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Ethical Framework for the Use of Social Media by Mental Health Professionals

Applicable Ethical Principles Relevant to Clinical Care and Social Media:

Multiple Relationships:

Testimonials:

Informed Consent:

Minimizing Intrusions on Privacy:

Initiating Professional Relationships:

Documenting and Maintaining Records:

Social Media Interactions Which Relate to Ethical Principles:

Personal vs. Professional Behavior on the web for practitioners:

Friend and follow requests:

Search Engines:

Interacting Using Email, SMS, @replies, and other on-site messaging systems:

Consumer review sites:

Location-based services:

Online treatment:

Practitioners work within their Scope of Practice

ation:

Competence:

Practitioners work within their boundaries of competence: they seek out training, knowledge and supervision Practitioners also consultwith other professionals, when appropriate.

Formal Training:

Informal Training:

Books:

Peer-reviewed Literature:

Popular Media

Clinical Consultation:

Practitioners display pertinent and necessary information on Websites practice.

Crisis Intervention Information

Practitioner Contact Information

Terms of Use, Privacy Policy, and Social Media Policy

Encrypted Transmission of Therapeutic and Payment Information

Practitioners offer an Informed Consent process

Encryption

Privacy Policy

Other Relevant Issues

Cultural Factors that May Impact Treatment es are

Dual Relationships

Peer Support and Self-Help:

References

……

TILT Magazine~ Therapeutic Innovations in Light of Technology:

BULLETIN

PsychotherapyOFFICIAL PUBLICATION OF DIVISION 29 OF THE

AMERICAN PSYCHOLOGICAL ASSOCIATION

www.divisionofpsychotherapy.org

2009 VOLUME 44 NO. 3

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In This IssueInterview

Abraham Wolf, Ph.D.

Psychotherapy Research, Scienceand Scholarship

Engaging Underrepresented, UnderservedCommunities in Psychotherapy-Related

Research: Notes from a Multicultural Journey

Ethics in PsychotherapyPsychotherapy, Online Social Networking, and Ethics

Education & TrainingPrioritizing Case Formulation in

Psychotherapy Training

Feature2009 Presidential Summit on the Future ofPsychology Practice: Collaborating for Change

PPrreessiiddeennttNadine Kaslow, Ph.D., ABPPEmory University Department of Psychiatry and Behavioral SciencesGrady Health System 80 Jesse Hill Jr Drive Atlanta, GA 30303Phone: 404-616-4757 Fax: 404-616-2898E-mail: [email protected] J. Magnavita, Ph.D. Glastonbury Psychological Associates PC 300 Hebron Ave., Ste. 215 Glastonbury, CT 06033 Ofc: 860-659-1202 Fax: 860-657-1535E-mail: [email protected] Jeffrey Younggren, Ph.D., 2009-2011827 Deep Valley Dr Ste 309 Rolling Hills Estates, CA 90274-3655Ofc: 310-377-4264 Fax: 310-541-6370E-mail: [email protected] Sobelman, Ph.D., 2007-20092901 Boston Street, #410Baltimore, MD 21224-4889Ofc: 410-583-1221 Fax: 410-675-3451Cell: 410-591-5215 E-mail: [email protected] PPrreessiiddeennttJeffrey E. Barnett, Psy.D., ABPP1511 Ritchie Highway, Suite 201Arnold, MD 21012Phone: 410-757-1511 Fax: 410-757-4888E-mail: [email protected] RReepprreesseennttaattiivveessPublic Policy and Social JusticeRosemary Adam-Terem, Ph.D.1833 Kalakaua Avenue, Suite 800Honolulu, HI 96815Tel: 808-955-7372 Fax: 808-981-9282E-mail: [email protected]

Professional PracticeJennifer Kelly, Ph.D., 2007-2009Atlanta Center for Behavioral Medicine3280 Howell Mill Rd. #100Atlanta, GA 30327Ofc: 404-351-6789 Fax: 404-351-2932E-mail: [email protected]

Education and TrainingMichael Murphy, Ph.D., 2007-2009Department of PsychologyIndiana State UniversityTerre Haute, IN 47809Ofc: 812-237-2465 Fax: 812-237-4378E-mail: [email protected]

MembershipLibby Nutt Williams, Ph.D, 2008-2009St. Mary’s College of Maryland18952 E. Fisher Rd.St. Mary’s City, MD 20686Ofc: 240- 895-4467 Fax: 240-895-4436E-mail: [email protected]

Early CareerMichael J. Constantino, Ph.D., 2007, 2008-2010Department of Psychology612 Tobin Hall - 135 Hicks WayUniversity of MassachusettsAmherst, MA 01003-9271Ofc: 413-545-1388 Fax: 413-545-0996E-mail: [email protected]

Science and ScholarshipNorm Abeles, Ph.D., 2008-2010Dept of Psychology Michigan State University 110C Psych Bldg East Lansing , MI 48824Ofc: 517-353-7274 Fax: 517-432-2476E-mail: [email protected]

DiversityCaryn Rodgers, Ph.D., 2008-2010Prevention Intervention Research CenterAlbert Einstein College of Medicine1300 Morris Park Ave., VE 6B19Bronx, NY 10461Ofc: 718-862-1727 Fax: 718-862-1753E-mail: [email protected]

DiversityErica Lee, Ph.D., 2008-200955 Coca Cola PlaceAtlanta, Georgia 30303Ofc: 404-616-1876 E-mail: [email protected]

AAPPAA CCoouunncciill RReepprreesseennttaattiivveessNorine G. Johnson, Ph.D., 2008-201013 Ashfield St.Roslindale, MA 02131 Ofc: 617-471-2268 Fax: 617-325-0225E-mail: [email protected]

Linda Campbell, Ph.D., 2008-2010Dept of Counseling & Human Development – University of Georgia 402 Aderhold Hall Athens , GA 30602Ofc: 706-542-8508 Fax: 770-594-9441E-mail: [email protected]

SSttuuddeenntt DDeevveellooppmmeenntt CChhaaiirrSheena Demery, 2009-2010728 N. Tazewell St.Arlington, VA 22203703-598-0382E-mail: [email protected]

FFeelllloowwssChair: Jeffrey Hayes, Ph.D.Pennsylvania State University 312 Cedar Bldg University Park , PA 16802 Ofc: 814-863-3799 Fax: 814-863-7750 E-mail: [email protected]

MMeemmbbeerrsshhiippChair: Chaundrissa Smith, Ph.D.Emory University SOM/Grady Health System49 Jesse Hill Drive, SE FOB 231Atlanta, GA 30303Ofc: 404-778-1535 Fax: 404-616-3241 E-mail: [email protected]

Past Chair: Sonja Linn, Ph.D.E-Mail: [email protected]

NNoommiinnaattiioonnss aanndd EElleeccttiioonnssChair: Jeffrey Magnavita, Ph.D.

PPrrooffeessssiioonnaall AAwwaarrddssChair: Jeff Barnett, Psy.D.

FFiinnaanncceeChair: Bonnie Markham, Ph.D., Psy.D.52 Pearl StreetMetuchen NJ 08840Ofc: 732-494-5471 Fax 206-338-6212E-mail: [email protected]

EEdduuccaattiioonn && TTrraaiinniinnggChair: Eugene W. Farber, PhDEmory University School of MedicineGrady Infectious Disease Program341 Ponce de Leon AvenueAtlanta, Georgia 30308Ofc: 404-616-6862 Fax: 404-616-1010E-mail: [email protected] Chair: Jean M. Birbilis, Ph.D., L.P.E-mail: [email protected]

CCoonnttiinnuuiinngg EEdduuccaattiioonnChair: Annie Judge, Ph.D.2440 M St., NW, Suite 411Washington, DC 20037Ofc: 202-905-7721 Fax: 202-887-8999E-mail: [email protected] Chair: Rodney Goodyear, Ph.D.E-mail: [email protected]

PPrrooggrraammChair: Nancy Murdock, Ph.D.Counseling and Educational PsychologyUniversity of Missouri-Kansas CityED 215 5100 Rockhill RoadKansas City, MO 64110Ofc: 816 235-2495 Fax: 816 235-5270E-mail: [email protected] Chair: Chrisanthia Brown, Ph.D.E-mail: [email protected]

PPssyycchhootthheerraappyy PPrraaccttiicceeChair: Bonita G. Cade, ,Ph.D., J.D.Department of PsychologyRoger Williams UniversityOne Old Ferry RoadBristol, Rhode Island 02809Ofc: 401-254-5347E-mail: [email protected] Chair: Patricia Coughlin, Ph.D.E-mail: [email protected]

PPssyycchhootthheerraappyy RReesseeaarrcchhChair: Susan S. Woodhouse, Ph.D. Department of Counselor EducationPennsylvania State University313 CEDAR BuildingUniversity Park, PA 16802-3110Ofc: 814-863-5726 Fax: 814-863-7750E-mail: [email protected] Chair: Sarah Knox, Ph.D.E-mail: [email protected]

LLiiaaiissoonnssCommittee on Women in PsychologyRosemary Adam-Terem, Ph.D.1833 Kalakaua Avenue, Suite 800Honolulu, HI 96815Tel: 808-955-7372 Fax: 808-981-9282E-mail: [email protected]

Division of Psychotherapy !! 2009 Governance StructureELECTED BOARD MEMBERS

STANDING COMMITTEES

DIVISION OF PSYCHOTHERAPY (29)Central Office, 6557 E. Riverdale Street, Mesa, AZ 85215

Ofc: (602) 363-9211 • Fax: (480) 854-8966 • E-mail: [email protected]

PSYCHOTHERAPY BULLETINPsychotherapy Bulletin is the official newsletter of Division 29 (Psychotherapy) of the American PsychologicalAssociation. Published four times each year (spring, summer, fall, winter), Psychotherapy Bulletin is designedto: 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 the-orists, researchers, practitioners, and trainers; 3) establish a forum for students and new members to offertheir contributions; and, 4) facilitate opportunities for dialogue and collaboration among the diverse mem-bers of our association.Contributors are invited to send articles (up to 2,250 words), interviews, commentaries, letters to theeditor, and announcements to Jenny Cornish, PhD, Editor, Psychotherapy Bulletin. Please note that Psy-chotherapy Bulletin does not publish book reviews (these are published in Psychotherapy, the official journalof Division 29). All submissions for Psychotherapy Bulletin should be sent electronically to [email protected] the subject header line Psychotherapy Bulletin; please ensure that articles conform to APA style. Dead-lines for submission are as follows: February 1 (#1); May 1 (#2); July 1 (#3); November 1 (#4). Past issuesof Psychotherapy Bulletin may be viewed at our website: www.divisionofpsychotherapy.org. Other inquiriesregarding Psychotherapy Bulletin (e.g., advertising) or Division 29 should be directed to Tracey Martin atthe Division 29 Central Office ([email protected] or 602-363-9211).

PUBLICATIONS BOARDChair : Jean Carter, Ph.D. 2009-20145225 Wisconsin Ave., N.W. #513Washington DC 20015Ofc: 202–244-3505 E-mail: [email protected]

Raymond A. DiGiuseppe, Ph.D., 2009-2014Psychology DepartmentSt John’s University 8000 Utopia Pkwy Jamaica , NY 11439 Ofc: 718-990-1955 Email: [email protected]

Laura Brown, Ph.D., 2008-2013Independent Practice3429 Fremont Place N #319 Seattle , WA 98103 Ofc: (206) 633-2405 Fax: (206) 632-1793Email: [email protected]

Jonathan Mohr, Ph.D., 2008-2012Clinical Psychology ProgramDepartment of PsychologyMSN 3F5George Mason UniversityFairfax, VA 22030Ofc: 703-993-1279 Fax: 703-993-1359 Email: [email protected]

Beverly Greene, Ph.D., 2007-2012Psychology St John’s Univ 8000 Utopia Pkwy Jamaica , NY 11439 Ofc: 718-638-6451Email: [email protected]

William Stiles, Ph.D., 2008-2011Department of Psychology Miami University Oxford, OH 45056 Ofc: 513-529-2405 Fax: 513-529-2420 Email: [email protected]

EDITORSPPssyycchhootthheerraappyy JJoouurrnnaall EEddiittoorrCharles Gelso, Ph.D., 2005-2009University of MarylandDept of PsychologyBiology-Psychology BuildingCollege Park, MD 20742-4411Ofc: 301-405-5909 Fax: 301-314-9566 E-mail: [email protected]

Mark J. HilsenrothDerner Institute of Advanced Psychological Studies220 Weinberg Bldg.158 Cambridge Ave.Adelphi UniversityGarden City, NY 11530E-mail: [email protected]: (516) 877-4748 Fax (516) 877-4805

PPssyycchhootthheerraappyy BBuulllleettiinn EEddiittoorrJenny Cornish, PhD, ABPP, 2008-2010University of Denver GSPP2460 S. Vine StreetDenver, CO 80208Ofc: 303-871-4737 E-mail: [email protected]

Associate EditorLavita Nadkarni, Ph.D.Director of Forensic StudiesUniversity of Denver-GSPP2450 South Vine StreetDenver, CO 80208Ofc: 303-871-3877E-mail: [email protected]

IInntteerrnneett EEddiittoorrAbraham W. Wolf, Ph.D.MetroHealth Medical Center2500 Metro Health DriveCleveland, OH 44109-1998Ofc: 216-778-4637 Fax: 216-778-8412E-mail: [email protected]

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PSYCHOTHERAPY BULLETINPublished by the

DIVISIONOF PSYCHOTHERAPYAmerican Psychological Association

6557 E. RiverdaleMesa, AZ 85215602-363-9211

e-mail: [email protected]

EDITORJennifer A. Erickson Cornish,

Ph.D., [email protected]

ASSOCIATE EDITORLavita Nadkarni, Ph.D.

CONTRIBUTING EDITORSDiversity

Erica Lee, Ph.D. andCaryn Rodgers, Ph.D.Education and Training

Michael Murphy, Ph.D., andEugene Farber, Ph.D.

Ethics in PsychotherapyJeffrey E. Barnett, Psy.D., ABPP

Practitioner ReportJennifer F. Kelly, Ph.D.Psychotherapy Research,Science, and Scholarship

Norman Abeles, Ph.D. and SusanS. Woodhouse, Ph.D.Perspectives on

Psychotherapy IntegrationGeorge Stricker, Ph.D.

Public Policy and Social JusticeRosemary Adam-Terem, Ph.D.

Washington ScenePatrick DeLeon, Ph.D.

Early CareerMichael J. Constantino, Ph.D. andRachel Gaillard Smook, Psy.D.

Student FeaturesSheena Demery, M.A.Editorial Assistant

Crystal A. Kannankeril, M.S.

STAFFCentral Office Administrator

Tracey Martin

Websitewww.divisionofpsychotherapy.org

PSYCHOTHERAPY BULLETINOfficial Publication of Division 29 of theAmerican Psychological Association

2009 Volume 44, Number 3

CONTENTSEditors’ Column ............................................................2President’s Column ......................................................2Interview ........................................................................7Abraham Wolf, Ph.D.

Psychotherapy research, scienceand Scholarship ..........................................................10Engaging Underrepresented, UnderservedCommunities in Psychotherapy-RelatedResearch: Notes from a Multicultural Journey

Ethics in Psychotherapy..............................................15Psychotherapy, Online Social Networking,and Ethics

Education & Training ..................................................21Prioritizing Case Formulation inPsychotherapy Training

Perspectives on Psychotherapy Integration ............25Making Evidence-Based Practice Work:The Future of Psychotherapy Integration

DIVISION 29 ~ 2009 APAPROGRAM ....................29Early Career ..................................................................33Building a Private Practice by Being Public:From Social Networking Circles toPsychotherapy Groups

Feature ..........................................................................372009 Presidential Summit on the Future ofPsychology Practice: Collaborating for Change

Feature ..........................................................................41Ethics and the Interrogation of Prisoners

Student Feature ............................................................47Journey to Adulthood in the 21st Century

Feature ..........................................................................50Psychotherapeutic Treatment Implicationsfor Obese Adolescents

Call for Fellowship ApplicationsDivision 29—Psychotherapy......................................54Membership Application............................................56

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EDITORS’ COLUMNJenny Cornish, Ph.D., ABPP, EditorLavita Nadkarni, Ph.D., Associate EditorUniversity of Denver Graduate School of Professional Psychology

Nadine J. Kaslow, Ph.D., ABPPEmory University Department of Psychiatry andBehavorial Sciences, Grady Health Systems

PRESIDENT’S COLUMN

We are excited thatthis issue is too full tofit in more than a shortparagraph from theeditors. There issomething for every-one: two timely pa-pers on ethics (onerelated to online socialnetworking and theother to interroga-tions), an importantarticle on research andmulticultural issues, ahelpful piece on caseformulation in train-

ing, a thoughtful submission on evi-

dence-based practice and integrativemodels of psychotherapy, an interestingearly career paper on social networkingand private practice, and three studentpapers on a variety of topics, includingan interview with Abraham Wolf,former D29 President and outgoing In-ternet Editor. In addition, be sure toread the President’s Column, and an im-portant report on the PsychotherapySummit. Finally, information about ourmany award winners and the upcomingAPAconvention is included.We hope tosee you soon in Toronto!

Jenny Cornish and Lavita Nadkarni(303-871-4737, [email protected])

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Culture of CompetenceThe current zeitgeistin professional psy-chology is competency-based. Competencerefers to knowledge,skills, and attitudes,and their integration.

Competencies are complex and dynam-ically interactive clusters of integratedknowledge of concepts and procedures,skills and abilities, behaviors and strate-gies, attitudes/beliefs/values, disposi-tions and personal characteristics, self-perceptions, andmotivations that enablea person to fully perform a task with awide range of outcomes.Educational programs are expected toproduce competence. Programs are ac-credited based in part on program out-

comes and training in key competencydomains. Professional credentialingbodies are expected to certify individu-als as competent. Policy makers laudcompetence and consumers increasinglydemand it. Thus, the time has come toembrace a culture of competence. Theremust be a shift within professional psy-chology toward the acquisition andmaintenance of competence as a pri-mary goal.

Many recent efforts have led to this shiftto a culture of competence and its assess-ment, including the identification of thekey foundational and functional compe-tencies and their essential components.Foundational competencies are thoseknowledge, skills, and attitudes that

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serve as the foundation for the functionsa psychologist is expected to carry out.The foundational competencies include:professionalism, reflective practice/self-assessment/self-care, scientific knowl-edge and methods, relationships,individual and cultural diversity, ethicaland legal standards and policies, andinterdisciplinary systems. Functionalcompetencies refer to the major func-tions that a psychologist is expected tocarry out. The functional competenciesthat have emerged by consensus withinprofessional psychology include:assessment, intervention, consultation,research/ evaluation, supervision,teaching, management-administration,and advocacy.

In an upcoming article, a CompetencyBenchmarks Document (Fouad et al., inpress) will appear that delineates the es-sential components that comprise eachof these core foundational and func-tional competencies. The CompetencyBenchmarks Document also articulatesbenchmarks, behavioral indicators thatreflect the expected level of perform-ance at each stage of professional devel-opment for the essential components ofeach competency domain. As a compan-ion to the Competency BenchmarksDocument, another soon to be pub-lished paper will describe a Compe-tency Assessment Toolkit forProfessional Psychology (Kaslow et al.,in press). This toolkit builds on a grow-ing and long history of competency ini-tiatives, both within the profession andin other healthcare disciplines. Themethods include: 360-degree evalua-tion, annual/ rotation performance re-views, case presentation reviews,client/patient process and outcomedata, competency evaluation ratingforms, consumer surveys, live orrecorded performance ratings, objec-tive structured clinical examinations,portfolios, record reviews, self-assessment, simulations/role plays,standardized client/patient interviews,

structured oral examinations, and writ-ten examinations. Given the tremen-dous strides that have been made withregard to evaluating competence, it isalso time to embrace a culture of the as-sessment of competence. The assess-ment of competence fosters learning,evaluations progress, assists in deter-mining curriculum and training pro-gram effectiveness, advances the field,and protects the public.

Psychotherapy CompetenceIntervention, which includes psy-chotherapy at its core, is one of the func-tional competencies. This competencyhas been defined as interventions thatare designed to alleviate suffering andto promote health and well-being of in-dividuals, groups, and/or organiza-tions. The essential components thathave been delineated for this compe-tency include: knowledge of interven-tions, intervention planning, skills,intervention implementation, and pro-gress evaluation. Benchmarks for eachof these essential components have beendetermined with regard to readiness forpracticum, readiness for internship, andreadiness for entry to practice.

I believe that members of the Divisionof Psychotherapy, those psychologistswith a passionate commitment anddedication to the conduct of effectivepsychotherapeutic interventions, shouldtake a leadership role in fleshing outthe intervention/psychotherapy compe-tence, including its essential compo-nents and benchmarks indicatingcompetent performance at each stage oftraining and credentialing and in termsof life-long learning. I am excited to readthe papers that will soon be publishedin Psychotherapy: Training, Research, Prac-tice, Training in which leading authorsdiscuss the essential components of thepsychotherapy competency and thefoundational and functional competen-cies informing the psychotherapy com-

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petency from various theoretical per-spectives: cognitive behavior, psycho-dynamic, family systems, andexistential/humanistic perspectives. Ibelieve that these papers will representan important effort toward advancing ashared articulation of the essential com-ponents of the psychotherapy compe-tency unique to each theoreticalorientation, as well as ways in whichvarious foundational and functionalcompetencies are linked to this compe-tency and how these linkages may beunique depending on the theoreticalframe and associated modality(ies).Hopefully, other scholars, practitioners,and educators from different orienta-tions can build on these contributions tofurther hone our understanding of thepsychotherapy competency across theo-retical perspectives. It also behooves usto consider how this competency wouldappear from other theoretical frame-works, including an integrative model.Further, we need to consider bench-marks that move beyond licensure, asthis will support the significant role thatlifelong learning must play in our pro-fession. Of course, most of us do not juststrive to be competent, but rather we arededicated to being capable. Capabilityrefers to the extent to which competentindividuals adapt their skills, generatenew knowledge, and continue to im-prove their performance. The confluenceof competence and lifelong learning iscapability. I hope that you will join theDivision and the field as we continue toadvance the competencies movement,and help us bring to bear our expertisein the psychotherapy competency.

What’s New In Division 29?We are in the midst of a changing of theguard in terms of our internet editor. Onbehalf of Division 29, I want to publicallythank Abe Wolf, PhD for doing a fantas-tic job for many years as our internet ed-itor. He is the founding editor of ourdivision’s website and Online Psy-chotherapy Editor. Dr. Wolf has been

wonderfully responsive to the membersof the governance in terms of their web-site and listserv needs, and with regardto Psychotherapy ENews. He has beenvery thoughtful in his approach to re-sponding to the various challenges anddecisions associated with the websiteand listservs. As most of you know, Dr.Wolf is a Past-President of the Division,as well as a fellow of the division, recip-ient of the division’s Jack KrasnerAwardfor distinguished early career, and amember of the division’s journal’s edito-rial board (Psychotherapy Theory, Research,Practice, Training). Dr. Wolf is on the staffof the Department of Psychiatry atMetroHealth Medical Center, the coun-try hospital for Cleveland, andAssociateDirector of Adult Outpatient Services.He is Professor of Psychology in Psychi-atry at the School of Medicine, CaseWestern Reserve University. Dr.Wolf hasa very active psychotherapy practice andhe lectures and supervises psychiatryresidents in individual psychotherapy.He has published in the areas of devel-opmental behavioral pediatrics, the useof technology in psychotherapy, and theapplication of psychometric theory to in-struments used to measure psychother-apy outcome. He is interested in the roleof therapist factors in psychotherapyprocess and outcome, especially thera-pist self-awareness of countertransfer-ence reactions. He loves doing psycho-therapy. We are extremely grateful toDr. Wolf for his wonderful contributionsto our division and we will miss him ashe transitions out of his role as interneteditor. However, he will remain anextended member of the Division 29governance family.I am delighted to introduce our new in-ternet editor, Chris Overtree, PhD. Dr.Overtree received his doctorate in clini-cal psychology from the University ofMassachusetts-Amherst. At the presenttime, he is the Director of the Psycholog-ical Services Center (PSC) and theAsso-

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ciate Director of Clinical Training forthe Clinical Psychology Program at theUniversity of Massachusetts-Amherst.His scholarship is focused on psy-chotherapy effectiveness in a naturalisticsetting, as well as more effective meth-ods of service provision in the commu-nity mental health system. He is achild/adolescent/adult and family ther-apist with specialties in anxiety disor-ders, depression, cognitive-behaviortherapy, and family conflict. He alsoserves as a consultant to schools regard-ing bullying/harassment, climate re-form, and improving academicoutcomes. Dr. Overtree has hit theground running. He is already liveningup our website, so check it out. In addi-tion, he will work with our Task Forceon Strategic Initiatives to significantlyenhance our website, so that it truly be-comes a creative and engaging informa-tion portal. We are so pleased to have Dr.Overtree on board. Do not hesitate tocontact me or Dr. Overtree if you havesuggestions about ways to make the Di-vision 29 internet presence more mem-ber-friendly, accessible, and valuable.

APAConventionYou will be receiving the PsychotherapyBulletin just a few days before the annualconvention. In the Bulletin, we have pro-vided you details of our wonderful di-visional programming. I am eager tointeract with each of you at the meetingin Toronto. I particularly hope to seeeveryone at our Business Meeting/Awards Ceremony and Social Hour,which will be held on Friday. Theseevents afford us the opportunity tohonor our awardees; meet, talk, and so-cialize with one another; and enjoy somespecial entertainment put on by mem-bers of the Division 29 Board.

Feel Free to Get in TouchI have really appreciated the chance tointeract with so many members of ourdivision since assuming the presidency.I really value everyone’s input andideas. Feel free to email me [email protected] with questions,concerns, and suggestions. Please enjoythe rest of your summer!

(References available on-line.)

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JOIN THE DIVISION OF PSYCHOTHERAPYON-LINE!

Please visit our website to become a member,

view back issues of the bulletin, join our listserv,

or connect to the Division:

www.divisionofpsychotherapy.org

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INTERVIEWAbrahamWolf, Ph.D.Crystal A. Kannankeril, M.S.Doctoral Student at Loyola College in Maryland

Formanypsychologists,joining a professionalorganization is anothertime-intensive respon-sibility added to theseveral demands in-volved in our profes-sion and our already

busy lives. For Dr. Abraham “Abe”Wolf,a job requirement for his faculty positionat Case Western Reserve Universityturned into a 15 year partnershipwith theDivision of Psychotherapy (29). Whenlooking for a professional organization tojoin, Dr.Wolf was invited to join theDivi-sion by Dr. Gerry Koocher, the incomingpresident. Dr. Wolf related that Division29 was a “natural Division for me to be-come involved with” given his interestsin psychotherapy and research.Since 1993, Dr. Wolf has been an activemember and leader in Division 29, oftenusing his interests and innovation as away to propel Division 29 into the fore-front of APA. Dr. Wolf began his serviceto Division 29 as the Co-Chair of theStudent Development Committee, aposition he held for five years. Duringthis time, he aimed to increase studentmembership which he successfullyaccomplished with several hundrednew student members. His committeeselected the winner of the student paperawards, which has seen several success-ful recipients including Dr. LouisCastonguay of Pennsylvania State Uni-versity. Pursuing even more leadershiproles, Dr. Wolf became coordinator ofAPA’sMid-Winter Convention Commit-tee, a joint Convention with Division 42(Independent Practice) and Division 43(Family Psychology) in 1998. From 1996to 1998, he served as aMember-at-Largefor Division 29 andwas amember of theDivision’s Publication Board from 1996

to 2002. Moreover, Dr. Wolf served twoterms as the Secretary for Division 29,which led up to his terms as President-Elect in 2005 and President of Division29 in 2006.Among these achievements and leader-ship roles, one of the hallmarks of Dr.Wolf’s service to Division 29 occurred in1997 when he became Division 29’s firstInternet Editor and World Wide WebCoordinator. Dr. Wolf’s interest in com-puters and statistics began early in highschool when he was offered to take partin a special computers program in 1967.During graduate school, these interestsonce again came to the forefront as hebecame more involved with statisticalanalysis and computers. Once theInternet hit in 1994, Dr. Wolf “jumpedon that right away as it was the mostamazing thing I’ve ever seen.” Whatmade Dr. Wolf a true asset and pioneerwas his determination to bring his earlyinterest and involvement with theInternet to Division 29. “No doubt, theDivision needed to jump on this band-wagon—the sooner the Division had anInternet presence, the better,” Dr. Wolfremarked during our interview.His foresight and hard work over thenext eight years as webmaster madeDivision 29 a front-runner among theAPA Divisions with many Internet-based activities. His initial goal as Inter-net Editor was for Division 29 to havea web-based presence; this includedcreating a website and listserv for mem-bers. Dr.Wolf described these early tasksas a “Mom and Pop operation.” The firstwebsite was originally attached to CaseWestern Reserve University where hehas been a professor of psychology inthe school’s Department of Psychiatry


for the past 30 years, hired right out ofinternship. After many versions of thewebsite, Dr. Wolf was able to create aseparate URL for Division 29 in 2004(www.divisionofpsychotherapy.org),allowing for easier access to users.

Dr. Wolf’s other achievements in hiseight-year term as Internet Editorincluded creating and editingAPA’s On-line Academy (www.apa.org/ce), mak-ing Division 29 one of the few Divisionsto post online CE credits. This websiteallows members to watch archivedconferences through web-streaming,making them easily accessible to mem-bers. Such CEs include Evidence-basedPsychotherapy Relationships:WhatWorksin General (2006), Treating the Hatedand Hateful Patient (2006), The ProperFocus of Evidence-Based Practice (2006),and Evidence-based Psychotherapy Re-lationships: Customizing the TreatmentRelationship to the Individual Patient(2007). This movement towards utilizingand pairing technologywith psychologyalso became part of Dr. Wolf’s presiden-tial initiative in 2006 and serves as oneof his favorite memories as InternetEditor. He recognized the importance ofthe Internet in psychology’s future andworked hard towards keeping psychologycurrent and relevant in this new age andgrowing field of technology. In addition,Dr. Wolf was named a Guest Editor for aspecial edition of Division 29’s JournalPsychotherapy: Theory/Practice/Research/Supervision which focused on the tech-nology of psychotherapy.

Dr. Wolf’s achievements, however, didnot comewithout their fair share of hur-dles. He explained that what makes theposition of Internet Editor unique andoften challenging is facilitating commu-nication and making this new mediummeaningful to all the members of Divi-sion 29. Specifically, Dr. Wolf noted thathaving a website, listserv, and onlinenewsletter may not be as simple or rele-vant for older, more well-establishedmembers who may have not have as

much experience with these technologi-cal advancements as compared to theiryounger counterparts. He indicated thatyounger psychologists or students maytake the Internet for granted, just asolder members may take radio and tele-vision for granted. So, for members whodid not grow up with the Internet, hav-ing these new online features may bemore complicated; getting them to uti-lize this medium thus becomes more ofa challenge. One of Dr. Wolf’s goals wasto help the older membership move intothe 21st century. He remarked that “it isstill a challenge to get people to join thelistserv and effectively use the medium,which will be a continuing challenge toleadership and members [in the fu-ture].” He did note that members are ex-cited and interested in this movement,though “it is hard to make those ideasinto realistic applications.”

When asked about his reflections on in-volvement with the Division, Dr. Wolfindicated that he has no regrets. Henoted that it has been “truly one of themost rewarding activities I have everdone – [it has allowed me] to exchangeideas, collaborate on research projects,and be involved with great peoplewhose articles you have been readingfor years - and then get to have dinnerwith them.” Dr. Wolf also joked, “for allthe meetings, it is really worth it.” Healso wanted to acknowledge that hecould not have accomplished all that hehas without the support of his family.

Division 29 formally created the positionof Internet Editor in 2005. With Dr. Wolfserving as Chair-Elect that year, Dr.Bryan Kim from the University ofHawaii became the next Internet Editorfrom 2005 to 2008. After Dr. Kim’s threeyears of service, Dr. Wolf returned asInterim Internet Editor in 2008. The In-coming Internet Editor is Dr. Christo-pher Overtree from the University ofMassachusetts Amhearst. In looking to-wards the future, Dr. Wolf is confident


in the direction of this position. Heexplained that the website is due for “amore professional makeover” as it isnow five years old. His words of wis-dom for Dr. Overtree were to have avision of where he sees the websitegrowing and continually work towardsthose goals. As Dr. Wolf’s leadershiprole in Division 29 come to a close, healso wanted to express the importance

of members to get involved and “showup for our meetings—it will be a deci-sion they will never regret!” On behalfof the members of Division 29, I wouldlike to thank you, Dr. Wolf, for all thatyou have given to us—wewill miss youas Internet Editor but look forward toyour continued involvement with theDivision of Psychotherapy.

9

APF ROSALEE G. WEISS LECTUREFOR

OUTSTANDING LEADERS IN PSYCHOLOGYGive an Hour: Shifting Our Nation’s View of

Mental Health and Psychology Care

Saturday, August 8, 20095:00 PM - 5:50 PM

Metro Toronto Convention Centre, Meeting Room 706

BARBARA VAN DAHLEN ROMBERGBarbara Van Dahlen Romberg, founder and president of Give an Hour, isa licensed clinical psychologist who has been practicing in the Washing-ton, D.C., area for 16 years. She specializes in the diagnosis and treatmentof children. Dr. Romberg has spent her career interacting with and coor-dinating services within large systems, including school districts andmen-tal health clinics. In addition, for many years, she served as an adjunctfaculty member at GeorgeWashington University, where she trained andsupervised developing clinicians. She received her Ph.D. in clinical psy-chology from the University of Maryland in 1991.Concerned about the mental health implications of the Iraq War, Dr.Romberg founded a nonprofit organization called Give an Hour in 2005.The organization is creating a national network of mental health profes-sionals who are providing free services to U.S. troops, veterans, and theirloved ones. As of February 2009, the network currently has over 3,600providers.As part of her work with Give an Hour, Dr. Romberg has participated innumerous panels, conferences, and hearings on issues facing veterans.She also writes a monthly column for Veterans Advantage and is con-tributing to a book on post-traumatic stress and traumatic brain injuries.She is quickly becoming a notable source and expert on the psychologicalimpact of war on troops and families.

Dr. Janet Helms, well-known for her re-search on racialidentity development(e.g., Helms, 1990),once said, “If you staywith any questionlong enough, it will

become a multicultural question.” Shesaid this when I was still a graduate stu-dent in Counseling Psychology at theUniversity of Maryland. I had an intel-lectual appreciation for what she wassaying, but only later developed adeeper understanding as my researchprogressed. Much of my current re-search focuses on how to improve briefpsychotherapywith parents and infants,including basic research on importantaspects of the parent-infant relationshipthat should be targeted in such psy-chotherapy. I would like to share thestory about how my psychotherapy-related research questions became mul-ticultural questions, and how the jour-ney has led to my current efforts toengage underrepresented, underservedminority group members in my psy-chotherapy-related research.The story begins with a randomizedcontrolled trial (RCT) of a brief, three-session, home visiting, preventive, psy-chotherapy intervention for first-time,economically stressed mothers of irrita-ble infants and their babies (Cassidy,Woodhouse, Sherman, Stupica, Ziv, &Lejuez, 2009). The goal of the brief psy-chotherapy was to reduce the risk of in-secure attachment. Attachment wastargeted at an outcome because of theempirical evidence that insecure infantattachment is associated with behavioral

problems and psychopathology (seeGreenberg, 1999, and Kobak, Cassidy,Lyons-Ruth, & Ziv, 2006, for reviews).While we were collecting data for thelarger RCT, a group of investigators de-cided to conduct a smaller, qualitativestudy focused on better understandingthe precursors to infant attachment(Cassidy,Woodhouse, Cooper, Hoffman,Powell, & Rodenberg, 2005). Our think-ing was that outcomes of mother-infantpsychotherapy could be greatly improvedif we could better understand the mostimportant precursors of attachment thatshould be targeted in treatment.After three decades of research, there isstill some degree of controversy aboutexactly how parental behavior serves asa precursor to attachment. Research hasfound via meta-analysis that there is arobust link between mothers’ attach-ment representations and their infants’attachment security: mothers who aresecure tend to have babies who are se-cure (van IJzendoorn, 1995). Attachmenttheory would suggest that the mecha-nism through which this link shouldoccur is maternal sensitive responsive-ness to the infant (Bowlby, 1969/1982).In fact, there is meta-analytic evidencethat maternal sensitivity serves as a me-diator of this link betweenmothers’ andinfants’ attachment (van IJzendoorn,1995). The problem, however, is that theeffect sizes for the mediation modelare much lower than theory would pre-dict; van IJzendoorn termed this issuethe transmission gap. In fact, the connec-tions between maternal behavior andinfant attachment are generally weakerin low-SES families (De Wolff & van

PSYCHOTHERAPY RESEARCH, SCIENCEAND SCHOLARSHIPEngaging Underrepresented, UnderservedCommunities in Psychotherapy-Related Research:Notes from a Multicultural JourneySusan S. Woodhouse, Ph.D., The Pennsylvania State University


IJzendoorn, 1997). The transmission gapraised many questions for us that wethought were important to resolve, par-ticularly if our goal was to make psy-chotherapy for low-income, at-riskmothers and their infants as efficaciousand efficient as possible. If it is impor-tant for infant-parent psychotherapy towork with parents on changing behav-iors, we need to make sure that weknow which behaviors really make adifference in later attachment outcomes.The Cassidy et al. (2009) RCT was con-ducted in a large, metropolitan area thathad a very diverse population; that di-versity was reflected in the sample of thestudy. Participants were 169 infants andtheir economically-stressedmothers, in-cluding 42.6%AfricanAmerican/Black,27.2%White, 19.5%Hispanic, and 10.7%mixed race or other. For the smaller,qualitative study we examined 18mother-infant dyads (78% racial or eth-nic minority groupmembers) who werea part of the control group in the largerRCT. As mentioned earlier, our goal inthe qualitative study was to try to figureout whichmaternal behaviors most mat-tered in predicting later attachment, soas to close the transmission gap. Wehoped to be able to make suggestionsabout which maternal behaviors weremost important to support and whichwere most important to target forchange in psychotherapy.Each research teammember watched allof the available videotape (approxi-mately 90 minutes of tape) from a labvisit (at 4.5 months) and three 30-minutevideotapes of naturalistic home observa-tions (7 to 9 months). We assessed ma-ternal behaviors by focusing on themother, but attended to the dyad forcontext using the Ainsworth, Blehar,Waters, and Wall (1978) conceptualiza-tion of sensitivity. Mothers were classi-fied as either insensitive or sensitiveaccording to theAinsworth et al concep-tualization of sensitivity. In order to bein the sensitive group mothers had tomeet only aminimum,moderate level of

sensitivity. We made extensive writtenqualitative notes on interactions. Basedon our observations we attempted topredict the infant 12-month Strange Sit-uation (Ainsworth et al., 1978) attach-ment classification and the maternalAdult Attachment Interview (AAI;George, Kaplan, & Main, 1996) classifi-cation. After independently making ourpredictions, we individually read theAAI and looked at the attachment classi-fication score, watched the 12 and 18months Strange Situation videos andlooked at the scores, and made notesabout what we had learned from thedyad. The team then met for a two-hourdiscussion of each dyad.

We were surprised at how few motherswere rated as sensitive according to theAinsworth et al. (1978) conceptualiza-tion of sensitivity, especially given therather moderate level of sensitivity re-quired to be assigned to the sensitivegroup. Of the 18 mothers, only 3 wereclassified as sensitive and 15 were classi-fied as insensitive. All of the motherswho were deemed sensitive had babieswhowere later classified as secure in theStrange Situation. Of the 15 motherswho were classified as insensitive, how-ever, 6 had babies who were later classi-fied as secure and 9 had babies whowere later classified as insecure in theStrange Situation. The proportion of in-fants that were categorized as secure(50%) via the Strange Situation was con-sistent with the proportion secure incomparable samples (Spieker & Booth,1988). Also, the 67% match of sensi-tive/secure and insensitive/insecure in-dicates that even in a small sample thereis evidence for a connection betweenmaternal sensitivity and infant attach-ment. Of greatest interest to us, how-ever, were the 6 infants with motherswho would be deemed insensitive ac-cording to traditional measures of sensi-tivity but who later turned out to besecure. What we learned from this qual-itative study was that what seemed to


best predict attachment outcomes wasnot sensitivity as typically conceptual-ized, but instead whether the motherwas willing to serve as a secure base forthe infant. Insensitivity, per se, was notantithetical to security. In other words,mothers could engage in a larger num-ber of insensitive behaviors as long as inthe end, at least 50% of the time, themother relented and allowed the baby tocome in for comfort when distressed,did not activate the attachment systemwhile the child was exploring, and re-frained from certain particularly nega-tive behaviors (e.g., frightening the baby,harsh/hostile responses to infant dis-tress). It was as if one central thing theinfants were learning from all their ex-periences with their mothers waswhether, on the whole, their motherswould provide a secure base for themwhen they most needed it. Instead oftaking an “average” of the mothers’ sen-sitive/insensitive behaviors in terms ofa moment-by-moment matching to in-fant signals, infants seemed to be think-ing about how episodes of distress tendedto turn out in the end when they mostneeded something (Cassidy et al., 2005).Based on these qualitative findings wedeveloped a quantitative, observationalmeasure of secure base provision and foundempirical evidence that secure base pro-vision predicted later infant attachmentwhereas a traditionalmeasure of sensitiv-ity did not in a low-income, diversesample (Woodhouse & Cassidy, 2009). Ithought that these findingswere very im-portant because we need to understandwhich parenting behaviorsmake a differ-ence in child outcomes and to have cul-turally-appropriate ways to assess thoseparenting behaviors. The Woodhouseand Cassidy (2009) findings supportedthe idea that secure base provision is amore culturally-appropriate measure ofparental responsiveness in a racially/eth-nically diverse, low-income sample ofparents than was sensitivity because se-cure base provision allowed for predic-tion of attachment security, whereassensitivity did not. I would argue that the

secure base provision measure avoidsemphasizing the importance of certainculturally-bound parenting practicesfound in white, middle class samples(e.g., sweet tone of voice, affectionatecomments, moment-to-moment affectiveattunement) and does not pathologizeother culturally-based parenting prac-tices (e.g., what might be termed “no-nonsense parenting”). Instead the codingsystem focuses on behaviors that appearto predict later infant attachment acrossgroups. Frequently, differences betweenracial groups are cast as an indication thatminority group children deviate fromtypically developing children, and thereis a lack of research on adaptive strategiesand pathways to success (Garcia-Coll,1990). Use of assessments of parentingthat are based on white, middle classnorms frequently results in the patholo-gizing of minority group parents’ care-giving. In order to design culturallyappropriate and relevant preventivepsychotherapy, it is crucial to avoidpathologizing culturally-based parentingpractices (e.g., “no nonsense parenting”)that are not detrimental to children’sattachment security.When I moved from my postdoctoralfellowship position in a major metropol-itan area to my current position at thePennsylvania State University, I wasvery excited to continue mywork in thisarea. Because there is not a great deal ofracial diversity in rural Pennsylvania, Idecided to pursue my research in thenearest urban area, Harrisburg, Pennsyl-vania. I found lab space and was able toobtain university seed money to pursuea pilot project there that focused on ex-amining relations between observationsof mothers’ caregiving behavior and (a)mother and infant emotion regulation(as indexed by heart rate variability), aswell as (b) mother and infant stress re-sponses (as indexed by cortisol andalpha-amylase in saliva), during times ofinfant distress. The goal was to try to un-derstand the role of mothers’ own emo-tion regulation in the process of caring


for their infants, as well as to under-stand how maternal caregiving waslinked to infant emotion regulation andlater attachment. My hope was that suchbasic research could help us better un-derstand potential targets for interven-tion, so as to design better a bettermother-infant psychotherapy protocolthat could later be tested. The demo-graphics of Harrisburg (e.g., 50%AfricanAmerican) struckme as ideal forcontinuing to explore parenting acrosscultures in order to help design mother-infant psychotherapy interventions thatwere culturally appropriate. Veryquickly, though, I began to realize thatdoing research in underrepresented, un-derserved communities outside of themajor metropolitan areas was going tobe unexpectedly challenging.Whenwe tried to recruit mothers to par-ticipate in the pilot study we found thatthe minority group mothers simply didnot trust us or research in general. I real-ized that we needed to build bridgeswith the community and find a way tobuild trust.I partnered with two other Penn Stateresearchers (Kristin Buss and LaureenTeti) whowere also interested inAfricanAmerican families. Together we metwith threeAfricanAmerican Harrisburgcommunity leaders that we knewthrough our Penn State connections.These community leaders served as cul-tural informants for us, telling us aboutthe history of racism in Pennsylvaniaand a community memory for the his-tory of misuse of research findings. Theyadvised us to get to know a variety ofcommunity leaders who could help in-troduce us to the community. Theytalked about the importance of incorpo-rating tangible ways of giving back tothe community into our efforts, includ-ing community workshops and findingways to bring the results of the researchback to communitymembers. They gaveus a great deal of advice on how to talkabout what we were doing and how itcould be relevant to the community.

Using seed money from our universityChildren, Youth, and Family Consor-tium we established Parents and Chil-dren Together (PACT): A Place forLearning about Children and Families.We met individually with a variety ofcommunity leaders including pastors,nurses, physicians, youth arts educators,agency administrators, social workersand others and invited them to join aTask Force to help guide our efforts toengage the community in research andfindmeaningful ways to give back to thecommunity. The Task Force gave usmany helpful ideas including hiringfrom the community and finding waysto partner with community groups to dothe research itself. We started to attendcommunity events to talk about our re-search in the community and we hired aresearch coordinator/recruiter from thecommunity. We began providing work-shops for community members andbuilding a database of families inter-ested in research participation.

All of our efforts in the community havehelped us to engage the community inour individual research projects. How-ever, the most recent step we (KristinBuss, Laureen Teti, Chalandra Bryant,and Susan Woodhouse) have taken is todevelop a research partnership with achurch-affiliated, non-profit communitydevelopment corporation, HolisticHandsCommunityDevelopment Corpo-ration (led by Brenda Alton and RobinPerry-Smith). We are using communitybased participatory research methodol-ogy to develop a specific research ques-tion related to children’s anxiety.Eventually, we expect to work with thecommunity to develop a culturally ap-propriate intervention that can help to re-duce the risk of anxiety disorders. Thework is in process, but very interestingthemes have already begun to emerge. Itis very exciting to watch communitymembers become engaged in thinkingabout research at a grassroots level.(References available on-line.)

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With each passing daytechnology plays anincreasingly importantrole in the lives of bothpsychotherapists andthose we serve. The In-ternet, E-mail, socialnetworking sites, chatrooms, professionalE-mail lists, and thelike each impact howwe live, work, com-municate, and relate toeach other. While itmay seem that howpsychotherapists uti-

lize various technologic advances in ourpersonal lives is not an ethical issue, inthe digital world in which we now livethere is no clear boundary or line ofseparation between our personal andprofessional lives. As will be presented,the use of social networking sites bypsychotherapists (professionally and/orpersonally) and by their clients presentsa unique set of ethical challenges anddilemmas.

Ethics and the InternetThe Ethical Principles of Psychologists andCode of Conduct (Ethics Code;APA, 2002)states clearly that: “The Ethics Code ap-plies to (professional) activities across avariety of contexts, such as in person,postal, telephone, Internet, and otherelectronic transmissions” (p. 1061). Ad-ditionally, the APA Ethics Committeehas promulgated the Statement by theEthics Committee on Services by Telephone,Teleconferencing, and the Internet (APA,1997) in recognition of the growing roletechnology plays in clinical practice. TheCanadian Psychological Association(2008) developed the Ethical Guidelinesfor Psychologists Providing PsychologicalServices Via Electronic Media to address

the ethical challenges and dilemmasoften associated with utilizing the Inter-net. Further, the International Society forMental Health Online has promulgatedthe Suggested Principles for the Online Pro-vision of Mental Health Services (2000).Thus, it is clear that psychotherapistsshould give thought to the role and im-pact of the use of electronic media intheir professional roles and use thesedocuments to inform these decisions.Familiarity with relevant ethical stan-dards and practice guidelines and care-ful consideration of the impact of the useof various online media are importantfor each practicing psychotherapist.Even with thoughtful utilization ofavailable resources, psychotherapistsmay face a myriad of ethical challengesand dilemmas regarding the role of so-cial networking sites in our professionaland personal lives that will require ourcareful consideration. Examples include:• A seasoned psychotherapist receivesan E-mail invitation to join a socialnetworking site. The site obtained hisname and E-mail address from one ofhis clients, who hoped to learn moreabout the clinician by “friending”him on the site.

• A supervisor performs a Googlesearch on one of her graduate studentsupervisees and finds a link to a pro-file he keeps on a social networkingsite. She views his profile and findsmany pictures of him in bars holdingand drinking alcoholic beverages.

• An early career psychologist who uti-lizes a social networking site to keepin touch with family and friends re-ceives a “friend request” from a for-mer client she treated for six monthsduring her graduate training.

ETHICS IN PSYCHOTHERAPYPsychotherapy, Online Social Networking, and EthicsJeffrey E. Barnett, Psy.D., ABPP and Allison Russo, M.S.


16

Social Networking SitesSocial networking sites (SNSs) are de-scribed as “interactive websites de-signed to build online communities forindividuals who have something incommon - an interest in a hobby, a topic,or an organization - and a simple desireto communicate across physical bound-aries with other interested people”(Carter, Foulger, & Ewbank, 2008, p.682). Themost popular of these are Face-book and MySpace, although others,such as LinkedIn and Friendster, alsohave followings, albeit to a lesser extent(Salaway & Caruso, 2008).

As part of their online networking prac-tice, users typically post personal infor-mation about themselves that mayinclude educational, occupational, andcontact information, as well as descrip-tions of their interests and activities.Many users also post photographs ofthemselves alone and/or in groups.Users may communicate with eachother by leaving messages on one an-other’s pages or merely learn moreabout other users via viewing their per-sonal profiles. While these sites are typ-ically used for general networkingpurposes, some appeal to particular in-terests (e.g., LinkedIn’s primary aim iscareer networking) or populations (e.g.,Facebook initially limited its member-ship to undergraduates, who continue tocomprise the bulk of its members; Sal-away & Caruso, 2008).

The sharing of personal informationacross as public a medium as the Inter-net brings with it a number of risks, andusers are wise to recognize that abuse orsimply negligent use of these sites mayhave deleterious effects. For example, re-vealing excessive personal informationwithout implementing sufficient privacycontrols has led to fear of identity theftand Internet stalking. Additionally, theprominent case of Megan Meier, the 13-year-old girl who committed suicide in2006 after receiving harassing messageson MySpace from a user who had cre-

ated a fraudulent profile, has made thepotential impact of SNSs in users’ livesand social functioning devastatingly ap-parent. Conversely, it appears as thoughSNS usage may also have positive socialeffects. Ellison, Steinfeld, and Lampe(2007) found that Facebook utilizationwas positively related to the amount ofsocial resources (“social capital”) en-joyed by undergraduate students. Thiseffect was exaggerated in students whoreported lower levels of life satisfactionand self-esteem, suggesting the particu-lar usefulness of SNS usage for individ-uals with social struggles offline.Patterns of Social Networking Site UseAn extensive survey conducted by theEducause Center for Applied Research(Salaway & Caruso, 2008) yields statis-tics on SNS usage that make the phe-nomenon impossible for psychologiststo ignore. The findings indicate that thevast majority (85.2%) of all undergradu-ate students frequent at least one SNS,with membership comprised of agreater proportion of younger studentsthan older students (i.e., fully 95.1% of18-19 year old students report SNSusage, compared with only 37% of un-dergraduates aged 30 years or more).Furthermore, 56.8% of respondentsmake SNS usage a part of their everydayactivities, up from 32.8% in 2006, whichdemonstrates the recent and consider-able rise in the integration of SNSs inusers’ daily functioning. The most fre-quently reported purpose of SNSs is tomaintain connections with existingfriends and acquaintances (96.8%); just16.8% make use of these sites to fosterentirely novel friendships. In addition,more than half of respondents use thesesites to gather more information aboutpeople they may or may not have met(51.6%) and to share photographs,videos, and other media (67.7%).

Yet, SNS use is not limited to undergrad-uate students. Facebook presently hasmore than 175 million registered users


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worldwide. More than 3 billion minutesare spent on Facebook each day andmore than 18 million users update theirpage each day (Facebook, 2009). My-Space presently has more than 185 mil-lion registered users worldwide.Approximately 25% of all Americans areactive MySpace users. Almost 350,000individuals sign up as new users of My-Space each day and it has achievedmorethan 4.5 billion page views in a singleday. Over 1.5 billion images are sharedvia MySpace each day. Fifty millionmails are sent each day through My-Space and there are over 10 billion activefriend relationships at present (SocialNetwork Stats, 2008). The ubiquitousnature of SNSs in the lives of so many isquite evident from the above data.

Ethical Challenges and DilemmasThe use of SNSs by psychotherapists andtheir clients raises a number ofethical challenges in areas that includeinformed consent, boundaries, self- dis-closure, and multiple relationships.Boundary violations and multiple rela-tionships are inherent concerns whenconsidering SNSs for psychotherapists.Practitioners who utilize these sites mayreceive online requests from their clientsto become “friends” on these sites, andaccepting these requests necessarilyblurs the lines of the therapeutic relation-ship. Although it is generally acceptedthat “friends” on SNSs are oftenmere ac-quaintances, the title may still complicateexpectations of the relationship and therole of the psychotherapist in the client’slife.Although befriending a client onlinedoes not necessarily constitute an ex-ploitativemultiple relationship (See Stan-dard 3.05 of theAPAEthics Code), it maybe the first step in a series of increasinglyinappropriate communications or disclo-sures that are not consistent with antici-pated professional roles.

Declining the client’s ‘friend’ requestmaybe a clinical challenge and may havesome impact on the psychotherapy rela-tionship and process if not addressed ap-

propriately. While it seems as though thesimple solution to this dilemma is to ei-ther limit search options or refrain fromusing SNSs altogether, even these precau-tionsmay not eradicate the issue: currentor former psychotherapy clients maysend electronic membership invitationsto clinicians who do not already have aSNS listing (as illustrated in Scenario 1above). For thosewho have a SNS the useof different levels of security settingsmayprevent clients from having free access tothe psychotherapist’s online materials,but the existence of the online profile isusually not hidden and clients may stillrequest being accepted as a friend. Fur-ther, some clients who are very computersavvymay be able to circumvent securitysettings and obtain access to informationintended only for personal use.In some ways, friend requests andmem-bership invitations may be viewed asauspicious, as they may indicate that theclient considers the therapeutic relation-ship to be a strong one. Theymay also in-dicate a client’s desire to share personalinformation with the clinician that is rel-evant to the psychotherapy and this maybe a valuable contribution to the psy-chotherapy process (Lehavot, 2009). Insuch cases, it may be possible to view theclient’s online materials together andprocess them as part of the ongoing ther-apeutic process. Alternatively, friend re-quests may indicate a client’s suspicionof the clinician or simply a boundarycrossing to obtain more informationabout the psychotherapist’s personal lifeto quell curiosity. Regardless, such anevent should be addressed in psy-chotherapy in order to determine the im-petus for the request and the client’sreaction if the psychotherapist chooses todecline the invitation. As Lehavot (2009)states: “By paying thoughtful attention tothe function of the client obtaining infor-mation about the clinician online, thepsychotherapist can examine this behav-ior as an opportunity to enhance theclient’s treatment” (p. 28).


It should be pointed out that sharing in-formation with a client in itself is notnecessarily unethical. Psychotherapistshave the right to decide how much per-sonal information they are comfortablesharing with clients. But, psychothera-pists should also consider the impact ofsuch online relationships on the psy-chotherapy relationship and process.Considering these issues and their po-tential consequences before they becomean issue with a particular client is rec-ommended.

Issues of informed consent arise whenclinicians decide to conduct onlinesearches for their clients without theirknowledge or prior approval. While onemay argue that viewing a client’s profilecan be useful clinically insofar as it mayprovide clinicians with additional orcorroborating data to enhance under-standing of various aspects of theclient’s life, doing so clandestinely mayhave substantial negative implicationsfor rapport. For example, if a psy-chotherapist learns of a client’s experi-mentation with illicit substances onlineand the client has not disclosed this intreatment, what does the psychothera-pist do with this information? Shouldone disclose their search and what theyhave learned, accepting any negativeimpact on the therapeutic relationship,or should one withhold the informationand not address in treatment a poten-tially significant clinical issue? Similarissues are relevant for supervisors whosearch for information about their su-pervisees online (as depicted in Scenario2 above). Psychotherapists and supervi-sors should consider issues of trust aswell as professional role modeling whenconsidering these decisions.

It should be noted that psychotherapistsvary in their perceptions of the clinicalimpact of self-disclosure, multiple rela-tionships, and boundary crossings andwill vary in their comfort level with theintersection of SNSs and their clinicalpractice. Williams (1997) has pointed out

that the clinician’s theoretical orienta-tion may impact views of the appropri-ateness and use of psychotherapistself-disclosure. Humanistic psychother-apists may be more open to the use ofself-disclosure to make themselves ap-pear more genuine and to narrow thepower differential between clinician andclient. In contrast, psychoanalysts andpsychodynamic psychotherapists mayprefer less transparency with theirclients to promote the transference rela-tionship and thusmay utilize self-disclo-sure much more sparingly. Williamsimportantly portends the possibility ofethically incorporating SNS usage intoclinical practice in his suggestions for athoughtful and flexible approach toboundaries and self-disclosure. Still, ifclinicians decide to use SNSs profession-ally, they are encouraged to do so onlyafter carefully weighing costs and bene-fits and proceeding with appropriatecaution so that the standards of theAPAEthics Code may be upheld and clients’best interests are addressed.It is, however, important to keep inmind that in the Internet age, manyclients are likely to search for informa-tion about their psychotherapist. Thiswill likely be true regardless of one’s de-cision to participate in SNSs given thatindividuals have been encouraged in re-cent years to become more informedconsumers of services and to bemore ac-tively involved in their care, and thatuse of the Internet for such purposes isprevalent. Psychotherapists should an-ticipate this occurring. In fact, one recentsurvey of consumers found that 80% ofall Internet users have searched forhealth care information online to includeinformation about specific health careprofessionals (Fox, 2005).Cohort EffectsSeasoned ProfessionalsWhile some senior psychotherapistsmay be active online, manymay feel un-affected by the SNS trend in terms of its


influence on their ethical practice byvirtue of the fact that relatively few ofthem participate in online social net-working. Many, although clearly not all,may also be unaware of the pervasive ef-fects of the SNS trend, given that theycame of age in a different time. How-ever, the issue remains an important oneto consider, especially when treatingclients who are active on the Internet.For seasoned professionals, limited fa-miliarity with SNSs may restrict theirability to comprehend the social sub-strate in which many of their clientsfunction, particularly those in the netgeneration. These clients are so-called“digital natives” (Prensky, 2001) in thatthey have been raised in an electronicculture, speaking a digital language thatis foreign to many “digital immigrant”seasoned professionals. Given the wide-spread use of SNSs, it is prudent to ob-tain at least a general awareness of thepurpose, features, and potential risksand benefits of these sites so that we areable to converse with clients and under-stand the world in which they function.

Students and TraineesThe psychology graduate student co-hort is arguably the one within our pro-fession most associated with the SNStrend. They are in a unique position asbudding professionals in the field inthat SNSs are already largely a part oftheir social lives; that is, many traineeswere undergraduates when the socialnetworking craze began and initiallythrived on college campuses (e.g., Face-book was launched in 2004). As such,the next generation of psychologists hasbeen largely immersed in the culture ofonline social networking and likelyhadn’t considered issues of profession-alism in social networking prior to en-tering graduate school. The recentconcern about psychology graduate stu-dents’ lives on the Internet has beenmirrored by similar concerns in themedical (Thompson et al., 2008) andteaching (Carter, Foulger, & Ewbank,2008) professions.

Trainees should very carefully monitorand consider the information they in-clude in their online profiles. While it isnecessary for all practitioners to be cog-nizant of the information they share on-line, many trainees will have developeda profile prior to their involvement inthe field of psychology. For that reason,it is recommended that trainees reviewall material on their profiles in order todetermine its appropriateness andmakealterations as needed. For example, on-line videos, photos, and writings thatseemed very appropriate for an audi-ence of peers when a college sophomoremay not be viewed in the same mannerby graduate school admissions commit-tee members or even by undergraduatefaculty who are asked to write letters ofrecommendation. Then, when in gradu-ate school, one’s online presence mayimpact externship and internship deci-sions. Graduate student psychothera-pists-in-training must also consider thepotential impact of their online presenceon their clients.RecommendationsPsychotherapists should consider all on-line posts they make and profiles theykeep to be self-disclosures, even if pre-cautions are taken by setting privacycontrols on SNSs. Clinicians are encour-aged to remain cognizant of the fact thateven if a given disclosure is not unethi-cal per se, it still may have an impactclinically; that is, anything that is put onthe Internet may influence our profes-sional roles and relationships. Further-more, although the Ethics Code onlytechnically pertains to professional en-deavors, materials placed on the Inter-net for personal relationships cannot bekept completely separate from our pro-fessional roles. Additionally, informa-tion accessed about psychotherapists inour personal lives may impact the pub-lic’s view of us professionally as well.It is recommended that psychotherapistsmaintain professional websites so that

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clients who search for us via the Internetwill access the information shared therethat is of relevance to our professionalroles and activities. Information sharedmay include credentials, trainingexperiences, areas of specialization andpopulations worked with, and relatedprofessional information (Barnett &Hillard, 1999).Always consider themean-ing of “friend” requests from clients in thecontext of their psychotherapy.When ap-propriate, use joint review of the SNSs asa therapeutic activity. That is, if a clienthas invited a psychotherapist to be their“friend” online in order to share personalinformation, photos, or othermedia, sug-gest the option of having the client log onto their profile during session so that theprofile viewing may be done together.This may help ensure a minimal likeli-hood of boundary violations or threatsto trust and guarantees that the onlinecontent may be jointly explored andprocessed in session.Consider the option of prescribing

SNS use to clients to address certainchallenges they may have, either as aprimary intervention or as a supplementto other, more traditional strategies.For example, a client who is strugglingto find a worthwhile career path mayengage in standard career counselingas well as become involved inLinkedIn.com, which is largely devotedto professional development.Teaching professionals should includetheir policy statement on online searchesof applicants and students in their pro-gram materials. Additionally, expecta-tions for student professionalism withregard to their online presence and ac-tivities should be included in studenthandbooks and be reviewed beginningat orientation and reviewed throughouttheir training.Assisting trainees to makethe digital transition from the purelypersonal to the professional is an impor-tant role for supervisors and faculty.


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EDUCATION & TRAININGPrioritizing Case Formulation in Psychotherapy TrainingEugene W. Farber, Ph.D., Emory University, Atlanta

Increasing emphasisrecently has beenplaced on identifyingfoundational and func-tional competenciesfor professional psy-chology practice (forreview, see Rodolfa et

al., 2005). A key purpose for elaboratingthese competencies is to inform the develop-ment of competency-based models for pro-fessional training in psychology (Kaslow,2004). In contributing to the professional di-alogue on this issue, Spruill et al. (2004)identified case formulation among a set ofimportant clinical competencies in interven-tion planning. They characterized compe-tency in case formulation as requiring skillsin integrating information gleaned from theclinical assessment into a conceptual modelof both the clinical problem and pathwaysfor addressing the problem. In their discus-sion of this issue, Spruill et al. also cited therole of clinical supervision in helping psy-chotherapists in training to develop compe-tency in case formulation. Concerns recentlyhave been raised, however, about a relativelack of explicit concentration on the devel-opment of case formulation competencies inpsychotherapy training (Ivey, 2006). Anelectronic search of the psychology literatureusing the keywords “case formulation andpsychotherapy training” yields only 6 arti-cles on this topic. This points to the paucityof professional dialogue on case formulationtraining. As such, there appears to be a needto raise the level of professional discussionon the issue of training in psychotherapycase formulation as part of the overallprocess of psychotherapy training in general.This includes the articulation of trainingstrategies that support development of keycase formulation competencies in psy-chotherapy trainees.

Case Formulation: Definition and Rele-vance to Psychotherapy TrainingPsychotherapy case formulation may be de-fined as “…a hypothesis about the causes,precipitants, and maintaining influences of aperson’s psychological, interpersonal, and be-havioral problems…” (Kendjelic & Eells,2007, p. 66). Teaching systematic case formu-lation strategies affords trainees the opportu-nity to organize their thinking about clinicalmaterial into a coherent plan for psychother-apy intervention. The formulation provides aconceptual framework for understanding theclient, including clinical symptoms, prob-lems, and psychological themes expressed inpsychotherapy. It also informs psychotherapyplanning, including the identification ofthemes that comprise the focus of treatment,the setting of treatment goals, the selection ofpsychotherapy techniques and interventionstrategies, and the management of the psy-chotherapy relationship. Finally, case formu-lation can be invaluable in making sense ofunanticipated and/or clinically complexevents, crises, or problems that arise in thecourse of psychotherapy. The psychotherapisttypically must improvise in responding tothese unpredictable clinical situations (e.g.,Binder, 2004), and having a clearly definedconceptual roadmap can provide a helpful ref-erence point that anchors the psychotherapistin this process. This is particularly valuablefor trainees, where continual and systematicuse of the case formulation as a basis for psy-chotherapeutic decision-making provides theclarity needed to organize a well thought-outresponse to challenging and ambiguous situ-ations arising in the psychotherapy process.Although research on this topic is limited,there are empirical findings supporting theusefulness of formulation-based psychother-apy practice, including the benefits of usingcase formulation in psychotherapy withclinically complex cases (for review, seeKendjelic & Eells, 2007).


Competencies and CaseFormulation TrainingA competencies-based approach can help toinform thinking about the issue of training inpsychotherapy case formulation. In reportinga study showing that expert psychotherapistsdemonstrated superior case formulationswhen compared with novice and experiencedpsychotherapists (Eells, Lombart, Kendjelic,Turner, & Lucas, 2005), the study authors of-fered interpretations in explaining their find-ings that may point to some clues regardingcompetencies in case formulation. For exam-ple, they suggested that experts in their studymight have a particularly well developed ca-pacity to glean a range of patterns from clin-ical data and use this capacity to developcomplex and nuanced formulations. Addi-tionally, the experts appeared to utilize a con-sistent and systematic formulation approachthat may facilitate a deep level of understand-ing of clinical material. The study authorsalso surmised that well developed self-mon-itoring skills also may be of benefit in thecase formulation process.

In describing a specific method for psycho-dynamically focused case formulationtraining, Ivey (2006) identified several com-petencies required for developing good for-mulations. These include skills in observingand describing both verbal and nonverbalbehavior, the ability to elicit a detailed de-scription of the patient’s experience that canbe elaborated into an experiential account ofthe patient’s problems, the capacity to trackthe patient’s perceptions of and relationshipsto self and others, awareness of the patient’sreactions to the psychotherapist, and a suffi-cient grasp of theory, including the capacityto apply it to the case formulation process.

Although not focusing on psychotherapy caseformulation competencies per se, Binder(2004), in a discussion of psychotherapy com-petency as applied to the clinical practice ofbrief dynamic psychotherapy, has describedseveral broad psychotherapy competenciesthat are instructive in thinking about psy-chotherapy case formulation training. Onesuch competency pertains to having a theo-retical framework for understanding personal-

ity functioning and psychotherapy process(Binder, 2004). When training psychothera-pists in case formulation, it is critical that thetrainee learn how to work within a conceptualmodel of psychological functioning and psy-chotherapy process to develop a theoreticallyinformed case formulation of a given clinicalcase. Often trainees experience a discrepancybetween their theoretical knowledge and theircapacity to apply this knowledge in develop-ing a clinically useful case formulation, andgood case formulation training should pro-vide opportunities for trainees to practice in-tegrating their theoretical knowledge withtheir clinical knowledge and skills (Ivey,2006). A second competency outlined byBinder (2004) involves skill in developing thecase formulation itself. To develop this com-petency, the trainee must learn to make effec-tive use of the assessment process and toorganize clinical material obtained throughthe assessment process into a theoretically in-formed and coherent formulation of the prob-lem. This formulation comprises a “story” ofthe problem and the factors sustaining theproblem and suggests a clinical focus thatguides treatment, including pathways to ad-dressing the problem (Binder, 2004). A thirdcompetency articulated by Binder (2004) in-volves the capacity of the psychotherapist toutilize the case formulation in the moment-to-moment unfolding of the psychotherapyprocess.As such, training also needs to focuson developing skills in tracking the treatmentfocus specified by the case formulation overthe course of treatment and to adjust the for-mulation where needed to accommodate newclinical findings over time.

Examples of Case FormulationTraining ApproachesDespite the paucity of written accounts ofsystematic approaches to psychotherapycase formulation training, Ivey (2006) offersa structured model for case formulationtraining for psychology trainees. Althoughpsychodynamic in focus, the general struc-ture of this approach could be applied to theprocess of case formulation training acrossthe spectrum of theoretical perspectives. Thetraining is conducted in a module that in-


cludes weekly sessions held over a 3 monthperiod concurrent with modules on psy-chopathology, psychotherapy, and psycho-logical assessment. Case formulationtraining occurs using an 8-step process. Thefirst step focuses on definitions of case for-mulation and the clinical information do-mains that are relevant to conducting caseformulation. In the second step, trainees areprovided with written case material for prac-tice in constructing a case formulationguided by specific instructions for doing so.Trainees use their practice case formulationin step 3 as a starting point for learning thespecific criteria for what a good case formu-lation looks like. Trainees then are asked toevaluate their practice formulations in accor-dance with these criteria. In step 4, havingalready covered general concepts of case for-mulation, the characteristics that make a for-mulation narrative explicitly psychodynamicare outlined. In step 5, the structure of thecase formulation is explained, including theconceptual elements of the formulation andhow they are synthesized to provide a coher-ent clinical narrative for understanding theproblems and concerns of the client. Thesixth step involves practice in small traininggroups, utilizing the structure outlined in theprevious step to develop case formulationsdrawn from written case material. These for-mulations are discussed and critiqued by thetrainee group. Videotaped clinical materialis provided in step 7 as the basis for furthercase formulation practice. This allowstrainees to expand their repertoire of caseformulation skills by learning to incorporateobservations of the client’s nonverbal behav-ior and patterns of response to the clinician.In the final step, trainees are asked to inte-grate their subjective emotional reactions tothe client observed in videotaped samplesinto their case formulations.

Levenson (1995, 2003) has described an ap-proach to psychotherapy case formulationtraining integrated within a 6-month programof training in time-limited dynamic psy-chotherapy (TLDP; Strupp & Binder, 1984).Levenson’s (1995, 2003) approach includes aweekly didactic seminar and a psychotherapysupervision group. Trainees receive instruction

in the theoretical underpinnings of TLDP andits theoretically grounded template for devel-oping a psychotherapy case formulation. Thistemplate is comprised of model-specific cate-gories of clinical data that can be organizedand synthesized into a narrative conceptual-ization of the case. Trainees also are explicitlyinvited to explore their own feelings and reac-tions to their clients and to incorporate theseexperiences into their case formulations.Trainees develop written case formulations oftheir psychotherapy patients using the TLDPtemplate and utilize these formulations to in-form the development of treatment goals. Thecase formulation and goals are routinely dis-cussed in group supervision as part of eachtrainee’s presentation of videotaped psy-chotherapy sessions, providing opportunitiesfor input from both the supervisor and traineepeers. Trainees are specifically encouraged toreflect on how the case formulation informspsychotherapeutic decision- making and howthe case formulation may evolve or change asnew clinical information emerges.

Kendjelic & Eells (2007) conducted a studyexamining the effects of clinician training inuse of a so-called generic components ap-proach to case formulation. The 4 compo-nents of their case formulation approachincluded symptoms and problems, precipi-tating stressors, predisposing events andconditions, and an inferred mechanism forconveying the psychotherapist’s explanationof patient’s problems. In this study, theTLDP case formulation approach was usedas an example of an inferred mechanism.Clinicians in the training group received a 2hour group presentation on case formulation.The training included discussion of why caseformulation is important, and introduced the4 generic components comprising the caseformulation approach. Factors contributingto the quality of a case formulation also werediscussed, and participants had an opportu-nity to practice the case formulation methodusing a sample vignette. Study resultsshowed that even with as little as 2 hours oftraining, clinicians in the training group pro-duced higher quality case formulations thanclinicians in the control group.

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Conclusions: Toward Increasing Dialogueon Case Formulation TrainingThe value of case formulation for psycho-therapy planning and intervention is widelyacknowledged across a spectrum ofpsychotherapy orientations (Eells, 2007).Recent empirical research underlines theusefulness of systematic training in methodsof psychotherapy case formulation (Kend-jelic & Eells, 2007). Given the importanceof good case formulation skills to psycho-therapy practice, the issue of how best to ap-

proach training in psychotherapy case for-mulation warrants further discussion. Thisdiscussion should include consideration of thekey competencies to be included in case for-mulation training and elaboration of methodsto systematically develop these competencies.Approaches to evaluating the effectivenessof trainingmethods in psychotherapy case for-mulation also should be considered.


CONGRATULATIONS TO OUR AWARD WINNERS!Distinguished Psychologist Award for Contri-butions to Psychology and Psychotherapy: TheDistinguished Psychologist Award is based onsignificance of contributions to the practice,research, and/or training in psychotherapy.The 2009 award is presented jointly to NorineJohnson, Ph.D and Jon Carlson Ed.D., in recog-nition of their outstanding accomplishmentsand significant lifetime contributions to the fieldof psychotherapyAmerican Psychological FoundationDivision of PsychotherapyEarly Career Award is presented to Katherine Muller, Psy.D.for distinguished early career contributions to the field ofpsychotherapy and the Division of Psychotherapy.

The Division of Psychotherapy Award for Best EmpiricalResearch Article in 2008 is presented to: Michelle Newman,Louis Castonguay, Thomas D. Borkovec, Aaron J. Fisher, &Samuel S. Nordberg. (2008). An open trial of integrative therapyfor generalized anxiety disorder. Psychotherapy: Theory, Research,Practice, Training, 45, 135-147

The Division of Psychotherapy Award for DistinguishedContributions to Teaching andMentoring,which is presentedin its inaugural year to Marvin Goldfried, Ph.D. in recognitionof his significant contributions to the field of psychotherapythrough his impact on the lives of developing psychologists intheir careers as psychotherapists

The Division is also pleased to announce the followingstudent paper ward winner:

Mathilda B. Canter Education and Training Student Awardpresented to Sarah M. Gates

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Within the past severaldecades, there has beenan increasing interest inpsychotherapy integra-tion, with several arti-cles on this topichaving recently ap-

peared in this newsletter. In writing stillanother article on psychotherapy inte-gration, my goal here is to provide a pre-diction about where it may be headingin the future. Although it is very risky topredict the future, I am taking that riskbecause of a number of convergingforces within the field that point to alikely direction.

A Bit of HistoryWhen the Society for the Exploration ofPsychotherapy Integration (SEPI) wasfounded in 1983, the goals were twofold:(1) the integration of the different ap-proaches to therapy, analyzing thepoints of similarity and differencesamong them, and (2) the integration ofresearch and practice. Since that time,the vast majority of work has dealt withthe first goal, which no doubt resulted increating a zeitgeist that is now more fa-vorable to the concept of psychotherapyintegration than it was over two decadesago. However, relatively little attentionhas been devoted to the second goal: theintegration of practice and research. Iwould suggest that the future of psy-chotherapy integration lies with the suc-cessful pursuit of this goal.

Although most of the work on integra-tion has involved a focus on consideringthe similarities and differences amongvarious theoretical orientations and theirprocedures, there nonetheless have beena number of workers in the field who

suggested that, in the final analysis, itwas the empirical approach to integra-tion that was most important (see Nor-cross & Goldfried, 2005). As early as the1950s, Frederich Thorne, a psychiatrist,commented that the practice of psy-chotherapy was very different fromwhat he learned in medical school,which emphasized empirically basedprinciples of bodily functioning as theguide to clinical practice, not theoreticalorientation. Several other therapists andresearchers over the years similarly ar-gued that psychotherapy integrationshould be based on empiricism, such asthe contributions of Beutler, Garfieldand Lazarus. Most recently, Castonguayand Beutler (2006) edited an importantvolume that specified empirically basedprinciples of change that were relevantfor dealing with various clinical prob-lems—regardless of one’s theoretical ori-entation.

The Strained Alliance betweenClinician and ResearcherAs is well known to readers of thisnewsletter, there has been a long-stand-ing strain in the alliance between clini-cians and researchers. Living in twodifferent professional worlds, membersof each group have tended to favor theirown approach to understanding humanbehavior and the therapeutic changeprocess—often going so far as to deni-grate the contribution of the other. Re-searchers have complained thatclinicians do not read the literature,while clinicians have argued that the lit-erature has little to say about their clini-cal practice.As recently noted by Kazdin(2008):

PERSPECTIVES ON PSYCHOTHERAPY INTEGRATIONMaking Evidence-Based Practice Work:The Future of Psychotherapy IntegrationMarvin R. Goldfried, Ph.D., Stony Brook University


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A frequently voiced and enduringconcern is that key conditions andcharacteristics of treatment research(e.g., therapists, patients, treatments,and contexts) depart markedly fromthose in clinical practice and bring intoquestion how andwhether to generalizethe results to practice (p. 147).Together with Barry Wolfe—who spent22 years of his career funding psy-chotherapy and research as a staff mem-ber of the NIMH—I have argued thatalthough randomized clinical trials canprovide us with important evidenceabout the efficacy of different therapyprocedures, many of the methodologicalconstraints associated with the researchoften undermine the clinical validity ofthe findings (Goldfried & Wolfe, 1996).Thus, unlike what occurs in controlledclinical trials, the practice of therapyoften involves more complex clinicalcases, and is not constrained by a treat-ment manual.

As a result of the lively controversy overempirically support treatments in the lit-erature, we happily seem to havemovedin the direction of recognizing that bothresearchers and clinicians have some-thing to offer. Acknowledging the limi-tations of simply identifying empiricallysupported treatments, the APA Presi-dential Task Force on Evidence-BasedPractice (American Psychological Asso-ciation, 2006) made it clear that random-ized clinical trials represent only oneapproach for providing empirical evi-dence that can inform clinical practice.Findings from other forms of research,such as basic research on the variablesassociated with various clinical disor-ders, as well as the findings on theprocess of change, are all most relevant.Moreover, the task force has under-scored the very important role of the cli-nician, defining evidence-based practicemuch more broadly than simply thepresence of research findings. What theyhave emphasized is the central role that

clinical expertise plays in implementingspecific intervention procedures or prin-ciples of change. Thus what has beenopenly acknowledged is what we allhave known to be true, namely thatwhen it comes to doing effective ther-apy, a competent clinician is alsoneeded. Indeed, whether we are re-searchers or clinicians, when we need toselect a physician to perform a compli-cated medical procedure, we are carefulto select someone who not only is awareof the state of the art, but also who is ex-perienced and competent.

To stay with the medical analogy a bitlonger, consider the interplay betweenresearch and practice in medicine. Cer-tainly in the area of pharmacology, evenwhen a drug has been approved by theFDA after a careful analysis of researchfindings, it nonetheless is subjected toclinical scrutiny. Physicians routinely fileincident reports, indicating some of theadverse effects of the drug that were notdetected during the research trials. Thisalso occurs in other aspects of medicine,such as recent clinical findings by ortho-pedic surgeons that certain approvedhip replacement parts have resulted inproblematic clinical findings. Thus, de-spite the tension that also exists betweenmedical researchers and practitioners,there nonetheless exists a two-waybridge, whereby each may inform theother.

Building a Two-Way Bridge BetweenPsychotherapy Practice and ResearchIn considering the relationship betweenpsychotherapy practice and research, itis possible to view clinical work as pro-viding us with the context of discovery.Working with clients directly and dis-cussing clinical cases with superviseesand colleagues presents the practitionerwith the challenge of translating generalresearch findings and clinical experienceso that they can be applied to the indi-


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vidual case at hand. It also affords theclinician with the opportunity of wit-nessing firsthand the ever-varying pa-rameters of human behavior and thepsychotherapy change process. In ourroles as clinicians, we can generate clini-cal hypotheses that may be studiedunder better-controlled research condi-tions, designed to verify what had beenobserved clinically. The findings fromsuch research—the context of verifica-tion—can then, in turn, readily be fedback to the clinical community.As of January 2010, I will assume therole of President of Division 12—theSociety of Clinical Psychology. The pres-idential initiative that I will be undertak-ing consists of a life-long desire to builda two-way bridge between practice andresearch. Taking the lead frommedicine,which has such a bridge, my goal is toestablish a mechanism whereby thera-pists can provide feedback to re-searchers about the successes andfailures in their attempts to apply empir-ically supported treatments in clinicalpractice. Exactly how this will be done,and what the mechanism will look like,is still in the developmental stage. For-tunately, I have a group of experienced,motivated and enthusiastic researchersand practitioners who similarly havehad an ongoing dedication to closing thegap between practice and research. Thisis a standing committee of Division 12,and includes Louis G. Castonguay (Pres-ident-Elect of the Society for Psychother-apy Research); Marvin R. Goldfried(Past-President of the Society for Psy-chotherapy Research and President-Elect of Division 12 as of 2009); Jeffrey J.Magnavita (President-Elect of Division29 as of 2009); Michelle G. Newman(psychotherapy researcher with expert-ise in anxiety disorders); Linda Sobell(Past-President of Division 12); andAbrahamW.Wolf (Past-President of Di-vision 29). In addition to their motiva-tion and interest, members of this grouphave had ongoing experience in work-

ing to close the gap between practition-ers and researchers, such as Cas-tonguay’s role as Co-Chair of theNational Research Practice Network;Goldfried’s founding of the journal InSession, which includes research reviewswritten for the practicing clinician; Mag-navita and Newman serving as GuestEditors for this journal; Sobell’s collabo-ration with therapists in designing atherapy manual and research protocolfor the treatment of substance abuse (So-bell, 1996); andWolf’s professional ded-ication to fulfilling the model of thescientist-practitioner.Our objective is to set up a mechanismfor providing feedback to researchers,piloting this mechanism with one clini-cal problem for which an empiricallysupported treatment has been identi-fied. We decided that a clinical problemthat has received favorable research ev-idence, and one that occurs frequently inclinical practice, would be panic disorder.Despite the fact that there has been ex-tensive research on the treatment ofpanic, we believe that there is still muchthat can be learned from the clinicianstreating such patients. Although all ther-apists who have experience with thisclinical problem would have much tooffer, we decided to focus on the use ofan intervention that has received empiri-cal support—cognitive-behavior therapy.There is a promising psychodynamictreatment for panic currently under in-vestigation, but it has yet to haveachieved empirically supported status(Milrod, et al., 2007). Starting with infor-mal interviewswith practicing cliniciansthat make use of such cognitive-behav-ioral interventions with this population,we hope to be able to identify those pa-tient, therapist, treatment, and contex-tual variables that are likely to influencethe clinical effectiveness of the empiri-cally supported treatment in actual prac-tice. With this information on hand, wewill thenmove on to apply this feedback


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procedure on a broader scale.

We believe that this initiative can pro-vide an approach where everyone bene-fits—the clinician, the researcher, andcertainly the client. It is our hope thatthis will afford the clinician with an op-portunity to provide invaluable infor-mation for future research. For theresearcher, it provides them with re-searchable—and hopefully fundable—hypotheses for research that is born outof clinical practice.

How does this all tie in to psychother-apy integration?A friendwho is a physi-cian once characterized psychotherapyas “an infant science,” where what wedo is based more on theory than evi-dence. In order for our field to mature,we need to move beyond theoreticalschools of thought and base what we doclinically on available and research find-ings that also have been shown to workin clinical practice. As I have suggestedin the past:Although varying theoretical orienta-tions have clearly been useful in helpingus to develop a wide variety of thera-peutic procedures, we see a need tomake greater use of what actually goeson clinically as a way of generating fruit-ful research hypotheses. Without such

close links between clinician and re-searcher, we face the danger of our the-ory and research becoming too farremoved from the clinical foundationsof our generalizations (Goldfried &Padawer, 1982, p. 41).

With psychotherapy in general respond-ing to pressures for accountability, evi-dence-based practice is likely to be thedriving force for how therapy is con-ducted in the future. For it to be imple-mented in an empirically and clinicallysophisticated way, the collaborative ef-forts of researcher and practitioner areessential. More than ever before, this col-laboration needs to become the organiz-ing theme for integration. It is for thisreason that I would suggest that empir-ical pragmatism—based on the converg-ing evidence obtained from research andpractice—not theory, will be the integra-tive theme of the 21st century.

Author NoteCorrespondence regarding this articlecan be addressed to Marvin R. Gold-fried, Department of Psychology, StonyBrook University, Stony Brook, NY,11794-2500. Electronic mail can be sentto: [email protected]


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NOTICE TO READERS

Please find the references for the articlesin this Bulletin posted on our website:

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THURSDAY, AUGUST 6thExistential Humanistic Therapy Comes of Age (Symposium)8:00 AM – 9:50 AM • Metro Toronto Convention Centre – Meeting Room 202CChair: Kirk J. Schneider, PhDParticipant/1st AuthorAlexander Bacher, MA Pernilla Nathan, MAStacie L. Cooper, MA Orah T. Krug, PhDDave Fischer, MA Kirk J. Schneider, PhD

Two Viewpoints on Future Directions for Alliance Theory (Symposium)10:00 AM – 10:50 AM • Metro Toronto Convention Centre – Meeting Room 203AChair: Robert L. Hatcher, PhDParticipant/1stAuthorRobert L. Hatcher, PhD Adam O. Horvath, EdD

Process and Outcome in CBT: The Importance ofCognitive Errors and Coping (Symposium)10:00 AM – 11:50 AM • Metro Toronto Convention Centre – Meeting Room 206AChair: Martin Drapeau, PhD, MAParticipant/1stAuthorDeborah Schwartzman, BA Jesse Renaud, MAMartin Drapeau, PhD, MA Debora D’Iuso, MA

Getting Real in Psychotherapy Explorations ofthe Real Relationship (Symposium)12:00 PM – 12:50 PM • Metro Toronto Convention Centre – Meeting Room 205AChair: Charles J. Gelso, PhDParticipant/1stAuthorCharles J. Gelso, PhDCheri L. Marmarosh, PhDDiscussant: Jeanne Watson, PhD

What We Wish We Had Known: Tips for Future Psychotherapists(Symposium)1:00 PM – 2:50 PM • Metro Toronto Convention Centre – Meeting Room 103AChair: Elizabeth Nutt Williams, PhDParticipant/1stAuthorAli M. Mattu, MA Norine G. Johnson, PhDJeffrey Zimmerman, PhD Jean A. Carter, PhD

Using a Training Center Database to Promote Science and Practice(Symposium)3:00 PM – 3:50 PM • Metro Toronto Convention Centre – Meeting Room 714AChair: Cynthia E. GliddenTracey, PhDParticipant/1stAuthorBrian Garbarini, MEdCharles C. Claiborn, PhDJessica E. Rohlfing, MA

DIVISION 29 ~ 2009 APA PROGRAM

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FRIDAY AUGUST 7thThe Art and Science of Impact: What Psychotherapists Can Learn FromFilmmakers and Social Psychologists (Symposium)8:00 AM – 9:50 AM • Metro Toronto Convention Centre – Meeting Room 713AChair: Jeffrey K. Zeig, PhDParticipant/1stAuthorJeffrey K. Zeig, PhDPatricia RozemaDiscussant: Lee D. Ross, PhD

Poster Session: Research in Psychotherapy12:00 PM – 12:50 PM • Metro Toronto Convention Centre – Exhibit Halls D & EParticipant/1st Author ____Kathleen R. Bhogal, MAFaye Mishna, PhDMichael Basseches, PhDDaniel L. Hoffman, MAGeneviève Bourdeau, BSJames M. Yokley, PhDCarey A. Heller, BAJennifer Grote, MAJulie R. Ancis, PhD, MSJoana Coutinho, PsyDNathaniel Thorn, BAShawn J. Harrington, BAAllen K. Hess, PhDMari Yoshikawa, EdDGrazyna T. Kusmierska, MARebecca S. Klinger, MSSaunia S. Ahmad, MA

Symposium (S):Eminent Psychotherapists Revealed Audiovisual Presentation ofPrinciples of Psychotherapy2:00 PM – 3:50 PM • Metro Toronto Convention Centre – Meeting Room 801AChair: Jeffrey J. Magnavita, PhDParticipant/1stAuthor ____Jeffrey J. Magnavita, PhD Hanna Levenson, PhDJay Lebow, PhD Judith S. Beck, PhDDiscussant: Nadine J. Kaslow, PhD

Business Meeting5:00 PM – 5:50 PM

Fairmont Royal York Hotel – Territories Room

Social Hour6:00 PM – 6:50 PM

Fairmont Royal York Hotel – Salon B

Robert J. Reese, PhDRebecca E. Sachs, MAToni J. Welsh, MAZita Sousa, MAJennifer R. Henretty, MSPatricia A. Rupert, PhDStephanie A. Wiebe, BAJessica E. Lambert, PhDSally M. Hage, PhD, MTSEnnio Ammendola, MADenise H. Bike, MSErin Olufs, BSAdam O. Horvath, EdDArlene J. Simpson, BAKC L. Collins, BANancy L. Murdock, PhD

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SATURDAY AUGUST 8thPsychotherapist Expertise Developing Wisdom toGuide Theory, Research, and Practice (Symposium)9:00 AM – 9:50 AM • Metro Toronto Convention Centre – Meeting Room 802BChair : Allen K. Hess, PhDParticipant/1stAuthorRobert M. Leve, PhDLeonard Greenberg, PhDBarbara Schwartz, PhDC. Alexander Simpkins, PhDTanya H. Hess, PhDDiscussantCarol Falender, PhDEdward P. Shafranske, PhD

Conversation Hour: Lunch With the Masters forGraduate Students and Early Career Psychologists12:00 PM – 1:50 PMFairmont Royal York HotelQuebec Room

Mistakes in Psychotherapy Yielding Power, ConstrainingDialogue, and Nurturing Envy (Symposium)2:00 PM – 2:50 PMFairmont Royal York Hotel British Columbia RoomChair: Randolph Pipes, PhDParticipant/1stAuthorRandolph Pipes, PhDAnnette S. Kluck, PhDCaroline Burke, PhDDiscussant: John Dagley, PhD

CWC/Evidence-Based Practice Using Evidence-Based Principles toOptimize Clinical Process and Outcome With Personality Disorders(Symposium)3:00 PM – 4:50 PMMetro Toronto Convention CentreMeeting Room 714AParticipant/1stAuthorJeffrey J. Magnavita, PhDKenneth L. Critchfield, PhD

SUNDAY, AUGUST 9thSchema Therapy for BPD Breakthrough: Treatment forImproving Life Functioning (Symposium)9:00 AM – 10:50 AMMetro Toronto Convention CentreMeeting Room 712Chair: Joan M. Farrell, PhDParticipant/1stAuthorArnoud Arntz, PhDGeorge Lockwood, PhDIda A. Shaw, MAMichael Webber, MDDiscussantJeffrey Young, PhD

Affect Phobia Treatment Approach: Two New Pathways to Change(Symposium)11:00 AM – 11:50 AMMetro Toronto Convention CentreMeeting Room 706Chair: Stuart Andrews, PhDParticipant/1stAuthorStuart Andrews, PhDKristin A.R. Osborn, MAManeet Bhatia, MADiscussantAllen Kalpin, MD

Culturally Informed Interventions With Ethnically Diverse Populations(Symposium)12:00 PM – 1:50 PMMetro Toronto Convention CentreMeeting Room 202AChair: Chaundrissa Oyeshiku Smith, PhDParticipant/1stAuthorGuillermo Bernal, PhDAsha Z. Ivey, PhDFrederick T.L. Leong, PhDKafi S. Bethea, BAJoseph E. Trimble, PhDDiscussantNadine J. Kaslow, PhD

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EARLY CAREERBuilding a Private Practice by Being Public:From Social Networking Circles to Psychotherapy GroupsRenee Hoekstra, Psy.D., Private Practice, Boston, MA

It Starts withYour StrengthsWhat now? My post-doc had ended, I hadno job, and I had livedin four different statesin order to completea master’s degree, a

doctorate degree, a pre-doctoral intern-ship, and a post-doctoral fellowship. Tothis end I found myself living in Bostonwith a determination to get licensed andto stop moving across the universe. Iwasn’t looking for the 9-5 grind, Iwanted autonomy and creativity in myclinical work, and I wanted to earn rea-sonable money. I had heard enough peo-ple complain about poor startingsalaries in hospital positions. I was notinterested in the responsibilities in-volved in administration or supervision,and I wanted the majority of my workto be direct clinical services. The onething that I wanted to do for sure was tolead psychotherapy groups.

Shortly after obtainingmy license, I tookout a calculator and figured that I couldmake more than my post-doc salary if Iconducted two psychotherapy groups aweek. The question was: Given that Iknew nothing about running my ownpractice or being in business for myself,how exactly was this going to happen?

Despite being here for one post-doctor-ate year, I still barely knew anyone inBoston; let alone how to get from Ja-maica Plain to Somerville without aGPS! I needed a job, a professional com-munity, and an opportunity to connectand establish myself as a professional.Boston was a huge city with many re-cent transplants. I wondered: Who else

was in this situation? Was anyone start-ing his or her own practice? Who elsewanted their own practice, but felt as ifthey had no idea where to go?And whoelse has been successful in starting apractice and would be willing to let mepick their brain?Inspiration from Revolve Nation’sBoston Entrepreneur GroupTwo weeks after I passed the Examina-tion for Professional Practice in Psychol-ogy (EPPP), I went to a meetup groupfor entrepreneurs. It was the business-networking world that I knew nothingabout, and I went not only for the social-izing, but also because I was thinkingabout selling my watercolor artwork. Iwas gently encouraged to come back. Istarted to think about the possibility ofbusiness networking, which led to moreideas about starting my practice, whichled to ideas about networking withhealthcare providers, which led tothe current brainstorms and flurry ofactivity that followed over the last year.I started joining list-serves and lookingfor books and articles about starting apractice. I dug upmypsychology of busi-ness class material and started poringthrough it. I tentatively proposed a studygroup on various list-serves, which led tomeeting other psychologists. I selected abook: Financial Success in Mental HealthPractice (Walfish & Barnett, 2009) andproposed to the online community astudy group with weekly meetings toread, discuss, and plan assignments thatmoved people in the direction of theirown practice. I established a mission forthe study group:• To help early career psychologists


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build and establish their own privatepractices

• To learn together the relevant aspectsof the business of psychology

• To decrease our vulnerability to pub-lic and private organizations inter-ested in hiring psychologists

• To decrease our vulnerability to poorpay

• To establish and generate goals andstrengths, and to be able to utilizethese in a marketable way

• To develop peer consultation, net-working groups, and the support andresources of other early career psy-chologists

• To locate available resources whenwe lack answers or have furtherquestions

I postedmymission on various list-servesand started to establish a following.The authors of Financial Success in Men-tal Health Practice contacted me and of-fered to answer questions via e-mailbetween our study groups. I began cre-ating assignments, such as developingmission statements for our practices,working on website and marketingplans, and generating and finding re-sources for ourselves.Fits and StartsDespite my involvement with theworthwhile early career activities above,I still did not have a job. I had been inter-viewing intermittently while studyingfor licensure, but nothing yet had cometo fruition. However, accessing re-sources, talking to psychologists, andreading the list-serves providedmewithimportant insight during my job search.For example, I had a firm grasp on thepros and cons of joining group practices.One narrative stood out to me- psychol-ogists in group practices were losingmoney that they could be retaining if ontheir own. Thus, I started calculating thecosts of starting out on my own and thepossible means to achieve this end.

I continued to attend the weekly meet-up groups hosted by the entrepreneuriallaw firm—the first to not bill by thehour. They served wine and cheese andwere attended by a range of businessprofessionals ranging from CEO’s to in-terested college students. People thereprovided a sense of business-mindedmentorship and had a plethora of re-sources I wouldn’t have known whereto find elsewhere. I met someone whoagreed to help me with a business plan.I started to think seriously about my el-evator speech and the audience of non-mental health professionals. I started tolisten to advice and feedback about mar-keting and business.

I also decided to host an EPPP forum forpost-docs. I rounded up recently li-censed psychologists to talk about the li-censure application process, studyingfor the EPPP, and the jurisprudenceexam.My state association offered officespace, and the rest was a matter of tap-ping the relevant list-serves. I e-mailedall of the post-doctoral training directorslisted onmy state association website, aswell as the EPPP and early career list-serves. This was popular. I felt as if I hadfound an unmet need in the communityand had been able to reach that need. Istarted to think about this as an experi-mental step in marketing, and I felt likeit was an additional way of being con-nected to early career psychologists.

My business of psychology class profes-sor had done something clever that I at-tempted to replicate: she brought inbusiness-related persons to our class.This not only allowed them to markettheir services, but also allowed her tomaintain her relationships with the busi-ness community. I started to think aboutthe various business-related personswho might be interested in fulfilling aneed for early career psychologists, andI started to put together workshops for


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early career and private practice-inter-ested psychologists. Early in my en-deavors, I was contacted by anotherearly career psychologist and encour-aged to apply for the early career schol-arship to attend the AmericanPsychological Association (APA) Lead-ership Convention. My state associationnominated me to the Early Career Psy-chologist Committee and I was grantedthe scholarship.

Connecting and IncludingCommunityI wanted to continue to give people achance to socialize and network, and Icontinued to have an interest in connect-ing recent post-doctoral transplants whohad similar confusion about drivingaround the Boston-cow-paths-turned-into-roads. My many transitions to getthrough graduate school had left withme several family-less holidays, and Ioften thought about hosting Thanksgiv-ing dinner for all the family-less post-docs and interns.

I started to host social hours, which pro-vided the opportunity for psychologistswhowere not interested in clinical workor private practice to connect and join.Through my social networking I foundsomeone with a space big enough tohost potlucks. I was also contacted bysenior psychologists, people interestedin hiring psychologists, and persons in-terested in mentorship. I was offered ajob shortly after hosting a social hour. Ialso offered to cross post job offers to dif-ferent list-serves and connect job-seekerswith job-finders.

Through all my efforts, I have been im-mensely rewarded and enriched in a va-riety of ways that I never anticipated atthe outset. The more I offered to host ac-tivities and spread the word, the more Iwas put into contact with persons whocould help me build my practice. Peoplebecame interested in me and my pur-suits. I found a diverse array of mentors,

both formal and informal. I met peoplewho were a few years down the roadfrom me and found out what they weredoing and how they were doing it. Peo-ple started asking me about taking ondifferent leadership roles. People startedto e-mail me and ask about job leads andother resources. I reflect back on the ad-vice of a psychologist I met in graduateschool, who stated that she made the ef-fort to meet someone connected to thefield of psychology for lunch at leastonce a week.

I was licensed in October of last year. Ihad a few false starts with jobs, butfound office space to sublet and got mywebsite up by April of this year. I wasoffered a job in a group practice in a dif-ferent geographical area than my ownpractice. The offer came from someonewho was clearly impressed with myearly career endeavors and receptive tothe idea of starting on my own at thesame time.

Practical AspectsI found someone to develop mywebsitefor a very reasonable rate. I found outhow easy it was to sublet office space fora few hours a week. I found a businessplanner who got me started with finan-cial bookkeeping software and devel-oped my own personal profit and lossstatement. I solicited feedback about mywebsite from various parties beforegoing live, and I created my own art-work to communicate my interest inpsychotherapy groups. I distributed var-ious mailings and found ways in whichpeople advertise services in the Bostonarea. I tried to meet people for lunchwhenever possible. I contacted peopleproviding Dialectical Behavioral Ther-apy (DBT), as well as group psychother-apy, and I joined the Northeast SocietyGroup Psychotherapy and presented attheir conference. I signed up to teach aclass through the Boston community


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college for adult education.

A Lot of WorkLike starting groups in private practice,starting the early career efforts wasn’t al-ways easy. Some things were not alwayswell attended, but I continue to committo doing them and meet new peopleevery time I host an event. I get what Ican out of what I do and continue to gofrom there.The client referrals are starting to tricklein. My business planner tells me that 4-5 phone calls a week is good news forsomeone just starting out. I get impa-tient, but people say that all my workwill pay off shortly. Someone recentlywas incredulous that I actually thoughtI might not get referrals. I panic some-times at the thought of getting flooded,and people say that private practice hasits ebbs and flows. I’ve almost gotenough people to start a DBT group, andI’m starting to get inquiries about indi-vidual clients. I’ve got a mixed bag withthe insurance: I’m not able to take it be-cause most insurance companies dis-criminate against recently licensedpsychologists. Although there is someroom for negotiation, I’ve gotten a widerange of feedback and perspectives fromprivate practice individuals who bothendorse and hate insurance companies.It’s a lot to think about. But I’ve workedvery hard to get to where I am today andam determined to generate revenue thatreflects that.AWays to GoWhile I haven’t yet climbed the ladderto financial freedom (although I’ve cer-tainly met my share of financial plan-ners!), the groundwork is being laid. I’m

not going to stop the social networkinganytime soon. I’m getting aroundBoston and I’m meeting people, and Ifeel more connected than I did before. Iknow people who work with autisticspectrum disorders, provide group ther-apy for substance abuse, work with deafchildren, and specialize in medical hyp-nosis and sexual pain disorders. And thebest part is that I could probably find areferral for a specific concern if I did alittle searching.

I’m having fun being the center of all theattention. The good news is that there isalways room for entrepreneurship andcreativity, and if people are willing to in-vest the energy they can create their ownearly career networking circles. I did. I’mmaking this up as I go along, and this ismy story of what’s happened as a result.And I’m certainly receptive to a helpinghand if a helping hand shows up.

I believe that if nothing else, Bostonearly career psychologists should havethe opportunity to socialize and net-work from time to time. I’m currentlyworking on establishing a “Welcome toBoston” social hour for incoming psy-chology interns and post-docs in Sep-tember of 2009. If you’ve never beenhere, I’ll teach you how to say things like“pahk” and “nor’easter” and tell youabout the pros and cons of buying aGPS. If interested in this or any of myother endeavors, you can check out mywebsite at www.bostondbtgroups.comor get in touch with me at [email protected].


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FEATURE2009 Presidential Summit on the Future of PsychologyPractice: Collaborating for ChangeJames H. Bray, APA President,Department of Family &Community Medicine BaylorCollege of MedicineCarol Goodheart, APA President-Elect, Independent Practice,Princeton, New JerseyMargaret Heldring, IndependentPractice, Seattle, Washington

When you bring 150leaders from psy-chology, business,consumer groups,economics, insurance,medicine, and politicstogether to transformthe practice of psy-chology, what do youget? The PresidentialSummit on the Futureof Psychology Practice,held May 14-17, in SanAntonio, Texas, was atransforming event tomove the practice ofpsychology forward inthe 21st century. Withadvances in neuro-science, genetics, col-laborative health careand international busi-

ness opportunities, psychology is morerelevant than ever and the summit illu-minatedmany new possibilities for psy-chology practice.

Division 29 was well represented at theSummit with two division delegates(Nadine Kaslow and Jeff Magnitva) anda number of invited psychologists (JeanCarter, Armand Cerbone, Pat DeLeon,Jennifer Kelly, Michael Murphy). The

Summit was supported by a financialcontribution from the division.Jeffrey Magnavita summed up hisexperience this way: “It was awesome,inspiring, frustrating, challenging, gen-erative and hopeful.” The recommenda-tions from the Summit need to beimplemented to make a real difference.The Summit is part of the 2009 Presiden-tial Initiative on the Future of PsychologyPractice. The Task Force (working since2008) and Summit are collaborative ef-forts and opportunities for strategicthinking about our future. JamesH. Bray,APA President, Carol Goodheart, APAPresident-elect and Margaret Heldringchair the Task Force that also includesRobert Gresen, Gary Hawley, TammyHughes, Jennifer Kelly, Jana Martin,Susan McDaniel, Thomas McNeese, andEmil Rodolfa; Sandra Shullman, JoanBrannick, and William Strickland areconsultants to the Task Force on organi-zational psychology issues.The Task Force is staffed by KatherineNordal, Randy Phelps, Joan Freund, andBeth Nichols-Howarth of the PracticeDirectorate. Cynthia Belar, executive di-rector of the Education Directorate, alsocontributed to the Task Force.


The Summit’s goal was to engage thebroader practice community in anagenda- and priority-setting meeting toinform the work of the APAPractice Di-rectorate and the APA Practice Organi-zation. We assembled leaders in thepractice of psychology and related pro-fessionals from other practice associa-tions, government entities, trainingorganizations, consumers, insurers, andbusinesses to identify:• Opportunities for future practice tomeet the needs of a diverse public.

• Priorities for psychologist practition-ers in private and public settings.

• Resources needed to address the pri-orities effectively.

• Partnerships and roles to implementthe priorities.

The Summit was a vehicle for considera-tion of new forms, settings and partner-ships for psychological practice;expanded thinking about practice trends;and conceptualizations of practice thatcross traditional lines. The Task Forcewilluse the findings from the Summit to de-velop clear recommendations for our di-verse practice community.There were a number of outstandingkeynote addresses. Day 1 included athought provoking talk by Dr. Ian Mor-rison, a futurist, who discussed howbusinesses change. Morrison stated thatin every business there are two curves:in the first, you already do well and feelcomfortable, but the second is a newway of doing things that is dramaticallydifferent from the first. To succeed, youhave to manage both curves—keepdoing what works while developingnew opportunities. Dr. Norman Ander-son addressed health disparities and theimportance of overcoming them in ourfuture work. We had a wonderful talkafter dinner by Ann McDaniel, vice-president of the Washington Post Com-panies, who gave an update on theObama administration and plans forhealth care reform.

Day 2 included a talk by health econo-mist Richard Frank, on the changes infunding for health and mental healthcare. He pointed out that while healthcare costs as a percentage of the GNPhave increased over the past 20 years,mental health care costs have stayed sta-ble as a percentage of the GNP. In addi-tion, there has been an increase in theuse of psychotropic medications, byboth psychiatrists and other physicians,while payments for psychotherapy havedeclined. This is a strong reason for psy-chology to continue to fight for prescrip-tive authority.Physician Tillman Farley spoke about hismodel of integrated community healthcare that places behavioral healthsquarely in the primary caremodel. JanetReingold, media and marketing expert,discussed how to brand the professionand distinguish psychology from otherdisciplines. OnDay 3 Elizabeth Gibson, aconsulting psychologist, described howshe helped transform Best Buy from abankrupt company to a leading retailerinAmerica. The principles she describedare applicable to transforming the profes-sion of psychology.The real work of the Summit occurred insmall work groups. The work groupswere urged to think big and outside thebox. Work groups addressed questionssuch as:• What are priorities for our con-stituents?

• What are the pathways to get there?• What partners should we develop?• What are the economic challengesthat present future opportunities?

• What will be the impact of cross-cut-ting changes in the future of psychol-ogy practice in regards to diversity,science & technology developments,and partnerships?

Here are some of the issues thatemerged at the summit, especially in


light of national health care reform:Practitioners are still being trained forthe “first curve”— traditional practice.To thrive in the future, psychologistswill need to redefine training and takeadvantages of new practice opportuni-ties outside of traditional psychotherapypractice. That doesn’t mean foregoingall the wonderful ways psychologistsare currently trained, but it does meanadding new elements, skills, embracingbest practices and getting interdiscipli-nary training.The need to collaborate in primarycare.As Summit speaker Frank DeGruysaid, “Mental health care cannot be di-vorced from primary medical care, andall attempts to do so are doomed to fail-ure.” It is becoming increasingly clearthat health-care reform will include agreater emphasis on primary care andprevention of chronic disease. These areboth areas that psychologists can makemajor contributions. This will requirethat we partner and practice with pri-mary-care physicians and nurse practi-tioners. Most practicing psychologistshave not been trained to work in thesesettings and in the busy style of pri-mary-care medicine. It is one of our fu-ture practice opportunities.The need to be accountable. Whetherwe like it or not, there are changes inhealth care payments and reimburse-ments that require practitioners todemonstrate accountability for theirwork. This was a clear message from theinsurance, business and legislative del-egates at the summit. We have the op-portunity to define how we should beevaluated by developing our own psy-chology treatment guidelines andmeth-ods to assess our work. Psychiatry hasdone this. Their guidelines are used bythe insurance industry to determinetreatment and reimbursements. Accord-ing to the summit’s insurance and leg-islative delegates, there are not any forpsychotherapy and psychological serv-

ices. We have long resisted developingthese guidelines, but the time has cometo define psychological treatment prac-tices, or others will do it for us.Health promotion and prevention. Thefocus on primary care also opens oppor-tunities for prevention of health prob-lems and enhancing the health of ourpopulation. Many chronic health prob-lems, such as diabetes, hypertension,obesity, are caused by psychosocial andlife-style problems. Psychologists havemuch to offer to prevent these problemsand help people better manage theirchronic health problems.Creating and nurturing partners forchange. One of the innovations of theSummit was to have a significant num-ber of invited guests who representedother organizations, businesses and con-sumers of psychological services. Theyare open and interested in partneringwith the APA in our advocacy efforts.These relationships need to be nurturedand strengthened in our future. Therewas much discussion at the summitabout who is the mental health cham-pion in the Obama administration—noone was clearly identified. We need todevelop our champion. The Campaignfor Mental Health Reform is a collabora-tive effort of 18 mental health organiza-tions; APA is a participating member ofthis coalition group.William Emmet, thedirector for Campaign for MentalHealth Reform, was the only mentalhealth person invited to PresidentObama’s White House health care re-form meeting. He was a delegate to thesummit and he provided important in-sights about the role of mental health innational reforms.Future PlansThe Task Force on the Future of Psychol-ogy Practice will synthesize the ideasand recommendations from the summit.The Task Force will recommend them tothe Committee for the Advancement of


Professional Practice and into the APAstrategic planning process and policychanges for the association. You canwatch portions of the summit on theAPAwebpage, www.apa.org. You can alsolearn more about the summit during a 2-hour session at theAPAConvention, Fri-day, August 7 from 10AM – 12 noon.

The impact of this summit has the po-

tential of bringing a sea change to thepractice of psychology. The ideas andrecommendations from the summitneed to be implemented at all levels ofour profession to make a real difference.As stated at the summit, “¡Lo que ocur-rió en San Antonio, no puede per-manecer en San Antonio! Whathappened in SanAntonio cannot stay inSan Antonio!”

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ATTENTION GRADUATE STUDENTS ANDEARLY CAREER PROFESSIONALS

You are invited to“Lunch with the Masters – For Graduate Students

and Early Career Psychologists”Saturday, August 8th12:00 Noon – 1:50 pm

Fairmont Royal York Hotel, Quebec RoomHosted by Division 29 (Psychotherapy) at the 2009 APAConvention.

Come join Drs. Lynne Angus, Judith Beck, Beverly Greene, LeslieGreenberg, Nadine Kaslow, Arthur Nezu, and others for lunch andconversation. We will also host a book raffle and early career focusgroup to determine the needs of our early career constituents.No RSVP needed, but please feel free to contactDr. Michael J. Constantino([email protected]) for additional information.

Come find out more about Division 29 and invite others to join!

You do not need to be a member of Division 29 to attend, but we willhave membership information available on site for those who are in-terested in joining.

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FEATUREEthics and the Interrogation of PrisonersNorman Abeles, Ph.D., Michigan State University

Recently, I was askedto co-author a bookchapter on the historyof ethics. Havingtaught a course onprofessional and sci-entific ethics to gradu-ate students for over

30 years, I readily agreed to do so. Ithought our readers would be interestedin reading about one of the topics I wasunable to include in the chapter due tolack of space: coerced therapy and theinterrogation of prisoners. This topic isknown to most of our readers, thoughthey may not know the significant de-tails which I discuss here.Coerced or mandated psychotherapyand interrogation of prisonersSome commentators have describedpsychotherapy as a means of social con-trol (Hurvitz, 1973) and compared it insome ways to brainwashing (Dolliver,1971; Gaylin, 1974). Others have dis-cussed the use of coercive persuasion,deprogramming, and hypnotic sugges-tion techniques from the viewpoint ofclient manipulation (Fromm, 1980;Kline, 1976). Many other types of coer-cive practices have become central tosome psychotherapeutic approacheswith strong public approval. These in-clude court ordered therapy for a rangeof conditions (e.g. anger management,driving while intoxicated, sexual actingout). Other therapeutic-like techniquesinclude restrictions placed on non-incar-cerated sex offenders (Schopp, Winick,& La Fond, 2003), restrictions in educa-tional settings (Sidman, 1999) and coer-cive restraint or forced holding therapiesfor children (Mercer, 9003). This raisesquestions about the extent to which psy-chological techniques permit the thera-

pist to manipulate or control the clientby force or threat.More recent concerns have focused onthe possible role of therapists in dealingwith alleged terrorist detainees held bymilitary authorities. In general, a psy-chotherapist cannot ethically coerce aclient into treatment or force certaingoals or outcomes against the client’swishes. Some special problem situationsexist along these lines including clientsin the military or involuntarily confinedin institutions such as prisons. The moresubtle aspects of coercion require partic-ular sensitivity. This might include theuse of group pressure, guilt induction,creating cognitive dissonance, attemptsat total environmental control, and theestablishment of a trusting relationshipin order to effect change in anotherperson (Dolliver, 1971). Therapists mustattempt to remain aware of potentiallycoercive influences and avoid any thatdo not offer full participation, discus-sion, and choice by the client. Theconstant critical re-examination of thestrategies and goals of treatment involv-ing both client and therapist affords thebest means to this end.Some of my colleagues tell me that theywould never accept a referral for courtmandated therapy, nor would they evertreat a client who is coerced into therapy.I respond by asking whether or not theyhave ever seen children and adolescentsfor treatment. They often respond bysaying that in those cases the parent isthe client. Then I ask them if they haveever seen a client who is contemplatingdivorce; usually they answer by sayingyes. Then I ask them if they would ter-minate a client who told them during


the 5th session that the main reason theycame for therapy is that they were givenan ultimatum by their spouse or partnerto seek therapy or ace divorce or separa-tion. The point I am making is that co-erced therapy is somewhat of a slipperyslope and yet many of us may havetreated individuals who at least believedthey were not coming of their own freewill.Psychologists’ Involvement inDetention of Alleged Terrorists(a.k.a. Violent Extremists)*In 2008, for the first time in the organiza-tion’s history, a petition signed by over1% APA members invoked a referen-dum provision of the by-laws calling fora vote on whether psychologists cancontinue to work in detention settingsthat exist in violation of internationallaw or the U.S. Constitution(http://www/apa.org/governance/resolutions/work-settings.html). The finalvote tally was 8792 voting in favor of theresolution and 6157 voting against theresolution. Note that this resolution it-self did not deal with the APA EthicsCode but rather where psychologistscould work.*In his June 2009 speech in Cairo, Presi-dent Obama used the term violentextremists rather than terrorists.In statements accompanying the ballots,advocates of the petition argued that ourfirst ethicalprinciple is to do no harm,yet alleged that psychologists have par-ticipated in the design and actual inter-rogations which equate to torture. Thestatement asserted that by participatingin the design of interrogations, psychol-ogists have helped to legitimize abusivetreatments at such sites. They also as-serted that the referendum does not pre-vent psychologists from working insettings which uphold international lawand human rights, such as the U.S. crim-inal justice system. The statement in op-position to the petition argued thatpassage would place ethical psycholo-

gists at risk and would harm vulnerablepopulations by restricting the practice ofpsychologists who work in a variety ofsettings such as psychiatric hospitals,correctional facilities and places whereauthorities detain individuals for theirown or the public’s safety. Constitu-tional challenges may arise in a range ofsettings which could result in conflictswith international standards. The state-ment also noted that the petition pro-vided two exemptions for psychologists:one for those who work directly for theperson held in detention and the otherfor those who work for an independentthird party involved in protectinghuman rights. The statement also notedthat APA had already prohibited as un-ethical any participation in torture in-cluding knowingly planning, designingparticipating or assisting in torture. Fi-nally, the opponents expressed concernabout the precedent of defining settingsin which psychologists may work.Understanding some of the history ofthis debate provides a useful backdropto ethics in psychotherapy, particularlywhen coercion applies (e.g. mandated orcourt-ordered treatment, involuntaryhospitalization, or treatment while in-carcerated). Almost 15 years ago, John-son (1995) warned of ethical quandariesin the military and talked about collabo-ration between APA and the Depart-ment of Defense. Such efforts caninclude the determination of personalqualifications, screening leadershipqualities, and examining organizationalproductivity. As Carter and Abeles(2009) point out, terrorist activities haveprovided the impetus for prisoner inter-rogations in a range of settings and lo-cales; thus there was continuing need forfurther consultation with experts. Psy-chologists have served on BehavioralScience Consultation teams (BSCT’s)where they observe interrogations andprovide interrogators with feedbackinformation. Okie (2005) underscores


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that these team members may not pro-vide confidential information aboutprisoners, nor may they advise militaryinterrogators to take advantage of psy-chological vulnerabilities. Carter andAbeles (2009) note that BSCT psycholo-gists have been accused of using theirtraining to develop interrogation pro-grams used at Guantanamo Bay. In par-ticular there is reference to the SurvivalEvasion Resistance and Escape (SERE)program; the allegations suggest thatsome psychologists reversed this train-ing in order to aid prisoner interroga-tion, Two psychologists (not members ofAPA) have been associated with this ef-fort. Evidence indicates that MichaelGelles, a psychologist at Guantanamoacted as a whistleblower and called at-tention to abuses (Soldz, 2007).

In part because of considerable outcryconcerning the participation of psychol-ogists in these interrogation ofprisoners, APA formed a Task Force(PENS) whose job it was to review theAPA Ethics Code to see if the ethical as-pects of prisoner interrogation were ad-equately addressed. The report of thistask force was published (APA, 2005)and notes that their charge did not in-clude an investigative or adjudicatoryrole. The PENS Task Force pointed outthat psychologists may serves in consul-tative roles to interrogation and infor-mation gathering processes, andacknowledged a long standing traditionfor doing so in other law enforcementcontexts. A recent editorial in Nature(2009) noted that six of the members ofthe PENS Task Force were on the Penta-gon’s payroll (p. 300) and states that theallegation that the Pentagon was dictat-ing policy to APA is not obvious in the12 principles. Additionally, the editorialpoints out that other professional soci-eties including the American MedicalAssociation, the American PsychiatricAssociation, and the World Medical As-sociation have come out against havingtheir members participate in interroga-

tions. APAexplicitly stated that it is eth-ical for psychologists to be involved ininterrogations. The editorial continuesby noting that “interrogation is neces-sary to prevent loss of life from terror-ism and that some professionals feel it istheir duty to ensure that activity is con-ducted responsibly” (p. 300). Even theNew York Times notes that harsh inter-rogation tactics were considered legal(Shane & Johnston, 2009), though legal-ity does not necessarily equal ethical be-havior. Pope and Gutheil (2009)recommend that professional organiza-tions should include specific and en-forceable ethics standards whenworking with particular at-risk groups.Further, professional organizationsshould make more effort to acquaint alltheir members about their ethical re-sponsibilities. Finally, they recommendthat there may be complex ethical ques-tions that arise in custodial settingswhere governmental authority may bein contrast to ethical responsibilities byprofessionals.We turn again to the PENS report. Toguide its thinking, the Task Force citedthe Preamble to the Ethics code (APA,2002) which states that psychologists re-spect and protect civil and humanrights. They also cited Principle A(Beneficence and Nonmaleficence)which asks psychologists to safeguardthe welfare and rights of those withwhom they interact professionally. Ad-ditionally, Principle D (Justice) and Prin-ciple E (Respect for people’s Rights andDignity) were cited. The PENS TaskForce concluded that the Ethics Code issound in addressing ethical dilemmasthat occurred in the context of nationalsecurity related work. Several state-ments were prepared with regard to thisoverall issue. These noted that psychol-ogists do not engage in, direct, support,facilitate, or offer training in torture orother cruel, inhuman or degrading treat-ment, and noted that psychologists have


an ethical responsibility to report suchacts to appropriate authorities. This alsoincluded reference to not using healthcare related information to the detrimentof the individual’s safety andwell being.It was pointed out that psychologistsneed to consult when facing ethicaldilemmas. They must be alert to acts oftorture and do not engage in behaviorsthat violate the laws of the United Statesthough they may refuse for ethical rea-sons to follow laws or orders that are un-just or that violate basic principles ofhuman rights. The report also reiteratedthat psychologists may serve in variousnational security related roles but mustremain mindful of factors unique toroles and contexts that require specialethical considerations.

The task force members did not reachconsensus on all issues. They differedwith regard to the role of human rightsand international standards; some ar-gued that international standardsshould be built into the Ethics Code.There was also disagreement on the ex-tent to which psychologists may ethi-cally disguise the purpose of their work,though they did agree that full disclo-sure of the nature and purposeof the work is not ethically required inall instances. Finally, there was no con-sensus onwhether the discussions of theTask Force should have beenmade pub-lically available. They voted to limitwhat information should be discussedconcerning the deliberations by the TaskForce. In later developments, APApassed a resolution on the reaffirmationof the position against torture and othercruel, inhuman, or degrading treatmentsor punishment, and its applications toindividuals defined by the United Statesas “enemy combatants.” The resolutionprovided condemnation and absoluteprohibitions against direct indirect par-ticipation in interrogations related tomock executions, water boarding orother simulated drowning, as well as ad-ditional humiliating practices.

It should be noted also that in 2002, Pres-ident Bush ordered an executive decla-ration indicating that the 1949 GenevaConvention did not protect al-Quaedacaptives at Guantanamo Bay becausethey were enemy combatants. Thatmeant they could not be consideredprisoners of war which would have en-titled them to the right to refuse ques-tioning (Carter and Abeles, 2009). Ofcourse that does not mean that theycould be tortured.

Concerning the reaffirmation againsttorture, there was an amendment pub-lished that included techniques listed bythe World Medical Association Declara-tion of Tokyo and the principles of med-ical ethics in the protection of prisonersand detainees against torture (APA,2008). A critique of this resolution bypsychologistArrigo and retired counter-intelligence operative De Batto arguesthat effective ethical oversight byAPAorany other outside organization is notpossible (Arrigo &De Batto, 2008). Theybelieve that the resolution is symboliconly and has no effect on operations;there are a number of institutional fac-tors that defeat this resolution. Theysuggest that in intelligence operations,information is given on a “need to knowbasis.” Further, the role of interrogationconsultant is one of several roles wherepsychologists can facilitate abusive in-terrogations. Since psychologists arestaff officers, they must obey field com-manders of whatever rank. Most psy-chologists in contact with detainees arejunior officers who owe service in ex-change for educational scholarships.While all this may be true, the enforce-ment of the APA Ethics Code dependson information presented as complaintsfiled by individuals with theAPAEthicsCommittee.

We should note that allegations thatAPAsupported participation of psychologists

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in interrogations suggest that APA didnot want to alienate key decisionmakersin the Bush Administration (Carter &Abeles, 2009). Former APA PresidentKoocher noted in rebuttal that APAvoted in favor of theMcCain anti-tortureresolution and past APA presidentSharon Brehm argued that having psy-chologists consult with interrogationteams assists in keeping interrogationssafe and ethical. APA also opposed theMilitary Commission Act (2006) since,unfortunately, this law created ambigu-ity concerning the types of interrogationswhich are permitted. The reader cancome to his or her own conclusions onthis difficult ethical issue. It is clear thatmore work needs to be done to resolveall the dilemmmas created by this com-plex, confusing topic. There will con-tinue to be debate about whether or nottheAPAEthics Code should include spe-cific and enforceable provisions concern-ing the ethics of interrogation tactics nowthat a referendum has determined that

psychologists can not work in detentionsettings that exist in violation of interna-tional law or the U.S. constitution.SummaryThis paper reports on the issue of co-erced or mandated psychotherapy andthe interrogation of prisoners. It beginsby raising the question as to whether ornot psychotherapy can be viewed as onemeans of social control and moves on tothe possible role of psychotherapists indealing with alleged terrorist (violentextremists) detainees held by militaryauthorities. It notes the recent APA ref-erendum forbidding psychologists towork in detention settings that exist inviolation of international law or the U.S.Constitution. It provides background onthis topic and raises the question as towhether or not the APA Ethics Codeshould include specific prohibitions con-cerning the interrogation of detaineeprisoners.(References available on-line.)

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Find Division 29 on the Internet. Visit our site atwww.divisionofpsychotherapy.org

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STUDENT FEATUREJourney to Adulthood in the 21st CenturyPekti Miles, M.A., Pacifica Graduate Institute

Adolescence is proba-bly the most infamousof all the developmen-tal stages. The “know-it-all” affect, rebellion,and mood swings as-sociated with this pe-riod of psychosocialtransition from child to

adult in a human lifetime has received agreat deal of attention in the field of de-velopmental psychology (Spruijy, 1999,pp. xi-xii). This paper will explore oneway that research on adolescent brainmaturity might support the rapidlychanging paradigm of adolescent devel-opment which aids understanding ofmultilevel systemic change and seeks toprovide an agenda for promoting posi-tive life experience (Lerner, 2004). Fi-nally, the implication of self-regulationtraining on adolescent educationalachievement is considered.How Adolescence Is ViewedGranville Stanley Hall is considered thefounder of adolescent psychology. In thebook Adolescence (1908) Hall suggestedthat adolescence is a developmental stageof “SturmundDrang” (storm and stress):Every step of the upward way isstrewnwith wreckage of body, mind,and morals. There is not only arrest,but pervasion at every stage, andhoodlumism, juvenile crime, and se-cret vice… (2005, p. XIV). … normalchildren often pass through stages ofpassionate cruelty, laziness, lying andthievery (p.334).More than a century after this work wasconceived, Hall’s take on adolescent per-sonality continues to influence the wayadults view this important juncture inhuman development.

Today a large part of the adult percep-tion of adolescence emerges from por-trayals tinted with the stereotypes of aprevious century. A nationwide poll ofadult’s attitudes about teenagers, spon-sored by Public Agenda in 1999, foundthat 71 percent of adults had a negativeopinion about youth; yet in a majorstudy on the self image of adolescents inten countries, 73 percent of the partici-pants reported a healthy self image(Offer, Howard, &Atkinson, 1988). Thisdiscrepancy between the way in whichadults perceive teens, and the way thatadolescents view themselves, may be ex-plained by the fact that teenagers spendclose to one third of their time talkingwith peers as opposed to 8% withadults. (Spear, 2000, p.120).Adolescence and SocietyJohn Santrock (2005), author of a recentbook also titled Adolescence, proposedthat conflicting perceptions about ado-lescence are increasingly a problem forsociety. “Although the majority of ado-lescents experience the transition fromchildhood to adulthoodmore positivelythan is portrayed by many adults andthe media, too many adolescents todayare not provided with adequate oppor-tunities and support to become compe-tent adults” (p.500). The gap betweenadult and adolescent perceptions is abroken link which threatens the sustain-ability of our society. In the book Child-hood and Society (1950) Erik Eriksonstated:…the human personality developsaccording to steps predetermined inthe growing person’s readiness to bedriven toward, to be aware of, andto interact with a widening socialradius; and… that society, in principal,


tends to safeguard and to encouragethe proper rate and the proper se-quences of their unfolding. This is the‘maintenance of the human world’(p.270).Since each stage is interdependent, Erik-son’s theory makes room for what hedescribed as the variations in “tempoand intensity” (1950, p.71) presented byculture. It also facilitates bits and piecesof the founding developmental theoret-ical contributions as well as the biologi-cal information that is being amassedfrom current brain research. For this rea-son attention to the stages provided byErikson’s Epigenetic Chart (1950 pp.272-273) can be very helpful in our quest fora stable society.According to Erikson’s system of stages,adults in our society are responsible forproviding the skills and tools necessaryfor young people to move into adult-hood. Nonetheless, it is important to notethat the advent of the Internet has com-pletely revolutionized our daily lives.The way that children absorb informa-tion has changed drastically in the lastdecade. In Erikson’s view, during periodsof rapid social change such as the oneweare experiencing now, the older genera-tion can no longer provide adequate rolemodels (1950, p.280). How then can weassist our children in making the transi-tion to a culture that we have yet learnedto navigate, much less master?21st Century TechnologyMany adults in this culture are dubiousabout the magnitude of unsupervisedexternal stimulation that dominates thepsychic space of our youth. What possi-ble training can help to reduce the dan-gers associated with being an adolescentin a changing society? Like teenagersfrom every generation, these kids aredoing their job of pushing human devel-opment in new directions.Thus, this generation’s children are pro-cessing information at a rate we cannot

even imagine.As they progress from onestage to the next, adolescents have not al-ways been able to depend on the preced-ing generation to provide psychosocialinstruction. The fact is that even if theolder generation provides informedboundaries, they will likely be rejectedbecause adolescents are sometimesmor-bidly, often curiously, preoccupied withwhat they appear to be in the eyes of oth-ers as comparedwithwhat they feel theyare and with the question of how to con-nect to earlier cultivated roles and skillswith the ideal prototypes of the day(Erikson, 1959, p.89).Implications are clear that a large part ofadolescent success in the current milieuis based on the development of an inter-nal locus of control. Adults are pressedto discover ways to help adolescents im-prove the input phase of processing.Recently adults in our culture havetaken a liking to deep breathing, medita-tion and yoga to help manage the stressof our new world (Barnes, 2008). Medi-tation research proves to be helpful inthe navigation of our increasingly com-plex environment. The information af-forded by new technology has thepotential to assist in developing innerawareness skills that would augment aninternal locus of control. Neuroimagingresearchers have described meditationas a set of “…practices that self-regulatethe body and mind, thereby affectingmental events by engaging a specific at-tentional set” (Cahn & Polich, 2006p.180). In the sameway that physical fit-ness can be enhanced through a regularexercise routine, research suggests thatthe mind can also be trained and im-proved through methodical practice.The Adolescent Brain and MeditationThere are brain changes related to eachstage of human development thatcontribute to responsible for sexualmaturation, physical growth, emotional

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expansion, cognitive development, selfregulation, and maturation of judg-ment. “Prominent developmental trans-formations are seen in prefrontal cortexand limbic brain regions of adolescentsacross a variety of species…. Develop-mental changes in these stressor-sensi-tive regions…likely contribute to theunique characteristics of adolescence”(Spear, 2000 p.418). Behaviors associ-ated with adolescence such as risk tak-ing, impulsiveness, poor self regulationand identity crisis might be soothed bythe trait changes afforded by medita-tion, as brain imaging has shown thesame areas of the brain most changedduring adolescence are activated alsoduring meditation.It is important to note that adolescentshave more pronounced brain activity inthe amygdala than in the frontallobe (Baird,et al.1999). The amygdalaprocesses emotions while the frontal lobeis involved with reasoning and thinking.Neuroimaging studies of meditationshow increased frontal-parietal andfrontal-occipital activation and decreasedposterior-anterior activation (Herzog, etal., 1990). “Trait changes from long-termmeditation include a deepened sense ofcalmness, increased sense of comfort,heightened awareness of the sensoryfield, and a shift in the relationship tothoughts, feelings, and experience of self“(Cahn & Polich, 2006 p.181). Therefore,it will be advantageous to explore the na-ture and consequence of meditation onthe developing adolescent brain; a morn-ing meditation in high school may proveto be as effective as a midday nap inkindergarten.Today’s AdolescentThe United Nations Population Fund

[UNFPA] has determined that for thefirst time in history more than half of theworld’s population will be living inurban areas and subjected to theplethora of pressures unique to thatlifestyle (UNFPA 2007 p.1). “Today’sgeneration of young people is the largestin history. Nearly half of the world’spopulation (almost 3 billion people) isunder the age of 25” (UNFPA, 2005p.45). The potential impact of today’syoung people on the future is stagger-ing. If these adolescents, who hold thepower to shape humanity, are to realizetheir collective potential, new solutionsmust be found for the many stressorsthey have inherited. Without an under-standing of the complexities of the ado-lescent brain, we will have little to offertheir succession. An investigation of theeffect of meditative traditions on adoles-cent development may expose far-reach-ing benefits for our global predicament.

ConclusionIn this essay I presented the argumentthat mindfulness works themental mus-cle, where the mind is trained to focuseven when bombardedwith a web of in-formation. Adolescents are required tosynthesize more technology than theprevious generation; therefore statisticsnudge us toward a new pedagogywhich includes intentional self-regula-tion of attention for self-inquiry. Canmeditation (e.g., in the school system,where our children spend the majorityof their day), be helpful? Research sug-gests that all of us, and particularly ado-lescents, need to stop a moment, sitsilently and take a long deep breath.


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FEATUREPsychotherapeutic Treatment Implications forObese AdolescentsDena F. Miller, M.A., University of Denver,Graduate School of Professional Psychology

Headlines regularlyhighlight the dramaticrise in the rate ofchildhood obesity.Photographs of 300pound teenagers ac-company headlineslike, “Into the Mouths

of Babes: ChildhoodObesity” in theNewYork Times (Zeller, 2007), “Dear Parents:Your Child Is Fat” in Time Magazine(Losh, 2008), and, “It’s not baby fat:Among 4-year-olds, nearly 1 in 5 isobese” on CNN (Park, 2009). Thesecatchy headlines point to the perceivedseverity and prevalence of childhoodobesity in the United States.

Obesity is diagnosed when a child’sBodyMass Index (BMI) is at or above the85th percentile for their age.According tothe American Heart Association (AHA;2009), 23.4 million children between theages two to nineteen are overweight andobese. Approximately 8-13% ofpreschoolers and between 13% and 22%of children and adolescents are now con-sidered overweight, and an additional31% are at risk for becoming obese(AHA, 2009; Powell, Calvin, & Calvin,2007). The consequences for children andadolescents who are obese can be signif-icant and lasting, including an increasedrisk for numerous health problems suchas coronary heart disease, type II dia-betes, cancer, and hypertension (Stice,Prensell, Shaw, & Rohde, 2005).

Increasingly described as a global epi-demic (Powell et al., 2007), obesity canresult not only in severe physical healthproblems, but has significant negativepsychosocial, emotional, and develop-

mental consequences for youths. Ado-lescence is an often anxiety-producingdevelopmental stage where peer pres-sure and psychosocial stressors abound.Teens who are overweight are at addi-tional risk for weight-related teasing,body dissatisfaction, low self-esteem,depression, anxiety, and suicidalideation (Fulkerson, Strauss, Neumark-Sztainer, Story, & Boutelle, 2007).There is a clear need for effective psy-chotherapeutic treatments for childhoodand adolescent obesity. Numerous med-ical treatments including drug therapyand surgical interventions exist to treatobesity, yet “successful [psychothera-peutic] treatments for obesity have beenelusive” (Stice, Shaw, & Marti, 2006, p.667). This article outlines psychotherapyinterventions to address the treatment ofobese adolescents. Family-based inter-ventions, cognitive behavioral therapy,and motivational interviewing modali-ties will be discussed.There are numerous obstacles to treatingadolescents who are obese. Weight gainis common and difficulty can be disap-pointing for counselors and therapists.Mental health providers often assumethat obesity can only be treated med-ically, rather than behaviorally. Other cli-nicians too readily accept that geneticblueprints for obesity preclude effectivenutritional and behavioral treatments(Panzer, 2006). Despite these challenges,it is the responsibility of mental healthproviders to learn and develop interven-tions to help obese teenagers who areclearly at risk and in need of services.Because obesity tends to run in families,

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researchers have developed family-based interventions, targeting eating be-havior and activity change in thechildren and their parents (Epstein,Paluch, Roemmich, & Beecher, 2007).This model includes teaching parents be-havioral skills to facilitate change in theirteenagers. The therapy focus is on be-havioral interventions including ad-dressing poor parental modeling andsupport for overeating and under exer-cising. A primary goal of family-basedinterventions is to mobilize family re-sources to support the teen’s healthy eat-ing as well as increased physical activitylevel. At least one parent is asked to takean active role in the intervention. Treat-ment typically lasts 16 weeks to 8months and includes follow-up periodsof at least one year with “booster” ses-sions to help children maintain bothhealthy eating behavior and physical ac-tivity (Epstein et al., 2007). The length oftreatment varies based on the family, andthe level of severity of the adolescent’sobesity. Some studies have taken intoconsideration different levels or severityof obesity (Panzer, 2006; White, 1986)given thatWhite (1986) found, “themoreobese the child, the greater the psycho-logical consequences” (p. 263).

In addition to behavioral interventions,other family-based treatment modelsfocus on the family environment and ac-tivities, such as mealtimes. Fulkerson etal. (2007) found that making familymeals a priority and having a positivemealtime environment were positivelyassociated with psychological wellbeing and inversely associated with de-pressive symptoms and unhealthyweight-control behaviors in adolescents.Indicators of poor psychological healthincluded family members teasing teensabout their weight and parental encour-agement to diet; such teasing wasstrongly correlated with negative psy-chosocial outcomes (Fulkerson et al.,2007). These findings indicate that fam-ily-based psychotherapy interventions

should focus on both behavior changeand parental and teen skill develop-ment, as well as increasing healthy eat-ing behavior with an emphasis onmealtime strategies and incorporatingpositive family support.Cognitive behavior therapy (CBT) is anevidence-based treatment modality de-signed to address the negative psycho-logical effects of obesity. One studyoutlines a CBT model that incorporatespsychoeducation, diet change, and in-creasing physical activity into therapy(Panzer, 2006). The treatment protocolstates that, “Sessions should includeweighing the child…reviewing food andactivity charts… providing positive re-inforcement, exploring and addressingvarious forms of nonadherence or resist-ance, assigning cogent homework tasks,summarizing the interview, and plan-ning for the next visit (Panzer, 2006, p.540).”CBT uses behavior modification to helpadolescents achieve diet and exercisegoals in treatment. Sessions begin withintroducing and refining specific strate-gies and using psychoeducation to teachadolescents about obesity. Identifyingand recognizing cognitive patternswithin the family is important, alongwith identifying negativistic and dichoto-mous thinking and overgeneralizations.Other cognitive techniques such as re-framing can be useful for teaching ado-lescents coping skills to manage feelingsof hunger and body image concerns. CBTis a structured psychotherapy model de-signed to help teenagers change un-healthy eating behavior throughidentifying and challenging their dys-functional thoughts and behaviors. Help-ing teens identify and then change theirdysfunctional thoughts about eating, andnegative thoughts about themselves cansignificantly increase self-esteem, as wellas create positive and lasting healthylifestyle changes.


Motivational interviewing (MI) is an-other therapeutic technique that has beenused to treat obesity (Carels et al., 2007).MI was designed to enhance motivationand decrease ambivalence toward behav-ior change (Miller & Rollnick, 2002). Al-though MI was originally developed totreat addictions, it is increasingly beingused in psychotherapy to motivate ado-lescents who are resistant to treatmentand to enhance health behaviors.Arecentstudy integrated MI into a behavioralweight loss intervention (Carels et al.,2007). When poor progress towardweight loss goals was detected, MI wasused to enhance motivation. Findingsshowed that participants lost moreweight and engaged in greater weeklyexercise when MI was used. Using MIalone, or in conjunction with other psy-chotherapy techniques may help moti-vate teens to decrease sedentary behaviorand increase both healthy eating and ex-ercise and physical activity.

In addition to outlining effective psy-chotherapeutic treatment interventionsfor obese teenagers, previous researchemphasizes the importance of consider-ing adolescents’ demographic character-istics in treatment. Race/ethnicity, age,gender, and socioeconomic status, all ef-fect adolescents’ presentation in therapy,and are especially important when treat-ing obese teenagers. Latino and Blackadolescents are more likely to be obese(Stice, Shaw, & Marti, 2006), and overone third of Latino and Black childrenages 2-19 are considered obese (AHA,2009). This suggests that interventionstargeting these high-risk youths may bemore effective because there is a greateropportunity to show a prevention effect.However, obesity is less stigmatized and

associated with less body dissatisfactionfor certain ethnic minority groups (Sticeet al., 2006). In addition to race and eth-nicity, age and development may impactpsychotherapeutic outcomes for obeseteenagers. For example, an insightfuland mature 17-year-old may be moresuccessful using a CBT perspective,while a younger child may benefit frommore parental guidance and supportusing a family-based approach.

Socioeconomic status and gender also ef-fect treatment outcomes. Children wholive in single-parent homes, for example,may not have a parent who can committo an intensive family-based intervention.Psychotherapists should be sensitive tothese important potential barriers to chil-dren’s success in therapy. Gender is an-other important consideration for thetreatment of obesity. One study foundthat, “sex differencesmay exist in vulner-ability to weight stigma in youths” (Puhl& Latner, 2007). For example girls tend toengage in relational aggressionmore fre-quently than boys (Simmons, 2002), andmay be at higher risk for being teasedand becoming depressed.

The medical and mental health risks forteenagers who are obese are great. Notonly does obesity increase the probabil-ity that these teens will face future med-ical complications and chronic healthconditions, but the psychological, social,and developmental repercussions ofobesity cannot be ignored. Mental healthproviders can make a difference in thechildhood obesity epidemic by helpingadolescents develop new behaviors andskills and ultimately lead healthier lives.


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CONGRATULATIONS TO DIVISION 29IMMEDIATE PAST PRESIDENT

JEFFREY E. BARNETT, PSY.D., ABPPAPAAward for Distinguished ProfessionalContributions to Independent Practice

The Complete Practitioner: Still a Work in ProgressFriday, August 7, 2009 from 11:00 am – 11:50 am,

at the Convention Center, South Building, Meeting Room 703The APA/APF Award Ceremony Friday from 4:00 pm – 5:50 pmin the Fairmont Royal York Hotel (room to be announced)

AWARDCITATION— “For outstanding, distinguished andmeritorious servicein several areas of professional practice, especially in the areas of professionalethics and psychotherapy treatment. Dr. Jeffrey E. Barnett has produced hundredsof high quality publications, workshops and symposia that have hadwidespreadimpact. He has provided visionary leadership service and outstanding legislativeadvocacy. He is well known for his quality mentoring of students, early careerprofessionals and members of diverse groups. He tackles projects, causes andsupport of people with a spirit of enthusiasm, passion, and care that is quiteunique. He is acknowledged, respected, and honored by all who know him.”

BRIEF BIO— Jeffrey E. Barnett, Psy.D., ABPP received his doctorate from theFerkauf Graduate School of Yeshiva University in 1984. He is a licensed psychol-ogist in independent practice inArnold,Marylandwhere he provides psychother-apy and comprehensive psychological evaluations, primarily for children andadolescents. He is Professor on the faculty of Loyola College of Maryland. He isa Diplomate of the American Board of Professional Psychology in Clinical Psy-chology and in Clinical Child and Adolescent Psychology and a DistinguishedPractitioner of the National Academies of Practice. He is a Fellow in seven APADivisions.

Dr. Barnett has served in numerous leadership roles including as President ofthe Maryland Psychological Association (MPA); in APA he served as PresidentDivisions 29, 31, and 42. He served on APA’s Council of Representatives for sixyears and is a trustee of the Association for the Advancement of Psychology. Dr.Barnett served as chair of APA’s Board of Convention Affairs and is presentlyChair of APA’s Ethics Committee. He is Associate Editor of the APA journal Pro-fessional Psychology: Research and Practice.

Professional interests reflected in his numerous publications and presentations in-clude ethics, legal, and professional practice issues in psychology; mentoring stu-dents and early career psychologists; working to advance diversity in ourprofession; and advocacy. Dr. Barnett liveswith hiswife of 23 years, Stephanie, andhis two children, Stuart andMadeline. He is an avid runner, swimmer, and cyclist,and continually endeavors to practice effective self-care and to strike a balanceamong his many interests.

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The Division of Psychotherapy is nowaccepting applications from those whowould like to nominate themselves orrecommend a deserving colleague forFellow status with the Division ofPsychotherapy. Fellow status in APA isawarded to psychologists in recognitionof outstanding contributions to psychol-ogy. Division 29 is eager to honor thosemembers of our division who have dis-tinguished themselves by exceptionalcontributions to psychotherapy in avariety of ways such as throughresearch, practice, and teaching.

The minimum standards for Fellowshipunder APABylaws are:• The receipt of a doctoral degreebased in part upon a psychologicaldissertation, or from a programprimarily psychological in nature;

• Prior membership as anAPAMemberfor at least one year and a Memberof the division through which thenomination is made;

• Active engagement at the time ofnomination in the advancement ofpsychology in any of its aspects;

• Five years of acceptable professionalexperience subsequent to the grant-ing of the doctoral degree;

• Evidence of unusual and outstand-ing contribution or performance inthe field of psychology; and

• Nomination by one of the divisionswhich member status is held.

There are two paths to fellowship. Forthose who are not currently Fellows ofAPA, you must apply for Initial Fellow-ship through the Division, which thensends applications for approval to theAPA Membership Committee and the

APA Council of Representatives. Thefollowing are the requirements for initialfellow applicants:• Completion of the Uniform FellowBlank;

• Adetailed curriculum vita (pleasesubmit 3 copies);

• A self-nominating letter (self-nomi-nating letter should also be sent toendorsers);

• Three (or more) letters of endorsementof your work by APA Fellows, atleast two of whom must be Division29 Fellows who can attest to the factthat your “recognition” has been be-yond the local level of psychology;

• A cover letter, together with your c.v.and self-nominating letter, to eachendorser.

Those members who have already at-tained Fellow status through another di-vision may pursue a direct applicationfor Division 29 Fellow by sending a cur-riculum vita and a letter to the Division29 Fellows Committee, indicating inyour letter how you meet the Division29 criteria.

Initial Fellow Applications can beattained from the central office oronline at APA:Tracey MartinDivision of Psychotherapy6557 E. Riverdale St.Mesa, AZ 85215Phone: 602-363-9211Fax: 480 854-8966Email: [email protected]

CALL FOR FELLOWSHIP APPLICATIONSDIVISION 29—PSYCHOTHERAPYJeff Hayes, Chair, Fellows Committee


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DEADLINE FOR SUBMISSIONThe deadline for submission to be con-sidered for 2010 is December 15, 2009.The initial nominee must enclose aUniform Fellow Application, self-nominat-ing letter, three or more letters of en-dorsement, updated CV, along with acover letter, and three copies of all theoriginal materials. Incomplete submis-sion packets after the deadline will notbe considered for this year. Those whoare current Fellows of APAwho want tobecome a Fellow of Division 29 need tosend a letter attesting to your qualifica-tions and a current CV.

Completed Applications should beforwarded to:Jeff HayesChair, Division 29 Fellows Committee307 Cedar BuildingPenn State UniversityUniversity Park, PA 16802Email: [email protected]: 814-863-3799Please feel free to contact me or otherFellows of Division 29 if you think youmight qualify and you are interestedin discussing your qualifications or theFellow process. Also, Fellows of ourDivision who want to recommend adeserving colleague should contactme with their name.

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THE DIVISION OF PSYCHOTHERAPYThe only APA division solely dedicated to advancing psychotherapy

MEMBERSHIP APPLICATIONDivision 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 AmericanPsychological Association (APA), APA membership is not required for membership in the Division.

JOIN DIVISION 29 AND GET THESE BENEFITS!

Name ____________________________________________ Degree ____________________

Address _____________________________________________________________________

City _______________________________________ State ________ ZIP________________

Phone _________________________________ FAX ________________________________

Email _______________________________________________

Member Type: ! Regular ! Fellow ! Associate! Non-APA Psychologist Affiliate ! Student ($29)

! Check ! Visa ! MasterCard

Card # ________________________________________________ Exp Date _____/_____

Signature ___________________________________________

Please return the completed application along withpayment of $40 by credit card or check to:

Division 29 Central Office, 6557 E. Riverdale St., Mesa, AZ 85215You can also join the Division online at: www.divisionofpsychotherapy.org

FREE SUBSCRIPTIONS TO:PsychotherapyThis quarterly journal features up-to-datearticles on psychotherapy. Contributorsinclude researchers, practitioners, andeducators with diverse approaches.Psychotherapy BulletinQuarterly newsletter contains the latest newsabout division activities, helpful articles ontraining, research, and practice. Availableto members only.

EARN CE CREDITSJournal LearningYou can earn Continuing Education (CE)credit from the comfort of your home oroffice—at your own pace—when it’s con-venient for you. Members earn CE creditby reading specific articles published inPsychotherapy and completing quizzes.

DIVISION 29 PROGRAMSWe offer exceptional programs at the APAconvention featuring leaders in the field ofpsychotherapy. Learn from the experts inpersonal settings and earn CE credits atreduced rates.

DIVISION 29 INITIATIVESProfit from Division 29 initiatives such asthe APA Psychotherapy Videotape Series,History of Psychotherapy book, andPsychotherapy Relationships that Work.

NETWORKING & REFERRAL SOURCESConnect with other psychotherapists sothat you may network, make or receivereferrals, and hear the latest importantinformation that affects the profession.

OPPORTUNITIES FOR LEADERSHIPExpand your influence and contributions.Join us in helping to shape the direction ofour chosen field. There are many opportu-nities to serve on a wide range of Divisioncommittees and task forces.

DIVISION 29 LISTSERVAs a member, you have access to ourDivision listserv, where you can exchangeinformation with other professionals.

VISIT OUR WEBSITEwww.divisionofpsychotherapy.org

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MMEEMMBBEERRSSHHIIPP RREEQQUUIIRREEMMEENNTTSS:: Doctorate in psychology • Payment of dues • Interest in advancing psychotherapy

If APA member, please provide membership #

Ethics and the Interrogation of Prisoners

Norman Abeles

Michigan State University

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Prioritizing Case Formulation in Psychotherapy Training

Eugene W. Farber, PhD

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579-589.

Ivey, G. (2006). A method of teaching psychodynamic case formulation. Psychotherapy:

Theory, Research, Practice, Training, 43, 322-336.

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774-781.

Kendjelic, E. M., & Eells, T. D. (2007). Generic psychotherapy case formulation training

improves formulation quality. Psychotherapy: Theory, Research, Practice, Training, 44, 66-77.

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York: Basic Books.

Levenson, H. ( 2003). Time-limited dynamic psychotherapy: An integrationist perspective.

Journal of Psychotherapy Integration, 13, 300-333.

Rodolfa, E., Bent, R., Eisman E., Nelson, P., Rehm, L., & Ritchie, P. (2005). A cube model for

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Spruill, J., Rozensky, R. H., Stigall, T. T., Vasquez, M., Bingham, R. P., & Olvey, C. D. V.

(2004). Becoming a competent clinicians: Basic competencies in intervention. Journal of

Clinical Psychology, 60, 741-754.

Strupp, H. H., & Binder, J. L. (1984). Psychotherapy in a new key. New York: Basic Books !

Making Evidence-Based Practice Work: The Future of Psychotherapy Integration

Marvin R. Goldfried

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American Psychological Association Presidential Task Force on Evidence-Based Practice

(2006). Evidence-based practice in psychology. AmericanPsychologist, 61, 271-285. Castonguay, LG., & Beutler, L.E. (2006). Principles of therapeutic change that work. New York: Oxford

University Press.

Goldfried, M. R., & Padawer W. (1982). Current status and future directions in psychotherapy.

In M. R. Goldfried (Ed.), Converging themes in psychotherapy: Trends in

psychodynamic, humanistic, and behavioral practice (pp. 3-49). New York: Springer.

Goldfried, M.R. & Wolfe, B.E. (1996). Psychotherapy practice and research:

Repairing a strained alliance. American Psychologist, 51 (10), 1007-1016.

Kazdin, A.E. (2008). Evidence-based treatment and practice: New opportunities to bridge

clinical research and practice, enhance the knowledge base, and improve patient care.

American Psychologist, 63, 146-159.

Milrod, B., Leon, A.C., Busch, F., Rudden, M., Schwalberg, M., Clarkin, J., et al. (2007). A

randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder.

American Journal of Psychiatry, 164 (2), 265-272.

Norcross, J. C., & Goldfried, M.R. (Eds.). (2005). Handbook of psychotherapy integration (2nd

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New York: Oxford University Press.

Sobell, L.C. (1996). Bridging the gap between scientists and practitioners: The challenge before

us. Behavior Therapy, 27 (3), 297-320.

Building a private practice by being public: From social networking circles to

psychotherapy groups

Renee Hoekstra

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DC: American Psychological Association.

Psychotherapeutic Treatment Implications for Obese Adolescents

Dena F. Miller

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change (2nd ed.). New York: Guilford.

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Stice, E., Shaw, H., & Marti, C. (2006). A meta-analytic review of obesity

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Psychotherapy, Online Social Networking, and Ethics

Jeffrey E. Barnett, Psy.D., ABPP

Allison Russo, M.S.

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Journey to Adulthood in the 21st Century

Pekti Miles, M.A.

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Engaging Underrepresented, Underserved Communities in Psychotherapy-Related

Research: Notes from a Multicultural Journey

Susan S. Woodhouse

The Pennsylvania State University

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psychcent ral.co m http://psychcentral.com/blog/archives/2008/05/15/social-networks-may-blur-pro fessional-boundaries/

Social Networks May Blur Professional Boundaries

With the rising movement of e-patients and social networking sites like Facebook, LinkedIn and Myspace, aquestion has recently surf aced on a mental health mailing list I subscribe to where a prof essional asks, “Whenshould I accept a ‘f riend’ request f rom a patient or f ormer patient?”

It ’s a good question and one that sheds some light on the blurring of the tradit ionally clear boundariesbetween doctor and patient (or, in the case of psychotherapy, therapist and client).

It helps f irst to understand some terminology. A “f riend request” is not exactly what it sounds like. “Friends” onsocial networks like Myspace or Facebook are not the same thing as when we typically think of as f riends. In asavvy marketing move, Myspace popularized the terminology to describe any contact — be it a stranger,spammer, f riend, enemy, f amily member or lover — who asks to allow them to add you to their list (or “addressbook,” using old-school terminology). Because Myspace makes no dif f erentiation as to what a “f riend” actuallyconstitutes, these people are more accurately described as contacts (a term which is decidedly f ar lessmarketing-f riendly). So if someone has 10,000 Myspace “f riends,” that really means next to nothing, sincenothing is qualif ied.

When you get a f riend request on a Myspace or Facebook, what you’re really getting is a simple request tof orm a network connection between your prof ile and his or her prof ile. This connection implies some sort oftwo-way relationship, but of ten says litt le about what that relationship actually is (some social networkingwebsites such as Facebook and LinkedIn do a better job of helping us identif y the type and closeness of theserelationships). Other people on both your network of “f riends” as well as their network can see this connection.

What’s a Professional To Do?

When a psychotherapist or psychologist receives a f riend request f rom a colleague, they typically accept it ifthey know (or know of ) the person. But when they receive a similar request f rom a client or f ormer client, manyare lef t scratching their heads. What to do? The same is true when they receive an email f rom a client orf ormer client. If the prof essional hasn’t set clear guidelines or expectations up-f ront, then it leaves the dooropen to such questions.

The key, then, is to clearly def ine the boundaries of the relationship, not only of f line, but online too. Thismeans putting together an “Internet & Email Policy” that you hand to clients during their f irst session and havethem read and understand it. A part of that policy describes whether you accept patient email, and if so, underwhat circumstances (e.g., appointment changes? therapy issues?).

But a part of what should be included in a therapist online policy is what a lot of therapists miss — what to doabout social networks. A f riend request isn’t an email, so it ’s not really covered by such things. The answer isto specif ically address social networks and “f riend requests” with an update to your online policy.

Consistency is important to clear boundaries in a prof essional therapeutic relationship. If a therapist makes anexception f or a client in one circumstance, the client may unf ortunately interpret that dif f erently than thetherapist intended. Clients are not a prof essional’s “f riend” (although a f riendship may develop over t ime) andwhile a prof essional relationship does exist amongst the two, it may not be a relationship a client or therapistis comf ortable publicizing via a public social networking website.

The publication of such inf ormation, whether a client realizes it or not, may result in a violation of the client’smental health care privacy. While they may think such a “f riend connection” on a social network is harmless f un,

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it may be used by f uture employers (or even signif icant others!) to pass judgment or draw conclusions f romthat are detrimental to the client. Worse yet, the client may never know or realize that such inf ormation may beharming them (since social networks don’t tell you who’s viewed what inf ormation of yours once you makesomeone a “f riend;” in some cases, you may not even need to be a person’s “f riend” in order to view suchinf ormation).

The Safest Approach — For Now

For now it ’s probably best to keep the therapist/client boundaries clear and consistent online: clients shouldnot send social networking “f riend requests” to prof essionals, and prof essionals should avoid accepting them(nor send out such requests to their clients or f ormer clients). This policy should be made clear to a new clientat the init iation of psychotherapy, to minimize f uture misunderstanding.

Social networking is a powerf ul tool, but it ’s also a tool that can be misused and sometimes even abused.People are not always clear or aware of what inf ormation is available to the public or their “f riends” list, andwhat inf ormation is private. And people may not always understand the longer term ramif ications andimplications of sharing such inf ormation with others.

Dr. John Grohol is the CEO and f ounder of Psych Central. He is an author, researcher andexpert in mental health online, and has been writ ing about online behavior, mental health andpsychology issues -- as well as the intersection of technology and human behavior -- since1992. Dr. Grohol sits on the editorial board of the journal Cyberpsychology, Behavior andSocial Networking and is a f ounding board member and treasurer of the Society f orParticipatory Medicine.

Like this author?Catch up on other posts by John M. Grohol, PsyD (or subscribe to their f eed).

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Last reviewed: By John M. Grohol, Psy.D. on 15 May 2008Published on PsychCentral.com. All rights reserved.

APA Reference Grohol, J. (2008). Social Networks May Blur Prof essional Boundaries. Psych Central. Retrieved on April 19,2013, f rom http://psychcentral.com/blog/archives/2008/05/15/social-networks-may-blur-prof essional-boundaries/

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The Internet’s ethical challengesShould you Google your clients? Should you ‘friend’ a student on Facebook? APA’s Ethics Director StephenBehnke answers those questions and more.

By Sara MartinMonitor StaffJuly 2010, Vol 41, No. 7Print version: page 32

QUESTIONNAIRE

No form of client communication is 100 percent guaranteed to be private. Conversations can be overheard, e-mails can besent to the wrong recipients and phone conversation can be listened to by others.

But in today’s age of e-mail, Facebook, Twitter and other social media, psychologists have to be more aware than ever ofthe ethical pitfalls they can fall into by using these types of communication.

“It’s easy not to be fully mindful about the possibility of disclosure with these communications because we use thesetechnologies so often in our social lives,” says Stephen Behnke, PhD, JD, director of APA’s Ethics Office (/ethics/behnke.aspx) . “It’s something that we haven’t gotten into the habit of thinking about.”

The Monitor sat down with Behnke to discuss the ethical aspects of the Internet for psychology practitioners and how tothink about them.

Does the APA Ethics Code guide practitioners on social media?

Yes. The current Ethics Code (/ethics/code/index.aspx) was drafted between 1997 and 2002. While it doesn’t use the terms“social media,” “Google” or “Facebook,” the code is very clear that it applies to all psychologists’ professional activities andto electronic communication, which of course social media is.

As we look at the Ethics Code, the sections that are particularly relevant to social media are on privacy and confidentiality,multiple relationships and the section on therapy. The Ethics Code does not prohibit all social relationships, but it does callon psychologists to ask, “How does this particular relationship fit with the treatment relationship?”

Is the APA Ethics Office seeing any particular problems in the use of social media?

Everyone is communicating with these new technologies, but our ethical obligation is to be thoughtful about how theEthics Code applies to these communications and how the laws and regulations apply.

For example, if you are communicating with your client via e-mail or text messaging, those communications might beconsidered part of your client’s record. Also, you want to consider who else might have access to the communication,something the client him- or herself may not be fully mindful of. When you communicate with clients, the communicationmay be kept on a server so anyone with access to that server may have access to your communications. Confidentialityshould be front and center in your thinking.

Also, consider the form of communication you are using, given the kind of treatment you are providing. For example, thereare two very different scenarios from a clinical perspective: In one scenario, you’ve been working with a client face-to-faceand you know the client’s clinical issues. Then the client goes away on vacation and you have one or two phone sessions,or a session or two on Skype. A very different scenario is that the psychologist treats a client online, a client he or she hasnever met or seen. In this case, the psychologist has to be very mindful of the kind of treatment he or she can provide.What sorts of issues are appropriate to treat in that manner? How do the relevant jurisdiction’s laws and regulations applyto the work you are doing?

That’s an example of how the technology is out in front of us. We have this wonderful new technology that allows us to

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offer services to folks who may never have had access to a psychologist. At the same time, the ethical, legal andregulatory infrastructure to support the technology is not yet in place. A good deal of thought and care must go into howwe use the technology, given how it may affect our clients and what it means for our professional lives.

APA needs to be involved in developing that ethical, legal and regulatory infrastructure and needs to be front and centeron this.

What do you want members to know about using Facebook?

People are generally aware that what they put on their Facebook pages may be publicly accessible. Even with privacysettings, there are ways that people can get access to your information.

My recommendation is to educate yourself about privacy settings and how you can make your page as private as youwant it to be [see further reading box on page 34]. Also, educate yourself about how the technology works and be mindfulof the information you make available about yourself. Historically, psychology has talked a lot about the clinicalimplications of self-disclosure, but this is several orders of magnitude greater, because now anyone sitting in their home orlibrary with access to a terminal can find out an enormous amount of information about you.

Facebook is a wonderful way to social network, to be part of a community. And of course psychologists are going to usethis, as is every segment of the population. But psychologists have special ethical issues they need to think through todetermine how this technology is going to affect their work.

These days, students are inviting professors to see their Facebook pages and professors are now privy to moreinformation on their students’ lives than ever before. What’s your advice on this trend?

Psychologists should be mindful that whether teaching, conducting research, providing a clinical service or acting in anadministrative capacity, they are in a professional role. Each role comes with its own unique expectations, and theseexpectations have ethical aspects. I would encourage a psychologist who’s considering whether to friend a student tothink through how the request fits into the professional relationship, and to weigh the potential benefits and harms thatcould come from adding that dimension to the teaching relationship. Of course, the professor should also be informedabout the school’s policy concerning interacting with students on social networking sites.

How about Googling clients — should you?

In certain circumstances, there may be a good reason to do a search of a client — there may be an issue of safety, forexample. In certain kinds of assessments, it might be a matter of confirming information. But again, we always need tothink about how this fits into the professional relationship, and what type of informed consent we’ve obtained. Curiosityabout a client is not a clinically appropriate reason to do an Internet search. Let’s put it this way: If you know that yourclient plays in a soccer league, it would be a little odd if on Saturday afternoon you drove by the game to see how yourclient is doing. In the same way, if you’re doing a search, thinking, “What can I find out about this person?” that raisesquestions about the psychologist’s motives.

What about Twitter?

Again, you first want to think about what are you disclosing and what is the potential impact the disclosure could have onthe clinical work. Also, if you are receiving Tweets from a client, how does that fit in with the treatment?

These questions are really interesting because they are pushing us to think clearly about the relationship between ourprofessional and personal lives. We all have our own social communities and networks, but we also have to be awareabout how we act and what we disclose in those domains, which are more accessible. Someone might say that thistechnology isn’t raising new questions, it’s raising old questions in different ways.

How about blogs?

Be aware that when you author a blog, you’re putting a lot of yourself into it. That’s why you’re doing it. So again, youneed to be mindful of the impact it will have on your clinical work. It also depends on what the blog is about. For example,if you’re blogging about religion, politics or movies, in this day and age, some of your clients are going to read thematerial. If you are sharing your personal views on some important societal issue, be mindful of how that might affect thework you are doing.

When is the next Ethics Code due out and will it more specifically address social media?

The next revision hasn’t been scheduled, but if I had to guess, probably in the next two to three years, APA will begin theprocess of drafting the next code. I can say with a very high degree of confidence that when APA does draft the next code,

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Find this article at:http://www.apa.org/monitor/2010/07-08/internet.aspx

the drafters will be very mindful of many issues being raised by social media.

It’s important to think about ethics from a developmental perspective. As our field evolves, new issues emerge anddevelop. Not all the questions about social media have crystallized yet. We have to make sure that we have a pretty goodsense of the right questions and the right issues before we start setting down the rules. Part of that process is exploringwhere the potential harms to our clients are.

We are just defining the questions, issues, the risks of harm to the client and we’re going to have to let the process unfold.In the meantime, we have to be aware that these technologies are very powerful and far-reaching and bring with themwonderful benefits, but also potential harms. Stay tuned.

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