidate Statement for Secretary John S. Currie

The issue today is managed care. The question is the survival of the profession of psychotherapy.

Some years ago the insurance companies foistered a peer review system onto APA. Many were cooped by the system. I collected hundreds of signatures and forced AP A to reconsider its position. I helped collect thousands of dollars to support the lawsui t against the insurance companies. I did not submit - I fought the system and we ultimately won. APAdid not become handmaiden to the insurance companies.

I was one of the original organizers of the Practice Directorate. I am currently involved in the Practice Directorate effort to preserve psychology's place in the national health reform act.

Managed care is a scam which has multiplied the cost of health care and destroyed the livelihood of thousands of practitioners and deprived consumers of desperately needed care. There are no independent managed care systems, they have all been purchased by insurance companies, our old adversaries.

I believe I can provide creati ve, irnaginati ve, forceful Ieadership to break the system which is going to leave 2/3 of us outside the referral pattern as the

I t is a pleasure to ron for office in our Division. Will you please vote for and support me for Secretary? It has been my honor to serve you in several positions of leadership in our governance. Most recently I was your representative to the AP A Council of Rep res entatives for three years. Here are other posi tions I have held in our Division:

• At Large board member

• Organized and chaired our first committee on professional liability

• Assistant Editor of The Psychotherapy Bulletin

• Program Committee member

panels close and reduce the income of those within the panels to levels which do not merit twelve years of education.

I am one of the founders of the Division of Psychotherapy and have served in every office and committee of the Division. I received the Distinguished Psychologist Award from the Division and the Distinguished Contribution to Applied Psychology from APA last year. I don't need honors and I don't status. I want the position that gives me the nnr,...,rf;,L.., nity to fight the robber barons who are destroying profession.

22

Now, I offer to serve you as Secretary and to meet regularly with the Administrative Committee of your governance group. I hope you agree that my experience involves good qualifications. I have served as recorder and secretary in other groups and would like to work again with our Division 29 Board.

As deliverers of health care we are in a crucial posture right now. We need to continue to fight for autonomy in Federal and state programs, and we must maintain a vigilant dialogue with the managed care people so that we can re-establish the psychologist-client/patientrelationship as the primary one in our work. Alas, with President Clinton's determination to cut the rapid growth rate of health care financing, psychologists must work diligently to maintain our viability in emerging new programs. For years I have workedcloseJy with my Congressman on behalf of organized psychology. He agreed to co-sign our Medicare legislation. I will continue to do so and to bring my skills to the 29 Board if you will elect me.

We psychologist-psychotherapists can take pride in our data-based scientifically oriented specialty, making us unique among the several provider groups. In addition, we have public credibility and political strength hardly dreamed of in decades past I propose to work hard to continue the progress wrought by our Division and APA Leaders. In the past I have had a small hand in some of these accomplishments (e.g., I was the maker of the motion in the Council of Representatives to authorize the APA Board of Directors to proceed with constructing and buying our new building).

Now, I ask your help in ascending to an office where I may once again apply my leadership experience and skills.

Thank you,

Candidate Statement for Secretary Diane J. Willis

Diane J. Willis is Professor of Medical Psychology, Department of Pediatrics, University of Oklahoma Health Sciences Center and Director of Psychological Services, Child Study Center. She has been active in APA governance in a variety of roles: Board of Professional Affairs, Policy & Planning Board, Council Rep. of Division 12 and President of Division 37 and Division 12 (Sections 1 & 5). She guest edited a special issue of Psychotherapy: Theory & Reseracb on violence and specializes in assessment and treatment of child abuse cases. She co-edited a book on Prevention of child maltreatment and is a member of the U.S. Advisory Board of Child Abuse and Neglect. She is a member of the Publication Board of Division 29 and chairs the Task Force on American Indian Mental Health which completes its report in December 1993. Finally, being of Kiowa Indian descent, Willis spends considerable time consulting with and treating American Indians.

The office of Secretary is extremely important in providing a historical record of the activities of the Division and facilitating communication among Divi-

sion officers and members. The Secretary serves in an organizational role and communicates with APA regarding the actions of the Division. I feel honored to be a candidate for Secretary of this Division, and promise to perform the job to the best of my ability should I be elected.

23

Candidate Statement for Council of Representatives, Psychotherapy Division

Ellen McGrath

Having served within the Division of Psychotherapy for the past fifteen years, I have experience on nearly every committee that the Division sponsors. I have chaired a number of these committees, including Program Chair, Continuing Education and Task Force on Trauma. For the last nine years, I have been a member of the Officers Administrative Committee, serving two terms as Secretary and one term as President of the Division. Currently, I am Chair of the Professional Practice Committee (the marketing committee for psychotherapy). I am also liaison to CAPP and the Practice Directorate to promote the Clinton's health care reform movement.

I would like to take all of these experiences and use them now within the Council of Representatives to support the interests of psychotherapy at a time when our horizons are shrinking due to political and economic pressures. As your Council Representative, I would like to pro-actively pursue every avenue possible to highlight the importance of promoting psychotherapy as critical for all interests in American psychology and health.

We need to become better translators of what we know about human behavior and psychology is

uniquely positioned to become this cultural translator since we are the only discipline so strongly based or. principles of both science and behavior. Througt influencing public policy and developing and disseminating public information about the value ar psychotherapy, we can ensure that psychotherapj retains it's position as a critical source of research. practice education for the improvement of human behavior.

On Council, I would like to work toward integrating the various special interest groups in AP A and help ar; of US focus on these common goals for the survival anc promotion of American psychology.

Candidate Statement for Council of Representatives, Psychotherapy Division

Reuben J. Silver

The issues facing professional psychologists are very serious. Our very survival as a profession hangs in the balance. The reforms in health care delivery could threaten our very existence as an independent profession.

Division 29 is particularly VUlnerable. Our Division is the one that is concerned with all aspects of psychotherapy, namely theory, practice, training, and research. These aspects are interdependent such that restriction of one would have dire consequences on the others. Therefore, it behooves all of us, regardless of our area of interest in psychotherapy, to protect practice.

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Division 29 must have on the floor of Council representatives who are knowledgeable in all areas of psychotherapy interest, On the floor of Council, we need representatives who will be able to work, collaboratively, with the Practice Directorate and help mobilize Council to action. But that action must be well-reasoned and thoughtful. And your representative must be knowledgeable about the methods and techniques of other mental health disciplines. At this crucial time in our history, we need level-headed Council members.

Although the threat to our practice is greatest from the changes in health care reform, there are other important issues that our Division should address on

the floor of Council. We need input on education of psychologists who deliver health care services. The area of Post-doctoral education, the place of psycho-pharmacological training, the support of research, public interest concerns, - all these are issues that will be coming before Council.

As the immediate Past President of our Division, I am very familiar with the needs and wishes of our membership. If elected, I believe that I will represent your concerns in a manner that will be productive for all of us.

Please exercise your vote in this election.

Candidate Statement for Member-At-large Norman Abeles

Norman is a Past President of the Division of Psychotherapy. He is well acquainted with activities within our Division having served as chair of the Fellows Committee and chair of the Division 29 Task Force on Geropsychology and was active in developing guidelines on psychotherapy with older adults. Norm does research on outcomes in psychotherapy and on mood and memory issues for older adults. He

. also serves on the Policy and Education Task Force of the Ethics Committee. If elected, he promises to be a proactive member of the Division 29 Board. He welcomes your support!

Candidate Statement for Member-At-large Ernst G. Beier

I am honored to be nominated for the position of Member-At-Large. As a past president of our Division and as a Division representative to the APA Council in the recent past, as a former editor of the Psychotherapy Bulletin, as a member of the executive board with the attached duties as a liaison between Di vision 29 and the AP A Committee of International Relations f.W e are working on an update of "Clinical Training Abroad"), I think that I know our Division well and understand its needs.

Throughout my professional life I have been associated with University teaching. clinical training. and psychotherapeutic work in my clinical practice. I feel

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that I needed to remind the leadership of the Division at times that our Division must concern itself with aU three aspects: clinical training, research and clinical practice. With sweeping changes expected in the Health Insurance picture, we need cool judgement of what is best for the country as well as which structure

is best suited to give our most adequate service to ; . public, trusting that these two goals are cornpli tary. Within the Division I try to work on securing 800 telephone number so that Division members acquaint us with the professional problems they m encounter.

Candidate Statement for Member-At .. Large Leonard J. Haas

I have broad AP A experience, currently serving on the Board of Professional Affairs, and having served in the past on Council, on the Ethics Committee, and as a member of APA Task Forces. My service to the Division includes experience on the Board, as Mid- Winter Meeting Coordinator, and as a member of the nominations and research committees. I had the honor of receiving the Division's Jack Krasner award in 1989. J am also the past president of the Utah Psychological Association and of the Rocky Mountain Psychological Association. As a clinical psychologist who practices in a medical school, (Department of Family & Preventive Medicine, University of Utah), and who has been in independent practice in one form or another since 1979, I am concerned with psychotherapy issues on a broad scale, This is a

critical time (aren't they always?) for the Di vision the profession, and I believe the Board can continue make significant contributions to advancing the It would be a privilege to be part of that process.

Candidate Statem.ent for Member-At-La,rge VictorR .. Nahmais

"May you live in interesting times," goes an ancient Chinese curse. These are interesting times, indeed. New legislation is likely to change the way that healthcare is delivered throughout the country and, in the process, change the ways in which we practice our profession and make our livelihood. Our clients' newly found freedom-of-choice is rapidly being supplanted by closed panels, closely regulated benefits, and the evolving institutionalization and bureaucratization of healthcare,

If we are to be included in the new system, we must take an active role in shaping the programs of the future. And we must demonstrate the efficacy of treatment provided by fully credentialed doctoral psychologists. Without advocacy and leadership in research, training, and direct service, we are likely to be excluded and become an anachronism.

I believe that psychologists have a place in the healthcare marketplace of the future. But we must work together to establish it. This will take coordi-

nated efforts at the local, state and national level. have experience working with our divisional ship as Chair of the Midwinter Committee; I worked with corporate hea1thcare and understand . intricacies of managed care; and I am in practice - so I understand the urgency and necessity carving out a place for us as the premier providers mental healthcare, Please use your vote and select candidate(s) that you believe will help represent interests in the years ahead.

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Candidate Statement for Member-At-large John C. Norcross

I was pleased to be nominated by Psychotherapy Division colleagues for membership on the Board of Directors and would genuinely appreciate your support for my candidacy.

Division 29 is my natural professional home in that my daily responsibilities entail teaching, practicing, supervising, and researching psychotherapy. My fascination with psychotherapy was nurtured through a baccalaureate from Rutgers University, a doctorate in clinical psychology from the University of Rhode Island, and an internship at Brown University of Scranton, a private practitioner, and an active author. I have served on the editorial boards of 10 journals, including Psychotherapy, and as a consultant to a number of organizations, including the National Institute of Mental Health. For the Division's journal, I edited the special issue devoted to the future of psychotherapy in celebration of APA's centennial, organized series on prescriptive matching and the therapeutic relationship, and conducted comprehensive surveys on the practices and attitudes of Division 29 members.

Succinctly put, my priorities as a member of the Board would be to: reverse the polarization between the practice and scientific communities; maintain the quality and integrity of psychological services in the face of continuing cost containment measures; and advocate for the inclusion of psychological treatment in all national health insurance proposals. Perhaps most importantly, I would strive for an open mind, a responsive ear, and an active stance toward the interests of the membership.

Candidate Statement for Member-At-large George P. Taylor

As both our country and profession face the problems of reforming the health care system, I would like to play a part in the leadership of the Division of Psychotherapy. We in this Division have much to offer. If we are successful in our presentation to the powers that be, we will continue to have a house to live in; and if we fail we stand to lose a great deal.

If elected, I will strive to help in this effort in three ways. The first is to shape the Division's support for the efforts of the Practice Directorate, spearheaded by Dr. Bryant Welch, to assure us a place in the new health care program. The second is to work to expand our sense of what we have to offer, to help llS to recognize that psychotherapy is a useful tool for prevention as well as for remediation, and that is has applicability to what are generally thought of as the physical illnesses as well as the mental illnesses. As Bill Moyers' programs demonstrated, we know a lot about mind/body interactions. And the third, a much

more specific focus, has to do with directing our focus on using Our ski11s and knowledge to work with the older Americans, the fastest growing segment of our population. We can benefit from continuing education programs about the unique and the common needs of this group.

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By way of past and current experience in the governance of this association: I am present! y a member of CAPP, the Committee for the Advancement ofProfessional Psychology, and am chair of its Personnel Subcommittee; I am a trustee of the American Psychological Association Insurance Trust; and I am a member of the Coordinating Committee, comprised of four

members of the Board of Directors of APA and fOlII members of CAPP, the function to which is to oversee the continued effective functioning of the Practice Directorate.

I would appreciate your support Thank you.

SUBSTANCE ABUSE

The New Division of the Addictions (Division 50) and Other Substance Abuse Updates

Harry K. Wexler

The Division of the Addictions (Division 50) was passed by Council unanimously! This is a landmark event that demonstrates APA's recognition of the addictions as a major human problem of paramount concern to all psychologists. The new Division provides a home for the many psychologists who work in the research and treatment of AOO problems and have felt outside of the psychological mainstream. Although other health and mental health professions have shown faster professional responses to the problems of AOD, psychology has now created an important vehicle that will facilitate a more meaningful psychological response. The establishment of the new Division follows the formation of the Office of Substance Abuse within the Practice Directorate. Close cooperation between the two will be of great service to psychology and the community. The Division 42 Standing Committee of Alcoholism and Substance Abuse, co-sponsored by Divisions 29 and 43, provided an important source of leadership in the campaign to form the Division 50. The committee is chaired by Dr. Herb Freudenberger.

As I reported in an earlier column, the stated goals of the new Division include;

• Establish research based standards of assessment, diagnosis, and treatment as a basis for rational client! treatment matching.

• Identify and/or assist in the development of a Continuing Education curriculum for psychologists who wish to improve their skill level in working with chemically dependent populations.

• Provide leadership in communicating with other professionals, government agencies, third-party payers, and self-help groups.

• Insure that research fmdings guide the continuing refinement of treatment models and that service deli very systems (public and private) utilize the most efficient and cost effective models.

While preparing this colwnn, I canvassed several good friends who are especially knowledgeable in the AOD area for notable updates that may be of interest to readers.

Rick Rawsen, the Executive Director of the Matrix Center in Beverly Hills, California, has informed me that the prototype user of the '80's is changing, and that there has been a new type of AOD client being encountered in our private treatment settings within the past few years. During the '80s, there was a mgt: rate of admission in the private treatment sector <f "pure'tcoeaine users who were typically of the middle class with a short drug use history. These users had excellent treatment prognoses. The new type of user however, tends to smoke cocaine, use multiple drugs (e.g, benzodiazipenes) and alcohol, and have concurrent psychiatric illnesses. Treatment of such patients" is much more difficult, and their prognosis is poorer

Dr. Rawsen has also been seeing a new trend il:. herione use among the middle class. Increased use within the Los Angeles entertainment industry (especially with the new wave of "Seattle grunge bands" may further contribute to widespread use, because this industry is often considered a trend-setter.

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These are still just rumors, though, but data in NY, Baltimore, and Detroit also show an increase in heroin use.

Another emerging issue, according to Dr. Rawsen, is the changing attitudes among managed care companies toward outpatient substance abuse treatment programs. 85% of Matrix Center patients are funded by managed care. An encouraging trend is that many companies are acknowledging the need for quality outpatient care for substance abuse patients. U nfortunately, another group of companies is trying to reduce costs by weeding away funds for outpatient treatment programs. Dr. Rawsen is concerned that there won't be enough funds for realistic treatment and that "budget care" will give participants inadequate substance abuse treatment.

Ed Schwab, who is a private practitioner with a wealth of experience in the field of managed care, predicts that the impact of managed care on substance abuse treatment will become even more dramatic in the near future. There is a rapidly accelerating movement towards expecting providers to provide "hard

data" in support of their claims of cost effectiveness. Providers who have the technical and economic resources necessary to support sophisticated computer systems will have a big edge in securing managed care contracts. Providers will also be expected to provide state of the art treatment (that is, treatment practice that has a foundation in the psychological literature).

Gill Hill, Director of APA's Office of Substance Abuse, reports that AOD competency training material has been developed and early piloting of it in NY has been successful. Further testing will take place in Florida in the near future. He also reports that a AP A project in Texas and Wyoming is developing linkages between psychologists and family physicians to improve the identification and treatment of AOD clients. While anecdotal evidence indicates some early success, a full evaluation is being conducted and results will be reported in a later column.

Contributed substance abuse updates will become a regular part of this column. Substance abuse updates are welcome from all readers.

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Congratulations!

to Division 29 Members (*)

and Nominees for APA President-Elect

*Dorothy Canter. Psy.D. *Robert 1. ResnicR. Ph.D.

*Joseph C. Kobos. Ph.D.

Elizabeth A. Robinson. Ph.D.

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: Lewis P. Lipsitt. Ph.D.

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29

MEDICAL PSYCHOLOGY

Current Concepts of Mind-Body Interface:

Psychoneuroimmunology & Psychotherapy

David B. Adams

Atlanta Medical & Neurological Psychology

Psychosomatic is a term variously applied to the interaction between physical symptoms and underlying, and often causative, psychological factors. This relationship between emotional symptoms and physical illness has received much attention in the newly emerging field of psychoneuroimmunology.

Chief concerns have been the relationship between the treating mental disorder and the impact upon the recovery process in physical illness or injury. Will the treatment of emotional symptoms change the course of a physical illness or condition? Interest has also been upon the impact of emotional stimuli upon the development of aIlergic response, immunity from disease and capacity to maintain physiologic homeostasis.

Perhaps the greatest focus of attention, however, has been upon the relationships between anxiety, depression and development of disease processes.

The Role of the Immune System

A knowledge of the relationship between the imm une system and the central nervous system is central to understanding how emotions and disease are interrelated. The immune system and central nervous system have many commonalities.

Immune cells produce material which is similar to neurotransmitters in the central nervous system, and, in tum, neurotransmitters are found within the immune system, especially in the blood cell producing bone marrow and in the thymus gland. The "helper T-ceUs" which are essential disease fighters (and are directly attached by the virus giving rise to AIDS) mature in the thymus.

Substances produced in the thymus regulate brain functioning by feeding back chemicals (neurochemistry) to the central nervous system. In both the immune cells and the nerve cells, the process of somatic mutation or genetic rearrangement occurs.

The natural pain relieving substances of the eN the enkephalins, are produced by some white Similarly, the immune system regulates itself by enkephalins produced in some white cells. Additionally the scavenger cell monocytes which destroy . has receptors for enkephalin-like substances and macrophage secretes a substance similar to that of monocytes.

The 'central nervous system contains rine, the neurotransmitter, but at low ('{'\rl<"p]~I'T<',ti{'\ndl this neurotransmitter also stimulates the immune tern. Foreign proteins which activate the system (antigens) lower norepinephrine levels of brain.

When the immune system is stimulated, activity the base of the brain (hypothalamus) increases. is indication that injuries to the brain's right sphere increases immune system functioning. to the brain's left hemisphere decreases immune tern functioning.

There has been research to indicate that the 11'1 'UI1W'O;;. system has "memory" in the sense that it has spec

ized lymphocytes which remain in the blood to a recurrent infection. The immune system may "learn" in the sense of being conditioned to T",,·nn,no1 to certain situations with either increased activity and other situations with decreased JU1I'UWIl~ activity.

The Endocrine System

The immune system closely interacts with the crine system. The endocrine system maintains stability of the body's internal environment central nervous system, endocrine system, and mune system all respond not only to transient repeated psychological stress but to chronic logical stress as well. Depressed immune t.," ..... h/'\n.n. has been associated with divor-ce, grief over loss,

of employment, and even loneliness. There have

30

studies to indicate that immunity is reduced when preparing for examinations in school, and other studies have suggested that stress lowers the capacity to reject tumors.

Similarly, studies have suggested that stress reduction techniques may improve immune system functioning. For example, relaxation training increased the immune system activity of nursing home patients. In another study, it increased NK cell activity and amount of lymphocytes in those undergoing examination.

A particularly interesting study was one which investigated the impact of having individuals write 20 minutes per day about both emotions and trauma. In this study, those who wrote daily for four days had increased number ofT cells (lymphocytes). In another study, relaxation therapies increased T cells by ten percent in men affected by HIV.

Many studies have shown a link between stress and the onset of colds and other upper respiratory infections. Anger and tension were the feelings most often preceding the onset of colds. In one particular study, 90% of those under greatest stress were found to develop colds. It was also reported that stress increased susceptibility to colds but did not increase the resulting discomfort.

Cancer and Stress

There have been many attempts to link the immune system's incapacity to ward off cancer to the influence of emotions and emotional conflict. Many researchers believe that stress occurs in individuals prior to the onset of their cancer.

Among the studies cited that link stress and cancer is one which reports that men whose psychological tests indicated depression were more I ikely to develop cancer and twice as likely to die from the disease even when correcting for factors such as family history and other risk factors. Another investigation of women with breast cancer found that those who developed the disease were more likely to have stressful events in the period prior to the discovery of their malignancy.

There are contradictory studies, however, that reach quite different conclusions. There have been studies which showed no increased incidence of cancer in

those with depression. In one study ,the only link between depression and cancer was found in the increased incidence of cancer in depressed indi viduals who were also cigarette smokers.

Some data indicate that indi viduals who have adapti ve and functional emotional responses to the diagnosis of cancer tend to have a better prognostic outcome .. That is, in a study of women with diagnosed breast cancer, those who felt they could successfully "fight" the disease were more likely to survive, Similarly. those women who perceived themselves as helpless once diagnosed were more likely to have a recurrence of the disease and/or die from it.

Psychotherapy and Cancer

A study has been reported in which women with breast cancer participated in weekly group therapy. The nature of their disease process was compared to that ora group of women who received only medical care. The group therapy sessions were supportive in nature. They assisted the patients in facing their fears, helped them interact more effectively with their physicians and their families, and encouraged them to take a more active role in the treatment decisions made about their condition.

Although immune bodies were not examined in this study, the outcome was seen as significant: women who received psychological support from their group lived twice as long as those who did nor receive suppon (received medical care only).

In another investigation of malignant melanoma, patients in group therapy had more energy and were both less confused and less depressed than those patients who received only standard medical care for their skin cancer. In this patient group which recei ved the psychological care, there was not only improvement in immune functioning but measurements taken of them six months later showed an even greater immune difference between the patients who recei ved psychological care and those who had received only standard medical care for their cancer.

Depression and Immunity

Depression involved multiple bodily functions and an essential biological crisis for the human organism. There are changes in appetite, sexual drive and sleep

31

pattern responses. There is increased activity of the adrenal glands and uneven production of cortisol.

Multiple studies have indicated that severely depressed individuals have significantly lower NK ("natural killer") cell activity than those who are not depressed. Although some studies indicate that this occurs only among those patients who are severely depressed and hospitalized. other studies indicate that the lowered NK cell activity was present even among mildly depressed patients.

Studies have indicated that males who were seen as pessimistic about their lives in their twenties were statistically more likely to have developed a chronic illness within the next two to three decades. Research has also indicated that depression slows recovery from the flu. This does not mean that all researchers uniformly accept these findings, and. indeed. many of the studies are criticized for not using reliable measures of immunity and that mere measurement of NK cell activity does prove lowered immunity to disease.

The interaction between immunity and depression has, however, recently been of increased importance in its relationship to mv positive patients. Evidence is currently unclear as to the relationship between depression and the course of AlDS. One study showed that AIDS patients tended to be more anxious but not more depressed. Another study indicated that those who were more depressed did not have more advanced AIDS symptoms than those who were less depressed.

Grief & The Immune System

Both widows and widowers have an increased death rate following the death of their spouse. Three years after the death of their wives, males over 65 years of age have a 50-percent higher than average death rate. Several studies indicate that following the death of a mate, there is increased risk of death from cancer and infection. Some studies indicate that tests of immune functioning show immune system deficiencies in the bereaved.

Caregivers who manage the chronic illnesses of their spouses are more socially isolated than other indi viduals who do not have this responsibility. These caregi vers have been found to have decreased immune

system functioning and increased incidence of infectious disease. The individuals with the fewest friends and outside assistance are more prone to develop illnesses while caring for a chronically ill mate or family member.

It should be noted that those who are socially isolated, however, are also more prone to depression. The changes in proneness to illness among these individuals may be more related to the impact of depression upon their immune system. Deficiencies in immune system functioning have been reported in social! y isolated breast cancer patients. There are also indications that individuals who are socially introverted are more susceptible to infection.

Complicating Factors

There may be other factors that influence compromised immune systems, People who are under stress do eat inappropriately, and they also smoke and drink more frequently. Depressed indi viduals may not seek out needed medical care. The death of those who are grieving may be dne to poor self-care which may occur as part of the grief process. It would, therefore, be premature to state that we have dramatic evidence of the relationship between stress and immune system functioning,

The most conservative statement appears to be that based upon currently available evidence, emotional factors may through hormonal influence change an individuals susceptibility to disease, reduce the change of recovering from disease, and that psychotherapy may be a means of restoring the balance.

Early life experiences may effect the adult immune system and condition it to respond in a particular fashion. As a result of early life experiences, the individual may be less able to resist disease. Stress reduction may, in the future, be found an effective way of increasing disease resistance. Psychotherapy may, thereby, be found to be a means of evoking biochemical change without introducing exogenous psychoactive chemistry.

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L FOR PAPERS

AABT 27th Annual Convention-November 18 .. 21, 1993-Atlanta, GA "Understanding Diversity"

Diversity exists. Our research subjects, our clients, our students, OUI colleagues differ in gender, ethnicity , sexual orientation, age, etc. Understanding diversity as a variable influencing behavior is essential for the behavioral scientist and scientist/professional. The road to such understanding depends upon empirical data, insightful theory, and appreciation of values.

We want to make this convention a significant milestone in AABT's contribution to this theme for all types of convention activities such as posters and symposia Although institutes, panels, workshops, invited addresses, and special events are typically by invitation, suggestions and ideas to meet the theme in effecti ve or innovative ways are clearly welcome. (A 250- word abstract and a current CV must accompany each workshop suggestion.

It is imperative that behavioral science empirical knowledge be transferred to those who would use that know ledge in prevention/intervention/assessment programs. We are therefore also encouraging work which will summarize current evidence and give us the "State of the Art" on various topics, such as, but not limited to: "State of the Art: Matching Behavioral Methods to Specific Behavioral Problems," "State of the Art:

Comparing Effect Sizes of Behavior Therapy and Other Therapies for Depression," "State of the Art:

Matching Research Methodology to Community Characteristics," "State of the Art: Empirical approaches for Diverse Populations."

Also encouraged are submissions by students and new professionals-in-the-field, and "Works in Progress," which should be so identified.

Submission may be either papers for presentations at poster sessions, or symposia. Submissions may consist of empirical research, discussion of conceptual or methodological issues, or presentation of innovative clinical or training methods. We encourage submissions by graduate student presenters and request that such presenters be identified on submissions.

For specific poster and symposium submission criteria contact Arthur M. Nezu, Ph.D., Program Chair, Division of Psychology, llahnemann University. Mail Stop 626, Broad and Vine Streets, Philadelphia, PA 19102-1192.

APA PRECONFERENCE WORKSHOP SPONSORED BY DIVISION 20: (Adult Development and Aging)

NEUROPSYCHOLOGICAL ASSESSMENT AND PSYCHOPHARMACOLOGICAL INTERVENTION IN CLINICAL GERONTOLOGY

PRESENTERS:

MARILYN ALBERT, PH.D,

Associate Professor of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School. "Issues in Assessing Dementia"

IRIS BELL, M.D., PH.D.,

Assistant Professor of Psychiatry and Psychology, Director of Program in Geriatric Psychiatty, University of Arizona. "Psychopharmacological Interventions in the Elderly"

The workshop will be held on August 19, prior to the APA meeti ng, at the mai n campus of the University of Toronto, close to conference hotels.

REGISTRATION FEE:

$125 for nonmembers of Division 20

33

$85 for members of Division 20

6 CE Credits Available

FOR REGISTRATIO AND MORE INFORMATION, CONTACT:

Fredda Blanchard-Fields, Ph.D., Department of Psychology, Louisiana State University, Baton Rouge, lA 70803-5501 (504) 388-4117

1-------------------------------,

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

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The BULLEf IN 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:

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Division of Psychotherapy of the American Psychological Association 1993

STANDING COMMITTEES

Education and Training

Jeffrey Binder, Ph.D., Co-Chair l31 Ponce de Leon Ave.,l\'E Georgia School of Prof. Psychology Atlanta, GA 30308

Office: 404·872-0707

FAX:. 404-499·8358

I

1

Hans Strupp, Ph.D., Co-Chair Dept. of Psych., Vanderbilt Univ, Nashville, TN 3724(1

Office: 615·322-0058

FeUows

Suzanne B. Sobel, Ph.D., Chair 1680 Highway Al A, Suite 5 Satellite Beach, FL 32937

Office: 407·773·5944

Finance

Alice Rubenstein, Ed.D., Chair Monroe Psychotherapy Ctr,

59·E Monroe Ave.

Pittsford, NY 14534

Office: 716·586·0410

FAX: 716·586-2029

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

116 B4, OE Teaque VA Center Temple, TX 76504

Office: 817·7784811

Barbara Wainrib, Ed.D~ Co-Chair RD. #1, Box 1290

Moretown, VT 05660

Office: 514481-8272

FAX: 514·484·2864

Membership

Richard Mikesel~ Ph.D., CIuJir 4801 Wisconsin Avenue NW Suile#503

Washinglm, D.C. 20016 Office: 202·966·7498 FAX: 202-966-3745

M ul1ic ulsural Affairs

Samuel s. HiI~ III, Psy.D, Chair Corpus Christi State University 6300 Ocean Drive

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

N ominaliom and Elections

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

701 S. Acadian Thruway

Batoo Rouge, LA 708{)6

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 McGrath, PI1D~ Chair 1938 Del Mar

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

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

1\0 W. Squanmm, #17 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 Offioe: 415-523-2300 FAX: 415-652-5078

WlIlJam S. Pollack, Ph.D., C.E. Chair, 1993.1994 Dept. Post Graduate & Continuing Education lIS Mill Street Belmont, MA 02178 Office: 617-855-2230 FAX: 617-855-2349

Publications Board Chair

Herbert J. Freudenberger, Ph.D. 18 East 87th St.

New York, NY 10128:

Office: 212-427-8500

Student Development

Michael Carlflo, Ph.D., Chair Barry University

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

Office: 305-899-3275

FAX: 305-899-3279

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

2500 Metro Health Drive Cleveland,OH 44109·1998 Office: 216459-4647

FAX: 216-459·5907

DIVISION OF PSYCHOTHERAPY (29)

Central Office 3875 N, 44th Street, 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 Psychotherapy Center

59 E. Monroe Avenue

Pittsford, NY

Office: 716-586-04\0

Task Force on Aging

Norman Abeles, PII.D., Co-Chair Psychology Research Bldg. Michigan SUIte University

East Lansing. MI 48824

Office: 517 ·355-9564

Carl Eisdorfer, Ph.D., Co·Chair DepL Of Psychiatry, D-28

P.O. Box 016960

Miami, FL 33136

Office: 305-545-6319

Task Force on American Indian Mental Health

Diane Willis, Ph.D., Chair Child Study Cir,

University of Oklahoma 1100 NE 131b St. Oklahoma City, OK 73117 Office: 405-271-6876

Task Force on Men's Roles and Psychotherapy

Ronald Levant, Ed.D., Chair 1093 Beacon St., Sle. 3C Brookline, MA 02146

Office: 617·566-4479

Task Force on Trauma Response & Research

Ellin Bloch, PIl.D., Co-Chair Dept. of Family Medicine Mail Location 582

University of Cincinnati

Moo. Or.

Cincinnati, OH 45227 Office: 513-5584020

Jon Perez, Ph.D., Co-Chair Life Plus Foundation

6421 Coldwater Canyon Ave. North Hollywood, CA 91606 Office: 818·769-1000

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Phoenix, AZ 85018

Non·Profit Orga nizat io n U,.S. Postage PAID Phoenix, AZ 85018 Permit No. 31,1

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