december 2012 issue - the national psychologist

By Paula E. Hartman-Stein, Ph.D.

Apathy is turning into urgency as clini-cians who bill under Medicare learn thatfinancial penalties are slated for 2015 fornon-compliance in the Physicians QualityReporting System (PQRS) beginning

January 2013.According to the website on PQRS from

the Center for Medicare and MedicaidServices (CMS),“Beginning in 2015,if the eligible profes-sional or group prac-tice does not satisfac-torily submit data onPhysician QualityReporting Systemquality measures, a

1.5 percent payment adjustment will apply.To avoid the 2015 adjustment, an eligibleprofessional must satisfactorily reportPhysician Quality Reporting System qualitymeasures during the 2013 reporting period(Jan. 1-Dec. 31, 2013).”

Anita Somplasky, director of health carequality improvement for the West VirginiaMedical Institute, clarified how the sanctionwill work: “The penalty for non-participa-tion in 2013 will be an automatic 1.5 percentreduction on each payment in 2015.”

Peter Kanaris, Ph.D., coordinator ofpublic education of the APA’s PublicEducation Campaign in New York and mem-ber at large of the executive committee of theNew York State Psychological Association(NYSPA), said, “Hearing about the penaltiesfor not participating in PQRS at a recentMedicare workshop sponsored by NYSPAtook me and the entire group by completesurprise.”

In a phone interview, Kanaris said hehad been aware of PQRS, but he and other

psychologists at the workshop lacked suffi-cient education about the program.

“Knowing there will be a penalty pro-vides sufficient stimulation to get me tomove myself and participate in the pro-gram,” he said. “I am more responsive to thestick rather than to the carrot.”

PQRS is a reporting program that hasbeen providing a small financial incentive toeligible Medicare providers who submit dataon specified screening measures onMedicare claim forms. Psychologists havebeen eligible to participate since 2008.

In 2012 CMS suggested that cliniciansreport on at least three screening measures,but as long as at least one measure has been

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Medicare to cut payments for not meeting reporting requirements

Continued on Page 4

By Paula E. Hartman-Stein, Ph.D.

Psychotherapists across all disciplineswill need to learn a new set of billing codesthat go into effect Jan. 1 in order to be reim-bursed by insurance companies, includingMedicare. The revision of the codes is a resultof the five-year review process required bythe Centers for Medicare and Medicaid(CMS) and conducted by the AmericanMedical Association (AMA).

psychotherapy has notchanged substantially,but descriptions havebeen replaced withmore modern lan-guage that reflects thefull range and vibran-cy of modern day psy-chotherapy,” he said.

Diagnostic evalu-ation for psychotherapy, formerly code 90801,is split into two diagnostic evaluation codes,one with medical management and one with-out. “The new system represents a different,clearer understanding of what has been occur-ring under the diagnostic evaluation activity.”

The site where the service is delivered isno longer a criterion for code selection,Puente said. For example, the work value forpsychotherapy done in the hospital or nursinghome is the same as for office-based work.

Reimbursement is based on three compo-nents: work value, liability insurance andpractice expense. “CMS has alwaysviewed practice expense as a split entity, sep-arating non-facility (office) and facility (hos-

pital),” said James Georgoulakis, Ph.D., APArepresentative to the Relative UpdateCommittee of the AMA.

“It is likely that there will be a reim-bursement difference between the two loca-tions, with the facility expense being muchhigher,” he said. “However, it is likely thatlong-term care facilities will be placed in thenon-facility care overhead expense areabecause they do not meet the CMS definitionof a hospital.”

Actual payment amounts for psychother-apy in 2013 will not be known until theFederal Register publishes reimbursementrates for all codes in November.

Puente said introducing significant othersto the psychotherapy equation has expanded.“Therapy can be done with the patient aloneduring the session, with the patient and a sig-nificant other or with the patient at one pointin the session and with a significant other at aseparate point in the session.”

New psychotherapy codes differentiatedby time may involve the family member in thesession in order to support the treatment planfor the patient, a practice that is commonwhen working with children or with adults

Continued on Page 3

Vol. 21 No. 6

The New Year will bring new billing codes for all psychotherapists

INSIDE THIS ISSUENFL suits spotlight TBIs .. Page 6

Evaluating credentials .... 3

Studying under a master:

First of a series ........... Page 17

“These changes made to the psychothera-py codes are the first revisions made for thefirst time in most all practitioners’ careers,”according to Tony Puente, Ph.D.

Puente, a professor of psychology at theUniversity of North Carolina who maintains aprivate practice in clinical neuropsychology inWilmington, is the only psychologist on the17-member voting panel of the AMA CurrentProcedural Terminology (CPT) committee.

In phone interviews, Puente explainedthe major coding revisions. “The definition of

Hartman-Stein

Puente

T H E N A T I O N A L P S Y C H O L O G I S TNovember/December 2012

ed was based upon the opinion of the workgroup that long engagements with patientsthat exceed 75 minutes tend to be crisis situa-tions. As a consequence, a new family ofcodes was created, the crisis codes, to be usedfor intense, intermittent engagements, typical-ly used in life threatening situations thatrequire immediate attention,” Puente said.

The interactive psychotherapy codes thathad been used if an interpreter was neededhave been eliminated. Complexity codes usedin conjunction with codes for primary servic-es such as diagnostic evaluations and psy-chotherapy have been added.

“In the former coding system practition-ers had been bound to one type of level ofpsychotherapy, regardless of intensity. Nownew ‘add on’ complexity codes can be used insituations of high intensity cognitive engage-ment,” Puente said. “As examples, thesecodes may be appropriate in cases of workingwith children or patients with dementia orpsychosis.”

A pharmacology management code forprescribing psychologists was added. “This isa major milestone and a very positive out-come for psychologists,” Puente said.

Codes that have not changed are psycho-

analysis, biofeedback, group psychotherapy,multi-family group psychotherapy and familypsychotherapy.

According to Puente, the development ofthe codes has been an ongoing two-yearprocess that included discussion with APAstaff, development of an APA-appointed workgroup, meetings with a work group estab-lished among all professions that do psy-chotherapy and a survey filled out by practi-tioners of psychotherapy including psycholo-gy, psychiatry and social work.

“The code revisions have been vettedover two years at multiple levels. It was not aclandestine process but has been done in aprogrammatic, well-reasoned and balancedperspective with multiple inputs and multiplelevels by individuals who are respected in thefield of psychotherapy. It has been doneaccording to the protocol that all 120 healthprofessions play by.”

Neil Pliskin, Ph.D., professor and chiefof neuropsychology with the University ofIllinois Hospital and Health Science Systemin Chicago, has been advisor to theAMA/CPT Health Care Professionals Advis-ory Committee on behalf of the APAsince 2009.

“Puente is psychology’s champion in thisendeavor,” Pliskin said. Both Pliskin and

Billing codes will change in 2013

with memory impairment, for example. Ineach session there must be some face-to-facecontact with the patient.

“The amount of time spent in psychother-apy has increased in granularity or levels,”said Puente. There are codes to indicate 15-,30- and 60-minute sessions. The standard timerules used by CPT will apply. For example, ifthe session is longer than 15 minutes, it willbe captured by the 30-minute code.

The website of the American Academy ofChild and Adolescent Psychiatry provides achart of time ranges for the new codes. Actualtime ranges include codes for 16 to 37 min-utes, 38 to 52 minutes and more than 53 min-utes. Psychotherapy lasting less than 16 min-utes is not reported.

According to Puente, the session beginswith face-to-face contact. “When I meet mypatient in the waiting room, the clock starts.”Time spent calling referrals and documentingthe activity is not captured as psychotherapy,but time spent in these clinical activities isconsidered in the work valuation of the code.

In the new system there is no separatecode for a 90-minute psychotherapy session.“The reason a 90 minute code was not includ-

November/December 2012T H E N A T I O N A L P S Y C H O L O G I S T

Puente also credit Randy Phelps, Ph.D.,deputy director of APA’s Practice Directorate,with representing the interests of psychologyvery well in the lengthy process.

The AMA and APA plan a webinar seriesto educate professionals on proper coding.

APA Division 20 (Adult Developmentand Aging) in conjunction with the Society ofClinical Geropsychology is planning a webi-nar in early 2013 on appropriate codingspecifically when using interventions withmemory impaired patients, according to PatParmelee, Ph.D., Division 20 president.

The AMA’s 2013 Current ProceduralTerminology (CPT) was published in mid-October. Copies of the CPT manual can beordered through Amazon or directly from theAMA online or by calling 800-621-8335. CE----------

Paula Hartman-Stein, Ph.D., is a con-sultant, trainer and geropsychologist in Kent,Ohio, and one of the original seven membersof the Technical Consulting Group forClinical Psychology when reimbursementrates for psychology services were first deter-mined by the Resource-Based Relative ValueScale. She is co-editor of Enhancing Cog-nitive Fitness in Adults (Springer, 2011). Herwebsite is www.centerforhealthyaging.com.

Continued from Page 1

reported in 50 percent of the applicableMedicare Part B fee-for-service patients, thehealth care professional was eligible for abonus payment of 0.5 percent to be distrib-uted in the fall of the subsequent year.Clinicians who participated in 2011 receivedtheir bonus checks in mid- October 2012.

Psychologists had 10 measures avail-able for reporting in 2012 under the individ-ual claims reporting system. Measures canalso be reported through a registry systemthat requires a fee to join. Regardless ofwhich system a health care provider choos-es, CMS suggests that clinicians decide thatthe screening areas they choose fit best withthe particular patient population they serve.

According to a recent trends report fromCMS, fewer than 200,000 eligible providersout of more than 600,000 participated inPQRS in 2010. Emergency physicians hadthe largest representation among all special-ties and also had a high rate of participation(65 percent). The CMS report said,“Hospital-based practices most likely haveprocesses in place to capture clinical dataaccurately, therefore allowing quickeruptake of reporting quality measure data.”

Of the 10 specialties listed in the CMSreport, psychologists fit into “Other EligibleProfessionals.” Only 17 percent of eligibleproviders participated in 2010.

Alice Randolph, Ed.D., MSCP, ownerof Psychological Transitions in Port Clinton,Ohio, a company that provides psychologi-cal services in long term care facilities infour states, said, “I have made it a require-ment for my 20 employees to participate inPQRS because it is worthwhile to change theway they think by rewarding them. This isvery positive on the part of CMS.”

Randolph said after studying the areasthat psychologists could screen under PQRSshe chose elder abuse, depression and tobac-co use. “These are very effective things toask in a psychological assessment,” she said.“I’m not asking the practitioners to do any-thing that is alien to a clinical interview.”

According to Randolph, asking ques-tions of nursing home patients about abuseelicited content for psychotherapy andhelped to explain why adjustment was notgoing well or the possible reason for nega-tive reactions of some female patients tomale nursing assistants. “There is a whole lotmore Post-Traumatic Stress Disorder thanwe realize. The elder abuse screen has fouror five questions that can generate painful

memories. That area of screening has beenthe most surprising and productive.”

Randolph said she was audited on heruse of PQRS measures two times by QualityInsights of Pennsylvania, the agency con-tracted to develop psychological measures,and she had no problems. “I have found thatby creating a form you don’t leave it up to aclinician’s memory. If you are organized andhave a form for it. It is no big deal.”

Mary Lewis, Ph.D., president ofPsychologists in Long-Term Care and psy-chologist with Senior Life Consultants inColumbus, Ohio, said, “I have not ever offi-cially participated in PQRS but I have beeninformally documenting measures on myclientele. “I think it has helped me tremen-dously because it standardized my assess-ment more than it used to be. It makes mecatch things that I might not have asked.”

Randolph said the most challenging partof participating in PQRS is going throughthe pages of measures and finding thoseapplicable to psychology. “I found theinstructional material to be cumbersome,convoluted. I waited till New Year’s Eve towade through the measures. It took fortitudeto figure it out.”

As of press time, the measures availablefor next year are not yet available. Thescreening measures are tied to the CurrentProcedural Terminology (CPT) codes thatthe AMA published in mid-October.Somplasky said she expects CMS to publishthem very soon.

Kanaris thinks psychologists’ participa-tion will increase if information is given inclear terms. “We are educable,” he said.

A webpage dedicated to all the latestnews on PQRS is available on the CMSwebsite at http://www.cms.gov/PQRS.Information from APA is also availablethrough http://apapracticecentral.org/ reim-bursement/improvement/pqri-faq.aspx----------

Paula E. Hartman-Stein, Ph.D., is aclinical geropsychologist who was chair ofthe Psychology and Social Work ExpertWork Group to develop quality measures forthe Physicians Quality Reporting Initiativein 2007 and co-chair of the Psychology WorkGroup in 2008. She is planning a nationalwebinar on PQRS 2013through her compa-ny in early December. It was at a workshopshe conducted that NYSPA members learnedof the coming penalties. Her website iswww.centerforhealthyaging.com.

November/December 2012 T H E N A T I O N A L P S Y C H O L O G I S T

Penalties join incentives in PQRS enactmentContinued from Page 1

Conference offers great tips for establishingand growing independent practices


By Jennifer Imig Huffman, Ph.D.

San Diego – Strategies for launching,growing and revitalizing independent prac-tices were featured at the first annual APADivision 42 Fast Forward Conference heldhere Oct. 5-6.

About 160 attended the sessions at theRancho Bernardo Inn and Spa.

Headline speakers included StevenWalfish, Ph.D., author of many books onmaking a practice successful; Keely Kolmes,Psy.D., who specializes in integrating psy-chology and social media; Katherine Nordal,Ph.D,, executive director of the APA PracticeOrganization; and Peter Sheras, Ph.D., andPhyllis Koch-Sheras, Ph.D., who specializein couples therapy.

Janet Lapp, Ph.D., gave the openingpresentation to begin the conference thatincluded presentations by 32 psychologistsand 18 programs offered CE credits.

One of the highlights was a speed men-toring event directed by Heather Wittenberg,Psy.D., of BabyShrink fame. The eventmatched doctoral, early career and newlyestablished independent practitioners with20 innovative psychologist mentors who hadbeen selected based on practice interests,career and personal goals.

The organizing committee for the con-ference included educational, inspirationaland practical sessions that emphasizedhands-on learning and expert training as wellas up-to-the minute ethics seminars on theinterface of psychology with technologies.

Programs focused on ethics in the age ofGoogle and Facebook, mindfullness, sup-porting parents, preparation for court testi-mony and legal and ethical issues in telepsy-chology.

Opportunities to network and socializeoutside of the presentations were alsoemphasized. The beautiful weather was thebackdrop to happy hour receptions, buffet-style lunches, and evening “Dine Arounds,”the latter which allowed attendees to sign upfor transportation to local restaurants andsocialize with other conference attendees.

The reactions to this conference asnoted through the list-serve and social mediaforums have been overwhelmingly positive.Several providers tweeted on Twitter duringthe conference and a summary of thesetweets is on the Division 42 website.

One of the consistent refrains heardfrom attendees across the board (from ECPto well-established practitioners) was thatthe Division 42’s Fast Forward Conferencewas one of the best conferences they hadever attended.

That was this psychologist’s sentimentexactly. Well done Fast Forward conferenceplanning committee, I cannot wait to seewhat you have in store for us next year! ----------

Jennifer Imig Huffman, Ph.D., is a clin-ical neuropsychologist specializing in devel-opmental conditions in children and adoles-cents. She is the owner of NeuropsychologyCenter for Attention, Behavior and Learningin Lincoln, Ill. She and her husband, Maj.Dennis Huffman, Illinois Army NationalGuard, are the co-founders of Little HeroHelpers, a non-profit organization designedto support the emotional well-being of mili-tary children and families. The Huffmanslive in Central Illinois with their three youngchildren. She may be reached by email at:[email protected]

Reports from former players who sus-tained head injuries throughout their careersexpress difficulties with memory loss,headaches, vision problems, speech prob-lems, early onset Alzheimer’s disease andother forms of dementia. The players alsoreport psychological symptoms of anxiety,difficulties with impulse control and emo-tion regulation, depression and suicidality.

There has been increased discussion atall levels of competition about the long-termrisks of playing football, the need to imple-ment protocols following a head injury or

possible concussionand ways to increasethe safety of the sport.

As the number offormer and currentplayers who are suf-fering from psycho-logical issues as aresult of their headtrauma increases, thenumber of licensedtherapists who areproviding treatment tothis population willneed to increase.There is limitedresearch on the psy-chological needs ofcurrent and formerplayers who present

with issues relating to head injury. We knowthese issues include depression, anxiety,anger management, family conflict, suicideideation and substance abuse.

The NFL is not the only organizationthat is under attack because of head injuries.Similar lawsuits at the NCAA and highschool levels contend that institutions have aresponsibility to protect their athletes.Licensed clinicians can partner with the NFL(and other organizations) to serve asresources for athletes who have sustainedhead injuries. As such, there are a few stepsthat therapists may be able to take in order tohelp athletes and organizations manage thechallenges related to concussions:

* Network and build relationships withNFL team physicians and player develop-ment personnel in your market.

* Partner with your NFL franchise toprovide comprehensive baseline testing(potentially in conjunction with a neuropsy-chologist).

* Be mindful of potential brain traumawhen working with an athlete in any mental

By Shaun Tyrance, Ph.D.and Nyaka NiiLampti, Ph.D.

The United States is obsessed with foot-ball, and especially the National FootballLeague (NFL). Between the artistry of thegame and fantasy football fanatics, the NFLhas become America’s pastime. The size andspeed of today’s NFL athlete is the reasonthe league is so popular, but it is also the rea-son that the game has become extraordinari-ly violent.

It is becoming more and more difficult

to watch an NFL game without witnessing aplayer being helped off the field with a headinjury or worse, seeing a player lay motion-less or unconscious on the field waiting to beassisted by the team physicians.

According to the Washington Times, asof Sept. 11, there are 3,569 plaintiffs in theimpending NFL lawsuits – currently 160lawsuits in total – in which retired NFL play-ers are suing the NFL for head injuries sus-tained during their tenure (http://www.wash-i n g t o n t i m e s . c o m / f o o t b a l l i n j u r i e s ) .According to the site, there are three playerswho began their careers in the 1940s, withthe greatest numbers of players listed havingplayed during the 1980s and 1990s, with 859and 811 plaintiffs listed for each decade,respectively. There are 318 plaintiffs listedas “never played.”

The lawsuits filed state that the NFL isliable for withholding information regardingthe long-term impacts of head injuries andconcussions and argue that the league shouldhave been more forthcoming in sharinginformation gathered from research.


Football head injuries create need for therapists

Continued on Page 14

Helmet-to-helmet contact can cause serious head injuries


Robert L. Mapou, Ph.D., ABPP

Most clinicians are aware that learningdisabilities arise early in development, arepresumed to be neurologically based andoften run in families. Yet, when reviewingreports I am frequently surprised to see thatmany clinicians are not aware of the evidencebase on these disorders. Statements I havefound in reports include:

* Test scatter indicates that Mr. White hasa learning disability.

* Mr. Smith’s reading disorder is due tohis slow processing speed.

* Ms. Jones’s reading disorder is directlyrelated to her visuospatial difficulties.

* Ms. Adams’s profile indicates a learn-ing disability in processing speed, conceptualthinking and visuospatial skills.

None of these statements is correct.Specifically, research has found that 1) vari-ability in test performance is the rule ratherthan the exception and is not diagnostic of alearning disability, 2) slow processing speedis associated with dyslexia or ADHD and mayreflect their genetic linkage but does not causeeither and 3) visuospatial difficulties mayaccompany reading disorders but do not cause

Assessment of learning disabilities in adults should be evidence-based

them, as they are rooted in the language sys-tem of the brain.

Learning disabilities also cannot be arbi-trarily diagnosed based on a cobbling togeth-er of weaknesses found on testing. Rather,only learning disabilities for which there isempirical support should be diagnosed, andthere should be associated empirically basedweaknesses in cognitive functioning.

Research on learning disabilities in chil-dren is well established. Over the past 15years, research on these disorders in adultshas grown substantially. Moreover, much ofwhat has been found to be true in children hasalso been found to be true in adults.

Consequently, much of what we knowabout children can, in combination withresearch on adults, be applied to assessmentof adults. Clinicians who routinely evaluateadults for learning disabilities should befamiliar with this research.

The following applies this research toclinical assessment. References to this workwill be provided on request.

Reading disabilitiesThe largest amount of research is on

reading disabilities, including dyslexia, a spe-

cific disorder affecting fluent decoding andreading of individual words as well asspelling. A thorough assessment of a readingdisability should include measures of:

* Phonological awareness (a deficit inphonological awareness is the core impair-ment in dyslexia but may be normal in adultswho have had early intervention)

* Spoken language comprehension(receptive language; word and sentence level)

General knowledge* Span for auditory-verbal information

and working memory* Processing speed* Word retrieval and, especially, rapid

visual naming* Decoding, single-word reading and

spelling* Reading comprehensionTimed measures of decoding, single-

word reading and reading comprehension areessential since many adults with reading dis-abilities, especially if they receive early inter-vention, can do fine when they have sufficienttime to read. They are typically slow and inef-ficient when reading text for comprehension.

Research on other learning disabilities inadults is less well established. But, there isstill sufficient research to guide assessmentsand to determine if the expected underlyingcognitive weaknesses are present.

Mathematics disabilitiesBased on research, assessment of math

disabilities should include measures of:* Attention* Executive functioning (especially plan-

ning and problem-solving)* Visuospatial skills* General knowledge* Speed when completing simple math * Written calculation* Math word problem solvingMathematics disabilities frequently co-

occur with reading disabilities, often affectingease of access to math facts. It can be helpfulto use timed math measures to examinewhether time constraints affect an adult’s abil-ity to demonstrate math skills.

Written language disabilitiesResearch is still in the early stages of

understanding for the cognitive basis for writ-ten language disabilities. Spelling difficultiesfrequently accompany reading disabilities.Problems with expressive writing can occur inassociation with reading disabilities or ADHDor on their own. Important areas for assessingwritten language disabilities are:

* Fine motor speed and dexterity* Handwriting quality* Fluency when writing words and sen-

tences* Spelling

* Word retrieval and oral sentence for-mulation

* Verbal organization* Essay writing, especially timedUnfortunately, assessment of essay writ-

ing is hampered by a lack of instrumentsappropriate for expressive writing in adults inpost-secondary education. Often, it is neces-sary to describe the errors on these measures,because they are not adequately reflected bythe final score.

Nonverbal learning disabilitiesAlthough some have questioned the use-

fulness of this classification, noting that itsfeatures overlap with those of mathematicsdisabilities and ADHD, others believe thatthere is sufficient data to support it as a sepa-rate disability. Unlike language-based learn-ing disabilities, which are attributed to dys-function in the brain’s left hemisphere, non-verbal learning disabilities are presumed to bedue to right hemisphere dysfunction. The coreimpairments in nonverbal learning disabilitiesshould be the focus of an assessment andinclude:

* Visuospatial skills* Attention and executive functioning* Mathematics (timed tasks are likely to

be more sensitive than untimed)* Interpersonal skillsAdults with nonverbal learning disabili-

ties also are prone to anxiety and mood disor-ders, often because of the impact of slownessand poor visuospatial skills on effective jobfunctioning and the associated interpersonaldifficulties. Consequently, an assessment ofemotional functioning is important.

SummaryOur knowledge on learning disabilities

has advanced to the point that evaluationsshould be evidence-based. Clinicians areencouraged to explore the research to insurethat their assessments are in keeping with thecurrent state of the art. Diagnoses shouldreflect those established by research and,when making a diagnosis, the expected cogni-tive impairments should be present. CE----------

Robert L. Mapou, Ph.D., ABPP, is boardcertified in clinical neuropsychology. He is inindependent practice with The Stixrud Group,in Silver Spring, Md., (www.stixrud.com)where he specializes in assessment of learningdisabilities and ADHD in adults and adoles-cents. He is author of Adult LearningDisabilities and ADHD: Research-InformedAssessment. Portions of this article appear inthat book and are reprinted with permission ofOxford University Press. Mapou may bereached at 301-565-0534, ext. 264 or by emailat: [email protected].

By Eric C. Marine

During the latter part of the 20thCentury and going on into the 21st Century,the pervasive expansion of mental healthcare has changed the practice of clinical psy-chology. During the last three decades, thenumber of people accessing psychologicalcare has grown exponentially. With thisexpansion has come a change in the wayservices are perceived and provided. Thepractice of psychology has maintained itsfocus on confidentiality and is attempting toadapt to the way our world now communi-cates and interacts.

The traditional method of recording ses-sions was with paper and pen. The docu-ments would then be stored in a file in alocked cabinet. This was a change from theuse of a notebook that may have containedmany notes from multiple patients. The cur-rent method is to use some form of electron-ic media to record and store patient charts.

In our lifetime, the use of computers hasbecome seamlessly integrated into the fabricof everyday life. College students no longercarry notebooks to class to take notes. In thepast decade, the use of laptop, notebook ortablet computer has replaced the venerablespiral binder. There is no wonder that stu-dents who are now licensed clinicians wouldcontinue to use the electronic media that hasserved them so well, and an entire industryhas developed to support all forms of socialand electronic media.

Another exciting use of the electronicworld is the ability to stream video. Thisallows a psychologist to have a session witha patient when they are in different locations.It allows the patient to control physical secu-rity and lets the clinician see the patient inreal time and in a comfortable setting.Controlled studies in telepsychiatry haveshown that this method is effective and that

patients embrace this approach. There is noreason to believe that psychology won’t seeresults similar to that in telepsychiatry.

In military parlance, this is a force mul-tiplier. It allows care to be provided to anunderserved portion of the population who,for one reason or another, have not been ableto get the care they need or want.

Unfortunately, the technology hasadvanced faster than the regulations thatgovern it, possibly affecting the standard ofcare that is the basis of good clinical prac-tice. Electronic record keeping and telemed-icine have helped advance patient care butimproper use of the current technology canlead to lawsuits, state board sanctions andgovernmental fines. If the clinician does nottake the proper precautions to protect patientprivacy there will be legal ramifications.

Since the thrust of this article is manag-ing the risk of these new and expandingtechnologies, some of the requirements andlimitations surrounding these developmentsare highlighted below:

1. The license(s) that you have are statespecific. If a patient is not within those geo-graphical boundaries, you may be practicingwithout a license, (e.g. Teletherapy).

2. Any transmission of PersonalHealthcare Information (PHI) must beencrypted as well as Teletherapy sessions.This is more than password protection.Therefore, be very careful that any informa-tion you communicate with a patient is in anencrypted electronic format. Lack of encryp-tion is a violation of federal statute (HIPAA,HITECH) and subject to a heavy fine.

3. If you use your computer to storeyour patients’ files, that data must beencrypted beyond password protection. Ifthe computer is stolen, you are subject to afine for every record on the computer. Theremediation cost can be staggering.(Recently a physician lost a laptop withunencrypted medical records of 3,600

patients on it. The employer of this physicianwas fined $1.5 million.)

Distance treatment using non-HIPAAcompliant systems is a breach of federal lawand an automatic breach of confidentiality.Currently there is no informed consent pro-vision that waives this requirement.

All the major mental health organiza-tions, including the APA, are formulatingstandards to deal with the way servicesshould be provided in an electronic format.These standards are the first basic step toallow new procedures to occur in a fashionthat will benefit patient and provider.

It is a basic tenet of risk management


Risk Management:

Digital age creates new hazards

that there are standards, so that the care thatis given can be administered, documentedand evaluated properly. The current lack ofestablished guidelines leads to an inability todefine proper care and puts all practitionersin jeopardy due to a lack of uniform stan-dards approved by governing entities. CE----------

Eric C. Marine is vice president ofclaims and risk management for AmericanProfessional Agency Inc., which providesprofessional liability and malpractice insur-ance. He may be reached by email at:[email protected].

Black psychologists oppose death penaltyThe Association of Black Psychologists unanimously approved a resolution opposing

death penalties at its 44th Annual Conference in Los Angeles earlier this year.The resolution advocated abolishing death penalties on a variety of grounds, including

statistics that show blacks are most vulnerable to wrongful conviction and capital punishmentis imposed against blacks at a greater rate than against other ethnic groups.

It was also noted that the death penalty does not deter violence or crime and that so longas the death penalty is used there is a risk of executing innocent people regardless of race orethnicity.

By Eric A. Harris, J.D., Ed.D.and Jeffrey N. Younggren, Ph.D.

Telepsychology is exploding, but manypsychologists remain in the dark about whenand how it makes sense for them to dip theirtoes into the flowing river that is runningrapidly by their office doors.

The American Psychological Associ-ation Insurance Trust (The Trust) has beenoffering workshops on this subject for twoyears and we have found there is an enor-mous interest in this area among practition-ers seeking guidance about how to proceed.

Further, the consultation calls we getindicate that many psychologists are facedwith actual situations where it makes senseto them to continue services to clients mak-ing use of some type of telepsychology plat-form. This article is intended to providesome basic ethical and risk managementsuggestions about decision making regard-ing when and how to provide these services.

Before starting, we need to clarify thatthis article will not address the legal and eth-ical arguments regarding the legitimacy ofinterjurisdictional practice. The authors haveaddressed these issues elsewhere. (Harris, E.and Younggren, J. “Risk Management in theDigital World” Professional Psychology:Research and Practice, V 42, #6 2011) Mostcommentators, including those who repre-

sent the interests of states in protecting con-sumers, believe that this issue will eventual-ly be resolved so that practitioners who arelicensed in one jurisdiction will be able toacquire the ability to practice across statelines. Meanwhile, if the suggestions made inthis article are followed, the risk of any legalor ethical problems is minimal.

The APA Ethics Committee has opinedthat it has no problem with remote telepsy-chology so long as practitioners apply thesame standards they would in any emergingarea where generally recognized standardsfor preparatory training do not yet exist.Practitioners should take “reasonable stepsto ensure the competence of their work andto protect patients, clients, students, researchparticipants, and others from harm.”

Since most of us do not have training orexperience with remote treatment, we wouldbe wise to start with cases where an argu-ment can be made that providing the servic-es remotely is superior to, or at least equalto, an in-person referral. Some clear exam-ples of such situations include:

1. Where the services are provided inthe context of, and/or in service of, an exist-

ing treatment relationship (e.g., if a patienttravels regularly, if a college student is goinghome for the summer, if a patient is movingto a different location or if both parties feelthat continuation is better than transfer);

2. Where in-person treatment is eitherdifficult or impossible to access where thepatient resides (e.g., where the patient is aresident of a foreign country where English-speaking therapists are rare; where aprovider is treating a child of divorced par-ents and one parent lives in another state;where the provider has a particular specialtyor expertise that the client, after appropriateresearch, has determined is well suited totheir particular needs; or where the patienthas great difficulty traveling to theprovider’s location).

3. Where remote services offer practicaladvantages over in-person treatment (e.g.,where progress is facilitated by short, regu-lar interactions rather than weekly hourlysessions; where clients feel more comfort-able communicating remotely than in per-son; or where clients have very busy lives,making remote sessions more efficient).

4. Where the client desires remote treat-

ment and the psychologist has sufficientinformation to assess whether this is arational, informed decision (e.g., where aclient feels more comfortable in sharing per-sonal information that is embarrassing orshameful through electronic technology.)

If the case falls into one of the abovecategories, one can move to the questionsthat should always be asked before begin-ning treatment. Do you have enough infor-mation about the client and his/her prob-lems, goals and objectives, mental healthhistory and previous treatment to be able toassess whether the client is an appropriatetelepsychology candidate? Many expertsfeel that some in-person assessment is nec-essary to make this decision. Past records ordiscussions with previous psychotherapistsmay be enough in some situations.

The important thing is to discoverwhether there are risk factors that make thecase inappropriate. You don’t want to betreating someone in Denmark and then dis-cover that he/she has a serious untreatedbipolar disorder and is in the midst of a seri-ous manic episode with no local psychiatristinvolved. Obviously, the more history onehas with a patient, the better one will be ableto assess these factors.

Client motivation is crucial since you

Ethical and risk-managed telepsychology practice: a beginner’s guide


Continued on next page


will not be able to control the environmentwhere the client will be receiving the servic-es. The Army and the Department ofVeterans Affairs currently require services tobe received in a facility with appropriatesupervision, a circumstance which will notbe possible for most private practitioners.

If the client is paying for the treatment,that will provide some incentive but the psy-chologist will have to discuss with the clientthe need to minimize distractions and inter-ruptions. It is also very important to knowhow to provide technologically based servic-es or, better said, to be technologically com-petent. Sadly, at this point, finding informa-tion and training in remote service provisionwill require some effort.

There are good continuing educationcourses and books on telepsychology avail-able and there will be more available soon.Also, you should check the telehealth guide-lines that are available. (For example,Division 29 of APA has a published set oftelepsychology guidelines and APA is underway in developing its own.)

Consultation with colleagues will helpidentify issues you have not thought aboutand will also provide backup for your judg-ments in the event that some type of legal oradministrative action is taken against you.Choose a technology that you have or candevelop some familiarity with. Technologythat most approximates an in-person visitwith the maximum amount of privacy pro-tection and reliability would be ideal.

At this point, perfect choices are veryexpensive but they can be expected tobecome cheaper. You can find a lot of valu-able information by using Google toresearch what is available or by using listservs to which you belong or which are setup to discuss telepsychology. As previouslynoted, competence with the technology youare using is vital. Obviously your first expe-rience with Skype or Facetime should notinvolve a remote patient.

All of the existing telehealth guidelinesput particular focus on informed consent.The client will need to have an adequateunderstanding of the technologies that willbe used, potential problems, reliability andprivacy and security problems. This willallow the client to decide whether the bene-fits of proceeding outweigh the risks.

In addition, the psychologist’s andclient’s lack of experience should lead to anagreement that if the treatment is not work-ing other arrangements will have to be made.

Agreements will have to be made aboutother issues as well: For example, how and ifcontact can be made between sessions andwhat will happen if the technology fails inthe middle of a session. It is very importantthat specific arrangements be made for anemergency, should that occur. In that spirit,requiring an emergency contact where theclient is located is highly recommended.

Finally, realize that if there is a problemthat leads to a licensing board complaint,board members, who are conservative bynature, are likely to be skeptical abouttelepsychology practices. If this turns out tobe the case, good documentation of yourthinking process, comprehensive informedconsent, consultations with other profession-als, discussions with clients and assessmentof the effectiveness of your work will be cru-cial. It is only in this fashion that you will beable to argue that your conduct was consis-tent with the standard of care. CE----------

Eric A. Harris, J.D., Ed.D., is a lawyerand psychologist. He is in part-time clinicalpractice. He is a consultant and has lecturedon risk management and managed careissues. His email is: [email protected].

Jeffrey N. Younggren, Ph.D., is a clini-cal and forensic psychologist in RollingHills Estates, Calif. He is also a clinical pro-fessor at the UCLA School of Medicine. Hisemail is: [email protected].

Ethics of telepsychologyThe APA has launched an initiative to

educate the public on the benefits of psy-chotherapy compared to drugs with animatedshorts that feature the fictitious drug “Fixitol.”

Each animation begins as a spoof ad forFixitol (Fix It All) that purports to curedepression, anxiety and almost any othermental disorder. After noting that “Fixitol isnot available in North America, SouthAmerica … (or the rest of the world),” themessage suggests patients ask their physiciansabout seeking help from a psychologist as atreatment option.

The animations may be viewed atwww.apa.org/psychotherapy.

The hope is to provide some balancefrom the barrage of information about drug

therapy consumers are exposed to from com-mercials and pop culture.

“While medication can be an appropriatepart of treatment, people should know thatpsychotherapy works,” said KatherineNordal, APA’s executive director for profes-sional practice. “Hundreds of studies havefound that psychotherapy is an effective wayto help people make positive changes in theirlives. Compared with medication, psychother-apy has fewer side effects and lower instancesof relapse when discontinued,” Nordal said.

Federal estimates are that one in 10 adultsin America report having depression andbetween 1996 and 2008, the number of pre-scriptions for antidepressants more than dou-bled from 55.9 million to 154.7 million.

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Continued from prior page

APA touts psychotherapy over drugs

By V. Edwin Bixenstine, Ph.D., ABPP

evising a long neglectedmanuscript on psychothera-py led me to a catch-up

review of the literature covering about 30years. The exercise caused me to feel a bitlike Rip Van Winkle down from the moun-tains. The state of psychology today, asregards its clinical applications, is not at allas I expected. Instead of convergence of the-ory, agreement on treatment procedures anda more confident base in empirical knowl-edge, I found divergence, contradiction anduncertainty.

Fomenting this state of affairs are recur-rent meta-analytic studies launched to wrestclarifying generalities from thousands ofdiverse researches on psychotherapy. Whathas emerged, however, while reliable, is aperplexing if not confounding conclusion.No theory-based approach has been foundmore effective than any other.

Psychotherapy in general does showmodest benefits over no therapy at all,although there is a downside risk that somepersons (5 percent to 10 percent) will fareless well than had they not received therapyat all. This is about where we were 76 yearsago when Saul Rosenzweig introduced hiswry “Dodo Bird Hypothesis” that differenttherapy approaches, like contestants in Alicein Wonderland’s foot race, are all winners“and all must have prizes.”

Yet, in spite of the substantial empiricalsupport for the Dodo Bird Hypothesis, manyif not most psychologists reject the idea thatsome therapy approach will not be found toexcel over all others. Inventive explorerscontinue searching afield for new approach-es, such as “mindfulness” (borrowed from

Buddhists thinking) or “narrative therapy,”all adding to the burgeoning numbers ofdivergent approaches (estimated at 400 ormore).

Many psychologists act, however, as ifthese meta-analyses results did not exist. Forexample, there is a strong professional (APAbacked) movement to emulate medicine andsanction only EST (Evidence Supported

Treatments), which sounds good but on itsface simply denies the relevancy of meta-analytic results. We do not have reliable evi-dence supportive of this-over-that proce-dure.

In addition, imposing an EST restrictionwould discourage clinical exploration ofnew (untested) and possibly more effectivetreatment approaches. Another problem isthat psychotherapy of whatever approachutilizes a human relationship rather than apill to carry the active ingredient to the dis-tressed person. This makes psychotherapyresearch far more challenging than drugresearch. For example, how does a blindcontrol (placebo) therapist not know thefacts and knowing, how to participate in anauthentic helping relationship?

There are those seeking to calm insecu-rities of professionals who are doing therapyor teaching it by assuring them that psy-chotherapy in general works, if not alwayswell, at least better than no therapy. Theyadvise dispensing with endless and futileefforts to confirm some superior therapy the-ory. Even if the benefit of therapies we con-

duct boils down to a placebo effect, as longas those effects over all are positive and thetherapy is construed in psychological termi-nology, then it remains a legitimate applica-tion and province of our discipline.

Unfortunately, this position simply sur-renders to the Dodo Bird Hypothesis. Yes, itmay give some succor to beleaguered practi-tioners, but such aid comes at the cost of

abandoning psychology the science. Theoryin science is more than mere suasion, morethan a convincing narrative. Theory, suffi-ciently undergirded in empirical evidence, iswhat we call knowledge. However, the DodoBird essentially says theory is irrelevant.

But why would all these therapy theo-ries, so varied in terms and concepts, bealike in bringing indistinguishable results? Iwould argue that there is a fundamental wayall researched approaches are indeed thesame. They all advance, often implicitly, thesame starting premise – that the basic causeof human psychological distress is negativeemotions that inspire various obsessive,ameliorative efforts (symptoms) and whichhave been seared into our psyches by bothdistant and current traumas. The goal, then,of psychotherapy is to annul these negative,victimizing emotions.

This premise, moreover, is so prevalentand unquestioned that you may well find itsrendering here merely a statement of theobvious, a fact rather than an assumption.Unless you are nearly as old as I am, youmight not recognize that 60 years ago O.

Hobart Mowrer explicitly challenged thisassumption and advanced a critically con-trasting premise – that the basic cause ofhuman distress is not “negative” emotionsbut “negative” behaviors, behaviors incom-patible with troubled persons’ values.

These behaviors represent departuresfrom personal integrity and prompt thosepainful emotions (such as guilt) and subse-quent efforts to deny and minimize them. Itfollows that the goal of psychotherapy is notto dismiss emotions but, instead, to attend tothem, be instructed by them and to discoverfrom them what behaviors troubled peoplemay be well advised to change.

If Mowrer’s integrity theory focusing onchanging behavior is right and the traumatheory focusing on changing emotions iswrong, then no matter how therapy is termi-nologically construed as it endeavors toannul negative emotions, it will be less use-ful than it could be and perhaps even harm-ful – precisely the results of the meta-analy-ses.

We do not need research on yet another“new” therapy based on the same underlyingpremise. We should be fairly confident nowthat the results will be unremarkable. Whatwe do need is a wide-gauged research effortto examine an “old” therapy, now all but for-gotten, but grounded in a truly differentpremise about the nature of human psychicmisery and the focus of psychological inter-vention.

The arguments I have presented here areelaborated and referenced in a manuscript,yet unpublished, titled “Integrity Therapy,How Do It and Why Do It: O. H. Mowrer’sTheories Revisited.”

Email me should you have an interest inexamining these matters in greater detail.

CE----------

V. Edwin Bixenstine, Ph.D., ABPP, is anemeritus professor at Kent State University.His email is:[email protected].

VIEWP‘Rip Van Winkle’ looks in

on psychology today

See our website at: www.nationalpsychologist.com

R

Reminder:

You can earn CE creditfor reading this issue.

See page 21 for details.

... What has emerged, ... is a perplexing if notconfounding conclusion. No theory-based approachhas been found more effective than any other.

By Jerrold Pollak, Ph.D.

onsumers of behavioral healthcare services are confrontedwith a bewildering array of

practitioners with a multitude of graduatedegrees, certifications/licensure and titles.This includes so called “vanity” credentialstoo often conferred based on a resume, a“work sample” and payment of a fee.

The proliferation of credentials has beendriven by the dissemination of informationafforded by the Internet, the heightenedcompetition for jobs and private practiceopportunities resulting from restrictive man-aged care practices and the increase in grad-uate programs in behavioral health caresince the start of the new century.

The pursuit of credentials is likely tointensify in view of the growing number of“fast track” masters and doctoral level pro-grams in behavioral health care that offerthe allure of completing nearly all degreerequirements on line. The “tipping point”appears to be rapidly approaching when abachelors degree from just about anywhereawarded in nearly any area of study, togeth-er with the ability to pay tuition and relatedcosts “up front,” may suffice to initiate thematriculation process when it comes tomany of these graduate programs.

“Gilding the lily” with regard to creden-tials for professional practice extends to allthe behavioral care professions. However,the biggest offenders come from the fields ofmental health counseling, clinical socialwork and professional psychology.

Clinical psychiatry is clearly not lackingin critics and skeptics, including many fromwithin its own ranks. Still, it has done a bet-ter job at adhering to standardized education,training and credentialing than the non-physician/M.D. behavioral health care pro-fessions. In contrast to clinical psychiatry,there is considerably more heterogeneity inthe non-medical behavioral health care fieldswith respect to education, training and cre-dentialing.

In tandem with the “Zeitgeist” of “lifelong” learning and the growing popularity ofon-line education, there has been a rise in thenumber of mid- and late-career mastersdegree level professionals in mental healthcounseling and clinical social work who

have been awarded doctorates in profession-al psychology and related fields.

Some of these graduates do not qualifyto take the psychology licensure examina-tion. Others decide against taking this exam-ination or are unsuccessful at passing it.These clinicians continue to bill for theirservices under their masters level licensewhile referring to themselves as “doctor so-and-so” and, at times, “sinning by omission”as to the precise nature of their additionaleducation/training and licensure status.

Within professional psychology, contro-versy continues as to who can legitimatelyuse the title of “psychologist.” While a doc-toral degree in psychology and a statelicense are needed for entry level practice innearly all states, West Virginia and Vermont

recognize master’s level practitioners.School psychologists, most of whom holdmasters degrees, routinely refer to them-selves as psychologists.

There is also the problem of licensedpsychologists who arrogate titles that falloutside the parameters of their license. Thisincludes practitioners who refer to them-selves as a “licensed clinical psychologists”or “licensed clinical neuropsychologists”when their state license (which, in moststates, are generic licenses as is true in med-icine) only permits the title of “licensed psy-chologist.”

As well, there are psychologists whoconduct evaluations of patients with benignmedical/neurological histories with ques-tions of attention deficit disorder and/or one

or more learning disabilities. To establishthis niche practice, some of these cliniciansmarket themselves as neuropsychologistsdespite limited, if any, formal training inclinical neuropsychology.

This is akin to primary care physicians,who may treat patients with migraineheadache, referring to themselves as neurol-ogists or dermatologists, who offer botoxwrinkle reduction treatment, advertising ascosmetic surgeons. Worse still, are thosepsychologists who broaden the scope of theirpractice from assessment of attention andlearning difficulties to evaluation of personswith known or suspected acquired neurobe-havioral impairment.

There are many dubious titles to goaround – behavioral coach, medical psy-

chotherapist, forensic examiner, disabilityconsultant etc. These are not titles regulatedby state law, recognized as legitimate spe-cialties by the APA or credentialing boardslike the American Board of ProfessionalPsychology or conferred on the basis of rig-orous examination and peer review.

The burnishing of questionable creden-tials/titles is enabled by the historic failure ofthe behavioral health care professions,including clinical psychiatry, to develop anygood competency-based tests for entry levelor advanced clinical practice.

Unfortunately, state licensure and evenboard certification/diplomate status, con-ferred by well regarded credentialing organ-izations like the American Board ofProfessional Psychology/ABPP, American

Board of Professional Neuropsychology/ABN and the American Board of Psychiatryand Neurology does not insure competentand ethical practice.

There are excellent resources availablethat review the licensure/certification andboard examination process in professionalpsychology. It is far from clear, however,whether graduate students in behavioralhealth care programs, including professionalpsychology, are being taught about legiti-mate and ersatz credentials.

Recommendations for reformConsumers of behavioral health servic-

es should be better informed about the edu-cation/training of practitioners from theranks of all the behavioral health care pro-fessions. Caveat emptor should prevail whenit comes to website advertisements of cre-dentials claimed by practitioners in behav-ioral health care.

Graduate programs in behavioral healthcare need to do a better job of educating stu-dents about legitimate and faux credentials.

Licensing examinations have to becomemuch more competency-based. Despite its35-year-plus history, the content/format ofthe Examination of Professional Practice ofPsychology has not substantially changed.

Furthermore, this entry level examina-tion has never demonstrated a clear relation-ship with competent or ethical practice.

Academic/research psychologists withno clinical training, but some prior study ofthe APA ethics code and state licensing laws,are probably still in as good, if not a betterposition, to pass this examination than manygraduates of doctoral training programs inprofessional psychology.

Data are needed on the opinions ofbehavioral health clinicians regarding vanitycredentials, the numbers of clinicians whohave obtained or are considering seekingsuch credentials and the ways these creden-tials are marketed to the public and toprospective employers. CE----------

Jerrold M. Pollak, Ph.D., ABPP, ABN, iscoordinator of the Program in Medical andForensic Neuropsychology and a staff clini-cian in emergency services at SeacoastMental Health Center in Portsmouth, N.H.His email is: [email protected].

Many credentialsin mental healthare questionable

CPOINT

Within professional psychology, controversy continues

as to who can legitimately use the title of “psychologist.”


health capacity, as brain injury can manifestitself in a multitude of ways.

* Consider providing (and marketing) apost-concussion protocol (possibly in con-junction with a neuropsychologist) for cur-rent and former players.

* Encourage athletes to obtain MRIs orbrain studies to assess possible brain injury.

* Provide psycho-educational informa-tion about the connection between physicalinjury/head trauma and mental health chal-lenges as a means of helping athletes andorganization understand and possibly pre-pare for such challenges.

* Provide counseling focusing onimpulse control, substance abuse, grief andloss and anger management.

* When working with current or formerplayers consider integrating strategies toincrease memory and slow down potentialside effects of brain injury.

* Help educate former players abouthealth benefits they are eligible for and assistthem in accessing those resources.

* Encourage honest communicationbetween athletes, coaches and trainersaround sports-related injuries, particularly

head injuries.* Help increase awareness related to

physical health and increase ability to assessreadiness to return to play realistically fol-lowing injuries.----------

Shaun Tyrance, Ph.D., is a licensedtherapist who specializes in sport psycholo-gy. Shaun earned his Ph.D. in counselingfrom the University of North Carolina atCharlotte, and his masters in sport psychol-ogy from the University of North Carolina atGreensboro. He was a four-year varsity let-ter winner in football at Davidson Collegewhere he played quarterback. He may bereached at [email protected]

Nyaka NiiLampti, Ph.D., is a licensedpsychologist at Mind over Body, a part ofSoutheast Psych in Charlotte, N.C. She hasan M.A. in sport psychology from theUniversity of North Carolina-Chapel Hilland completed her internship at theUniversity of Miami’s Counseling Center,where she worked with both student-athletesand nonathletes.

Symptoms vary in head injuriesContinued from Page 6


Appreciating the sparkleBy Emily Moore, MFT

A sweet piece of terminology that Ipicked up from my studies of narrative ther-apy is “sparkling moment.” The idea is tosearch for what shines in a positive way bycontrast to the predominantly dark problem-saturated stories our clients can be stuck in.

The challenge in this situation is tolocate a moment that sparkles in the eyes ofthe client. Regardless of how brilliantlysomething stands out in our minds, it’s dullas a coal smudge if the client is not on boardwith acknowledging it as an exception to therule, or a “unique outcome,” as theAustralian family therapist Michael Whitewould say.

In simple terms, narrative therapy positsthe idea that we make meaning out of ourlives by stringing together moments in ourlives of which a story can be made. Becausethere is no such thing as an “objective reali-ty” according to the post-moderns, the storywe construct from moment to moment isonly one of an almost infinite number ofchoices.

However, once we have created a storyfor ourselves, our minds immediately begin

to filter out experiences, thoughts, feelings,relationships and pieces of our history thatdo not make sense within our pre-existingstory. Because this happens, whatever storywe have adopted tends to grow bigger andstronger over time as we collect more andmore instances that appear to support it.

In the process, other possibilities andother realities that might provide the struc-ture for a very different story are left unseen,their value unacknowledged. The hopeful,liberating idea is that if we pay attention tomoments, experiences etc. that we acknowl-edge cannot be made sense of within theproblematic story to which we have becomeso attached, other stories will emerge andmeanings and identities we thought werepermanent fixtures start to make room fornew realities about ourselves.

As therapists, it is sometimes hard tomaintain a sense of freshness about ourwork. It can be challenging to sustain an atti-tude of hopeful curiosity about what mightbe coming next. This can be true under vari-ous circumstances: if we feel tired and unap-preciated or if difficult problems with noeasy solutions seem to fly at us relentlesslyor if we have had a big disappointment in

our professional or personal lives, as a fewexamples.

At times like these, we need to look forsparkling moments that may have been hid-den under a thick layer of frustration and dis-couragement, moments that simply will notconform to our temporarily dreary percep-tion of ourselves as not-very-good therapistsand the world as tired, old, predictable andboring.

A client of mine came in who has beenseeing me for more than two years on aweekly basis. Together we have gonethrough days of despair, self-loathing andhopelessness that have appeared to her to becertainly interminable. The person she wastwo years ago would not have believed thatshe could ever be the person she is today:she would have tossed that person off as fic-tion.

Today, however, she is able to see her-self as happy, capable of being alone as wellas in relationships with others, clear aboutwhat she wants and what she will accept in

life and much more in control of her life andits direction than she was in the past.

Today she sparkles and serves as a re-minder that life, as a therapist or otherwise,will produce moments of delight and thatthey may be waiting just around the corner.----------

Emily Moore, MFT, is a licensed familytherapist who practices in Pasadena, Calif.Her email is: [email protected].

Order your 2013 Appointment Calendar

for Mental Health ProfessionalsSee ad on Page 18 or call 800-486-1985

USC fosters technology advancesAn article in the July/August edition of

The National Psychologist on virtual realitytreatment for PTSD incorrectly said theInstitute for Creative Technologies (ICT) isaffiliated with the University of California. Itis actually affiliated with the University ofSouthern California.

By Len Bergantino, Ed.D., Ph.D.

Carl A. Whitaker, M.D., was a pioneerin psychotherapy as well as family therapy.He co-authored the master classic, The Rootsof Psychotherapy, with Thomas P. Malone,M.D., Ph.D. Whitaker’s major contributionwas freeing up the use of self to shoot fromthe hip concerning such unconscious materi-als as suicide, homicide, incest etc. that ther-apists and patients customarily do not dealwith.

I first met him when he came to theBonaventure Hotel in Los Angeles and pre-sented to 700 licensed psychiatrists, psy-chologists and social workers. He began bytelling a story about a farmer and his son:

Son: “Dad, I’m going over the hill andget me a wife!”

Father: “Good, son. How long will yoube gone?”

Son: “A couple of days.”Father: “All right, son. I will see you

when you get back.”

Two days later the son came back.Father: Well, son, where is she?”Son: “Well, dad, I found her but she was

a virgin.”Father: “Son, you did the right thing. If

she wasn’t good enough for her own family,she isn’t good enough for us!”

The 700 clinicians in the room were indisbelief.

Later, I went up to him and said, “Dr.Whitaker, I spent a week at the AtlantaPsychiatric Clinic getting to know TomMalone but I never got a sense of his style ofwork. You were very good at demonstratingyour style. I wonder if you could give me anexample of how Tom Malone actuallyworked.”

Whitaker pensively looked up in the airfor a moment and then said, “Tom Malonewas catatonic, but you ought to look him up.I think he has something to offer you.”

He subsequently wrote the foreword tomy book, Psychotherapy, Insight and Style:The Existential Moment. (Allen and BaconInc., Boston.)

I next saw Whitaker at The Evolution ofPsychotherapy Conference after MiltonErickson’s death on March 3, 1980. He saidhe and Erickson met only once. Ericksonpicked him up at the airport when he wasinvited to be a guest speaker at Wayne StateHospital.

Erickson said, “How many kids yougot?” Whitaker said, “I’ve got six.” Ericksonsaid, “I’ve got eight.”

Whitaker said they never spoke anotherword to each other.

I asked Whitaker to supervise me and heagreed to do so by speakerphone, as he wasat the University of Wisconsin MedicalSchool and I was in Los Angeles. He keptthrowing down the gauntlet, realizing I wasdedicated. He kept saying, “How can I takeyou seriously that you want to learn familytherapy when you don’t have your own fam-ily in family therapy?”

So I mobilized my parents inConnecticut, my wife and her parents andher brother and his girlfriend with a speaker-phone in Los Angeles and Whitaker worked

26 weeks with all of us once a week byspeakerphone coast to coast.

My parents had been considering mov-ing to Los Angeles near me for years andbrought it up in one session. Whitaker raisedevery fear they had not voiced:

“You have to be crazy to uproot at yourages and move close to that one-way son-of-a-bitch son of yours who is so involved inhis practice that he will never make time tosee you. You will be giving up all your life-time friends and family.”

And then, in the last seconds of the ses-sion, he said, “Take a chance,” and hung up.

I did not think much about it, but I got aphone call from my father two days later,saying, “Len, your mother and I are movingto California. We will be there in twomonths.”

So, Whitaker gave me something ofvalue: my parents for the last few years oftheir lives.

PsychologistThe National

The National Psychologist is published six timesa year, in January, March, May, July, September andNovember. Business and editorial offices are located at:

620-A Taylor Station Rd.Gahanna, Ohio 43230; Tel: 614/ 861-1999;

Fax: 614/ 861-1996; Email: [email protected]

This publication is intended to keep psychologistsinformed about practice issues. Contributions and let-ters are invited. The editorial staff reserves the right toedit articles and submissions for clarity and/or length.Publication staff is not responsible for opinions or factsin bylined articles.

Copyright 2012 by Ohio PsychologyPublications, Inc. All rights reserved. Articles may becopied for personal use, but, proper notice of copyrightand credit to The National Psychologist must appear onall copies made. This permission does not apply toreproduction for advertising, promotion, resale or othercommercial purposes.

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ISSN 1058-6776

Learning from a master:

My experience with Carl Whitaker


The other thing I learned from him isthat in doing family therapy it is imperativeto have the battle for control right in thebeginning and win it in terms of getting allthe family members present, such as mother,father, children and grandparents on bothsides and, where applicable, the lover of oneor both spouses. A paranoid situation will beset up if you only bring one spouse in later.

Whitaker worked with me only longenough for me to set the dynamite necessaryto get all family members involved. Herefused to work with a family if only somewere present. “I have enough blood spilled,”he said. “I don’t need another failure. I havealready failed enough times. Are you sureyou want to do this? I am not a good as youheard.”----------

Len Bergantino, Ed.D., Ph.D., is alicensed psychologist in California, Arizonaand Hawaii with an ABPP diplomate in fam-ily psychology. He is the author ofPsychotherapy, Insight and Style: TheExistential Movement. He may be reachedat [email protected] or 310-207-9397.

Earn CE credit for reading The National Psychologist and

completing the CE Quiz on Page 21.

Also available are 3 new online courses available at:www.pdresources.com/tnp

This is the first of a series by practitioners who learned first-hand from pioneers

who shaped modern psychotherpy

MMSE screener available for mobile devicesPAR Inc. announced that the

MMSE/MMSE-2 screen for cognitiveimpairment is now available as an app forsmartphones and tablets.

“Like the paper-and-pencil version, theapp can be used to screen for cognitiveimpairment, to select patients for clinical tri-als research in dementia treatment, or totrack patients’ progress over time,” the com-pany’s press release said.

The app includes an instructional videoto walk users through its features and isavailable in the original, standard and briefversions of the MMSE.

Scoring is done automatically, andpatient records can be uploaded directly toan electronic medical records (EMR) systemor emailed to appropriate personnel.Equivalent, alternate forms of the MMSE-2decrease the possibility of practice effectsthat can occur over serial examinations. Theapp also includes norms for both versions byage and education level.

The app is available to qualified healthcare professionals from the Apple® AppStoreSM (for the iPhone® or iPad®) andfrom Google Play (for Android™ devices).

While I have not yet had the pleasure ofreading Justin A. Frank’s latest explorationof the mind of a famous political figure(Inside the Mind of the President: Obama onthe Couch), I have had the considerable dis-pleasure of reading Gilbert O. Sanders’ cri-tique of Frank’s work (“Analyzing Obama’sabsentee analyst,” The National Psycholo-gist Sept/Oct 2012).

Regrettably, Sanders’ review suggeststhat he is guilty of the very co-mingling ofpolitical ideology and professional judgmentwith which he charges Frank. Indeed, pro-jection appears to be fully at work within thepsyche of Dr. Sanders.

What are we to make of Sanders repeat-ed right-wing reconstruction, recounting andspecious spinning of recent political history?If I close my eyes, I can hear the so-called

conservative echo chamber’s version ofpolitical events, masked insufficiently bySanders’ fig leaf veneer of intellectualrespectability.

One can put lipstick on a pig, and it isstill just a pig. Similarly, one can dress upideology as “fair and balanced” criticism,and it is still just thinly disguised politicalideology. The National Psychologist’s read-ers deserve greater intellectual honesty thanthis.

Robert J. Silver, Ph.D.Taos, N. M.

Editor’s Note: The National Psychologistrequested a companion review from aDemocratic perspective but it did not materi-alize.


Expert disagrees on gifted children attributes

In their July/August 2012 Viewpoint,“Practice opportunities with gifted childrenand their families,” Webb, Gallagher andKuzujanakis make a number of erroneousstatements about gifted children. Based onextensive literature searches of three data-bases, the following were found:

1. Traits listed as “often misdiagnosedas psychopathology” are not characteristic ofgifted children, such as delayed speech/lan-guage and reading difficulties. Gifted chil-dren are advanced in talking and reading.

2. Symptoms characteristic of ADHDare listed as traits of giftedness. Researchstudies of executive functions, self-regula-tion, attention, distractibility and cognitiveinhibition of gifted children without ADHDshow superior ability compared to averagechildren without ADHD. Gifted childrenwithout ADHD do not show the deficits inattention, inhibition, distractibility and per-formance speed shown by children withADHD. These are not traits of giftedness.

3. Webb et al. state that gifted childrenare at risk for misdiagnosis for ADHD,Asperger Syndrome and OppositionalDefiant Disorder without any research evi-dence that this is so. No studies have beendone. The literature shows supposition andopinion that gifted children are being misdi-agnosed, without any clinical basis.

4. Webb et al. stated that there is strongclinical support that gifted children are atincreased risk for anorexia, obsessive-com-pulsive disorders and depression. Far fromstrong clinical support, there are no clinicalor research studies that show increasedprevalence of any mental health disorder forgifted children. The few studies that exist

show similar levels of anxiety and depres-sion as in the general population.

Gifted children do have special academ-ic, social and emotional needs, and cliniciansworking with them need education abouthow best to serve this population; however,information needs to be checked to deter-mine its validity.

Deirdre V. Lovecky, Ph.D., DirectorGifted Resource Center of New EnglandProvidence, R.I.

Lovecky is the author of DifferentMinds: Gifted Children with AD/HD,Asperger Syndrome and Other LearningDeficits. She may be reached by email at:[email protected].

LETTERSBook review was view from the far right

Editor’s note: James T. Webb, Ph.D.,Rosina M. Gallagher, Ph.D. and MarianneKuzujanakis, MD, submitted this response.Webb is lead author of Misdiagnosis andDual Diagnoses of Gifted Children andAdults. Gallagher is president of the IllinoisAssociation for Gifted Children andKuzujanakis is on the board of SENG(Supporting Emotional Needs of Gifted.)

Their response: We agree that, 1) clini-cian education requires training in gifted-ness, and 2) there is need for further researchin this area.

To clarify our basic premise, weacknowledge that some gifted children dosuffer certain disorders, but many, in ourexperience, are being misdiagnosed for lack-ing understanding of asynchronous develop-ment (brain studies report prefrontal corticaldelays) and the effects of educational mis-match and/or environmental stress.

Most of the research is summarized inMisdiagnosis and Dual Diagnoses of GiftedChildren and Adults, and in dissertationstudies suggesting gifted individuals aremore at risk for certain disorders (bulimia,cutting, etc.). Further research is under way.

The rise in ADHD and AutismSpectrum, among other diagnoses, is alarm-ing. This may be due to increased awareness,but also arbitrary treatment before confirm-ing diagnoses. Learning disabilities are notalways properly identified. Yet there is notraining available to help pediatric cliniciansunderstand giftedness and complex multi-exceptionalities. Giftedness may mask a dis-order or a disorder may mask giftedness.

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Dump DSM and moreDumping the DSM is only the first step.

APA must rewrite any form of coding basedon science. The mapping of the Genome hasled to valuable new research that demon-strates that many characteristics, traits etc.are genetically predisposed, such as addic-tion. It is not a disease or even a disorder.Simply swapping psychopathological termsfor made up “medical” terms is of no value.

Roger T. Strachan Ph.D.Director, Center for Creative ChoicePrescott, Ariz.

Learning the business of practice in grad schoolBy Amy Todey

There were two equally importantmotives that attracted me to the field of psy-chology. First, I had a natural desire to helpothers and felt that I possessed the intrinsicqualities of empathy, altruism and intuitionthat I envisioned to be a necessary part of theprofession. Second, I wanted to be a small-business owner, to utilize my creativity andingenuity to grow a psychological practicefrom scratch, knowing that this would affordme the freedom and autonomy that are at thecore of my personal values.

While therapeutic qualities of warmth,compassion and charity are germane to mypersonality, the assertiveness, pragmatismand profit-mindedness requisite of success-ful business people are intrinsically foreign.Similarly, my doctoral training successfullyreinforces my natural therapeutic abilitieswhile neglecting the entrepreneurial skillsthat I need most help developing.

I am discouraged by messages frompsychology-educators and practice profes-sionals that financial ambition and psycho-logical healing are incompatible goals, that Iwill be unable to have a lucrative career as apsychologist and that the complications ofprivate practice outweigh its benefits. Takentogether, these perceived obstacles have

made my dream of becoming a successfulindependent psychologist-practitioner seemdaunting and elusive.

With 34 percent of psychologists choos-ing careers in private practice, I know that Iam not alone in my concern that my gradu-ate training does not sufficiently prepare mefor independent practice. As students, it isincumbent upon us to hone fundamentalentrepreneurial skills to complement ourclinical expertise.

There are several things that have madethis business learning possible for me. First,through networking I have formed relation-ships with several successful independentpractitioners who serve as mentors to me,offering career-related advice, sharingimportant private practice issues and pre-senting me with future job opportunities. Iam a member of divisions of the AmericanPsychological Association such as Division42 (Independent Practice) that offer leader-ship and professional growth opportunitiesspecific to private practice.

Second, I have gained professional busi-ness skills through financial classes, privatepractice workshops and practicum trainingin a private practice setting. These experi-ences have offered clear strategies for devel-oping a business plan, finding a niche andmarketing my future practice.

STUDENT VOICES


Cancer becomes life lesson in grad school

By Lisa Bolshin

Cancer.It’s a very scary word, one most of us

have had to deal with and one we associatewith many different things. Whether it hasaffected us personally, a family member, afriend or a friend of a friend, we have allendured cancer in some way. While it isnever easy, it affects each person differently,each coping in his or her individual style.

I did not personally suffer from cancer,but had to experience my father enduring theillness, as well as the residual effects it hadon my entire family. As a result, I understandhow challenging it can be, the influence ithas on a person's mental health and theobstacles it creates in reaching one’s goals.Just as I was embarking on my academicgoals and adjusting to the grueling nature ofgraduate studies, I was overwhelmed by theeffects of cancer.

My story begins as I was about to startstudent orientation of my Ph.D. program inclinical psychology. Unfortunately, my grad-

uate academic career did not start off as I hadanticipated. My excitement quickly dissipat-ed and my nervousness about the long, ardu-ous academic path ahead was replaced withthe guilt of leaving my sick father at home.

The subsequent semesters of my firstyear of graduate school are a blur. I learneda lot from my classes, but learned more frommy own life experiences in those firstmonths. I worried incessantly about writingtop-notch papers, doing endless research andperfecting assignments all in tandem withthe incessant worry for my father’s comfort,safety and well-being.

This steady focus on my school workaided in dealing with cancer. I knew thatbeing preoccupied and solely focused onnegativity was not a healthy way to function

and my studies were just the distraction Ineeded. Even so, there needs to be balanceand harmony in what preoccupies ourthoughts.

Everything around me began to beabout cancer; everything I read, everything Iheard, everything I did. In an attempt toground myself, I began practicing yoga as away to de-stress and detoxify my mind.While knowledge is power, so is making theright healthy choices and staying on track.

While going through all of this, a friendread me a very powerful and insightful emailfrom her friend’s brother who was also suf-fering from cancer. He wrote how in copingwith his cancer, he had no expectations. Hecouldn’t have prevented it from occurring sonow he would just deal with it as it came. He

said his “decisions appear so clear. It is as ifthere is only one option in the world; to getbetter ... whatever the prognosis … it wasalways 100 percent.”

To know that such a young person wassuffering with what I was watching with myown eyes and had such a clear outlook onlife was incredibly refreshing. I looked at myfather and saw before me a hero. It changedmy perspective on life and gave me thestrength to carry on.

I would never wish to have a friendgoing through the same thing I did, but themutual understanding helped immensely.Friends and family who provide loving andcaring support is crucial. My extensive sup-port system helped me air my worries andmaintain a clear, focused mind. My mentalhealth was vital in caring for my father, aswell as my mother. With the help of my sup-port system, I was able to mentally and emo-tionally be there for my mother at her mostvulnerable moments.

All the while I felt that I had to be thestrong one. I had to keep reminding myselfthat it’s O.K. to show weakness and cry; infact, it’s human. Even now that my father’shealth has returned, worry is still prevalent.When a disease like cancer strikes, it takesthe immune system with it for a while.Therefore, practicing healthy living is key.

Even though there is no cancer to worryabout, the stress and anxiety of being ingraduate school suddenly caught up withme. My distraction from cancer was school,but my preoccupation with cancer ended updistracting me from school.

It seemed to hit really hard how heavy awork load graduate school can be. So main-taining that balance, support system andfocused mind is still essential. Take on theburdens that others cannot carry, but remem-ber to show compassion and love – andreceive it back.

If there’s one thing I’ve learned it’s tonever be afraid to ask for help and never beafraid to show emotion. You’re human. Andpeople will be there for you; they are humantoo.----------

Lisa Bolshin is a Ph.D. student in clini-cal psychology at the distributed learningprogram at Fielding Graduate University.She currently lives in Toronto, Ontario,Canada while pursuing her degree and con-ducting research at the Rotman ResearchInstitute for Baycrest. Her email address is:[email protected].

Third, as much as possible, I have takenadvantage of open-ended course projects toresearch and write about my practice goals.While the learning of small business skills isdifficult in graduate school in light of all ofour other educational demands, my initiativeto connect to the private practice world hasmade my doctoral training more focused andmeaningful and has restored my hope that asuccessful independent practice career ispossible.----------

Amy Todey is a doctoral student at theUniversity of Georgia in the Division ofCounseling Psychology. She is the AmericanPsychological Association of GraduateStudents’ state advocacy coordinator forGeorgia and campus representative toStudent Affiliates of Seventeen, the studentaffiliate group for Division 17 of APA.Avocationally, Amy works as a collegiatewomen’s basketball official in the NCAA.Her research interests include private prac-tice issues and the experiences of femalesports officials. Her email address is:[email protected].

November/December 2012 T H E N A T I O N A L P S Y C H O L O G I S T

Continuing Education CreditsYou can earn one (1) Continuing

Education (CE) credit for studying the currentissue of The National Psychologist (TNP).This offer is made possible in collaborationwith Professional Development Resources, aprovider approved by the American Psycho-logical Association to sponsor continuing edu-cation credits for psychologists. Under thisagreement, Professional DevelopmentResources reviews TNP content in advance,selects substantive articles, formulates the CEquiz and maintains responsibility for the CEprogram.

After reading the articles in this issuemarked with a "CE" symbol, complete thequiz by circling the correct answers and returnit to:

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National Psychologist QuizVol 21 No 6 Nov - Dec 2012

New billing codes…1. Which of the following is one of the majorrevisions in the new CPT psychotherapycodes for 2013?

a. The definition of psychotherapy hasnot changed substantially, but descriptionshave been replaced with more modern lan-guage

b. Descriptions of therapeutic tasks havenot changed, but the definition of psychother-apy has been replaced with more modern lan-guage

c. Diagnostic evaluation for psychother-apy, formerly code 90801, is now split intothree diagnostic evaluation codes

d. The work value for psychotherapydone in a hospital or nursing home is differentfrom office-based work

2. In the new system there is no separate codefor a 90-minute psychotherapy session. Thework group’s reason for this is:

a. long engagements with patients thatexceed 75 minutes tend to be crisis situations,which have new codes

b. long sessions tend to be those thatinclude significant others, which have sepa-

rate billing codesc. long sessions sometimes include time

spent documenting the activity, which is notbilled as psychotherapy

d. the session begins when it is formallystarted by the therapist, not at the start of face-to-face contact

Assessment of learning disabilities…3. Which of the following statements aboutlearning disabilities is true?

a. Reading disorders are due to slow pro-cessing speed

b. Variability in test performance is diag-nostic of a learning disability

c. Reading disorders are directly relatedto visuospatial difficulties

d. Slow processing speed is associatedwith dyslexia or ADHD and may reflect theirgenetic linkage but does not cause either

4. Mapou says the largest amount of researchon learning disabilities is in the area of:

a. mathematics disabilitiesb. nonverbal learning disabilitiesc. reading disabilitiesd. written language disabilities

Risk management: digital age…5. Which of the following statements aboutelectronic record-keeping and teletherapy istrue?

a. Most state licenses are valid across geo-graphical boundaries for purposes of treatingunderserved populations

b. Lack of encryption is a violation of fed-eral statute (HIPAA, HITECH) and subject toa heavy fine

c. Any transmission of PersonalHealthcare Information (PHI) must be pass-word protected

d. The regulations that govern technologyhave advanced at the same pace as technologyitself

Ethics of telepsychology….6. Which of the following is an example of asituation in which a case can be made thatproviding the services remotely is superior to,or at least equal to, an in-person referral?

a. There is an existing treatment relation-ship, and the client is moving elsewhere

b. The client has difficulty traveling tothe provider’s location

c. The client feels more comfortable com-municating remotely than in person

d. Any of the above, but with the addedcondition that the therapist has sufficientinformation to assess whether this is anappropriate choice

7. From a risk management perspective,which of the following is an important con-sideration in deciding whether or not toengage in teletherapy?

a. If a problem leads to a licensing boardcomplaint, board members are likely to besympathetic to the licensee

b. If there is a complaint, the current stateof the evidence on teletherapy is likely to pro-vide a solid defense

c. If there is a complaint, it is important tohave very detailed documentation of informedconsent discussions

d. If technology fails in the middle of asession, the client must understand that it isbeyond the psychologist’s control

Rip van Winkle…8. Bixenstine suggests that the concept of EST(Evidence Supported Treatments) has somecomplications, among them:

a. imposing an EST restriction encour-ages clinical exploration of new and possiblymore effective treatments

b. emulating medicine will likely serve toenhance the practice of psychology

c. psychotherapy research is far morechallenging than drug research

d. once we have reliable evidence sup-portive of this procedure over that one, someapproaches will fall into disuse

Mental health credentials…9. What do titles such as “behavioral coach,”“medical psychotherapist,” “forensic examin-er,” and “disability consultant” have in com-mon?

a. They represent a variety of valid sub-specialties in the field of clinical psychology

b. They are not titles regulated by statelaw or recognized as legitimate specialties bythe APA or credentialing boards

c. They are descriptors that can help con-sumers be better informed about the educa-tion/training of practitioners

d. They depict professionals who havepassed competency-based tests for advancedclinical practice

CE QUIZ (earn one C.E. credit)


Coming next issue:

Albert Ellis

Part 2 of the series

Learning from a master

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Employment

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Miscellaneous

founder and first president of the AmericanPsychology-Law Society, which later becameDivision 41 of the APA.

Back in the late 1960s and early 1970s,psychological testimony was heavily psycho-analytically informed. Thus, a psychologistmight testify regarding some psychoanalytic“truth” that was completely unproven, unsci-entific and, quite possibly, was a bone of con-tention even within psychoanalytic circles.This expert might consider it appropriate toconceal from the court that some other psy-choanalytic thinkers disagreed with him or herbecause that expert might hold those who dis-agreed in utter contempt.

Along similar lines, perhaps a Rorschachresult, based on some impressionistic scoringsystem, would “prove” that a defendant was apsychopathic killer, and the psychiatric expertwould explain this “fact” to the jury.

Ziskin looked at this state of affairs,along with other forms of psychological“knowledge” that were unproven and ofunknown validity and was appalled. Howcould the courts rely on psychological “evi-dence,” how could juries be swayed by suchevidence when it was not evidence at all? Itwas merely opinion, conjecture and beliefmasquerading as some sort of science.

Ziskin’s first edition predated theDaubert rulings of the Supreme Court thatattempted to set new standards for scientifictestimony. When Ziskin first published, thefield of psychological testimony basicallyexisted without standards. The original pur-pose of his book was to assist attorneys indemonstrating the often weak foundation ofpsychological testimony. No expert witnesscould withstand a cross examination guidedby Ziskin’s book (being “Ziskinized”) unlessthat expert’s testimony was scientifically sup-ported, valid and objective.

This sixth edition is brilliantly authoredby David Faust, Ph.D., (co-author with Ziskinof the fourth edition). The series takes a dif-ferent slant as the field of forensic psychologyhas changed. No longer is unfounded psycho-logical opinion likely to be accepted unchal-lenged. Forensic psychology has evolved,largely in reaction to what Ziskin started, intoa field with a solid scientific basis.

Today, testimony is often supported byvalid, peer-reviewed findings. Nevertheless,data can be argued, bias can be introduced andthe scientific basis can be stretched.Explanations can be offered as to why thisparticular set of findings, regarding this par-ticular individual, should be interpreted using


a modified set of standards – even unpub-lished and unproven ones. Experts can ven-ture into the realm of unscientific conjecturewhere plausibility is taken as proof. Anyattorney who reviews the relevant portions ofthis book will be prepared to punch holes inthe testimony of any expert who oversteps thelimits of scientific evidence.

The book contains 47 chapters, writtenby Faust along with other contributors whoconstitute a who’s who of leading forensicpsychologists, attorneys and psychiatrists. It ismassive, over one thousand pages, andexhaustive. Although it retains Ziskin’s origi-nal title, Coping with Psychiatric andPsychological Testimony, and although it wasoriginally directed to attorneys, who were theones who needed to “cope” with said testimo-ny, it is probably of greater use today to thepsychologists and psychiatrists who mighttestify, rather than the attorneys who mightemploy or cross-examine them.

This is not to say attorneys will not bene-fit from reviewing the relevant chapters priorto cross-examining a psychological witness,but the book is steeped in the language of psy-chology and psychological research. If any-one needs to read this book it is psychologists!

Regardless of whether the question is tes-tamentary capacity, competence to stand trial,insanity defense, a civil suit over a braininjury or psychological trauma, prediction ofviolent or sexual re-offense, matters of intelli-gence or substance abuse, this book will pro-vide guidance. Its final section, on practicalapplications, is useful for attorneys and psy-chologists seeking assistance on the nuts andbolts of preparing psychological testimonyand making it effective.

Ziskin would be proud of the latest edi-tion of his classic work. Not only because thebook is as authoritative as the editions pre-pared by Ziskin himself but because, thanks toZiskin’s original challenge, he would haveseen that forensic psychology has become acredible and useful scientific endeavor.

This is one book that every forensic psy-chologist must own and that every psycholo-gist must consult should he or she ever be fac-ing an interaction with the legal system.----------

Martin H. Williams, Ph.D., is a forensicpsychologist in San Jose and Los Angeles,Calif. He is on the Forensic Panel of theSuperior Court of California. He is anapproved evaluator for Immigration andCustoms Enforcement, Enforcement andRemoval Operations, San Francisco Region,and was formerly with the ForensicAssessment Division, Board of ParoleHearings, California Department ofCorrections and Rehabilitation. He can bereached through www.drmwilliams.com.

Revised ‘Bible’ of forensic testimony is excellent

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BOOK REVIEW

Coping with Psychiatric and Psycholog-ical Testimony, Sixth Edition, updated byDavid Faust, Ph.D., and based on the originalwork by Jay Ziskin, J.D., Ph.D. (2011)Oxford: Oxford University Press. $225.

Review by Martin H. Williams, Ph.D.This is the sixth edition of a classic work

in the field of psychology and law. It is a com-pendium of ways that psychological testimo-ny or expertise can be employed in criminal,civil or administrative courts, along with anexpose of the procedures, strengths and weak-nesses of each. In this sense, it is an invalu-able resource for attorneys seeking to find theflaws underlying expert testimony.

Even more important, it is a reference forany psychologist who plans on offering testi-mony, as it advises the psychologist on thechoice of measures and procedures to employ,as well as what cross-examination questionsto expect. It is an excellent and comprehen-sive book. Indeed, it has become The Bible offorensic psychology.

The book has evolved from the originalintent and vision of Dr. Jay Ziskin, whopassed away in 1997. Ziskin was the co-

T H E N A T I O N A L P S Y C H O L O G I S T

November/December 2012

California – In September, Californiabecame the first state in the country to bancontroversial therapy practices that attemptto change the sexual orientation of minors.The law bars mental health practitionersfrom performing so-called reparative thera-py, labeled by professional psychologicalorganizations as potentially harmful and bygay rights groups as dangerous and abusive.

Connecticut – Research at YaleUniversity continues to support the promiseof ketamine as a treatment for depression. Astudy released in the Oct. 5 issue of Sciencesaid that administering small amounts of thedrug regenerates synaptic connections,bringing patients almost immediate relieffrom depression’s most debilitating symp-toms. Psychotherapy still is recommendedfor long-term recovery. In larger doses keta-mine is used illegally as a “party drug”known in street lingo as “Special K.”

Florida – A federal suit filed two yearsago by forensic psychologist MichaelBrannon after his yearly income from theBroward County Public Defender’s Office

fell from $608,757 in 2007 to $390,000 in2008 then to $170,162 in 2009 and $12,800in 2010 has been dismissed. Brannon con-tended Public Defender Howard Finklesteinreduced his assignments in retaliationbecause Finklestein disagreed with testimo-ny Brannon gave concerning a judicial mis-conduct complaint. U.S. District JudgeDonald Graham dismissed the suit, sayingthe reductions paralleled budget reductionsin the public defender’s office.

Kentucky – Blue Cross/Blue Shield(BC/BS) and the Kentucky PsychologicalAssociation have been in talks to resolveissues related to BC/BS not wanting to cre-dential autonomously functioning master’s-level psychological providers in the state.Those providers have long been grandfa-thered in under previous rules. BC/BS saysthey have “created a mechanism by which(the master’s level providers) may providepsychological services to Anthem policyholders.”

Louisiana – Marie Leiner, a researchassociate professor at Texas Tech University

Health Sciences, presented research at anOctober conference of the AmericanAcademy of Pediatrics in New Orleansshowing that border violence in the ElPaso/Juarez region is creating mental healthproblems among poor children. Her researchshows that between 2007 and 2010 childrenliving in poverty in El Paso showed signifi-cant but not increasing levels of psychoso-cial problems. On the Mexican side of theborder children in poverty showed signifi-cant increases in social problems, rule-breaking and aggressive behavior.

Maryland – On Oct. 1 Marylandbecame the 13th state to require private sec-tor insurance companies to pay for telehealthservices considered medically necessary thatwould be covered when provided face-to-face. The law defines telehealth as “interac-tive audio, video or other telecommunica-tions or electronic technology... to deliver ahealth care service.”

New Jersey – Princeton alumni NancyPeretsman and Robert Scully have donated$20 million to name a new psychology

building Peretsman-Scully Hall being builton the Princeton University campus.Peretsman, a trustee of the university, co-chaired a campaign that raised $1.88 billionfor Princeton, and her husband Scully is onthe board of dean’s advisors. Neither is apsychologist, although Scully has a bache-lor’s degree in psychology from Princeton.

Oregon – The Portland Police Bureau iscreating a mental health unit of officersspecifically trained to handle mental healthrelated calls. The department is also reinstat-ing crisis intervention training for all offi-cers. The actions are in response to ascathing U.S. Justice Department report inSeptember that showed “a pattern and prac-tice” of excessive force in handling those inmental health crises.

Pennsylvania – Thomas H. DeWall,CAE, executive director of the PennsylvaniaPsychological Association announced thathe will retire in August 2013 after 25 yearsat the helm of the association. He plans tocontinue consulting with association leader-ship and his successor.

What’s happening across the USAT H E N A T I O N A L P S Y C H O L O G I S T

November/December 2012

Give a holiday gift that will last all year and it’s FREE!Order a new two-year subscription for yourself and give a FREE one-year subscription to a friend or colleague.

For orders received before December 10, 2012, The National Psychologist will send a notice announcing your thoughtful gift.

___ One year subscription $35 _____ Two year subscription $60 $55 _____ One year student subscription $20

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Return this completed form with payment to: The National Psychologist, 620-A Taylor Station Rd., Gahanna, Ohio 43230; call toll-free 800/486-1985 or see our website at: www.nationalpsychologist.com tnp 11/12

Act now before this offer expireson December 31

december 2012 issue - the national psychologist

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