Вы находитесь на странице: 1из 56

B

U
Psychotherapy

L
O F F I C I A L P U B L I C AT I O N O F D I V I S I O N 2 9 O F T H E
A M E R I C A N P S Y C H O L O G I C A L A S S O C I AT I O N

L
www.divisionofpsychotherapy.org

In This Issue
Personal Reflections From Diverse Early Careers
Opportunities in Private Practice

E
Perspectives on Psychotherapy Integration
Enhancing Emotion Regulation:
An Implicit Common Factor Among Psychotherapies
for Borderline Personality Disorders

T
Ethics in Psychotherapy
Psychotherapy for the Psychotherapist:
Optional Activity or Ethical Imperative?

I
Washington Scene
Steadily Evolving Into The 21st Century—
Working With Others

N
Division 29 APA Convention
Program Summary

2008 VOLUME 43 NO. 3


Division of Psychotherapy 䡲 2008 Governance Structure
ELECTED BOARD MEMBERS
President Professional Practice Diversity
Jeffrey E. Barnett, Psy.D., ABPP Jennifer Kelly, Ph.D., 2007-2009 Caryn Rogers, Ph.D.
1511 Ritchie Highway, Suite 201 Atlanta Center for Behavioral Medicine Johns Hopkins University
Arnold, MD 21012 3280 Howell Mill Rd. #100 Department of Health, Behavior
Phone: 410-757-1511 Fax: 410-757-4888 Atlanta, GA 30327 and Society
Email: drjbarnett1@comcast.net Ofc: 404-351-6789 Fax: 404-351-2932 624 N. Broadway, HH280
Email: jfkphd@aol.com Baltimore, MD 21205
President-elect
Ofc: 443-287-5327 Fax: 410-502- 6719
Nadine Kaslow, Ph.D., ABPP Education and Training Email: caryn_rodgers@yahoo.com
Emory University Department of Michael Murphy, Ph.D., 2007-2009
Psychiatry and Behavioral Sciences Department of Psychology Diversity
Grady Health System Indiana State University Erica Lee, Ph.D.
80 Jesse Hill Jr Drive Terre Haute, IN 47809 55 Coca Cola Place
Atlanta, GA 30303 Ofc: 812-237-2465 Fax: 812-237-4378 Atlanta, Georgia 30303
Phone: 404-616-4757 Fax: 404-616-2898 Email: mmurphy4@isugw.indstate.edu Ofc: 404-616-1876
Email: nkaslow@emory.edu Email: edlee@emory.edu
Membership
Secretary
Libby Nutt Williams, Ph.D., 2008-2009 APA Council Representatives
Armand Cerbone, Ph.D., 2006-2008
St. Mary’s College of Maryland Norine G. Johnson, Ph.D., 2008-2010
3625 North Paulina
18952 E. Fisher Rd. 13 Ashfield St.
Chicago, IL 60613
St. Mary’s City, MD 20686 Roslindale, MA 02131
Ofc: 773-755-0833 Fax: 773-755-0834
Ofc: 240- 895-4467 Fax: 240-895-4436 Ofc: 617-471-2268 Fax: 617-325-0225
Email: arcerbone@aol.com
Email: enwilliams@smcm.edu Email: NorineJ@aol.com
Treasurer
Steve Sobelman, Ph.D., 2007-2009 Early Career Linda Campbell, Ph.D., 2008-2010
2901 Boston Street, #410 Michael J. Constantino, Ph.D., 2008-10 Dept of Counseling & Human Dev
Baltimore, MD 21224-4889 Department of Psychology University of Georgia
Ofc: 410-583-1221 Fax: 410-675-3451 612 Tobin Hall - 135 Hicks Way 402 Aderhold Hall
Cell: 410-591-5215 University of Massachusetts Athens, GA 30602
Email : steve@cantoncove.com Amherst, MA 01003-9271 Ofc: 706-542-8508 Fax: 770-594-9441
Ofc: 413-545-1388 Fax: 413-545-0996 Email: lcampbel@uga.edu
Past President Email: mconstantino@psych.umass.edu
Jean Carter, Ph.D Student Development Chair
5225 Wisconsin Ave., N.W. #513 Science and Scholarship Michael Garfinkle, 2008
Washington, DC 20015 Norm Abeles, Ph.D., 2008-2010 Derner Institute
Ofc: 202–244-3505 Dept of Psych Adelphi University
Email: jcarterphd@aol.com Michigan State University 1 South Avenue
Domain Representatives 110C Psych Bldg Garden City, NY 11530
Public Policy and Social Justice East Lansing, MI 48824 Ofc: 917-733-3879
Irene Deitch, Ph.D., 2006-2008 Ofc: 517-353-7274 Fax: 517-432-2476 Email: michaelsg@verizon.net
31 Hylan Blvd 14B Email: abeles@msu.edu
Staten Island, NY 10305-2079
Ofc: 718-273-1441 Fax-1-718-273-1445
Email: ProfID@AOL.COM

STANDING COMMITTEES
Continuing Education Finance Program, continued
Chair: Annie Judge, Ph.D. Chair: Bonnie Markham, Ph.D., Psy.D. Associate Chair: Chrisanthia Brown, Ph.D.
2440 M St., NW, Suite 411 52 Pearl Street Email: brownchr@umkc.edu
Washington, DC 20037 Metuchen, NJ 08840
Ofc: 202-905-7721 Fax: 202-887-8999 Ofc: 732-494-5471 Fax 206-338-6212 Psychotherapy Practice
Email: Anniejudge@aol.com Email: drbonniemarkham@hotmail.com Chair: John M. O’Brien, Ph.D.
465 Congress St. Suite 700
Associate Chair: Membership Portland, ME 04101
Rodney Goodyear, Ph.D. Chair: Sonja Linn, Ph.D. Ofc: 207-773-2828 x1310
Email: goodyea@usc.edu 2440 M St, NW, Suite 411, Fax: 207-761-8150
Washington, DC 20037. Email: jobinport@aol.com
Education & Training Ofc: 202-887-8088
Chair: Jean M. Birbilis, Ph.D., L.P. Email: sglinn@verizon.net Associate Chair: Patricia Coughlin, Ph.D.
University of St. Thomas Email: drpcoughlin@gmail.com
1000 LaSalle Ave., TMH 455E Associate Chair:
Minneapolis, Minnesota 55403 Chaundrissa Smith, Ph.D. Psychotherapy Research
Ofc: 651-962-4654 Fax: 651-962-4651 Email: csmit33@emory.edu Chair: Sarah Knox, Ph.D.
Email: jmbirbilis@stthomas.edu Nominations and Elections Department of Counseling and
Associate Chair: Gene Farber, Ph.D. Chair: Nadine Kaslow, Ph.D. Educational Psychology
Email: efarber@emory.edu Marquette University
Professional Awards Milwaukee, WI 53201-1881
Fellows Chair: Jean Carter, Ph.D. Ofc: 414/288-5942 Fax: 414/288-6100
Chair: Jeffrey Magnavita, Ph.D. Email: sarah.knox@marquette.edu
Program
Glastonbury Psychological Associates PC Chair: Nancy Murdock, Ph.D. Associate Chair: Susan Woodhouse, Ph.D.
300 Hebron Ave., Ste. 215 Counseling and Educational Psychology Email: ssw10@psu.edu
Glastonbury, CT 06033 University of Missouri-Kansas City
Ofc: 860-659-1202 Fax: 860-657-1535 ED 215 5100 Rockhill Road
Email: magnapsych@aol.com Kansas City, MO 64110
Associate Chair: Jeffrey Hayes, Ph.D. Ofc; 816 235-2495 Fax: 816 235-5270
Email: jxh34@psu.edu Email: murdockn@umkc.edu
PSYCHOTHERAPY BULLETIN PSYCHOTHERAPY BULLETIN
Official Publication of Division 29 of the
Published by the
DIVISION OF PSYCHOTHERAPY American Psychological Association
American Psychological Association
2008 Volume 43, Number 3
6557 E. Riverdale

CONTENTS
Mesa, AZ 85215
602-363-9211
e-mail: assnmgmt1@cox.net President’s Column . . . . . . . . . . . . . . . . . . . . . . . . .2
EDITOR President-Elect’s Column . . . . . . . . . . . . . . . . . . . .4
Jennifer A. E. Cornish, Ph.D., ABPP
jcornish@du.edu Psychotherapy Research, Science, and
Scholarship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
ASSOCIATE EDITOR Counseling South Asian Immigrant
Lavita Nadkarni, Ph.D. Communities: Identities and Contexts
CONTRIBUTING EDITORS Division 29 Welcomes New Members
Diversity to the Board of Directors . . . . . . . . . . . . . . . . . . . . .9
Erica Lee, Ph.D. and
Caryn Rodgers, Ph.D. Psychotherapy Research, Science, and
Education and Training Scholarship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Jean M. Birbilis, Ph.D., L.P. Psychological Treatments and
Practitioner Report
Psychotherapy with Older Adults
Jennifer F. Kelly, Ph.D. and Personal Reflections From Diverse
John M. O’Brien, Ph.D.
Early Careers . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Psychotherapy Research, Opportunities in Private Practice
Science, and Scholarship
Norman Abeles, Ph.D., Sarah Knox, Practitioner Report . . . . . . . . . . . . . . . . . . . . . . . . .20
Ph.D., Michael J. Murphy, Ph.D., and Practice Domain Update: Progress and
Susan S. Woodhouse, Ph.D. Challenges
Perspectives on Practitioner Report . . . . . . . . . . . . . . . . . . . . . . . . .22
Psychotherapy Integration Outcome Measures in Psychotherapy:
George Stricker, Ph.D. Blessings or Curses
Public Policy and Social Justice
TBA Division 29 APA Convention
Program Summary . . . . . . . . . . . . . . . . . . . . . . . .25
Washington Scene
Patrick DeLeon, Ph.D. Perspectives on Psychotherapy Integration . . . .29
Early Career
Enhancing Emotion Regulation: An Implicit
Michael J. Constantino, Ph.D. Common Factor Among Psychotherapies
for Borderline Personality Disorders
Student Features
Michael Stuart Garfinkle, M.A. Ethics in Psychotherapy . . . . . . . . . . . . . . . . . . . .36
Editorial Assistant
Psychotherapy for the Psychotherapist:
Crystal A. Kannankeril, M.S. Optional Activity or Ethical Imperative?
Student Interview: Jeffrey Magnavita, Ph.D. . . . . .42
STAFF
Central Office Administrator Washington Scene . . . . . . . . . . . . . . . . . . . . . . . . .46
Tracey Martin Steadily Evolving Into The 21st
Website Century—Working With Others
www.divisionofpsychotherapy.org
Membership Application . . . . . . . . . . . . . . . . . . .52
PRESIDENT’S COLUMN Jeffrey E. Barnett, Psy.D., ABPP

Exciting Times for 29: Be Connected!


It is with great pleasure The event will be on Saturday, August 16
and pride that I write from 12:00pm – 1:50pm in the Common-
this President’s Column wealth Room of the Sheraton Boston Hotel.
for the Psychotherapy This year’s masters are Judith Beck, Lorna
Bulletin. There are sev- Benjamin, Linda Campbell, Charles Gelso,
eral events I am excited Norine Johnson, Jeffrey Magnavita, and
about that help make Jeffrey Barnett. I express my deep apprecia-
this issue a special one tion to each for the valuable contribution
for me. First, in this issue you can see the they are making to our next generation of
division’s outstanding program at the psychotherapy clinicians, researchers, edu-
upcoming APA Convention. Our cators, and supervisors.
Convention Program Chair, Nancy
Murdoch, and her Co-Chair, Chris Brown, An additional major source of excitement
have put together a truly outstanding con- about this year’s convention is the fact that
vention program for you. Please see the this year we mark the 40th Anniversary of
complete listing of convention offerings the founding of Division 29. This is a major
elsewhere in this issue. milestone. I personally invite each you to
join us at our special Awards Ceremony
One important event at the convention will and 40th Anniversary Celebration which is
be our “Lunch with the Masters” event. immediately followed by our Social Hour.
Building on our success last year when we At the Awards Ceremony we will be hon-
had attendees waiting in line out the door oring and recognizing a number of col-
and in the hallway, we have expanded this leagues who have made singular, and actu-
popular program to ensure even greater ally quite remarkable, contributions to the
success. Division 29 Board members field of psychotherapy. Our Award win-
Michael Constantino, Annie Judge, Nancy ners include:
Murdock, and Libby Nutt Williams, have
put together a great group of “masters” • 2008 Distinguished Psychologist Award
(senior psychotherapists who have made for Contributions to Psychology and
significant contributions to the advance- Psychotherapy: Bruce E. Wampold,
ment of our profession and who have an Ph.D.
interest in mentoring students and early • 2008 Division 29/American
career psychotherapists) who will have Psychological Foundation Jack D.
lunch with all interested students and early Krasner Early Career Award: Kenneth
career psychologists who attend this free N. Levy, Ph.D.
event. Additionally, each of the “masters”
as well as a number of others who are not • 2008 Division 29 Award for
able to attend the event have donated Distinguished Contributions to
signed copies of books they have pub- Teaching and Mentoring: Mathilda
lished, to be raffled off free to those in atten- Canter, Ph.D.
dance. It should be an exciting event and a
• Distinguished Publication of
singularly great opportunity for those in
Psychotherapy Research Award: Scott
attendance to spend time chatting infor-
A. Baldwin, Bruce E. Wampold, and
mally with some of the top leaders of our
Zac E. Imel, for their article:
field. Please spread the word to all students
and early career psychologists you know. continued on page 3
2
Baldwin, S.A., Wampold, B.E., & Imel, tal in assisting me with developing and
Z.E. (2007). Untangling the alliance-out- implementing this program. There are stu-
come correlation: Exploring the relative dents around the world who are studying
importance of therapist and patient psychology in the hope of obtaining the
variability in the alliance. Journal of knowledge and skills needed to help ease
Consulting and Clinical Psychology, 75(6), suffering in their countries. But, they often
842-852. do so with limited resources and in situa-
tions where they face significant adversity.
Additionally, our student award winners To reach out to these students around the
include: world the Division 29 Board of Directors
has approved free electronic memberships
• 2008 Mathilda B. Canter Education and
to all interested international psychology
Training Student Award: Jenelle Slavin
students. Additionally, they will each
• 2008 Donald K. Freedheim Student receive copies of the division’s journal
Development Award: Joshua K. Swift directly from APA as members of the divi-
sion. All interested international student
• 2008 Student Diversity Award: Arien members will participate in a mentoring
Muzacz program where we pair them with current
student members of the division. These stu-
Please join us to celebrate the accomplish- dent mentors will develop online collegial
ments of these colleagues. relationships with their assigned mentees
offering them support, sharing their experi-
Following the award presentations, Matty
ences, and sharing information and
Canter will provide reflections on 40 years
resources of potential value to them. Our
of Division 29. Matty will share little
program has already begun. At the time of
known, yet important aspects of the history
the writing of this column contact has been
of the division along with many contribu-
made with schools in Rwanda, Cambodia,
tions of its members that have greatly
South Viet Nam, and China. Contacts with
impacted the profession and the field of
schools in other countries are planned. I
psychotherapy. It should prove to be truly
will hope to have more information to
inspirational and should not be missed.
share with you about this important initia-
Following this, we will hold our Social
tive in my next column. Should you have
Hour where all Past Presidents and Past
international contacts that I could use to
Award Recipients of the division will be
further expand this program please contact
honored. We will also have several other
me directly at drjbarnett1@comcast.net .
surprises in store for you. I hope each
member can be there to participate in this The field of psychotherapy is alive and
historic event and celebration. Please honor well. It is an exciting and vibrant field. Our
us with your presence at these events as we members regularly make significant and
celebrate our division and honor all the noteworthy contributions that greatly
great leaders who came before us and did impact the quality of others’ lives. We reg-
so much for us with their volunteer efforts. ularly make contributions in research, the-
ory, education and training, clinical prac-
Finally, I am excited to tell you about a new
tice, and supervision. I hope you will join
Division 29 initiative. This year we have
us at this year’s APA Convention and espe-
begun an international student member-
cially at Division 29’s 40th Anniversary
ship and mentoring program. While this is
Celebration. Be Connected!
one of my presidential initiatives it was
motivated and stimulated by the work of Best wishes to all —
Division 29 Board member, Norine
Johnson, Ph.D. Norine has been instrumen- Jeff

3
PRESIDENT-ELECT’S COLUMN
Jeffrey J. Magnavita

other organizations that also advance psy-


chotherapy, such as the Society for
Psychotherapy Research (SPR) and Society
for Psychotherapy Exploration and
Integration (SEPI). Many of the leading
theorists, practitioners, and researchers are
working collaboratively in an increasingly
challenging professional world to assure
the growth and evolution of our science
and art. I also am hoping to strengthen our
commitment to pubic service. There are so
many people who could benefit from psy-
chotherapy but who have limited access to
the expert caring of a well trained psy-
It is with great pleasure that I assume the chotherapist. Psychologists enter the pro-
role of President-elect of Division 29! I fession to make a contribution and many of
appreciate the opportunity to serve the our members silently give of their time and
Division in this capacity and look forward knowledge without recognition. I want to
to contributing my time and energy to be able to hear these stories and honor the
shaping the future course of the Division silent contributors. I am also a believer in
and the field of psychotherapy. The prac- the possibilities that neuroscience offers us
tice of psychotherapy has been my main in creating a more robust evidence base for
professional interest over the past 25 years what we do. As part of my summer fun I
and I continue to be privileged by the con- am going to be attending a three-day sem-
fidence that is placed in me and my train- inar in neuroscience and human brain dis-
ing when I open the door to my waiting section to further my understanding of the
room and met a new patient, couple, or neural networks that are affected by both
family. The field of psychology and the emotional and physical trauma.
practice of psychotherapy combine two of
my core beliefs in science and the art of I hope that the summer finds you all well
healing. We are a very privileged group and that you will be able to find time to
invited to bear witness to human suffering, replenish your souls, somas, and minds. We
transformation, and healing in a way that are planning a great summer celebration
few other professions can claim. under the expert leadership of Jeff Barnett
our current President and our devoted
As part of my presidential agenda I am Board for D29’s 40th anniversary in Boston.
hoping to continue to advance our I hope to meet many of you there for intel-
Division’s use of technology to provide lectual, emotional, and social stimulation.
access to information and learning. I also We stand together at a time of enormous
want to continue to strengthen alliances global and professional transformation.
with our researchers and members of other Division 29 plans to be a leader in address-
disciplines to enrich our knowledge and ing the challenges of the new global village.
understanding of human nature. Many of I look forward to hearing from all of you
our members maintain membership in with your suggestions and concerns.

4
PSYCHOTHERAPY RESEARCH, SCIENCE, AND
SCHOLARSHIP
Counseling South Asian Immigrant Communities:
Identities and Contexts
Arpana G. Inman, Lehigh University

Counseling Immigrant identity negotiation, one based in an inter-


Communities: nalized sense of cultural expectations
Identities and Contexts based in one’s own ethnic culture (e.g.,
With the significant interdependence) and another based in
shift in the U.S. demo- externalized societal expectations of the
graphics, the counseling host culture (e.g., independence or autono-
profession has provided my). In understanding this diasporic exis-
a strong impetus to tence, as practitioners, we need to ask:
examine how life’s issues are influenced by What is the influence of immigration on
contextual variables (e.g., ethnicity). The personhood and how does immigration
importance of these variables has led to the and the evaluation and valuation of con-
development of multicultural counseling structs such as ethnicity and race impact
competencies, providing guidelines for personal identities?
effective and ethical clinical practice
(Sue, Arredondo, & McDavis, 1992). What we know about a diasporic identity is
Immigration from one country to another that negotiating identity is often complicat-
is one such life experience that entails com- ed by factors such as migration histories,
plex psycho-social processes, influenced by pre- and post-immigrational expectations
varying contexts. and experiences (Inman, Howard, et al.,
2007), visa statuses (Akhtar, 1999, Inman
Literature suggests that immigration poses Yeh, Maden-Bahel, & Nath, 2007), shifts in
significant pressures on first and subse- familial roles (Uba, 1994), generational con-
quent generations (Inman, Howard, flicts (Inman, Constantine, & Ladany, 1999;
Beaumont, & Walker, 2007). In essence, Inman, Ladany, Constantine, & Morano,
immigration involves the crossing of cul- 2001), minority experiences (Inman, 2006),
tural and national boundaries, creating sig- and related coping mechanisms (Inman &
nificant opportunities and dilemmas Yeh, 2007). Because of the diversity in
impacting both individual and familial immigration histories, the factors that
identities (Akhtar, 1999). Although educa- influence the extent to which individuals
tional and economic successes are impor- hold onto their own culture or adapt to the
tant gains that immigrant families experi- host culture varies by generation. In fact, in
ence, immigration also creates significant recent research on South Asian and in par-
cultural incongruence for these families. ticular Asian Indian immigrants, the notion
These cultural inconsistencies heighten the of cultural conflicts has been identified as
experience of loss as old ways of being no an important variable influencing both
longer work within the new context first- and second-generation individuals
(Hedge, 1998). Within this context, families (Inman, et al., 1999; Inman, et al., 2001).
engage in an active process of self-explo- How first- and second-generation Asian
ration and decision-making about the role Indians navigate their relationships within
that different cultural values and contexts multiple cultural contexts has significant
play in one’s life (Phinney, 1989). In effect, implications for intergenerational interac-
families experience a parallel process of continued on page 6
5
tions, parenting practices, and individual tity in constant flux based on their age and
and group identities, resulting in specific phase of life, with dissonance varying as a
challenges. function of time (Inman et al. 1999). The
maintaining of a “true” cultural identity
Specific Immigrant Challenges (Dasgupta, 1998) that was conceptualized
Research has noted specific challenges at the time of the parents’ immigration
among first- and second-generation Asian becomes a litmus test for an authentic iden-
Indian immigrant communities. While both tity. Rather than acknowledging that immi-
generational groups tend to compartmen- grant children live in a plane of many
talize their roles and behaviors (i.e., being truths and develop an identity that is based
more Indian at home and American outside in a “third space” (i.e., a hyphenated exis-
the home), Inman and colleagues (1999, tence of being both Indian and American),
2001, 2006, 2007) have found that national, children are perceived to be Americanized
linguistic, religious, and communal identi- and not appreciative of their own cultures.
ties dominate the ideologies of first-genera- Due to these issues, second-generation
tion Asian Indians, with ethnic identity Asian Indians have been known to experi-
serving as a buffer in situations of stress. As ence intergenerational conflicts related to
parents of second-generation Asian career decisions, identity issues, family
Indians, these first-generation individuals conflicts, dating, and sexuality concerns.
have a strong desire to maintain a tradi- Further, given their socialization within the
tional cultural identity because of their dominant culture, race and racial identity
fears of cultural dilution. Due to the lack of play an important influential role in their
a social support system (e.g., familial guid- lives, and racial identity has been identi-
ance, cultural social structure) and systemic fied as a buffer against stress for second-
barriers (e.g., work schedules) that prevent generation Asian Indians (Inman, 2006).
families from practicing their cultural activ-
ities, parents experience feelings of isola- Assessment and Intervention
tion but also pressure to create a sustainable When working with first- and second-gen-
process of cultural transmission. These erational diasporic communities, it becomes
pressures evolve from a fear that their chil- important to assess and intervene in cultur-
dren’s cultural awareness and commitment ally sensitive ways and across generational
may decrease as a result of the children’s lines. For instance, constructs of encultura-
acculturation to the U.S. culture and marry- tion and acculturation, cultural values, and
ing outside of the ethnic community. minority status are important considera-
Further, the challenges of needing to learn tions for immigrant communities in the U.S.
about their own cultural practices in order Enculturation refers to socialization within
to transmit cultural knowledge to their chil- one’s own cultural values, whereas accul-
dren can be time consuming without ade- turation refers to socialization within the
quate support systems. This can create sig- dominant cultural values and the inherent
nificant dilemmas regarding aspects of cul- decision to choose aspects of the two cul-
ture that parents should retain and those tures. Interestingly, literature suggests that
that they can forsake. In addition, manag- immigrants tend to selectively acculturate
ing their children’s bicultural struggles that to the host culture (Ramisetty-Mikler, 1993).
do not reflect their own personal experi- Thus, while being more adaptable to work
ences can create feelings of helplessness in practices or clothing choices, we see that
these parents. first-generation Asian Indians tend to hold
on to core values related to family relations,
Second-generation Asian Indians, on the gendered roles, and issues related to intima-
other hand, experience significant social cy and marriage. For instance, filial obliga-
censures and restrictions due to not being tions to elders (e.g., children taking care of
“ethnic” enough. They perceive their iden- continued on page 7
6
the elderly in their old age), career choices racial socialization as well as a language to
being made with family interests in mind, speak to racial issues among new immi-
family members maintaining a strong sense grants (Inman & Alvarez, in press). This is
of interdependence, women serving as car- reflected in the following example: a father
riers of tradition and bearing the responsi- of a 6-year-old Indian girl being taken aback
bility of preserving cultural identities, chil- when his daughter asks if she can wash off the
dren marrying within their community and brown color of her skin to look more like her
culture, and dating occurring in committed “fair-colored” friends. Yet others may appre-
“engaged” relationships are some of the val- ciate the impact of differences as highlight-
ues that influence the first-generation ed in the following example: parental recog-
expectations of their children. Illustrations nition that although children were born in the
of these issues are evident in the following U.S., they would always be treated differently
examples: a 23-year-old college senior strug- because of their ethnic/racial background.
gling with graduation, going into a profession in Issues of skin color or sense of difference
which she had no interest and disappointing her can have significant implications for self-
father; a 25-year-old woman dealing with the perceptions of attractiveness, familial feel-
anxiety of her father making plans to arrange her ings about interracial relations, and the
marriage. Conversely, parents noting that the family’s ability to deal with race-based dis-
challenge of bringing up children in the U.S. is crimination (Mehta, 1998).
that as children grow up in America, they want
to be more like their American friends; that out- Because families can function as both risk
side influences create difficulty for children in and protective factors, understanding fam-
having the same kind of respect that these par- ily histories of immigration and discrimi-
ents would have for elders back home. These nation, familial structures and alliances,
examples highlight how culturally bound patterns of communication, levels of accul-
values can influence one’s perception and turation, and ethnic/racial identification is
assessment of events and create potential important when negotiating intergenera-
for intergenerational conflicts. tional conflicts and challenges. Within this
context, narratives become important tools
As immigrant communities migrate to the in immigrant counseling experiences
United States, the notions of minority sta- (Almeida, 1996). They help contextualize
tus and its related consequences are also the experience and provide a systemic
important considerations. What is evident frame for issues that ensue. Thus, having
in the long history of immigration is that parents share their stories of immigration,
all communities have experienced discrim- their struggles with acculturation, and
ination in the form of stereotypes, preju- their particular coping styles can help
dice, and racist acts that can have a nega- acknowledge their losses, but also put into
tive influence on their wellbeing. Despite a context the expectations that parents have
long history of racism and discrimination for their children (Inman & Tewari, 2003).
(e.g., denial of land ownership and citizen- Additionally, use of the therapeutic self
ship, anti-miscegenation laws, racial profil- and self-disclosure has been found to be a
ing, targets of racial slurs and violence, Sue beneficial tool among collectivistic cultures
& Sue, 2003), communities may have vary- (Das & Kemp, 1997). This reduces a
ing views of and acceptance of racism voyeuristic stance on part of the therapist
within and outside of this community. This and allows for greater trust and rapport
is true of Asian Indians as well. Although that can help build a stronger working
this community has experienced prejudice alliance. Finally, use of bibliotherapy
and racism, their discriminatory experi- brings a level of objectivity and distance
ences have been masked by several factors: while also normalizing issues that may
the model minority myth, the related poli- otherwise be stigmatizing and create a loss
tics of economic success, and the limited continued on page 8
7
of face for these communities (Inman & B. T., (eds)., Developing Multicultural
Tewari, 2003). Counseling Competency: A Systems
Approach. Pearson Merrill Prentice Hall.
Conclusion Inman, A. G., Constantine, M. G., &
The varied characteristics associated with Ladany, N. (1999). Cultural value con-
the multiple, overlapping, and often con- flict: Anexamination of Asian Indian
flicting definitions of a personal identity and women’s bicultural experience. In D. S.
group membership are important considera- Sandhu (Ed.), Asian and Pacific Islander
tions in examining issues for immigrant Americans: Issues and Concerns for
communities. However, to prevent stereo- Counseling and Psychotherapy (pp. 31-41).
typing or overgeneralizations, it is essential Commack, NY: Nova Science Publishers.
to assess individual differences that exist Inman, A. G., Howard, E. E., Beaumont, L.
within and across generations. Given the R. & Walker, J. (2007). Cultural
individual, systemic (e.g., relational), and Transmission: Influence of Contextual
environmental influences (Sue & Sue, 2003), Factors in Asian Indian Immigrant
it becomes important to contextualize immi- Parent’s Experience. Journal of
grant experiences and examine issues from Counseling Psychology, 54. 93-100.
an ecosystemic perspective. Inman, A. G., Ladany, N., Constantine, M.
G., & Morano, C. K. (2001). Develop-
Reference ment and Preliminary validation of the
Almeida, R. (1996). Hindu, Christian, and cultural values conflict scale for South
Muslim families. In M. McGoldrick, J. Asian women. Journal of Counseling
Giordano, & J. K. Pearce (Eds.), Psychology, 48, 17-27.
Ethnicity and family therapy. (pp. 395- Inman, A. G., & Tewari N (2003). The
423). New York: Guilford power of context: Counseling South
Akhtar, S. (1999). Immigration and identity: Asians within a family context. In
Turmoil, treatment, and transformation. G.Roysircar, D. S. Sandhu, & V. B.
New Jersey: Jason Aronson. Bibbins (Eds.). A guidebook: Practices of
Dasgupta, S. D. (1998). Gender roles and multicultural competencies (pp. 97-107).
cultural continuity in the Asian Indian Alexandria, VA: ACA publishers.
immigrant community in the U.S.. Sex Inman, A. G., & Yeh, C. (2007). Stress and
Roles, 38, 953-974. Coping. In F. Leong, A. G. Inman, A.
Das, A. K., & Kemp, S. F. (1997). Between Ebreo, L. Lang, L. Kinoshita, M. Fu
two worlds: Counseling South Asian (Eds.), Handbook of Asian American
Americans. Journal of Multicultural Psychology (pp.323-340). (2nd ed.).
Counseling and Development, 25, 23-33. Thousand Oaks, CA: Sage.
Hegde, R. (1998). Swinging the trapeze: Inman, A. G., Yeh, C. J, Madan-Bahel A., &
The negotiation of identity among Nath, S. (2007). Bereavement and
Asian Indian immigrant women in the Coping of South Asian Families post
United States. In D. Tanno & A. 9/11. Journal of Multicultural Counseling
Gonzalez (Eds.), and Development, 35, 101-115.
Communication and identity across cultures Mehta, P. (1998). The emergence, conflicts
(pp. 34-55). Thousand Oaks, CA: Sage and integration of the bi-cultural self:
Publications, Inc. Psychoanalysis of an adolescent daugh-
Inman, A. G. (2006) South Asian Women: ter of South Asian immigrant parents.
Identities and Conflicts. Cultural In S. Akhtar, & S. Kramer, (1998). The
Diversity and Ethnic Minority Psychology, colors of childhood: Separation-individua-
12, 306-319. tion across cultural, racial and ethnic differ-
Inman, A. G. & Alvarez, A. N. (in press). ences (pp. 129-168). Northvale, NJ: Jason
Individuals and Families of Asian
Descent. In Hays, D. C., & Erford., continued on page 9
8
Aronson, Inc. (1992). Multicultural counseling compe-
Phinney, J.S. (1989). Stages of ethnic iden- tencies and standards: A call to the pro-
tity development in minority group fession. Journal of Multicultural
adolescents. Journal of Early Adolescence, Counseling and Development, 20, 64-68.
9, 34-49. Sue, D. W., & Sue, D. (2003). Counseling the
Ramisetty-Mikler, S. (1993). Asian Indian culturally diverse: Theory and practice.
immigrants in America and sociocultur- (4th ed.). New York: Wiley.
al issues in counseling. Journal of Uba, L. (1994). Asian Americans: Personality
Multicultural Counseling, 21, 36–49. patterns, identity, and mental health. New
Sue, D.W., Arredondo, P., & McDavis, R.J. York: Guilford Press.

DIVISION 29 WELCOMES NEW MEMBERS TO


OUR BOARD OF DIRECTORS
Jeffrey Younggren, Ph.D., Secretary – 2009-2011

Dr. Jeffrey N. Younggren, a Fellow of the American Psychological


Association, is a clinical and forensic psychologist who practices in
Rolling Hills Estates, California. He also is an associate clinical
professor at the University of California, Los Angeles, School of
Medicine and is a Risk Management Consultant for the American
Psychological Association Insurance Trust.

Jeff has always focused on the importance of developing new and expanding roles for
psychologists and this continues to be an area of his primary interest. He believes that,
not only should we secure prescriptive authority for those psychologists who want to
provide these services, but we must also look forward to developing new and creative
avenues for the delivery of psychotherapeutic services. Finally, we must work to
maintain a clear identity for psychology as a distinct profession separate from other
mental health providers and that we maintain high standards in training and that
training programs prepare psychologists for the complexity of their profession.

Rosemary Adam-Terem, Ph.D., Domain Representative for


Public Policy and Social Justice – 2009-2011

Aloha,
I have been a practicing psychotherapist specializing in women’s,
health, and divorce/custody issues in Honolulu, Hawai`i for over
20 years and have been active in our state psychological associa-
tion for even longer. I teach clinical classes occasionally as an
adjunct faculty member at the University of Hawaii Department of
Psychology. Currently president-elect of HPA, I am the chair of the Ethics Committee,
and co-chair of the Convention Committee. I was HPA’s Council representative from
2005-7 and now serve as a member of APA’s Committee on Rural Health. This is the
first time I have been involved in any role in the division, and I am happy to be part
of the board of Division 29 where I look forward to working on issues of importance
to the psychotherapy community in the realm of public policy and social justice.

9
PSYCHOTHERAPY RESEARCH, SCIENCE, AND
SCHOLARSHIP
Psychological Treatments and Psychotherapy with Older Adults
Norman Abeles, Ph.D., Michigan State University

The core identity of home patients) especially for individuals


most practicing psy- suffering from mild to moderate dementia.
chologists is psy- He argues that these psychological inter-
chotherapy and this ventions are different from psychothera-
practice is directed at pies or more generic treatments that deal in
the treatment of psy- problems of living, growth, and self-under-
chopathology or psy- standing. He is certainly supportive of
chological components these more generic therapies but believes
of physical disorders, they are simply different from psychologi-
David Barlow (2004) reminds us. He recog- cal interventions. He also argues that psy-
nizes (in a footnote) that there are many chologists are well trained in psychological
individuals who seek psychotherapy for interventions and are good at performing
improvements in problems of living, better them, while the more generic psychothera-
adjustment and personal growth (p. 871). I pies are often conducted by a range of ther-
am reminded of discussions that were apists from many areas of specialization.
ongoing when there was consideration of Barlow (2005) argues that psychologists
the adoption of the Guidelines for have declared themselves health service
Psychological Practice with Older Adults professionals and evidence-based practice
(APA, 2003). Several of my colleagues appears to be policy in health care. His sug-
asked whether or not such guidelines were gestion is that the term psychological treat-
necessary. After all, they argued, all of us ment be used for health care related disor-
can recognize when an older adult ders, while psychotherapy be used for non-
becomes demented or severely impaired. health care problems. Both psychological
In all other cases we can continue doing treatments and psychotherapy can be evi-
psychotherapy as we had in the past. We dence-based, but psychological treatments
can grow older with our clients so let us are designed specifically for use in the
not get too preoccupied with Guidelines, health care system. He insists that psychol-
since a smart attorney can use them against ogists would be in a better position by tar-
therapists even though they are only geting some of their interventions to well
Guidelines and not standards. defined pathologies which are generally
accepted as being reimbursable. Let me
Barlow suggests we differentiate between illustrate this issue by discussing treat-
psychological interventions which are ments for older adults.
specifically designed to assist the individ-
ual to deal with impairment and stress and In a recent issues of Psychology and Aging,
psychotherapy. Psychological interven- Scogin (2007) presents a range of evidence-
tions have been designed to impact panic based treatments including treatments for
disorder, insomnia, Irritable Bowel Syn- late-life anxiety, insomnia, disruptive
drome, and other impairments. Older behaviors in individuals with dementia
adults at times complain of problems asso- and treatments for distress in family care-
ciated with urinary incontinence, while givers of older adults. In the introduction
caretakers may note aggressive behavior to this special section, Scogin notes that the
and wandering (often noted in nursing continued on page 11
10
APA Presidential Task Force on Evidence- phobias, panic disorders, obsessive com-
Based practice (2006) incorporates three pulsive disorders and PTSD appear to be
elements which are listed as client prefer- limited at best.
ence, clinician expertise and the use of the
best available scientific information (p. 1). Another study in the special section on
He points out that there is considerable psychological treatments for older adults
controversy about evidence-based treat- focused on caregivers of older adults. The
ments. These include concerns about their majority of studies reviewed were efforts at
impact on the independence of clinicians psychoeducational-skill building but they
and the dangers inherent in endorsing also included psychotherapy-counseling as
brand name therapies. On the other hand, well as multicomponent programs. The
he argues that older adults do not neces- largest effect sizes were found in the psy-
sarily share these concerns. He points out chotherapy area where caregivers treated
that Section II (Clinical Geropsychology) of by means of cognitive-behavioral therapy
the Society of Clinical Psychology, initially showed reductions in their depressive
investigated treatments for depression in symptoms. The authors concluded that the
older adults and identified those that met identification of interventions which
criteria based on a coding manual. They demonstrate empirical support are more
selected six evidence-based treatments. likely to obtain private or public funding
These included behavioral therapy, cogni- support and there may be increased appli-
tive-behavioral therapy, cognitive biblio- cations to more ethnically diverse care-
therapy, problem solving therapy, brief givers (p. 49).
psychodynamic therapy and reminiscence
therapy. Treatments and various dimensions
of diversity
Aside from depression, late life anxiety is a In their book on evidence-based practices
frequently occurring problem in older in mental health (Norcross, Beutler, &
adults. Ayers et al (2007) propose that the Levant, 2006), the editors raise the issue of
best estimate for general anxiety disorders the extent to which evidence-based treat-
in older adults is about 10% with diagnos- ments and treatment as usual address eth-
able anxiety disorders in older adults rang- nic minority issues. Sue and Zane (2006)
ing from 2-19%. These authors found sup- agree that psychological treatments should
port for four kinds of evidence-based treat- be supported by research evidence but
ments including relaxation training, cogni- note that little research has taken place
tive behavioral therapy, supportive thera- with clients from ethnic minority groups.
py and cognitive therapy, though there was They argue that the lack of research is a
somewhat less support for the latter two function of systemic reasons because it is
therapies. They stated that their findings too costly, samples are difficult to obtain,
are consistent with other reviews that and research is difficult to conduct.
found psychosocial interventions to be Further, research with ethnic minorities is
moderately efficacious and that some treat- often controversial because it deals with
ments were more effective than others. topics of differential treatment, prejudice,
However, they caution that findings for values, and other difficult questions.
treatments of late life anxiety are limited. Finally, psychologists want to be sure that
Out of 77 studies reviewed, only 17 war- internal validity is obtained and there is
ranted inclusion criteria for additional less interest in the extent to which research
analyses. Further, the authors note that findings can be generalized to other popu-
there has not been any research to investi- lations or situations (p. 332). They also
gate the mechanisms underlying success- raise the issue of cultural competency
ful treatment of late life anxiety (p. 13) and defined as the knowledge and skills need-
data for late life anxiety disorders such as continued on page 12
11
ed to deliver services to those of a given cul- What should the psychologist do after the
ture. Therapists may change their approach break? Is this TAU (therapy as usual) or is
almost without awareness by becoming the therapist dealing with the issue of cul-
more cautious about making inferences, and tural competence? Is this an evidence-
may place more emphasis on the interven- based treatment session or is this an assess-
tion rather than its context. This refers to ment or is it both? Should she have accept-
include client characteristics, therapist char- ed the referral in the first place? What will
acteristics, type of intervention, and treat- she tell the referring physician? What will
ment settings (p. 336). In order to under- she tell the client? Is the daughter a client
stand cultural competency, we need to also? Should the client be referred for a
deconstruct the treatment process into com- neuropsychological evaluation? These are
ponents. Interestingly enough there is no all difficult questions to answer in the
discussion of the concerns of older adults in absence of evidence-based treatments for
this book. Let me describe a brief vignette to ethnic minority individuals and older
highlight issues concerning older adults, adults. Will the APA Guidelines for
culture and ethnicity. Psychological Practice with Older Adults
(2003) be of help? Are there signs of dimin-
A physician refers a 72 year old second ished capacity and is a formal assessment
generation Korean American to you. The required? These are just some of he con-
client has a high school education and cerns therapists need to consider when
worked as a wait person in a Chinese they are working with older adults. Of
restaurant until he retired at age 70. The course some of the general issues can be
problem cited by the physician includes reviewed by reading the article by the APA
concern about memory loss, and the physi- working group on older adults (1998) but
cian asks for a report from you as to the for those who limit their practice to work-
outcome of assessment and treatment. The ing with older adults more education and
client arrives accompanied by his 40 year training is very desirable as is suggested in
old daughter who talks about her concerns the APA Guidelines.
regarding her dad. She notes that he does
not remember where he parked his car at Working with older adults at times inter-
the supermarket parking lot, misplaces his acts with the topic of working with people
keys, forgot to turn off the burners on his with disabilities. Olkin and Taliaferro
stove on one occasion, has lost weight in (2006) suggest that evidence-based prac-
the last year and does not seem like his old tices for people with disabilities have been
self. The psychologist asks the client about ignored and there is a lack of knowledge
all this. The client does not maintain eye generally concerning the disability com-
contact and says only that his daughter munity and culturally competent practice
worries too much, that there is really noth- with regard to disability is not the norm (p.
ing wrong with him except for old age and 355). The interested reader may want to
that he came mainly to please his daughter. consult Olkin’s (1999) discussion on aging
You, a Latina psychologist become a little and long-term care which discusses indi-
uncomfortable at this point because this viduals with disabilities who are aging and
situation reminds you of your relationship those who acquire disabilities as they
with your own father. You note that the become older. She points out that while
daughter maintains excellent eye contact most older adults do not have disabilities,
with you. You continue to ask questions of many individuals do retire because of ill
the daughter and begin to wonder whether health. Further, people who do have dis-
you should administer a memory test to abilities may have more pronounced prob-
the client. Instead you decide to take a lems as they become older and may need
break and have a cup of tea with the increased support from family members
daughter and her dad. continued on page 13
12
and service agencies. comments on the split within clinical psy-
chology (Kazdin, 2008) between those who
The focus on cultural competence is also support evidence-based practices and
very relevant for lesbian, gay, bisexual and those who raise concerns about these treat-
transgendered clients (Brown, 2006) and is ments. He points out that patients in con-
also relevant for older adults. Brown trolled trials may suffer from less severe
argues that LGBT clients require therapists disorders and less comorbidity than
who take an affirmative stance whereby patients routinely seen by practitioners. He
the therapist avoids making the client’s also reiterates that much of psychotherapy
sexual or gender orientation the problem is less concerned with symptoms and more
and focuses instead on the distress that concerned with the ability to cope and
brings the client into treatment. In addition agree that psychotherapy is much broader
the therapist should not ignore the client’s in attempting to deal with multiple stres-
LGBT identity (p. 350). sors (p147). However, similar to Barlow,
Kazdin argues that we need to be con-
The treatment of personality disorders in cerned with state legislatures and third
older adults party payers who are trying to determine
It is easy to forget that personality disor- what will be reimbursed and what will not
ders persist into old age and are likely to be reimbursed. He describes two guiding
warrant treatment. There has been little questions: “Are there better ways to bridge
research designed especially for the treat- the divide between clinical research and
ment of older adults (Segal, Coolidge and practice; and, how can we improve the
Rosowsky, 2006.) Recently Hinrichson and quality of patient care (p. 157). I would
Clougherty (2006) adapted interpersonal submit that working with older adults is an
psychotherapy (IPT) for older adults, but it excellent example of dealing with these
has not been applied to older adults guiding questions. Many older adults do
whether or not they suffered from depres- need help in coping with the aging process
sion. Dialectical behavior therapy has and will clearly benefit from psychothera-
received some research attention with py. On the other hand there are other older
regard to older adults but some studies are adults who may suffer from specific prob-
beginning to be done with older adults lems which clearly need psychological
who manifest comorbid depression. Since treatments. Whether or not Barlow’s dis-
DBT is described as a skills based approach tinction will be helpful to psychologists is a
according to Segal, Coolidge and topic that is worthy of investigation!
Rosowsky, it ought to be suitable for older
adults. These authors also contend that the Summary
most appropriate treatments for older I began this article by describing Barlow’s
adult with personality disorders are those differentiation between psychological
that focus on the symptoms rather than the treatments and psychotherapy and utiliz-
characterological infrastructure (p. 282). ing evidence-based treatments with older
Cognitive behavioral therapies are likely to adults to provide examples of treatments. I
be helpful once a therapeutic alliance has talked about the dearth of research with
been established. There is a high comorbid- regard to the treatment of ethnic minority
ity rate of Axis I and Axis II Disorders, and elders, those with disabilities, and older
comorbid depression is frequent as is anxi- LGBT clients. I presented a vignette con-
ety and somatization disorders. cerning an older ethnic individual and the
dilemmas faced by therapists in providing
Is evidence-based therapy transferable to treatments. I then returned to the knotty
clinical practice? issue of whether or not evidence-based
The current President of the American treatments are transferable to clinical prac-
Psychological Association, Alan Kazdin, continued on page 14
13
tice. Hopefully my discussion will stimu- treatments for disruptive behaviors in
late your thinking about all these areas. individuals with dementia. Psychology
of Aging, 22, 47-51.
References Hinrichson,G & Clougherty,F. (2006).
Abeles, N. (in press) Supervising novice Interpersonal Psychotherapy for Depressed
geropsychologists. In Hess, A., Older Adults. Washington,D.C:
Psychotherapy Supervision, Theory, American Psychological Association.
Research and Practice. New York: Wiley. Kazdin,A. (2008) Evidence-based treat-
American Psychological Association ment and practice. American
(1998) What practitioners should know Psychologist, 63,146-159.
about working with older adults. Norcross, J., Beutler, L. & Levant, R.
Professional Psychology, 29, 413-427. (2006). Evidence-Based Practices in Mental
American Psychological Association Health. Washington, D.C: American
(2003). Guidelines for Psychological Psychological Association.
Practice with Older Adults. Washington, Olkin,R, (1999). What Psychotherapists
DC: Author. Should Know About Disability. New York:
APA Presidential task force on evidence- Guilford Press.
based practice (2006).Evidence-based Olkin, R. & Taliaferro,G. Evidence-based
practice in psychology. American practices have ignored people with dis-
Psychologist, 61, 271-285. abilities (p 359). In Norcross,J. Beutler,L
Ayers, C, Sorrell, J, Thorp, S., and and Levant, R.(2006). Evidence-Based
Wetherell, J.(2007). Evidence-based Mental Health Practices in Mental Health.
treatments for late life anxiety. (359).
Psychology and Aging, 22, 8-17, Scogin, F. (2007) Special section: Evidence-
Barlow,D. (2005) Clarification on psycho- based psychological treatments for
logical treatments and psychotherapy. older adults. Psychology of Aging, 22, 1-
American Psychologist, 734-735 55.
Barlow, D. (2004). Psychological Segal,D., Coolidge,F. and Rosowsky, E.
Treatments. American Psychologist, 869- (2006). Personality Disorders and Older
878 Adults. Hoboken, NJ: Wiley and Sons
Brown, L. (2006) The neglect of lesbian, Sue, S .and Zane, N. Ethnic minority pop-
gay, bisexual and transgendered clients. ulations have been neglected by evi-
In Norcross, J, Beutler, L., & Levant, R. dence-based practices. (pp 329-337). In
Evidence-Based Practices in Mental Health. Norcross, J. Beutler, L. & Levant,R.
Washington, D.C: American (2006). Evidence-Based Practices in Mental
Psychological Association. Health. Washington, D.C: American
Gallagher-Thompson, D. & Coon, D. Psychological Association.
(2007) Evidence-based psychological

N O F P S Y C H O THE
O
RA P Y
D I V I SI

29
ASSN.
AMER I

C
A
N PSYCHOLOGI C
AL

14
PERSONAL REFLECTIONS FROM
DIVERSE EARLY CAREERS
Michael J. Constantino (Series Editor)
University of Massachusetts, Amherst, Massachusetts

This is the third installment of a 4-5 part series that focuses on first-
hand accounts from early career psychologists (ECPs) in diverse
positions that value psychotherapy practice, training/teaching,
and/or research. In these papers, the authors will (a) describe the nature of their position,
(b) outline how they got to their current position, (c) share the most satisfying aspects of
their job, (d) discuss the most challenging aspects of their job and how they have negoti-
ated such challenges, and (e) provide pearls of wisdom for achieving and succeeding in
their type of position.

OPPORTUNITIES IN PRIVATE PRACTICE


Julianne I. Yanko

Throughout graduate patients in my primary office three


school, I repeatedly days/week. In the four years since begin-
heard the faculty warn, ning my practice, the only consistency in
“don’t plan on hanging my caseload has been change. The referral
a shingle and having a types and percentages of college student
private practice.” With vs. non-college student clients in my case-
such clearly worded load are always changing.
commentary, I initially
believed that a career in In addition to the cases noted above, I see
private practice was not a realistic option. clients one morning a week in a family
Yet, today, my professional interests and practice office, in one of the same exam
personal needs have been satisfied in, yes, rooms used by the medical providers. I
private practice! usually offer the time slots that I have in
that office to the clients referred by the
POSITION DESCRIPTION family practitioners who work there. In
I am a part-time, solo private practitioner some instances, coming to a familiar office
in Amherst, Massachusetts, a small town is an important factor in helping clients to
that is also home to five colleges. My time access mental health services.
is divided between the provision of psy-
chotherapy, administration and consulta- Administration
tion, and supervision. I also spend time on administrative activi-
ties, such as submitting insurance claims,
Psychotherapy returning calls to prospective clients, and
I spend most of my time as a therapist, see- mailing questionnaire packets to new
ing adult clients presenting with a variety clients. When I first began my practice, a
of mood and anxiety disorders and health- key activity was developing connections
related issues. These clients are referred by (i.e., having coffee or eating lunch!) with
medical providers, local college counseling some of my referral sources and getting to
staff, mental health colleagues, academic know other providers to whom I might
psychologist colleagues, and an insurance make referrals. For instance, I met with a
plan in which I participate. I see these continued on page 16
15
psychologist and medical providers at a practice. I have also provided individual and
large medical center that is about 20 miles group supervision to doctoral students in
away. They offer specialty medical services clinical psychology, including cases that
there and some of their patients live closer were part of a clinical research trial.
to where I practice, so I am a viable referral
possibility. I have also maintained open ROAD TO CURRENT POSITION
communication with staff at the local col- I arrived at my current position thanks to
leges and have become part of their referral the breadth and depth of my clinical train-
networks. Finally, I met with psychologists ing, as well as a fair amount of luck! My
at one of the larger mental health clinics in fascination with psychology began with
the area and several in solo private practice the courses I took to fulfill my undergrad-
and have been able to refer out cases to uate general education requirements and
them. This bidirectional referral process led me to enter a masters program of gen-
has made for satisfying professional rela- eral psychology at California State
tionships and has promoted important University Long Beach. While there, I
partnerships from a business perspective. became involved in a research project at
the neighboring Veterans Administration
Consultation and Training Hospital and also gained clinical experi-
Several times a year, I provide consultation ence co-leading groups at a day treatment
or training for psychologists and providers center. These experiences led me to pursue
from non-mental health disciplines, as well additional clinical research, to train in
as give talks to community groups or med- empirically-validated therapy techniques,
ical patients. For example, I have consulted and to focus on populations with health
with clinic nurses regarding psychosocial issues and older adults. After completing
interventions for women undergoing infer- this master’s program, I began the doctor-
tility treatment. I have presented on the al program in clinical psychology at the
psychosocial impact of polycystic ovarian University of Massachusetts-Amherst
syndrome as part of an informational (UMass), which emphasized the scientist-
series at a medical center for patients with practitioner training model.
the disorder. I have also consulted with a
local nutritionist on issues surrounding At UMass, outstanding mentors encour-
behavior change and eating for family aged me to engage in a broad diversity of
practice patients. I have also trained grad- clinical and research experiences. I obtained
uate students and led a continuing medical clinical training with populations across the
education workshop on integrating mind- lifespan, in outpatient and inpatient set-
fulness techniques with cognitive behav- tings, and with serious mental illness. I also
ioral therapy (CBT). As a final example, I received extensive training in psychological
conducted an inservice on CBT for anxiety testing. Because I was still interested in
disorders for the staff at a college counsel- empirically-supported techniques and
ing center. These types of trainings require behavior change, I sought out specialized
that I stay current with the mental health training in behavioral medicine during an
and psychotherapy literatures, and they 18-month practicum at an academic medical
provide me the opportunity to meet other center. I thoroughly enjoyed working in a
providers in the community (who often hospital setting, learning about the interre-
become new referral sources). lationship between mental and physical
health, and collaborating with other disci-
Supervision plines. For internship, I wanted to receive
Another regular part of my practice is super- additional behavioral medicine training and
vision. I meet twice monthly with a peer to develop other competencies. Internship
consultation group to discuss clinical cases, afforded me a great mix of training experi-
ethical issues, and other aspects of private continued on page 17
16
ences. For example, on an inpatient psychi- and I enjoy it most when I can collaborate
atric unit, I primarily conducted therapy with other medical providers, college staff,
and some assessment. In an interdiscipli- or therapists-in-training.
nary outpatient clinic, I provided therapy
for homeless and medically ill clients. And After my post-doc, I moved to the five-col-
finally, in the behavioral medicine clinic, I lege area knowing that there would be
conducted outpatient individual and group ample opportunities for adjunct teaching. I
therapy, as well as inpatient consultation- hoped to teach and to find a part-time, clin-
liaison work. ical position. I had never given any serious
thought to private practice; besides being
Finally, I completed a two-year post-doc- warned against it, I had no exposure to it
toral fellowship in behavioral medicine to whatsoever. Unexpectedly, there were refer-
sharpen skills in that specialty and to rals from former patients and providers at
engage in research on end-of-life issues. my post-doc site and as soon as I could
This professional environment fulfilled my wrap my brain around “hanging out a shin-
ideal training goal—i.e., working in an aca- gle,” I decided to start a practice. I found
demic medical center, simultaneously that it was a better fit, both time-wise and
immersed in providing clinical services, economically, with raising a young family,
being involved in medical student and res- and I have been doing it ever since.
ident education, supervising psychology
practicum students and interns, develop- MOST SATISFYING ASPECTS
ing clinical programs, and working on a OF POSITION
grant and an article. Not incidentally, I love having the opportunity to conduct
though I did not realize it at the time, one therapy with heterogeneous individuals
of the aspects of my internship and fellow- with a variety of presenting problems. It is
ship training that proved to be most infor- interesting, challenging, and rewarding
mative was learning about the constraints work. Initially I was concerned that not
and pitfalls associated with third-party being in a medical setting would be a dis-
payment, productivity requirements, and appointment, but those feelings soon dissi-
other factors that affect the “bottom line.” pated as I found a niche providing behav-
ioral medicine services for patients referred
The shift from postdoctoral fellowship to by their local medical providers or special-
private practice was not my original plan, ty providers at the nearest medical center. I
but my perspective on the ideal career also enjoy having a relationship with a
began shifting. Throughout graduate busy, local family practice.
school and fellowship training, I enjoyed
being active in numerous clinical, research, Being in solo practice also made it neces-
and teaching activities, and I held the belief sary for me to connect with other mental
that I would most enjoy a career where I health providers in my area. Although it is
was involved regularly in all of them, per- important for me to have trusted col-
haps adding some administrative duties leagues to whom I can refer cases that I do
and political advocacy for additional pro- not have room to accept or that require spe-
fessional fulfillment. However, as I envi- cialties other than my own, the social con-
sioned a family life, I began to think of my nection with colleagues is also very enjoy-
career in terms of a series of stages in able. Furthermore, it would be hard to
which I would emphasize different activi- overestimate the importance of the func-
ties at different times. Subsequently, as tions served by my peer supervision
each of my three children has come on the group. They have provided consultation
scene, I have adjusted my professional pri- on complex ethical issues, rich perspectives
orities and expectations according to fami- on clinical issues, and saved me from
ly needs. Clinical work is my core interest continued on page 18
17
having to figure out all of the nuts and MOST CHALLENGING ASPECTS
bolts of private practice administration on OF POSITION
my own. Some of the most rewarding parts of this
work are closely related to the most chal-
Working in private practice has also been lenging aspects. Though I relish making
wonderful for me personally and as a decisions that affect the direction of my
mother. I was able to choose a practice practice, there are times when administra-
location minutes from my home, enabling tive duties demand more time than I
me to spend the bulk of the time away would like. Working part-time compounds
from my children and family life doing this problem, as it requires comparable
clinical work rather than commuting. At mundane administrative activities as full-
different times, I have shifted my sched- time practice. Thus, tasks that seem least
ule in ways that best balance work and important and interesting can consume a
family needs. For instance, this year I had greater percentage of my time than they
a greater percentage of college students in would of a full-time schedule. I also miss
my caseload who leave the area during having colleagues an office door away, but
summer, leaving me with the opportunity that is what compelled me to join a peer
to have a smaller caseload if I choose not consultation group. Of course, I am also
to take new cases for several months. I am affected by the larger forces at play in the
considering the possibility of making this current health care climate, which is as dis-
a practice when all of my children are astrous for mental health as it is for medi-
school age. I was also able to reduce my cine. In the short time I have accepted
caseload when my children were infants reimbursement from third-party payers,
and to build it back up as my family’s there have been depressing, rapid develop-
needs allowed. Overall, I feel that I have ments that I have had to react to despite
been able to have an engaging, rewarding my best-laid plans to make choices about
practice that is a strong base from which I my practice in a pro-active way. Finally, the
can expand to other areas in the future. flexibility that I value in terms of lighter
Not insignificantly, at least in this area, schedules at particular times means that I
salaries for part-time or fee-for-service have a very demanding schedule at other
psychologists are on the low side and not times.
likely to cover the cost of childcare. By
managing my own overhead and refer- PEARLS OF WISDOM
rals, the percentage of the reimbursement I realize that admonitions against “hanging
that I earn is significantly greater than that out a shingle” were likely motivated by
paid by local clinics. This is what has concerns about the third-party payer deba-
made it financially possible to be more cle. Yet, my shingle is out and referrals are
flexible in my schedule. steady. People will continue to have mental
health needs and the key is to figure out
To some extent, being in private practice how to serve them while making a good
has let me be guided by my own values as living. To that end, there are several guide-
I make business decisions, which can be lines that might be useful to those consid-
wonderfully efficient. I am not affected by ering private practice.
seemingly random decisions made by
administrators, and by being aware of all The first is to know what you need from
of the factors, I can make the decisions that your practice. As with any other job, you
I think are best. I never waste time on a will consider the schedule, workload, and
meeting or wait for someone else to make a income that you require. In thinking about
decision that impacts my work. how to structure your practice, there are
continued on page 19
18
numerous invaluable resources, such as position. Once you have a plan, flexibility
books, articles on the APA website, and is essential. All obstacles have the potential
your state psychological association. The for being opportunities. Finally, be present
second critical piece is to formulate what and enjoy the work. You have spent thou-
you would like the content of your work to sands of hours in training and jumped the
be – i.e., what types of referrals, what types hurdles of comprehensive exams, disserta-
of involvement with other professionals, tions, and licensing exams to be at this
etc. Then you can start developing a plan point!
that integrates your basic job requirements
and your desires regarding the work con- AUTHOR NOTE: I welcome any follow up
tent. It might be helpful to think in terms of communications or questions at julian-
multiple steps leading to the ultimate, ideal neyanko@aol.com.

ATTENTION GRADUATE STUDENTS AND


EARLY CAREER PROFESSIONALS

You are invited to our second annual

“Lunch with the Masters:


For New Professionals Interested in Psychotherapy”
at the APA Convention
Saturday, August 16th from 12 – 1:50 pm
at the Sheraton Boston Hotel, Commonwealth Room

Come have lunch with the Masters of


the profession and learn more about Division 29.
Invite others to come as well!

19
PRACTITIONER REPORT
Practice Domain Update: Progress and Challenges
Jennifer F. Kelly, Ph.D.

I am so excited about 2008 Associate Chair of the Psychotherapy


having the opportunity Practice Committee. She will be working
to be a part of Division with us to assist in developing the Practice
29, and to be serving agenda for the division. Dr. Coughlin has
you as the Practice been a licensed Clinical Psychologist for
Domain Representa- over 25 years. In addition to seeing
tive. I would like to patients in her private practice in
start my tenure by Philadelphia, PA, Dr. Coughlin conducts
introducing myself and the persons work- training and supervision groups for mental
ing with me in this domain. My name is health professionals around the world.
Jennifer F. Kelly. I am a Past President of
the Georgia Psychological Association and When I think about our profession, I feel
currently represent the state of Georgia on that we are facing interesting times. At
the Council of Representatives. I am Past- times there is much uncertainty and anxi-
Chair of the Board of Professional Affairs ety about our future, while at other times it
(1997) and currently serve on the is exciting to see what APA is doing to meet
Committee for the Advancement of the challenges. The practice community of
Professional Practice (CAPP) and the the American Psychological Association
Board of Trustees of the Association for the has seen exciting changes over the past
Advancement of Psychology (AAP)-cur- year. As you all know, we have a new
rent Chair. I am an independent practition- Executive Director for Professional
er in Atlanta, Georgia, primarily working Practice, Dr. Katherine Nordal. Dr. Nordal
with individuals with health related condi- brings a unique set of background and
tions. I have a special interest in advocacy, experience to the position, including public
especially for the underserved popula- policy, APA governance and independent
tions. I feel that my involvement with practice for 27 years. Being an independent
Division 29 fits very well into my experi- practitioner helps her to understand the
ence, practice, and goals. challenges that practicing clinicians face.
Because she has experience on Capitol Hill
I would like to welcome Dr. John O’Brien as well as the state legislature, she under-
to the Division as he is serving as 2008 stands legal, regulatory, legislative and
Chair of the Psychotherapy Practice marketplace issues in the field, all the
Committee. John is an independent practi- things that affect the way we do business.
tioner living in Portland, Maine. He is a She has served on APA’s Council of
graduate of Michigan State University and Representatives, Board of Directors, and
specializes in substance abuse, trauma, was chair of the Committee for the
LGB issues and grief. He currently serves Advancement of Professional Practice. In
as president of the Maine Psychological addition, she is a past president of the
Association. Coordinating the practice sec- Mississippi Psychological Association and
tion of the Psychotherapy Bulletin is one has served on the Mississippi Board of
important aspect of John’s responsibilities Psychological Examiners. We look forward
and you will be hearing more from him in to collaborating with Dr. Nordal as she
the near future. works to advance the psychology agenda.

Dr. Patricia Coughlin will be serving as the continued on page 21


20
The primary mission of the Practice tion, some insurers have been developing
Domain is to focus on the issues related their own approach to assessing the quali-
to practice, and we would like to provide ty of the care they provide to insured pop-
you with an update of the progress and ulations. Pay-for-performance is now
challenges. directed toward consumers, as some com-
panies offer individuals reduced premi-
This spring, on March 5, 2008 the U.S. ums, lower deductibles and co-payments
House of Representatives passed the Paul for selecting practitioners who meet quali-
Wellstone Mental Health and Addiction ty standards. There is growing concern that
Equity Act, also known as Mental Health they are moving toward including behav-
Parity. With this passage we are closer to ioral health care in performance measure-
ensuring equal treatment for millions of ment development, quality improvement
Americans with mental health and sub- efforts and pay-for-performance initiatives.
stance use disorders. Last September, the
Senate unanimously passed the Mental Medicare’s Physician Quality Reporting
Health Parity Act. Although there are dif- Initiative (PQRI) initiative is one of the
ferences in the two bills, they are similar in most well known pay-for-performance
many important aspects. Both preserve efforts, and was implemented in 2007. At
strong parity and consumer protection this time it is rewarding independent prac-
laws at the state level while extending fed- titioners for reporting data on a selected
eral parity protections to millions more series of measures. There are six measures
Americans. We have worked to end dis- that relate to mental health services deliv-
criminatory health insurance coverage for ery. These include medication assessment,
over a decade; we are finally seeing the developing a treatment plan with the
payoff for all the hard work. Although we patient, screening for cognitive impair-
are almost there, the work is not over. We ment, depression screening, performing a
now need to advocate for Members of diagnostic evaluation and assessing sui-
Congress to complete the negotiations on a cide risk.
parity bill that can pass both chambers.
Our goal is to have it passed this year! To close on a positive note: It is nice to see
that, under the leadership of APA’s
Another issue the Practice Directorate/ President-Elect, Dr. James Bray, and co-
Organization has been addressing and fol- chars, Drs. Carol Goodheart and Paul
lowing is Pay-for-Performance programs Craig, there will be a Practice Summit on
and other quality improvement efforts. As the Future of Psychology in 2009.
noted by the Practice Organization, the Hopefully, this will help prepare us to meet
programs are already widespread in med- the challenges in providing adequate men-
ical settings, and insurance companies and tal health care to our clients.
government agencies have been applying
these programs to mental health services Although there is anxiety about the future
delivery. of practice, it is reassuring to know that our
leaders are working hard to address our
Federal initiatives include the Centers for concerns.
Medicare and Medicaid Services (CMS)
Physician Quality Reporting Initiative We will be providing you updates about
(PQRI) and the Hospital Quality Initiative. what is happening in practice in future
Professional organization and federal issues of the Psychotherapy Bulletin. We look
efforts to improve care have been support- forward to working together to further
ed and extended by purchasers (employ- advance the practice agenda.
ers) and commercial health plans. In addi-

21
PRACTITIONER REPORT
Outcome Measures in Psychotherapy: Blessings or Curses?
John O’Brien

Background received sufficient feedback in their clinical


Evidence-based treat- training and they do not wish to have any
ment has become an further evaluation of their work. However,
increasingly important these practitioners will be left behind as
concept in numerous psychotherapy practice becomes increas-
fields of practice over ingly structured through the use of out-
the past several years comes. The question is no longer whether
(Reed, 2006). In particu- or not to use outcomes. At present, the
lar, physicians have come under escalating question is how to use outcomes in provid-
pressure to use evidence based interven- ing psychotherapy.
tions as opposed to “folklore” in treating
patients (Kihlstrom, 2006). Physicians’ pay Voice from the Frontline
and performance are now being tied to their I’ll admit it. I was not excited about the use
adherence to evidence-based practices and of outcome measures in psychotherapy
to the treatment outcomes of their patients. when I initially learned of this trend. I was
Insurers are rapidly moving in the direction trained in an era just prior to “evidence
of measuring outcomes to determine the based practice.” In my training, we focused
treatments for which they will (and will not) on how to establish and manage a thera-
be willing to pay (Bachman, 2006). peutic relationship with a client and
viewed technique as important but sec-
The field of psychotherapy is being asked ondary. My clinical instructors guided me
for similar evidence (Asay, Lambert, in understanding patient dynamics and
Gregersen & Goates, 2002). Numerous how they manifest in the therapeutic rela-
insurance providers are now requiring tionship. We talked about how it could be
psychologists to utilize different outcome useful to use measures of depression or
measures to demonstrate the benefit and anxiety to chart client progress but this
impact of psychotherapy. These measures process was not emphasized.
vary widely in their clinical utility and
validity/reliability. Yet in partnering with I first heard of a large scale plan to use out-
business and industry, psychologists will come measures in psychotherapy in a
increasingly be required to present evi- Quality Assurance meeting for a local man-
dence of their effectiveness. aged care company. As I sat in this board
meeting, I learned of the plan to use a
However, there has been significant resis- depression measure designed for primary
tance to the uses of outcomes in psy- care offices to assess depression in patients
chotherapy, particularly among private with co-morbid medical issues. This mea-
practitioners. Reasons for this resistance sure would be used with psychotherapy
are numerous but include lack of funding, clients. I asked what the reliability and
time constraints, lack of appropriate instru- validity of this measure were. I was
ments and lack of skill in research design assured that they were excellent. I then
(Asay, et al., 2002). In addition, the process asked about the group on which this mea-
of evaluating one’s skill as a therapist can sure was normed. “Patients in primary
be threatening (Asay, et al., 2002). care” was the answer. I pointed out that
Psychologists may believe that they have continued on page 23
22
this was a different population from the trainings. I helped to coordinate a study in
psychotherapy population, to which the our state psychological association that
response was, “It doesn’t matter.” looked at if and how to use measures. We
hope to publish our findings.
I then heard a physician staff member of
the group talk very excitedly about how I am happy to report that through this
we would be able to chart individual client process, I have worked through my initial
progress based on this measure. He talked resistance to the use of outcomes. I now
about how this would allow for greater integrate some symptom measurement
communication between primary care into all the treatment that I do. Through
physicians and behavioral health this process, I continue to learn about my
“providers.” This sounded reasonable. practice and about my clients. Outcome
measurement in psychotherapy is not all
The physician then went on to talk about bad. However, I am still concerned about
how we could use these measures to judge many of its aspects. In the interest of fair-
therapist effectiveness and integrate these ness, I thought that I would first share
outcomes into quality ratings. “We can what I consider to be the benefits (“bless-
then reimburse providers with better out- ings”) of outcomes and then identify some
comes at a higher rate.” The hair on the of my concerns (“curses”).
back of my neck stood up straight. Once
again, I could not contain myself. “We will Blessings:
use these data to judge therapist effective- Corroboration of symptoms. I find it very
ness? How about those therapists who are interesting to see how a client’s self-report
seeing a more seriously impaired popula- of symptoms compares to my clinical inter-
tion? Their clients will not be showing as view. It is not unusual, especially with my
much progress on this measure, if any. I see male clients, to see a discrepancy between
many clients with trauma issues and their what is verbally reported versus what is
progress is often slower and more compli- reported in writing. This can lead to inter-
cated. How will that be accounted for?” esting conversations with clients. Measures
There was no clear answer. “This will be can also help me to confirm my thinking
punishing those therapists who see more diagnostically.
seriously impaired clients. If that is the
Tool in psychotherapy. I will sometimes use
case, why would a therapist continue to see
outcome measures as a point of discussion
those clients? Their ratings will be pulled
in treatment. For example, a female client
down. I would imagine that the next step
in treatment rated her depression as very
would be for therapists to dump their more
low. In sessions, she would easily become
seriously impaired clients so that their rat-
tearful, expressed negative thoughts about
ings will improve. What will prevent this?”
self, had difficulty getting motivated to do
Again, there were no answers. However, I
things, and was socially isolated. This led
was the only member of the Board who
to a discussion of the difference between
had concerns about this. So, the group
her behavioral indications of depression
moved ahead with the plan to implement
versus her self report. She was able to see
this process. I was horrified.
that her lack of acknowledgement of her
symptoms was impeding her recovery
I decided that I needed to learn more about
process.
these issues. Rather than just sit and whine
(which I do quite well) about this state of
Tracking individual client progress. I can easi-
affairs, I have focused on exploring how
ly see client progress (hopefully) in therapy
outcomes are being used and have learned
and I will often articulate my impressions
ways that they can be effective. I have
attended many professional seminars/ continued on page 24
23
for clients during treatment. Although this Fortunately, I was able to appeal this deci-
can be beneficial, I also realize that having sion and explain my client’s needs.
an “objective” measure that clients can Outcome measures can be reified to repre-
review provides another more concrete sent the BEST representation of a client’s
piece of evidence of their progress. It is one functioning. In truth, they are one in a
thing to HEAR about progress but it seems number of data points to consider.
very powerful for clients to SEE their
progress. People often forget how bad And what can we conclude about the therapist?
things have been. Many outcome measure systems are incor-
porating measures of the effectiveness of
Evidence (hopefully!) that the psychotherapy I the therapist based on client responses.
provide makes a difference. I like to believe Therapists are compared across clients and
that what I do is helpful to clients and that with each other. As I reflect on my case-
I help them change. Using outcomes can be load, I am aware of the differences that my
beneficial in demonstrating that my work clients have in how much independence
in therapy with clients is effective. they demonstrate in their treatment, the
speed with which they can learn and uti-
Curses: lize skills, and how much they are able to
And what are we measuring? As a psycholo- follow through with treatment recommen-
gist, I work with my client for 50 minutes a dations. The conclusions about my effec-
week (on average). How much of an tiveness as a therapist will vary widely,
impact am I having in my client’s life as depending upon the sample of my client
compared to (1) appropriate psychotropic population that is drawn.
medication being prescribed (if needed),
(2) medication adherence, (3) exercise, (4) And where is this information going? Some of
ensuring healthy sleeping patterns, (5) the measures that I have used in practice
ensuring healthy eating patterns, (6) that are required by insurers are faxed off
healthy socialization, and, (7) use of skills to the company. The only feedback that I
as recommended. Outcome measures may received was an authorization letter for
be reflecting a client’s motivation, their further sessions (or not). No other clinical
treatment adherence, or other life circum- feedback came to me. This process provid-
stances impinging on their treatment. ed no helpful information to me. In addi-
tion. I had no way of knowing what the
And what can we conclude about the patient? company was using the information for or
Sometimes conclusions may be drawn how it was being tied to a client’s overall
about a client that are not reflective of their record. Could the information that a client
clinical presentation. For example, I had a completes come back to haunt them one
client who started in therapy and complet- day in applying for other health insurance?
ed an outcome measure for his insurance Life insurance? I try to highlight this for
company to get sessions authorized. This my clients but I worry that they are not
client was having panic attacks, was drink- fully understanding the potential implica-
ing daily, had significant marital conflict tions. I think that there are significant ethi-
and was questioning whether or not to stay cal issues inherent in this process.
in his marriage. After he completed the
outcome measure, I faxed it off to the In closing, I can happily report that my
insurance company. The letter that I resistance to the process of outcome mea-
received in return was a surprise. “We are surement in psychotherapy has been suc-
authorizing 3 sessions based on this client’s cessfully managed. I don’t believe that the
symptoms. Congratulations! This client is use of outcomes and the movement toward
ready for discharge! Thank you for your “evidence-based practice” is all bad. There
excellent work with this client.” continued on page 28
24
DIVISION 29 APA CONVENTION PROGRAM SUMMARY

Participant/1st Author:
Jairo N. Fuertes, PhD
THURSDAY, AUGUST 14, 2008
Symposium: Psychotherapy for Cardiac Participant/1st Author:
Patients—Translating Research Into Practice Frances A. Kelley, PhD
8:00 AM – 8:50 AM Boston Convention Discussant: Dennis M. Kivlighan, Jr., PhD
and Exhibition Center, Meeting Room 155
Chair: Ellen A. Dornelas, PhD Symposium: Therapist as Human—Crying,
Participant/1st Author: Lying, and Expressing Anger
Matthew M. Burg, PhD 2:00 PM – 2:50 PM Boston Convention
Participant/1st Author: and Exhibition Center, Meeting Room 150
Ellen A. Dornelas, PhD Chair: Annette S. Kluck, PhD
Discussant: Leigh McCullough, PhD Participant/1st Author:
John Westefeld, PhD
Symposium: Supervision From Multiple Participant/1st Author:
Theoretical Perspectives—Integrating These Randolph Pipes, PhD
Approaches Participant/1st Author:
9:00 AM – 9:50 AM Boston Convention Caroline Burke, PhD
and Exhibition Center, Meeting Room 251 Discussant: Melba J.T. Vasquez, PhD
Chair: Nadine J. Kaslow, PhD
Participant/1st Author: Workshop: Challenges in the Integrated
Josh S. Spitalnick, PhD Practice of Psychotherapy and
Participant/1st Author: Psychopharmacology
Marianne Celano, PhD 3:00 PM – 3:50 PM Boston Convention
Participant/1st Author: and Exhibition Center, Meeting Room 254B
Eugene W. Farber, PhD Chair: Jeremy Kisch, PhD
Participant/1st Author: Chaundrissa O.
Smith, PhD
Discussant: Nadine J. Kaslow, PhD
FRIDAY, AUGUST 15, 2008
Symposium: Emotional Healing in Tibet—
Workshop: Sexual Relationship Satisfaction, Implications for Psychotherapy
Sexual Dysfunction, and Differentiation— 8:00 AM – 9:50 AM Boston Convention
Research and Treatment and Exhibition Center, Meeting Room 207
10:00 AM – 11:50 AM Boston Chair: Lillian Comas-Diaz, PhD
Convention and Exhibition Center, Participant/1st Author: Alan Pope, PhD
Meeting Room 209 Participant/1st Author:
Chair: David Schnarch, PhD Frederick M. Jacobsen, MD
Participant/1st Author: Susan Regas, PhD Participant/1st Author: Ellen Littman, PhD
Participant/1st Author:
Symposium: Real Relationship in Fayth M. Parks, PhD
Psychotherapy—Latest Findings About a Discussant: Norine G. Johnson, PhD
Controversial Concept
12:00 PM – 1:50 PM Boston Convention Symposium: MySpace, YouTube,
and Exhibition Center, Meeting Room 101 Psychotherapy, and Professional
Chair: Charles J. Gelso, PhD Relationships—Crisis or Opportunity?
Participant/1st Author: 2:00 PM – 3:50 PM Boston Convention
Charles J. Gelso, PhD and Exhibition Center, Meeting Room 261
Participant/1st Author:
Eric B. Spiegel, PhD continued on page 26
25
Chair: Jeffrey E. Barnett, PsyD
Participant/1st Author:
SATURDAY, AUGUST 16, 2008

Jeffrey E. Barnett, PsyD Symposium: New Look at Grief—Evidence


Participant/1st Author: Keren Lehavot, MA on Process and Treatment Outcome
Participant/1st Author: 8:00 AM – 8:50 AM Boston Convention
David P. Powers, PhD and Exhibition Center, Meeting Boom 156B
Discussant: Stephen Behnke, JD, PhD Chair: Dale G. Larson, PhD
Participant/1st Author:
Poster Session I George A. Bonanno, PhD
4:00 PM – 4:50 PM Boston Convention and Participant/1st Author:
Exhibition Center, Exhibit Halls A and B1 William T. Hoyt, PhD
Marjan Ghahramanlou-Holloway, PhD Discussant: Stephen R. Connor, PhD
Jennie Sharf, PhD
Barbara M. Vollmer, PhD Symposium: Eminent Psychotherapists
Cheri L. Marmarosh, PhD Revealed—Microanalysis of Essential
Cheri L. Marmarosh, PhD Components of Psychotherapy
Karen L. Jacob, PhD 10:00 AM – 11:50 AM Boston Convention
Karen E. Godfredsen, PsyD, MA and Exhibition Center, Meeting Room 258C
Raia S. Gorcheva, MA Chair: Jeffrey J. Magnavita, PhD
Diane Hiebert-Murphy, PhD Participant/1st Author:
Denise H. Bike, MS Jeffrey J. Magnavita, PhD
Robert J. Wright, PhD Participant/1st Author:
Luo-Wen Wong, MA, No Degree Lorna Smith Benjamin, PhD
Cortney S. Warren, PhD Participant/1st Author:
Joan M. Farrell, PhD Arthur Freeman, EdD
Sunyoung Kim, PhD Participant/1st Author:
Danielle R. Probst, MS Judith S. Beck, PhD
Pedja Stevanovic, MA Discussant: David H. Barlow, PhD
Arlene Barrow, MA
Angela Fang, BA Conversation Hour: Lunch With the
Sandra L. Perosa, PhD Masters—For Graduate Students and Early
Myeong Seon Choi, PhD Career Psychologists
Geetanjali Sharma, MS 12:00 PM – 1:50 PM Sheraton Boston
Peter A. Weiss, PhD Hotel, Commonwealth Room
Megan M. MacNamara, MA
Nancy L. Murdock, PhD Workshop: Treatment of Body Dysmorphic
Katreena L. Scott, PhD Disorder
Christopher G. Black, BS 12:00 PM – 1:50 PM Boston Convention
Tamar J. Kairy, MA and Exhibition Center, Meeting Room 251
Cochair: Sabine Wilhelm, PhD
Business Meeting and Awards Ceremony: Cochair: Luana M. Miller, PhD
Celebrating the 40th Anniversary of the Participant/1st Author: Anne Chosak, PhD
Division of Psychotherapy
5:00 PM – 5:50 PM Boston Marriott Committee Meeting: Psychotherapy—
Copley Place Hotel, Wellesley Room Theory, Research, Practice, Training
Editorial Board Meeting
Social Hour: Celebrating the 40th 3:00 PM– 3:50 PM Sheraton Boston Hotel,
Anniversary of the Division of Psychotherapy Berkeley Room
6:00 PM – 6:50 PM Boston Marriott
Copley Place Hotel, Suffolk Room continued on page 27

26
Poster Session II Symposium: Innovating Evidence-Based
4:00 PM – 4:50 PM Boston Convention and Practice With Session-by-Session Outcome
Exhibition Center, Exhibit Halls A and B1 Measures
Ehsan Gharadjedaghi, BA 10:00 AM – 11:50 AM Boston Convention
Jun Jung-Mi, MD and Exhibition Center, Meeting Room 213
Shana L. Markle, MA Chair: David W. Smart, PhD
Veronika Karpenko, MS Participant/1st Author: John Okiishi, PhD
Kathleen Chwalisz, PhD Participant/1st Author:
Robert J. Reese, PhD Stevan L. Nielsen, PhD
Daniel L. Hoffman, MA Participant/1st Author:
Michael M. Omizo, PhD Jason Southwick, BS
Aaron H. Carlstrom, PhD Participant/1st Author:
Jeana L. Magyar-Moe, PhD Kenichi Shimokawa, BS
Wendy L. Dickinson, PhD Participant/1st Author: Karen Evans, PhD
Amanda G. Ferrier-Auerbach, PhD Discussant: Raymond A. DiGiuseppe, PhD
Robert W. Lent, PhD
Paul M. Spengler, PhD, MA Symposium: Role of Psychotherapy in
Narine Karakashian, PhD Health Care
Jason K. White, PhD 12:00 PM – 1:50 PM Boston Convention
Dominick A. Scalise, MA, BA and Exhibition Center, Meeting Room 158
Laura Smith, PhD Chair: Norine G. Johnson, PhD
Participant/1st Author:
Armand R. Cerbone, PhD
Participant/1st Author:
Michael F. Hoyt, PhD
Participant/1st Author:
SUNDAY, AUGUST 17, 2008

Symposium: Practice, Training, and Lillian Comas-Diaz, PhD


Outcomes in Walk-In, Single-Session Therapy Participant/1st Author:
8:00 AM –9:50 AM Boston Convention Susan H. McDaniel, PhD
and Exhibition Center, Meeting Room 213
Chair: Monte Bobele, PhD
Participant/1st Author: Arnold Slive, PhD
Participant/1st Author:
Bernadette Solorzano, PsyD
Participant/1st Author: Teresa Corriea, MS

N O F P S Y C H O THE
O
RA P Y
D I V I SI

29
ASSN.
AMER I

C
A
N PSYCHOLOGI C
AL

27
Practitioner Report, continued on page 24
are numerous positives to this, some of primary and specialty behavioral health
which are noted above. However, it is also care: Two concept proposals. Professional
important to be clear about the potential Psychology: Research and Practice, 37, 384-
problems. We as psychologists need to be 388.
strong advocates for how these systems are Kihlstrom, J. (2006). Scientific research. In
implemented and monitor the ethical Norcross, J., Beutler, L. and Levant, R.
issues inherent in the process. (Eds). Evidence-based practices in mental
health. (pp. 338-345). Washington, DC:
References American Psychological Association.
Asay, T., Lambert, M., Gregersen, A., and Reed, G. (2006). Clinical expertise. In
Goates, M. (2002). Using patient-focused Norcross, J., Beutler, L. and Levant, R.
research in evaluating treatment out- (Eds). Evidence-based practices in mental
come in private practice. Journal of health. (pp. 13-23). Washington, DC:
Clinical Psychology, 58, 1213-1225. American Psychological Association.
Bachman, J. (2006). Pay for performance in

28
PERSPECTIVES ON PSYCHOTHERAPY INTEGRATION

Enhancing Emotion Regulation:


An Implicit Common Factor
Among Psychotherapies for
Borderline Personality Disorder
Shelley F. McMain, Ph.D., Centre for Addiction and
Mental Health and the Department of Psychiatry,
University of Toronto, Toronto, Ontario, Canada
Susan Wnuk, M.A., Centre for Addiction and Mental
Health and York University
Alberta E. Pos, Ph.D., York University

Borderline personality disorder (BPD), cessful treatment for


once regarded as untreatable, now has a BPD. While examining
more favorable prognosis due to growing the specific change
empirical support for the effectiveness factors within treat-
of psychotherapies for BPD. These include ments is important,
Dialectical Behavior Therapy (DBT) (e.g. equally important is
Linehan. 1993; Linehan et al., 2006), Schema to consider change
Therapy (ST) (Giesen-Bloo et al., 2006), mechanisms common
Transference Focused Psychotherapy (TFP) to all effective thera-
(Clarkin, Levy, Lenzenweger, & Kernberg, pies for BPD.
2007), Mentalization-based psychodynam-
ic day treatment (MBT) (Bateman & Fonagy, This paper argues for a central factor oper-
1999; Bateman & Fonagy, 2001), Cognitive ating across diverse psychotherapies for
Behavior Therapy (CBT) (Davidson et al., BPD: emotion regulation. Not only do all
2006), and Cognitive-Behavioral Systems- schools of psychotherapy for BPD aim to
Based group treatment (STEPPS) (Blum et improve emotion regulation, this process
al., 2008). At present, there is no com- has been suggested as a common factor
pelling indication that one particular thera- underlying all psychotherapies for psychi-
py for BPD will emerge as superior. atric disorders (e.g., Burum & Goldfried,
Consistent with research on other disor- 2007). This article defines emotion and core
ders, all therapies may prove to be equally features of emotion dysregulation, exam-
effective. Still, controlled trials for the treat- ines emotion dysregulation in BPD, and
ment of BPD have produced meaningful common principles underlying techniques
results, the most important being that psy- associated with the major schools of thera-
chotherapy for BPD is effective. This alone py for BPD.
has revolutionized treatment for this disor-
Emotion, Emotion Dysregulation, and
der. Now more important than a “horse
Borderline Personality Disorder
race” to find the “winning” treatment, a
Emotion is viewed as a complex, full system
priority must be to understand how effec-
response that includes: biochemical
tive treatments for BPD work.
changes; physiological changes; cognitions;
Many researchers advocate turning atten- expressive-action tendencies; and subjective
tion to the mechanisms of action in suc- continued on page 30
29
experiences (Frijda, 1986). It provides tions, particularly aggression, interacting
important information, organizes the indi- with early relationship factors, leading to a
vidual for action, communicates intentions failure in the integration of disparate repre-
to others and signals that important needs sentations of self and other (Clarkin,
are at stake (Scherer, 1984). Therefore, Yoemans & Kernberg, 2006). In ST theory,
accessing emotions facilitates awareness of BPD is again thought to develop as a con-
motivations, needs, and goals and mobilizes sequence of the interaction between the
individuals to engage effectively in the emotional temperament and painful child-
world (Greenberg & Safran, 1987). hood events (Young, 1999). Symptoms
associated with the disorder are viewed as
The inability to access emotions and relat- responses to underlying dysfunctional
ed adaptive action tendencies leads to dif- schemas, which are defined as self-perpet-
ficulties in emotion regulation and func- uating and self-defeating emotional and
tioning (Greenberg & Safran, 1987). cognitive patterns that develop in early
Emotion regulation difficulties can take a life. In the STEPPS approach, BPD is again
variety of forms. Gratz and Roemer (2004) defined as an “emotional instability” disor-
identified four key features of emotional der (Black & Blum, 2004). Therefore, there
dysregulation: (a) lack of awareness, is convergence that emotion dysregulation,
understanding, and acceptance of emo- whether a primary or secondary phenome-
tions; (b) lack of access to adaptive strate- non, is a key feature of BPD.
gies for modulating emotional responses;
(c) an unwillingness to experience emo- This assumption is supported by a grow-
tional distress; and (d) the inability to ing body of empirical evidence (Putnam &
engage in goal-directed behaviors when Silk, 2005). BPD individuals report prob-
experiencing distress. lems with awareness of emotions, intense
negative emotional responses, (Levine,
Emotion dysregulation is a defining fea- Marziali, & Hood, 1997), more trait-nega-
ture of BPD characterized by unstable emo- tive affect (Trull, 2001), and less tolerance
tions, emotional inhibition, intense nega- of emotion distress while pursuing goals
tive emotions, emotional crisis, feelings of (Gratz et al.2006). Support for the centrali-
emptiness, chaotic interpersonal relation- ty of emotion dysregulation in BPD has
ships and impulsive behaviours. Emotion also emerged from physiological and neu-
dysregulation figures centrally in diverse roimaging research with data suggesting a
theories of the pathogenesis of BPD. In dysfunction in the prefrontal, limbic, and
MBT emotion dysregulation is assumed to corticostriatal pathways that process emo-
develop as a consequence of deficits in tions and modulate behavior (Johnson et
mentalizing capacities; the capacity to dif- al., 2003).
ferentiate and recognize one’s own and
other’s states of mind (Bateman & Fonagy, Facilitating Emotion Regulation in
2004). Mentalization deficits develop as a Psychotherapies for BPD: Common
consequence of disorganized and insecure Principles
early attachment. DBT’s biosocial theory Notwithstanding important differences in
assumes that pervasive emotion dysregu- technique and theory within specific thera-
lation is the core problem underlying the pies for BPD, we argue for three common
disorder, and develops as a consequence of guiding principles to facilitate client emo-
inherent emotion vulnerability and perva- tion regulation: 1) the promotion of aware-
sive invalidating environmental experi- ness and acceptance of emotion; 2) the
ences (Linehan, 1993). Similarly, TFP’s psy- modulation of emotion; and 3) changing or
chodynamic theory assumes that BPD restructuring emotional experience
develops as a result of a constitutional through access to new information.
propensity for high levels of negative emo- continued on page 31
30
Promoting awareness and acceptance of tions, behaviors and emotions. ST, DBT,
emotions, essential to emotion regulation, and STEPPS help clients identify triggers
is a common strategy in all therapies. to emotions and to specify important links
Therapists from all major schools use a between cognitions, emotions, and behav-
range of strategies such as reflection, iors. Psychodynamic approaches under-
empathy, and validation to increase client score the importance of connecting reflec-
awareness and acceptance of emotions. In tive functioning and mentalization to affect
DBT, validation counters emotional inhibi- and behavioral patterns to help clients gain
tion and avoidance, and functions to an understanding of the precursors to emo-
decrease emotional arousal, thereby help- tions and to recognize and modify future
ing clients to value and accept their experi- responses (Fonagy & Bateman, 2006). TFP
ences. In MBT, therapists employ valida- therapists also make links between disor-
tion to help clients recognize and label ganized affect and cognitions to help
thoughts and feelings (Fonagy & Bateman, clients contain, contextualize and promote
2006). In TFP, therapists use reflection and understanding of emotional experience.
clarification to help clients attend to and
integrate emotional experience, and to con- CBT approaches for BPD also utilize skills
nect cognitions to disorganized affect training and psycho education to enhance
(Clarkin & Levy, 2006). Similarly, ST thera- clients’ emotional awareness and accep-
pists focus on clients’ current feelings and tance. DBT, ST and STEPPS, all explicitly
problems and the expression of related teach clients the adaptive value of emotion
needs to enhance clients’ awareness of (Blum et al, 2008; Linehan, 1993; Young,
schemas (Young, 1999). Klosko, & Weishaar, 2003). As well, in DBT,
clients are taught to observe, describe, and
Attending to here-and-now emotional expe- label emotions. In STEPPS, clients are
rience also leads to increasing awareness of taught to notice physical sensations,
emotions. For example, MBT therapists thoughts, emotional intensity and action
work in the “emotional present” to promote urges associated with emotions,
the capacity to mentalize, viewed as a pre-
requisite to understanding and regulating Effective therapies for BPD also help
intense emotional experience (Bateman & clients modulate the intensity of emotional
Fonagy, 2004). In TFP, there is an emphasis experience. Common strategies for pro-
on affect-laden here-and-now enactment of moting emotional modulation involve
the transference, as well as articulation of increasing clients attentional control and
immediate feelings. In ST, therapists utilize their capacity to maintain cognitive dis-
experiential techniques such as imagery and tance. In DBT, mindfulness skills are taught
role-plays to explicitly activate dysfunction- to increase clients control over their atten-
al schemas in session so they are more tional processes. Clarkin and Levy (2006)
accessible to restructuring (Kellogg & have noted the similarity between DBT
Young, 2006). Similarly, in DBT, therapists mindfulness training and mentalization in
maintain an emotion focus and stimulate MBT, and reflective functioning in TFP. All
inhibited emotions as indicated. DBT thera- are processes that promote reflection and
pists attend to the components of emotional observation of experience, which in turn
responses (e.g. physical sensations, posture, helps to modulate emotional arousal.
body and facial expressions) and use expo-
Another attentional control strategy
sure strategies to enhance in-session emo-
involves helping clients shift their atten-
tional experience.
tion away from arousing stimuli. In DBT,
Different therapeutic schools increase STEPPS, and other CBT treatments for BPD
awareness of emotional experience by (e.g., Beck & Freeman, 1990; Gratz &
identifying the relationship between cogni- continued on page 32
31
Gunderson, 2006), clients are taught skills clients feel understood, mentalize experi-
such as distraction in order to tolerate ence, and regulate emotions (Fonagy &
intense negative emotions and inhibit Bateman, 2006). In ST, bonding and “limit-
mood-dependent behaviors. ed reparenting” are viewed as critical to
enhancing emotion regulation. ST thera-
Finally, modulation of emotional experi- pists respond with warmth and in a sym-
ence also occurs through interventions tar- pathetic manner in an effort to compensate
geting emotion action tendencies. DBT and for clients’ unmet emotional needs. In TFP,
STEPPS teach clients how to self-soothe therapists’ active engagement and non-
and decrease emotional distress though judgmental stance, reduces anxiety, there-
balanced diet, sleeping, and exercise. by allowing representations to arise in the
Additionally, DBT, ST, and STEPPS also interaction. Similarly, DBT therapists com-
use role-playing and behavioral rehearsal municate using a warm, supportive, and
to help clients develop adaptive behaviors non-judgmental style to provide an envi-
that can be utilized in the context of intense ronment that enables clients to work on
negative emotional states. emotionally difficult material.
Changing emotions through accessing new As well as providing warmth, many
information is emphasized by all schools. schools emphasize the importance of main-
In ST, experiential techniques and home- taining a calm, strong and steadfast man-
work are employed to activate schemas ner, especially in the face of a client’s emo-
and enhance awareness of relevant emo- tional storms. This may include a direct,
tions and cognitions. This new information intense, and confrontational communica-
helps clients develop and practice adaptive tion style. For example, sometimes DBT
responses and modifies dysfunctional therapists intentionally respond to clients
schemas (Young et al., 2003). Through in a provocative, and irreverent manner as
exposure techniques in DBT, clients a means of shifting a client’s affective
unlearn problematic reactions and develop response. Likewise, in TFP, the therapeutic
new associations to negative emotions. style is emotionally intense and provides
Irreverent and provocative communication “emotional holding” (Levy et al., 2006).
in DBT helps clients see a different point of
view and to shift emotional experience. In Providing a well-structured treatment is
TFP, clarification and interpretation helps common to therapies for BPD and is
clients understand how emotions are asso- assumed to enhance clients’ emotion regu-
ciated with various self-states. Similarly, in lation. Practical elements such as a treat-
MBT, the client is encouraged to experi- ment manual, clarification of roles and
ence, verbalize and express internal states. responsibilities, and supervision for thera-
This new experience increases the client’s pists are emphasized in most major
capacity to mentalize and modulates the schools. For example, ST therapists estab-
client’s reactivity and vulnerability to emo- lish a safe and predictable atmosphere in
tions (Fonagy & Bateman, 2006). order to facilitate emotional expression
(Young et al., 2003). In TFP, treatment con-
Therapy Relationship and tracting is employed to help clients experi-
Treatment Structure ence safety and express emotions fully
In all therapies for BPD, both therapeutic without becoming overwhelmed. In MBT,
relationship and treatment structure are the treatment structure helps to “catch
critical to emotion regulation. All things when they get out of control”
approaches stress the importance of being (Bateman & Fonagy, 2004, p. 184). In DBT,
empathic, supportive and non-judgmental the treatment structure similarly allows
as a means to increase client safety and to the client to interact and be protected
reduce anxiety. MBT therapists employ
empathy and validation as a means to help
32
from uncontrollable negative emotions (2004). Cognitive Therapy of Personality
(Linehan, 1993). In sum, structured treat- Disorders. (Second ed.) New York:
ment provides a predictability and famil- Guilford Press.
iarity that is regulating. Black, D.W., and Blum, N. (2004). The
STEPPS Group Treatment Program for
Summary Outpatients with Borderline Personality
While there are important differences in Disorder, Journal of Contemporary
the theories and techniques associated Psychotherapy, 34,193-210.
with different psychotherapies for BPD, all Blum, N., St. John, D., Pfohl, B., Stuart, S.,
approaches view the enhancement of emo- McCormick, B., Allen, J., Arndt, S., &
tion regulation as essential to successful Black, D.W. (2008). Systems training for
treatment outcome. This paper delineated emotional predictability and problem
common emotion regulation principles solving (STEPPS) for outpatients with
underlying psychotherapy techniques borderline personality disorder: A ran-
associated with diverse approaches. domized controlled trial and 1-year fol-
Enhancing emotion regulation in therapies low-up. American Journal of Psychiatry,
for BPD, enables clients to approach, 165, 468-478.
describe and use the adaptive information Burum, B. A. & Goldfried, M. R. (2007).
contained in emotions, as well as to disen- The centrality of emotion to psycholog-
gage from and act independently of highly ical change. Clinical Psychology-Science
aroused, unproductive emotional states. And Practice, 14, 407-413.
Achieving emotional balance may be the Clarkin, J. F. & Levy, K. N. (2006). Psycho-
hallmark of effective treatment for BPD. therapy for Patients with Borderline
Focusing on this common principle may Personality Disorder: Focusing on the
counter fractions between different thera- Mechanisms of Change. Journal of
pies for BPD and help us enhance all treat- Clinical Psychology, 62, 405-410.
ments for this disorder. Clarkin, J. F., Levy, K. N., Lenzenweger,
M. F., & Kernberg, O. F. (2007).
Evaluating three treatments for border-
Correspondence concerning this article should line personality disorder: a multiwave
be addressed to: Shelley F. McMain, Centre for study. American Journal of Psychiatry,
Addiction and Mental Health, 33 Russell 164, 922-928.
Street, Toronto, Ontario, Canada, M5S 2S1. Clarkin, J.F., Yeomans, F., & Kernberg, O.F.
E-mail: shelley_mcmain@camh.net. (2006). Psychotherapy of borderline per-
Reference List sonality: Focusing on object relations.
Bateman, A. & Fonagy, P. (1999). Washington, dc: American Psychiatric
Effectiveness of partial hospitalisation Press.
in the treatment of borderline personal- Davidson, K., Norrie, J., Tyrer, P., Gumley,
ity disorder: a randomised controlled A., Tata, P., Murray, H., & Palmer, S.
trial. American Journal of Psychiatry, 156, (2006). The Effectiveness of Cognitive
1563-1569. Behavior Therapy for Borderline
Bateman, A. & Fonagy, P. (2001). Personality Disorder: Results from the
Treatment of borderline personality Borderline Personality Disorder Study
disorder with psychoanalytically ori- of Cognitive Therapy (BOSCOT) Trial.
ented partial hospitalisation: an 18 Journal of Personality Disorders, 20, 450-
month follow-up. American Journal of 465.
Psychiatry 158, 36-42. Fonagy, P. & Bateman, A. W. (2006).
Bateman, A. W. & Fonagy, P. (2004). Mechanisms of change in mentaliza-
Mentalization-Based Treatment of BPD. tion-based treatment of BPD. Journal of
Journal of Personality Disorders, 18, 36-51.
Beck, A. T., Freeman, A., & Davis, D. D. continued on page 34
33
Clinical Psychology, 62, 411-430. Journal of Neuropsychiatry and Clinical
Frijda, N. H. (1986). The emotions. Neurosciences, 15, 397-402.
Cambridge: Cambridge University Kellogg, S. H. & Young, J. E. (2006).
Press. Schema therapy for borderline person-
Giesen-Bloo, J., van Dyck, R., Spinhoven, ality disorder. Journal of Clinical
P., van Tilburg, W., Dirksen, C., van Psychology, 62, 445-458.
Asselt, T., Kremers, I., Nadort, M., & Levine, D., Marziali, E., & Hood, J. (1997).
Arntz, A. (2006). Outpatient Psycho- Emotion processing in borderline per-
therapy for Borderline Personality sonality disorders. The Journal of Nervous
Disorder: Randomized Trial of Schema- and Mental Disease, 185, 240-246.
Focused Therapy vs Transference- Levy, K., N., Clarkin, J.F., Yeomans, F.E.,
Focused Psychotherapy. Archives of Scott, L.N., Wasserman, R.H. &
General Psychiatry, 63, 649-658. Kernberg, O.F. (2006). The mechanisms
Giesen-Bloo, J., van Dyck, R., Spinhoven, of change in the treatment of border-
P., van Tilburg, W., Dirksen, C., van line personality disorder with transfer-
Asselt, T. et al. (2006). Outpatient ence focused psychotherapy. Journal of
Psychotherapy for Borderline Clinical Psychology, 62(4), 481-501.
Personality Disorder: Randomized Trial Linehan, M. M. (1993). Cognitive
of Schema-Focused Therapy vs Behavioural Treatment of Borderline
Transference-Focused Psychotherapy. Personality Disorder. New York:
Archives of General Psychiatry, 63, 649- Guilford Press.
658. Linehan, M. M., Armstrong, H. E., Suarez,
Gratz, K. L. & Gunderson, J. G. (2006). A., Allmon, D., & Heard, H. L. (1991).
Preliminary data on an acceptance- Cognitive-behavioral treatment of
based emotion regulation group inter- chronically parasuicidal borderline
vention for deliberate self-harm among patients. Archives of General Psychiatry,
women with borderline personality 48, 1060-1064.
disorder. Behavior Therapy, 37, 35. Linehan, M. M., Comtois, K. A., Murray,
Gratz, K. L. & Roemer, L. (2004). Multi- A. M., Brown, M. Z., Gallop, R. J.,
dimensional Assessment of Emotion Heard, H. L.,Korslund, K.E., Tutek,
Regulation and Dysregulation: D.A., Reynolds, S.K., & Lindenboim, N.
Development, Factor Structure, and (2006). Two-Year Randomized Trial +
Initial Validation of the Difficulties in Follow-up of Dialectical Behavior
Emotion Regulation Scale. Journal of Therapy vs. Therapy by Experts for
Psychopathology and Behavioral Suicidal Behaviors and Borderline
Assessment, 26, 41-54. Personality Disorder. Archives of General
Gratz, K. L., Rosenthal, M. Z., Tull, M. T., Psychiatry, 63, 757-766.
Lejuez, C. W., & Gunderson, J. G. Putnam, K. M. & Silk, K. R. (2005).
(2006). An experimental investigation Emotion dysregulation and the devel-
of emotion dysregulation in borderline opment of borderline personality disor-
personality disorder. Journal of der. Development and Psychopathology,
Abnormal Psychology, 115, 850-855. 17, 899-925.
Greenberg, L. S. & Safran, J. D. (1987). Scherer, K. R. (1984). On the nature and
Emotion in psychotherapy: Affect, cogni- function of emotion: A component
tions and the process of change. New process approach. In K.R. Scherer & P.
York: Guilford. Ekman (Eds.), Approaches to emotion
Johnson, P. A., Hurley, R. A., Benkelfat, C., (pp. 293–318). Hillsdale, NJ: Erlbaum.
Herpertz, S. C., & Taber, K. H. (2003). Trull, T. J. (2001). Relationships of border-
Understanding emotion regulation in line features to parental mental illness,
borderline personality disorder: childhood abuse, Axis I disorder, and
Contributions of neuroimaging. continued on page 35
34
current functioning. Journal of Professional Resource Press.
Personality Disorders, 15, 19-32. Young, J.E., Klosko, J.S., & Weishaar, M.E.
Young, J.E. (1999). Cognitive therapy for per- (2003). Schema therapy: A practitioner’s
sonality disorders: A schema-focused guide. New York: The Guilford Press.
approach. 3rd Ed. Sarasota, FL:

Bulletin ADVERTISING RATES


Full Page (8.5” x 5.75”) $300 per issue Deadlines for Submission
Half Page (4.25” x 5.75”) $200 per issue February 1 for First Issue
Quarter Page (4.25” x 3”) $100 per issue May 1 for Second Issue
July 1 for Third Issue
Send your camera ready advertisement,
along with a check made payable to November 1 for Fourth Issue
Division 29, to: All APA Divisions and Subsidiaries (Task
Division of Psychotherapy (29) Forces, Standing and Ad Hoc Committees,
6557 E. Riverdale Liaison and Representative Roles) materials
Mesa, AZ 85215 will be published at no charge as space allows.

35
ETHICS IN PSYCHOTHERAPY
Psychotherapy for the Psychotherapist:
Optional Activity or Ethical Imperative?
Jeffrey E. Barnett, Psy.D., ABPP, Independent Practice,
Arnold, Maryland and Loyola College in Maryland and
Ian Goncher, M.S., Loyola College in Maryland

In addition to a variety Tabachnick (1994) found 84% of psycholo-


of other professional gists surveyed to have been a client in psy-
roles, the vast majority chotherapy, with 85.6% reporting it to be a
of practicing psycholo- very helpful or exceptionally helpful expe-
gists regularly function rience. Mahoney (1997) found that 88% of
as psychotherapists. As practicing psychotherapists surveyed had
such, it might make participated in personal psychotherapy
great sense that all and of these, 90% rated this experience as
future psychotherapists positive. Similarly, Norcross, Dryden, and
participate in their own DeMichele (1992) found that 96% of psy-
psychotherapy as part chologists they surveyed who had partici-
of the training process. pated in personal psychotherapy viewed it
Experiencing the role of as crucial for effectively working as a psy-
client as they address chotherapist themselves.
their own issues can
greatly impact how Benefits of Personal Psychotherapy
psychotherapists see In reviewing the current literature, Bellows
the process of psychotherapy as well as (2007) summarizes the benefits of psy-
their role and their clients’ role in it. chotherapists’ personal psychotherapy as
Additionally, personal psychotherapy dur- including:
ing one’s training may be valuable for
addressing personal issues that, if left • Enhanced self-understanding and self-
unresolved, may adversely impact one’s awareness
clients. • Enhanced self-esteem and self-confidence
• Improved interpersonal relationships
Sherman (2000) reports that only 5% of all • Enhanced therapeutic skills (empathy,
doctoral programs in clinical psychology in using countertransference, in struc-
require their students to participate in per- turing their treatment, in understanding
sonal psychotherapy as a requirement for the process of psychotherapy)
receiving their degree. Yet, it is believed • Reducing characterological conflicts
that many trainees participate in their own and enhanced symptom alleviation
psychotherapy. Importantly, Dearing, (p. 208)
Maddux, and Tangney (2005) found that
faculty attitudes about personal psy- Orlinsky and Ronnestad (2005) found that,
chotherapy significantly impact trainees’ of 4,000 psychologists surveyed, personal
help seeking behaviors, indicating that fac- psychotherapy was one of the principal
ulty mentors play an important role in factors cited as being most influential in
their students’ decisions about pursuing their clinical training. McWilliams (2005)
personal psychotherapy. recommends that all psychotherapists par-
ticipate in their own psychotherapy as part
For practicing psychologists, Pope and continued on page 37
36
of their training and throughout their The practice of psychotherapy is very
careers “…to explore their own vulnerabil- demanding and regularly can lead to dis-
ities” (p. 142). Furthermore, Pearlman and tress. Clients may not improve or may
Saakvitne (1995) describe the psychothera- even relapse or deteriorate. Psycho-
pist’s own psychotherapy as “…a place in therapists may have clients attempt or
which to process the impact and effect of commit suicide, they may have clients
our therapeutic work on ourselves, to take assault them, and they may experience vic-
all of our needs, our wishes, our fears, all of arious traumatization as a result of work-
our feelings and thoughts” (p. 394). ing with trauma clients. Further, financial
Holzman, Searight, and Hughes (1996) stressors and administrative demands of
found that among the 1,018 clinical psy- working with insurance and managed
chology graduate students surveyed, 74% care, managing a staff, professional isola-
endorsed the importance of participating tion, and the risk of malpractice suits all
in personal psychotherapy. The reasons may contribute to the stress of work as a
cited for seeking treatment included, per- psychotherapist (Sherman & Thelen, 1998).
sonal growth (71%), improvement as a
therapist (65%), dealing with adjustment In a study of the members of the APA
issues (59%), and depression (38%). Division of Psychotherapy, 85% of partici-
pants reported the belief that working when
Norcross, Strausser-Kirtland, and Missar too distressed to be effective is unethical.
(1988) identified six common themes in the Yet, 60% of those questioned in this study
literature that suggest that personal psy- acknowledged having previously done so
chotherapy will likely improve each psy- (Pope, Tabachnick, & Keith-Spiegel, 1987).
chologist’s ability to care for their clients. In another study, Guy, Poelstra, and Stark
These themes include an improvement in (1989) found 36.7% of psychologists sur-
the emotional functioning of the psy- veyed acknowledging experiencing distress
chotherapist, developing a clearer percep- with 4.6% indicating they realized that the
tion of client dynamics, learning ways to quality of care they were providing to
manage stressors unique to the practice of clients was inadequate. Further, beyond the
psychotherapy, participating in a profound effects of distress and burnout on our clini-
socialization experience, becoming sensi- cal competence, the deleterious effects of the
tized to the personal needs of our clients, many stressors we deal with may also lead
and providing a first-hand account of psy- to impaired objectivity and judgment. As a
chotherapeutic methods. result, we may engage in a range of unethi-
cal behaviors as a result of inadequate atten-
An Ethical Imperative? tion to these issues.
Beyond enhanced personal functioning and
What Ethics Codes Have to Say
enhanced skill as a psychotherapist, person-
The Ethical Principles of Psychologists and
al psychotherapy may be seen as an ethical
Code of Conduct (APA Ethics Code) (APA,
mandate at different points in psychologists’
2002) requires psychologists to “undertake
careers. It is well documented that psycholo-
ongoing efforts to develop and maintain
gists and other mental health professionals
their competence” (p. 1064) and to “take
experience a range of difficulties as a result
reasonable steps to avoid harming their
of our personal issues and predispositions,
clients/patients… and to minimize harm
the nature of the work we do, and ongoing
where it is foreseeable” (p. 1065). Further,
life and work stresses (see Barnett, Johnston,
the Ethics Code states in Standard 2.06,
& Hillard, 2006 for a review of these data). Personal Problems and Conflicts:
Practicing psychologists experience distress
with significant frequency and left untreat- • Psychologists refrain from initiating an
ed, can lead to burnout and impaired pro- activity when they know or should
fessional competence. continued on page 38
37
know that there is a substantial likeli- for those trainees experiencing some dis-
hood that their personal problems will tress or impairment who do not have
prevent them from performing their supervisors and faculty members recom-
work-related activities in a competent mend treatment, they may see this as min-
manner. imizing the value of personal psychothera-
• When psychologists become aware of py and may carry this attitude with them
personal problems that may interfere- throughout their careers. Additionally, for
with their performing work-related those trainees who desire participating in
duties adequately, they take appropriate personal psychotherapy, financial limita-
measures, such as obtaining profession- tions have been repeatedly cited as one of
al consultation or assistance, and deter- the primary obstacles present (e.g.,
mine whether they should limit, sus- Holzman, Searight, & Hughes, 1996;
pend, or terminate their work-related Macaskill & Macaskill, 1992).
duties. (p. 1064)
For practicing psychologists, studies have
Accordingly, an argument can be made found a number of reasons given for not
that participation in personal psychothera- seeking out personal psychotherapy, even
py can be seen as an important aspect of when it clearly is needed. These include
every psychotherapist’s professional train- feeling the need to maintain an image of
ing and development as well as an essen- professional competence and invulnerabili-
tial activity for promoting ongoing compe- ty (O’Connor, 2001), feeling that they should
tence and clinical effectiveness in addition be able to work out difficulties themselves
to other stress management and self-care (Gilroy, Carroll, & Murra, 2002), experienc-
activities (see Barnett, 2008 for recommen- ing embarrassment or having concerns
dations on general self-care strategies). As about confidentiality (Stevanovic & Rupert,
stated in our profession’s ethics code, each 2004), and fear of disclosure to colleagues
psychologist is required to work toward and risking sanctions for unethical behav-
the highest ideals of competence in his or iors (Deutsch, 1985).
her work as well as to be alert to factors
that may impact his or her personal and Although these fears and concerns may
clinical effectiveness and then to take exist for some psychologists and trainees, it
appropriate actions to ensure that clients seems that better education and profes-
are not harmed. Rather than wait until sional role modeling should help assuage
experiencing the symptoms of burnout or these concerns. After all, available data on
having a colleague confront us regarding the experiences of those who do participate
potentially unethical behavior, it is recom- in personal psychotherapy highlight the
mended that each psychotherapist engage generally positive outcomes experienced.
in ongoing self-reflection and self-monitor- Still, more active education and outreach
ing and then to take corrective action as by professional associations and training
needed, which may very appropriately institutions may go a long way to advanc-
include seeking personal psychotherapy. ing this cause.

Why Some Don’t Seek Out Moving Forward


Personal Psychotherapy This approach is in keeping with the aspi-
There may be a variety of reasons why rational ideal of Beneficence (working to
some psychologists do not seek out per- help others and provide the highest quali-
sonal psychotherapy. For those trainees ty of care possible) from the APA Ethics
who do not have role models that empha- Code and the goal of a preventive
size and encourage it, they may not inter- approach and an ongoing aspiration to
nalize the importance of personal psy- achieve the highest standards of promoting
chotherapy for themselves. Further, continued on page 39
38
self-care, clinical competence, and clinical Deutsch, C.J. (1985). A survey of thera-
effectiveness. It is hoped that personal psy- pists’ personal problems and treatment.
chotherapy will be seen as an essential Professional Psychology: Research and
aspect of each psychotherapist’s profes- Practice, 16, 305–315.
sional training and identity development Gilroy, P.J., Carroll, L., & Murra, J. (2002).
as well as an essential resource for main- A preliminary survey of counseling psy-
taining clinical competence and effective- chologists’ personal experiences with
ness throughout our careers. Finally, as depression and treatment. Professional
Norcross (2005) recommends, it is hoped Psychology: Research and Practice, 33(4),
that training programs will recommend 402-407.
personal psychotherapy for their students, Guy, J.D., Poelstra, P.L., & Stark, M.J.
integrate its role into all aspects of training, (1989). Professional distress and thera-
and develop low-cost resources for their peutic effectiveness: National survey of
students to increase the availability of psychologists practicing psychotherapy.
accessible personal psychotherapy. It is Professional Psychology: Research and
also hoped that faculty will demonstrate to Practice, 20(1), 48-50.
students that personal psychotherapy is an Holzman, L. A., Searight, H. R., & Hughes,
important aspect of each psychologist’s H. M. (1996). Clinical psychology grad-
lifelong professional development process. uate students and personal psychother-
apy: Results of an exploratory survey.
References Professional Psychology: Research and
American Psychological Association. Practice, 27, 98–101.
(2002). Ethical principles of psycholo- Macaskill, N. D., & Macaskill, A. (1992).
gists and code of conduct. American Psychotherapists-in training evaluate
Psychologist, 57(12), 1060-1073. their personal therapy: Results of a UK
Barnett, J.E. (2008). Impaired profession- survey. British Journal of Psychotherapy, 9,
als: Distress, professional impairment, 133-138.
self-care, and psychological wellness. In Mahoney, M.J. (1997). Psychotherapists’
Herson, M., & Gross, A.M. (Eds.), personal problems and self-care pat-
Handbook of Clinical Psychology (Volume terns. Professional Psychology: Research
One) (pp. 857-884). New York: John and Practice, 28(1), 14-16.
Wiley & sons. McWilliams, N. (2005). Preserving our
Barnett, J.E., Johnston, L.C., & Hillard, D. humanity as therapists. Psychotherapy:
(2006). Psychotherapist wellness as an Theory, Research, Practice, Training, 42(2),
ethical imperative. In VandeCreek, L., & 139-151.
Allen, J.B. (Eds.), Innovations in Clinical Norcross, J.C. (2005). The psychothera-
Practice: Focus on Health and Wellness, pist’s own psychotherapy: Educating
(257-271). Sarasota, FL: Professional and developing psychologists. American
Resources Press. Psychologist, 60(8), 840–850.
Bellows, K.F. (2007). Psychotherapists’ Norcross, J.C., Dryden, W., & DeMichele,
personal psychotherapy and its per- J.T. (1992). British clinical psychologists
ceived influence on clinical practice. and personal therapy: III. What’s good
Bulletin of the Menninger Clinic, 71, 204- for the goose? Clinical Psychology Forum,
226. 44, 29-33.
Dearing, R.L., Maddux, J.E., & Tangney, Norcross, J.C., Strausser-Kirtland, D.J., &
J.P. (2005). Predictors of psychological Missar, C.D. (1988). The processes and
help seeking in clinical and counseling outcomes of psychotherapists’ personal
psychology graduate students. treatment experiences. Psychotherapy:
Professional Psychology: Research and Theory, Research, Practice, Training, 25, 36-43.
Practice, 36(3), 323-329. continued on page 40

39
O’Connor, M.F. (2001). On the etiology Spiegel, P. (1987). Ethics of practice: The
and effective management of profes- beliefs and behaviors of psychologists
sional distress and impairment among as therapists. American Psychologist, 42,
psychologists. Professional Psychology: 993-1006.
Research and Practice, 32(4), 345-350. Sherman, J.B. (2000). Required psy-
Orlinsky, D.E., & Ronnestad, M.H. (2005). chotherapy for psychology graduate
How psychotherapists develop: A study of students: Psychotherapists’ evaluation
therapeutic work and professional growth. of process. Dissertation abstracts interna-
Washington, D.C.: American tional: Section B: The Sciences and
Psychological Association. Engineering, 60(9-B), 4910.
Pearlman, L.A., & Saakvitne, K.W. (1995). Sherman, M.D., & Thelen, M.H. (1998).
Trauma and the therapist-Counter-transfer- Distress and professional impairment
ence and vicarious traumatization in psy- among psychologists in clinical prac-
chotherapy with incest survivors. New tice. Professional Psychology: Research and
York: W.W. Norton. Practice, 29(1), 79-85.
Pope, K.S., & Tabachnick, B.G. (1994). Stevanovic, P., & Rupert, P.A. (2004).
Therapists as patients: A national sur- Career-sustaining behaviors, satisfac-
vey of psychologists’ experiences, prob- tions, and stresses of professional psy-
lems, and beliefs. Professional Psychology: chologists. Psychotherapy: Theory,
Research and Practice, 25(3), 247-258. Research, Practice, Training, 41, 301-309.
Pope, K.S., Tabachnick, B.G., & Keith-

Find Division 29 on the Internet. Visit our site at


www.divisionofpsychotherapy.org

40
41
STUDENT INTERVIEW
Interview With Jeffrey Magnavita, Ph.D.
Eva Schmidt, M.A., University of St. Thomas
Jessica Mijal, M.A., University of St. Thomas

Eva Schmidt, M.A.


Eva Schmidt, M.A., and
Jessica Mijal, M.A.,
doctoral students at your theoretical orientation?
the University of St.
Thomas, interviewed Magnavita: At this point I would define
Jeffrey J. Magnavita, my theoretical orientation as unified, by
Ph.D., ABPP, FAPA, a which I mean moving beyond single
Fellow of Divisions 12, school approaches or even integration to a
Jeffrey Magnavita, Ph.D. 29, and 42, with an
new unified framework which seeks to
active history of gover- understand the organizing principles and
nance positions within Division 29 includ- processes in all evidence-based domains of
ing his current role as President-Elect. Dr. psychotherapy and more broadly clinical
Magnavita is the Founder of Glastonbury science.
Psychological Associates, P.C. and an
Affiliate Professor of Professional Psych- Schmidt and Mijal: What are the chal-
ology at the University of Hartford in lenges of working with clients with per-
Connecticut. He has been in clinical prac- sonality disorders?
tice for over 20 years, specializing in inten-
sive psychotherapy for children, adoles- Magnavita: There are many challenges that
cents, and adults manifesting personality are inherent in working with people and
dysfunction, relational disturbances and systems with personality disturbances. One
complex clinical syndromes. Dr. Magnavita of the central problems is the challenge of
is the recipient of the 2006 Distinguished developing a working alliance when the
Contribution to Independent Practice in the nature of one’s difficulties includes prob-
Private Sector Award from the American lems in establishing secure attachments
Psychological Association for his work in with others. We are always working with
developing integrative and unified models the underlying attachment system (i.e., inse-
of psychotherapy. He has authored a num- cure, ambivalent) and with the severe per-
ber of acclaimed works, including Person- sonality disorders (i.e., disorganized). These
ality-Guided Relational Therapy: A Unified systems are reawakened in the therapeutic
Approach, Handbook of Personality Disorders: relationship and re-enactment is often an
Theory and Practice, Restructuring Person- expression of the interpersonal script which
ality Disorders: A Short-Term Dynamic attempts to draw the psychotherapist into
Approach, Theories of Personality: Contem- treating the patient as he or she was treated
porary Approaches to the Science of by earlier attachment figures. The other
Personality, and Relational Therapy for challenge is not becoming demoralized or
Personality Disorders. He has published burned out when working with people who
extensively on personality disorders and often have pretty severe neglect and trauma
psychotherapy and is interested in pursu- histories. Vicarious retraumatization is a
ing the unification of clinical science and risk for the psychotherapist. This is not a
psychotherapy. specialty for one who is not patient and
Schmidt and Mijal: How do you define continued on page 46
42
essentially optimistic about the capacity for therapy after a year of treatment, which is
change and growth. very promising.

Schmidt and Mijal: How do you define Schmidt and Mijal: What are your selec-
brief therapy? tion criteria for using brief therapy with a
client who has a personality disorder?
Magnavita: There are many definitions,
Magnavita: Generally speaking, the faster
depending on the type, from one session to
you go the more ego adaptive capacity the
40, although with the severe personality
person needs to tolerate the impact of
disorders this may be intermittent over
change on self and others. Even positive
the course of years. The patient may return
changes can destabilize a marriage or fam-
for another block of therapy then go out
ily when that person shifts from their pre-
and live, returning during transition peri-
vious role. I like to use the Psychodynamic
ods which are often stressing their system’s
Diagnostic Manual to determine level of
tolerance.
capacity. The more the person is toward the
Schmidt and Mijal: What types of brief neurotic level the faster they can go and the
therapies do you use with clients with per- more toward borderline the slower.
sonality disorders?
Schmidt and Mijal: How do the brief ther-
Magnavita: I utilize a range of approaches apies differ from long-term therapy?
from psychodynamic, interpersonal, fami-
ly and couples depending on the patient’s Magnavita: Basically there is a higher level
life circumstances, motivation, and of therapist activity, greater focus on core
resources. issues, and more structure.

Schmidt and Mijal: Does the type of brief Schmidt and Mijal: What do you view as
therapy you use depend on what type of the mechanism of change in brief therapy?
personality disorder the client has and/or
particular client characteristics? Magnavita: The mechanism of change is
a comprehensive restructuring of the
Magnavita: Yes, with cluster C patients internal schema (attachment patterns),
you can use more anxiety arousing enhancement of defensive capacity (more
approaches to activate and process affect. mature defenses), and greater emotional
The cluster B patients need a mixed capacity as a result of emotionally process-
empathic and structural approach where ing and integrating affect and cognition
you build defenses and emotional compe- while in a regulating relationship that mod-
tency. The cluster A patients generally need ulates the intensity with an attuned other.
a multimodal approach with medication,
supportive psychotherapy, skills building, Schmidt and Mijal: How do you deter-
cognitive, and behavioral methods. mine a focus and set goals in brief therapy?
Schmidt and Mijal: What research sup-
ports the type of brief therapy that you do? Magnavita: The focus is derived from the
patient’s goals and then expanded or con-
Magnavita: There is an accumulating body tracted as more information is gathered.
of evidence that support the efficacy of The initial focus might, for instance, be
brief psychotherapy with some PD depression and then a link might be made
patients. The best results show up with to non-metabolized grief over a lost rela-
cluster C but there is evidence that even tionship which needs to be processed ther-
borderline patients improve with transfer- apeutically.
ence-focused therapy and schema-focused continued on page 47
43
Schmidt and Mijal: What are the advan- clients reported to you about their experi-
tages and disadvantages of brief therapy? ences in brief therapy?

Magnavita: The rapidity of change is much Magnavita: I could write a book on this
faster and the possibility of iatrogenic question. They tell all kinds of stories from
disturbance much higher when you mobi- changing their lives in ways they could
lize so much affect and challenge or unbal- never imagine to developing a greater
ance a system which may be in homeosta- awareness of living in their skin in the here
sis even though uncomfortable. and now as opposed to worrying and act-
ing in self-sabotaging ways.
Schmidt and Mijal: What types of changes
or improvements do you see in clients with Schmidt and Mijal: Are there resources
personality disorders in brief therapy? you would recommend?

Magnavita: There is a spectrum from an Magnavita: There are many. I have a DVD
occasional quantum change where there is with APA, Treating Personality Disorders,
a massive transformation, to baby step- and have just completed a series on psy-
ping, which is gradual change. chotherapy over time which depicts the
course of treatment over six sessions. These
Schmidt and Mijal: Does this differ are excellent resources that allow you to
depending on the type of personality dis- really witness the process of assessment
order the client is diagnosed with? and change. I am editing a book, due out
with APA next year, on Evidenced-Based
Magnavita: In part this is based on the per- Treatment of Personality Dysfunction with
sonality diagnosed but the DSM tends to contributions from many of the leading
be a crude system. What is more telling are clinical researchers in the field. Also, I am
the active convergence of forces in the sys- very excited about writing a book for the
tem such as pressure from a spouse or legal public called Stuck: Prisoners of Our Past,
system, or an optimal period where some- which will explain many of the concepts in
one may be really looking at their patterns lay terms for those stuck in self-defeating
of self-defeating behavior and deciding it is patterns. There are many other resources
time to do something different. available, but for those who are interested
in the field of personality disorders the
Schmidt and Mijal: How do you track International Society for the Study of
client progress in brief therapy? Personality Disorders is a wonderful orga-
nization that presents cutting edge work in
Magnavita: We track what is going on in the Journal of Personality Disorders and
their lives outside the session: quality of offers international and national confer-
relationships, ability to seek and attain ences where you can meet those doing cut-
goals, capacity for emotional experience, ting edge work. Our division has many
etc. resources and was seminal in developing
the APA video series with Jon Carlson.
Schmidt and Mijal: What have your

44
45
WASHINGTON SCENE
Steadily Evolving Into The 21st Century — Working With Others
Pat DeLeon, Ph.D., former APA President

From a public policy ees and organizations. In practice, this


perspective, it is increas- leverages psychology’s expertise in human
ingly evident that our behavior to create significant and sustain-
nation is steadily evolv- able changes at both the employee and
ing towards the enact- organizational level. Utilizing primary,
ment of a comprehen- secondary, and tertiary level interventions,
sive National Health it relies on an action research model, which
Insurance program. The includes needs assessment, customized
form of coverage and roles of federal and program design and implementation, and
state governments are still far from deter- ongoing evaluation. Many organizations
mined. Similarly, it is too early to predict implement health and wellness initiatives,
the role that will exist for psychology and but fail to consider that these initiatives do
other non-physician healthcare providers. not exist in a vacuum. Every program or
Will the all important psychosocial-eco- policy interacts with the organization’s
nomic-cultural gradient of health care other programs and policies, thus requir-
finally become an integral component of ing custom-tailoring.
society’s definition of “quality” care?
Those colleagues who have had the oppor- Business’s Interest In Cost-Effective
tunity to participate in the Practice Health Care: The Chairman of the Board
Directorate’s State Leadership conferences, of Governors of the Federal Reserve
under the leadership of Dan Abrahamson, System (i.e., the central bank of the United
have had a unique glimpse into the world States) testifying before the Senate Finance
of one of the most critical players in this Committee stated:
ongoing national debate - the American Improving the performance of our health-
Business community. The Psychologically care system is without a doubt one of the
Healthy Workplace program each year rec- most important challenges that our nation
ognizes organizations from across the faces. In recent decades, improvements in
nation and Canada which implement medical knowledge and standards of care
exemplary programs and policies that fos- have allowed people to live healthier,
ter employee health and well-being, while longer, and more productive lives… But
enhancing organizational performance. health care is not only a scientific and
Through this innovative initiative, David social issue; it is an economic issue as well.
Ballard and his colleagues in our state asso-
ciations have developed critical relation- By any measure, the health-care sector rep-
ships with the business community, as well resents a major segment of our economy.
as an appreciation by both parties of the Spending on health-care services currently
importance and cost-effectiveness of data- exceeds 15 percent of the gross domestic
based, psychological interventions. product (GDP). Indeed, health-care spend-
ing is the single largest component of per-
David’s vision integrates the two dominant sonal consumption—larger than spending
approaches to organizational health (the on either housing or food.
organizational effectiveness approach and
the employee benefits approach) in a way
that optimizes outcomes for both employ- continued on page 47
46
Importantly, health care also has long been, are provided in practice.... Inconsistent use
and continues to be, one of the fastest- of best practices by doctors and hospitals is
growing sectors in the economy. Over the also surprisingly widespread.... Although
past four decades, this sector has grown, some patients do not receive the care they
on average, at a rate of about 2-1/2 per- need, others receive more (and more geo-
centage points faster than the GDP. Should graphic variation in health-care practices
this rate of growth continue, health spend- and costs confirms this point. For example,
ing would exceed 22 percent of GDP by Medicare expenditures per eligible recipi-
2020 and reach almost 30 percent of GDP ent vary widely across regions, yet areas
by 2030....The Congressional Budget Office with the highest expenditures do not
(CBO) projects that, under current policies, appear to have better outcomes than those
health spending will account for almost with the lowest expenditures; indeed, the
one-half of all federal non-interest outlays reverse seems to be true.
by 2050....
Cost:.... The problem here is not only the
Challenges for Health-Care Reform: Access to current level of health-care spending (U.S.
health care is the first major challenge spending exceeds that of most other indus-
that health-care reform must address. In trial countries) but, to an even greater
2006, a total of 47 million Americans, or degree, the continued rapid growth of that
almost 16 percent of the population, lacked spending. Per capita health-care spending
health insurance. Although the federal and in the United States has increased at a
state governments spent more than $35 bil- faster rate than per capita income for a
lion to finance uncompensated care in number of decades... A piece of wisdom
2004, the evidence nonetheless indicates attributed to the economist Herbert Stein
that uninsured persons receive less health holds that if something cannot go on forev-
care than those who are insured and that er, it will stop. At some point, health-care
their health suffers as a consequence.... spending as a share of GDP will stop ris-
People who are uninsured are less likely to ing, but it is difficult to guess when that
receive preventive and screening services, will be, and there is little sign of it yet....
less likely to receive appropriate care to (A)s we all know, although testing and
manage chronic illnesses, and more likely treatment decisions may be undertaken on
to die prematurely from cancer—largely the presumption that ‘someone else will
because they tend to be diagnosed when pay,’ the public eventually pays for all
the disease is more advanced.... these costs, either through higher insur-
ance premiums or higher taxes.... Rapid
Quality: …The quality of medical research, increases in health spending also portent
training, and technology in the United increasingly difficult access to health ser-
States is generally very high. However, the vices for people with lower incomes. As
quality of health care is determined not health spending continues to outpace
only by, say, technological advances in pre- income, health insurance and out-of-pock-
venting and treating disease but also by et payments will become increasingly
our ability to deliver the benefits of those unaffordable....
advances to patients.
Taking on these challenges will be daunt-
ing. Because our health-care system is so
For maximum impact, advances in medical
complex, the challenges so diverse, and
knowledge must be widely disseminated
our knowledge so incomplete, we should
and consistently and efficiently imple-
not expect a single set of reforms to address
mented. But evidence suggests a disturb-
all concerns. Rather, an eclectic approach
ing gap between the quality of health ser-
will probably be needed. In particular, we
vices that can be provided in principle and
the quality of health services that actually continued on page 48
47
may need to first address the problems that It is important that we talk to others out-
seem more easily managed rather than side the association and develop ways to
waiting for a solution that will address all work more closely together towards mutu-
problems at once.... (T)he types of reforms al goals. This year we have invited repre-
we choose will depend importantly on sentatives from the California Primary
value judgments and the tradeoffs made Care Association, the Mental Health
among social objectives. Such choices are Services Act and the California Institute for
appropriately left to the public and Mental Health; and finally, representatives
their elected representatives.... from the California Latino Psychological
Association, the National Latina/o
The solutions we choose for access and Psychological Association, the Asian
quality will interact in importan ways with American Psychological Association, and
the third critical issue—the issue of cost. the Southern California Chapter of the
Greater access to health care will improve Association of Black Psychologists. Thus
health outcomes, but it almost certainly far we have met with the Primary Care
will raise financial costs. Increasing the Association and MHSA/CA Institute for
quality of health care, although highly Mental Health. As a result of our first two
desirable, could also result in higher total meetings with these associations, we have
health-care spending.... “improving access continued the dialogue and are beginning
and quality may increase rather than to develop ways to work collaboratively.
reduce total costs. From the economist’s At the last board meeting of the year, in
perspective, the question of whether we October, various representatives from the
are spending too much on health care can- ethnic-specific associations will be joining
not ultimately be answered by looking at us. I am hopeful for a similar outcome after
total expenditures relative to GDP or the this meeting.
federal budget. Rather, the question, what-
ever we spend, is whether we are getting We must use time creatively—and forever
our money’s worth. In general, good infor- realize that the time is always hope to do
mation and appropriate incentives are nec- great things [Martin Luther King, Jr.].
essary to allocate resources efficiently. In ..(C)reative focus and shared responsibility
health care, the necessary information make all the difference….other people’s
should include not only the clinical effec- perceptions of the power leaders hold can
tiveness of certain tests or courses of treat- be more impactful than power alone.
ment but also their cost-effectiveness.... In There are few opportunities to be in a lead-
devising policies to reform our health-care ership as a President on the state level in
system, we must take care to maintain the psychology. While attempting to create
vitality and spirit of innovation that has change can be rewarding, it does not come
been its hallmark.” without challenges…. few psychologists
will argue about the overarching changes
Miguel Gallardo, President of the and progress needed to enhance the field
California Psychological Association of psychology, both statewide and nation-
(CPA), has fostered the theme “Building ally. But … there is debate about how we
Coalitions, Creating Change, and Shaping move in these directions and what deci-
CPA’s Future” during his tenure. His most sions we make to get us there….when we
recent message to his membership stay focused on our common goals and
describes the CPA’s Board’s efforts to Build shared vision, dialogue happens, our
External Relationships: shared intellectual capacity is more cre-
ative, and of course, we have more power
“I have invited guests to each of our CPA as a whole. The strength of an associa-
Board Meetings with the goal of beginning
a dialogue with other associations/entities. continued on page 49
48
tion/organization comes in the strength of The Alliance For Health Reform, co-
its members and leadership, and how these chaired by U.S. Senators Jay Rockefeller
two entities work together. and Susan Collins, notes that America’s
health care system is always a work in
…One of the most fascinating aspects of progress. Every year brings new challenges
leadership is the nature of people’s inter- and new proposed solutions. Since 1991,
pretations about who you are, what you the Alliance has organized more than 200
do, and how you do it. One of the most forums around the nation. No matter who
salient comments that a colleague made to wins the White House and control of
me was, ‘You do not recognize the power Congress this fall, health reform legislation
you have.’ My response to this colleague will likely be a front-burner issue in 2009.
was, ‘What makes you think I do not rec- The debates around reform and the
ognize it? What if I told you that I recog- behind-the-scenes meetings of 1993 and
nize the power I have, but choose to use it 1994 produced a wealth of knowledge on
differently?’ At that point, I realized that what should be done differently.
other’s perceptions of power placed upon
leaders are, at times, more powerful than Nine lessons learned: 1) Strike while the
power itself.” iron is hot—in the first year after an elec-
tion, 2) Go for the easiest procedural path,
Miguel’s reflections remind me of an 3) Involve Congress from the very begin-
equally astute observation made by Bonnie ning, 4) Raising taxes is tough, but NOT
Straiger, Executive Director of the North raising taxes can also carry a price, 5) Don’t
Dakota Psychological Association, that try to put everything into one bill, 6) Be
many of our practicing colleagues seem willing to deal, 7) Expect pushback—major
almost clinically depressed about the health reform means change, and many
future of their practices and the profession resist change, 8) If you’re from Venus,
of psychology. We would suggest that listen to the people from Mars, and 9) It
more of our state associations should won’t happen if it’s not a priority.
embrace the inclusive-oriented leadership
style Miguel has followed and actively Aloha,
encourage our practitioners to become
involved, and thereby accept personal Pat DeLeon, former APA President -
responsibility for their own destiny. Division 29 - July, 2008

N O F P S Y C H O THE
O
RA P Y
D I V I SI

29
ASSN.
AMER I

C
A
N PSYCHOLOGI C
AL

49
CONGRATULATIONS TO OUR AWARD WINNERS!

Distinguished Psychologist Award for Contributions to Psychology and


Psychotherapy: The Distinguished Psychologist Award is based on significance of
contributions to the practice, research, and/or training in psychotherapy. The 2008
award is presented to Bruce E. Wampold, Ph.D in recognition of his outstanding
accomplishments and significant lifetime contributions to the field of psychotherapy.

American Psychological Foundation Division of Psychotherapy Early Career Award


is presented to Kenneth N. Levy, Ph.D for distinguished early career contributions to
the field of psychotherapy and the Division of Psychotherapy.

The Award for Best Empirical Research Article in 2007 is presented to:
Scott A Baldwin, PhD, Bruce E. Wampold, PhD, and Zac E. Imel
Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and
patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75, 842-852

In 2008, the Division is instituting an award for Distinguished Contributions to


Teaching and Mentoring, which is presented in its inaugural year to Mathilda Canter,
PhD, in recognition of her significant contributions to the field of psychotherapy
through her impact on the lives of developing psychologists in their careers as
psychotherapists.

The Division is also pleased to announce the following student paper award winners:

Mathilda B. Canter Education and Training Student Award


Jenelle Slavin
Adelphi University
The Effects of Training, Clinical, Supervisory, and Scholarly Experience on
Supervisors’ Views of Therapuetic Techniques
Donald K. Freedheim Student Development Award
Joshua K Swift, MS
Oklahoma State University
The Impact of Client Treatment Preferences on Outcome: A Meta-Analysis
Student Diversity Award
Arien Muzacz
City College of the City University of New York
Older Adults, Sexuality and Psychotherapy: Implications for Ethnic and Sexual
Minorities

50
N O F P S Y C H O THE
O
THE DIVISION OF PSYCHOTHERAPY

RA P Y
D I V I SI

29 The only APA division solely dedicated to advancing psychotherapy

ASSN.
AMER I

M E M B E R S H I P APPLICATION
C
A
N PSYCHOLOGI C

AL
Division 29 meets the unique needs of psychologists interested in psychotherapy.
By joining the Division of Psychotherapy,you become part of a family of practitioners,scholars,and students who exchange ideas in order to advance psychotherapy.
Division 29 is comprised of psychologists and students who are interested in psychotherapy.Although Division 29 is a division of the American Psychological
Association (APA),APA membership is not required for membership in the Division.
JOIN DIVISION 29 AND GET THESE BENEFITS!
FREE SUBSCRIPTIONS TO: DIVISION 29 INITIATIVES
Psychotherapy Profit from Division 29 initiatives such as the
This quarterly journal features up-to-date APA Psychotherapy Videotape Series, History
articles on psychotherapy. Contributors of Psychotherapy book, and Psychotherapy
include researchers, practitioners, and Relationships that Work.
educators with diverse approaches.
Psychotherapy Bulletin NETWORKING & REFERRAL SOURCES
Quarterly newsletter contains the latest news Connect with other psychotherapists so that
about division activities, helpful articles on you may network, make or receive referrals,
training, research, and practice. Available to and hear the latest important information that
members only. affects the profession.

EARN CE CREDITS OPPORTUNITIES FOR LEADERSHIP


Journal Learning Expand your influence and contributions. Join
You can earn Continuing Education (CE) cred- us in helping to shape the direction of our cho-
it from the comfort of your home or office — sen field. There are many opportunities to
at your own pace — when it’s convenient for serve on a wide range of Division committees
you. Members earn CE credit by reading and task forces.
specific articles published in Psychotherapy
and completing quizzes. DIVISION 29 LISTSERV
As a member, you have access to our Division
DIVISION 29 PROGRAMS listserv, where you can exchange information
We offer exceptional programs at the APA with other professionals.
convention featuring leaders in the field of
psychotherapy. Learn from the experts in
personal settings and earn CE credits at VISIT OUR WEBSITE
reduced rates. www.divisionofpsychotherapy.org

MEMBERSHIP REQUIREMENTS: Doctorate in psychology • Payment of dues • Interest in advancing psychotherapy

Name _________________________________________________ Degree ______________________


Address _____________________________________________________________________________
City __________________________________________ State __________ ZIP ________________
Phone ____________________________________ FAX ____________________________________
Email _______________________________________________________
If APA member, please
Member Type: 䡵 Regular 䡵 Fellow 䡵 Associate provide membership #
䡵 Non-APA Psychologist Affiliate 䡵 Student ($29)
䡵 Check 䡵 Visa 䡵 MasterCard
Card # _______________________________________________ Exp Date _____/_____

Signature ___________________________________________
Please return the completed application along with payment of $40 by credit card or check to:
Division 29 Central Office, 6557 E. Riverdale St., Mesa, AZ 85215
You can also join the Division online at: www.divisionofpsychotherapy.org
PUBLICATIONS BOARD EDITORS
Chair 2003-2008 Psychotherapy Journal Editor Internet Editor
Raymond A. DiGiuseppe, Ph.D., Charles Gelso, Ph.D., 2005-2009 Abraham W. Wolf, Ph.D.
Psychology Department University of Maryland MetroHealth Medical Center
St John’s University Dept of Psychology 2500 Metro Health Drive
8000 Utopia Pkwy Biology-Psychology Building Cleveland, OH 44109-1998
Jamaica , NY 11439 College Park, MD 20742-4411 Ofc: 216-778-4637 Fax: 216-778-8412
Ofc: 718-990-1955 Ofc: 301-405-5909 Fax: 301-314-9566 Email: axw7@cwru.edu
Email: DiGiuser@STJOHNS.edu Email: Gelso@psyc.umd.edu
Student Website Coordinator
Laura Brown, Ph.D., 2008-2013 Psychotherapy Bulletin Editor Nisha Nayak
Independent Practice Jenny Cornish, PhD, ABPP, 2008-2010 University of Houston
3429 Fremont Place N #319 University of Denver GSPP Dept of Psychology (MS 5022)
Seattle , WA 98103 2460 S. Vine Street 126 Heyne Building
Ofc: (206) 633-2405 Fax: (206) 632-1793 Denver, CO 80208 Houston, TX 77204-5022
Email: Lsbrownphd@cs.com Ofc: 303-871-4737 Ofc: 713-743-8600 or -8611
Email: jcornish@du.edu Fax: 713-743-8633
Jonathan Mohr, Ph.D., 2008-2012 Email: nnayak@uh.edu
Clinical Psychology Program Psychotherapy Bulletin Associate Editor
Department of Psychology Lavita Nadkarni, Ph.D.
MSN 3F5 Director of Forensic Studies
George Mason University University of Denver-GSPP
Fairfax, VA 22030 2450 South Vine Street
Ofc: 703-993-1279 Fax: 703-993-1359 Denver, CO 80208
Email: jmohr@gmu.edu Ofc: 303-871-3877
Email: lnadkarn@du.edu
Beverly Greene, Ph.D., 2007-2012
Psychology Psychotherapy Bulletin Editorial
St John’s Univ Assistant
8000 Utopia Pkwy Crystal A. Kannankeril, M.S.
Jamaica , NY 11439 Department of Psychology
Ofc: 718-638-6451 Loyola College in Maryland
Email: bgreene203@aol.com 4501 N. Charles Street
Baltimore, MD 21210
George Stricker, Ph.D., 2003-2008
Email: Crystal.Kannankeril@gmail.com
Argosy University/Washington DC
Phone: (973) 670-4255
1550 Wilson Blvd., #610
Email: cakannankeril@loyola.edu
Arlington, VA 22209
Ofc: 703-247-2199 Fax: 301-598-2436
Email: geostricker@comcast.net

William Stiles, Ph.D., 2008-2011


Department of Psychology
Miami University
Oxford, OH 45056
Ofc: 513-529-2405 Fax: 513-529-2420
Email: stileswb@muohio.edu

PSYCHOTHERAPY BULLETIN
Psychotherapy Bulletin is the official newsletter of Division 29 (Psychotherapy) of the American Psychological
Association. Published four times each year (spring, summer, fall, winter), Psychotherapy Bulletin is designed to:
1) inform the membership of Division 29 about relevant events, awards, and professional opportunities; 2) provide
articles and commentary regarding the range of issues that are of interest to psychotherapy theorists, researchers,
practitioners, and trainers; 3) establish a forum for students and new members to offer their contributions; and, 4)
facilitate opportunities for dialogue and collaboration among the diverse members of our association.
Contributors are invited to send articles (up to 2,250 words), interviews, commentaries, letters to the editor, and
announcements to Jenny Cornish, PhD, Editor, Psychotherapy Bulletin. Please note that Psychotherapy Bulletin does
not publish book reviews (these are published in Psychotherapy, the official journal of Division 29). All submis-
sions for Psychotherapy Bulletin should be sent electronically to jcornish@du.edu with the subject header line
Psychotherapy Bulletin; please ensure that articles conform to APA style. Deadlines for submission are as follows:
February 1 (#1); May 1 (#2); July 1 (#3); November 1 (#4). Past issues of Psychotherapy Bulletin may
be viewed at our website: www.divisionofpsychotherapy.org. Other inquiries regarding Psychotherapy Bulletin
(e.g., advertising) or Division 29 should be directed to Tracey Martin at the Division 29 Central Office
(assnmgmt1@cox.net or 602-363-9211).

DIVISION OF PSYCHOTHERAPY (29)


Central Office, 6557 E. Riverdale Street, Mesa, AZ 85215
Ofc: (602) 363-9211 • Fax: (480) 854-8966 • E-mail: assnmgmt1@cox.net
www.divisionofpsychotherapy.org
DIVISION OF PSYCHOTHERAPY
N O F P S Y C H O THE

American Psychological Association


O

RA P Y
D I V I SI

6557 E. Riverdale
Mesa, AZ 85215
29

ASSN.
AMER I

www.divisionofpsychotherapy.org
AL
C
A
N PSYCHOLOGI C