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BULLETIN

PsychotherapyOFFICIAL PUBLICATION OF DIVISION 29 OF THE

AMERICAN PSYCHOLOGICAL ASSOCIATION

www.divisionofpsychotherapy.org

2011 VOLUME 46 NO. 3

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In This Issue

Psychotherapy IntegrationSocial and Cultural Dimensions of

Psychotherapy Integration

Education and Training—Student FeatureSupervisee Experiences of Corrective Feedback

in Clinical Supervision

Professional PracticeDoctoral Psychology Student Indebtedness:

Current Status and Resources

Ethics in PsychotherapySimilarities and Differences in the Ethics Codes ofThe American Psychological Association andThe American Counseling Association:

The Application of Competence

Early CareerRed Convertible vs. Doctoral Degree: Reflections on

being a Midlife Early Career Psychologist

Student FeatureMotivational Interviewing with Older Adults:

Enhancing Health Behavior Change

PPrreessiiddeennttElizabeth Nutt Williams, Ph.D.St. Mary’s College of Maryland18952 E. Fisher Rd.St. Mary’s City, MD 20686Ofc: 240- 895-4467 / Fax: 240-895-2234E-mail: [email protected]

PPrreessiiddeenntt--eelleeccttMarvin Goldfried, Ph.D.Psychology SUNY Stony Brook Stony Brook, NY 11794-2500 Ofc: (631) 632-7823 / Fax: (212) 988-4495 E-mail: [email protected]

SSeeccrreettaarryy Jeffrey Younggren, Ph.D., 2009-2011827 Deep Valley Dr Ste 309 Rolling Hills Estates, CA 90274-3655Ofc: 310-377-4264 / Fax: 310-541-6370E-mail: [email protected]

TTrreeaassuurreerrSteve Sobelman, Ph.D., 2010-20122901 Boston Street, #410Baltimore, MD 21224-4889Ofc: 410-583-1221 / Fax: 410-675-3451Cell: 410-591-5215 E-mail : [email protected]

PPaasstt PPrreessiiddeennttJeffrey J. Magnavita, Ph.D., ABPPGlastonbury Psychological Associates PC 300 Hebron Ave., Ste. 215 Glastonbury, CT 06033 Ofc: 860-659-1202 / Fax: 860-657-1535E-mail: [email protected]

DDoommaaiinn RReepprreesseennttaattiivveessPublic Interest and Social JusticeRosemary Adam-Terem, Ph.D. 2009-20111833 Kalakaua Avenue, Suite 800Honolulu, HI 96815Ofc: 808-955-7372 / Fax: 808-981-9282Cell: 808-292-4793E-mail: [email protected]

Professional PracticeMiguel Gallardo, Psy.D., 2010-2012Pepperdine University 18111 Von Karman Ave Ste 209 Irvine, CA 92612Ofc: (949) 223-2500 / Fax: (949) 223-2575E-mail: [email protected]

Education and TrainingSarah Knox Ph.D., 2010-2012Department of Counselor Education and

Counseling PsychologyMarquette UniversityMilwaukee, WI 53201-1881Ofc: 414/288-5942 / Fax: 414/288-6100E-mail: [email protected]

MembershipAnnie Judge, Ph.D. 2010-20122440 M St., NW, Suite 411Washington, DC 20037Ofc: 202-905-7721 / Fax: 202-887-8999E-mail: [email protected]

Early CareerSusan S. Woodhouse, Ph.D. 2011-2013Department of Counselor Education, Counseling Psychology and Rehabilitation Services

Pennsylvania State University313 CEDAR BuildingUniversity Park, PA 16802-3110Ofc: 814-863-5726 / Fax: 814-863-7750E-mail: [email protected]

Science and ScholarshipNorm Abeles, Ph.D., ABPP, 2011-2013Dept of Psychology, Michigan State University 110C Psych Bldg East Lansing , MI 48824Ofc: 517-337-0853 / Fax: 517-333-0542E-mail: [email protected]

DiversityCaryn Rodgers, Ph.D. 2011-2013Prevention Intervention Research CenterAlbert Einstein College of Medicine1300 Morris Park Ave., VE 6B19Bronx, NY 10461Ofc: 718-862-1727 / Fax: 718-862-1753E-mail: [email protected]

DiversityErica Lee, Ph.D., 2010-201280 Jesse Hill Jr.Atlanta, Georgia 30303Ofc: 404-616-1876 E-mail: [email protected]

AAPPAA CCoouunncciill RReepprreesseennttaattiivveessJohn Norcross, Ph.D., 2011-2013Dept of Psychology, Univ of Scranton Scranton , PA 18510-4596 Ofc: (570) 941-7638 / Fax: (570) 941-7899E-mail: [email protected]

Linda Campbell, Ph.D., 2011-2013Dept of Counseling & Human DevelopmentUniversity of Georgia 402 Aderhold Hall Athens, GA 30602Ofc: 706-542-8508 / Fax: 770-594-9441E-mail: [email protected]

SSttuuddeenntt DDeevveellooppmmeenntt CChhaaiirrDoug Wilson, 2011-2012419 N. Larchmont Blvd. #69Los Angeles, CA 90004Phone: 323-938-9828E-mail: [email protected]

CCoonnttiinnuuiinngg EEdduuccaattiioonnChair: Rodney Goodyear, Ph.D.1100BWPH Rossier School of EducationUniveristy of Southern CaliforniaLos Angeles CA 90089-0001Ofc: 213-740-3267E-mail: [email protected]

EEaarrllyy CCaarreeeerr PPssyycchhoollooggiissttssChair: Rachel Galliard Smook, Ph.D.47 Prospect St.West Boylston, MA 01583Ofc: 5089250530E-mail: [email protected]

EEdduuccaattiioonn && TTrraaiinniinnggChair: Jairo N. Fuertes, Ph.D., ABPPAssociate ProfessorDerner Institute of Advanced Psychological StudiesAdelphi UniversityHy Weinberg Center - Rm 319158 Cambridge AvenueGarden City, NY 11530tel [email protected]

FFeelllloowwssChair: Clara Hill, Ph.D.Dept of Psychology University of Maryland College Park , MD 20742 Ofc: (301) 405-5791 / Fax: (301) 314-9566E-mail: [email protected]

FFiinnaanncceeChair: Jeffrey Zimmerman, Ph.D., ABPP391 Highland Ave.Cheshire, CT 06410Phone: 203-271-1990333 Westchester Ave., Suite E-102White Plains, NY 10604Ofc: 914-595-4040E-mail: [email protected]

MMeemmbbeerrsshhiippChair: Jean Birbilis, Ph.D.University of St. Thomas1000 LaSalle Ave., MOH 217Minneapolis, Minnesota 55403Ofc: 651-962-4654 / Fax: 651-962-4651E-mail: [email protected]

NNoommiinnaattiioonnss aanndd EElleeccttiioonnssChair: Marvin Goldfried, Ph.D.

PPrrooffeessssiioonnaall AAwwaarrddssChair: Jeffrey Magnavita, Ph.D.

PPrrooggrraammChair: Shane Davis, Ph.D. Office on Smoking and Health Centers for Disease Control and Prevention 4770 Buford Highway, MS K-50 Atlanta, GA 30341Ofc: 770-488-5726 / Fax: 770-488-5848E-mail: [email protected]

PPssyycchhootthheerraappyy PPrraaccttiicceeChair: Barbara Thompson, Ph.D.3355 St. Johns Lane, Suite F.Ellicott City, MD 21042Ofc: 443 629-3761E-mail: [email protected]

PPssyycchhootthheerraappyy RReesseeaarrcchhChair: James Fauth, Ph.D.40 Avon St.Keene, NH 03431Ofc: 603-283-2181E-mail: [email protected]

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

Federal Advocacy CoordinatorBonita Cade, Ph.D.63 Ash St New Bedford, MA 02740 Ofc: (508) 990-1077 / Fax : (508) 990-1077E-mail: [email protected]

Division of Psychotherapy �� 2011 Governance StructureELECTED BOARD MEMBERS

STANDING COMMITTEES

PSYCHOTHERAPY BULLETIN

Published by theDIVISION OF PSYCHOTHERAPYAmerican Psychological Association

6557 E. RiverdaleMesa, AZ 85215602-363-9211

e-mail: [email protected]

EDITORLavita Nadkarni, [email protected]

ASSOCIATE EDITORLynett Henderson Metzger, Psy.D.

[email protected]

CONTRIBUTING EDITORSDiversity

Erica Lee, Ph.D. and Caryn Rodgers, Ph.D.Education and TrainingSarah Knox, Ph.D. andJairo Fuertes, Ph.D.

Ethics in PsychotherapyJennifer A.E. Cornish, Ph.D.Psychotherapy Practice

Miguel Gallardo, Psy.D. and Barbara Thompson, Ph.D.Psychotherapy Research, Science, and ScholarshipNorman Abeles, Ph.D. and

James Fauth, Ph.D.Perspectives on

Psychotherapy IntegrationGeorge Stricker, Ph.D.

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

Washington ScenePatrick DeLeon, Ph.D.

Early Career Susan Woodhouse, Ph.D. andRachel Gaillard Smook, Psy.D.

Student FeaturesDoug C. Wilson, M.A.Editorial Assistant

Jessica del Rosario, M.A.

STAFFCentral Office Administrator

Tracey Martin

Websitewww.divisionofpsychotherapy.org

PSYCHOTHERAPY BULLETINOfficial Publication of Division 29 of the American Psychological Association

2011 Volume 46, Number 3

CONTENTS

President’s Column ......................................................2

Editors’ Column ............................................................5

Psychotherapy Integration ..........................................6Social and Cultural Dimensions of Psychotherapy Integration

Education and Training-Student Feature ................14Supervisee Experiences of Corrective Feedback in Clinical Supervision

Professional Practice....................................................21Doctoral Psychology Student Indebtedness: Current Status and Resources

Ethics in Psychotherapy..............................................28Similarities and Differences in the Ethics Codes of The American Psychological Association and The American Counseling Association: The Application of Competence

Early Career ..................................................................34Red Convertible vs. Doctoral Degree: Reflections on being a Midlife Early Career Psychologist

Student Feature ............................................................37Motivational Interviewing with Older Adults: Enhancing Health Behavior Change

Washington Scene........................................................41If You Miss The Train I’m On

References ....................................................................46

Membership Application............................................50

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PRESIDENT’S COLUMN

Elizabeth Nutt Williams, Ph.D.St. Mary’s College of Maryland

I begin this column in the wake of theever-exciting and ever-exhausting APA Con-vention. Many of youjoined us in DC for the Convention. Noteven the humidity

could dampen the experience … the joyof greeting old friends, the wonder ofmeeting new colleagues, the thoughtfulchallenges to our intellects from creativeand cutting-edge symposia, the delightin seeing former students stretching intonew and more demanding roles. Goodstuff. Division 29’s convention programwas extraordinary. We are grateful toour program chair, Shane Davis, for hercoordination of the presentations andgreat attention to detail. Just as a sam-pling, we had presentations on multicul-tural competencies, spirituality, andstigma in therapy, with topics rangingfrom psychotherapy training to conver-sations with eminent psychotherapists.The convention theme of resilience wasemphasized by several presentations,such as the Grady Nia project (chairedby Nadine Kaslow) and the presidentialsymposium on Psychotherapy, Re-silience and Social Justice (featuring pa-pers by Ray Hanbury on disaster reliefresponses in the shadow of the 9/11, byOksana Yakushko on immigration chal-lenges and joys, by Laura Smith on re-envisioning our understanding ofpoverty, and by Caryn Rodgers on ado-lescent resiliency and empowerment). Iam truly humbled and delighted by theskill, insight, and compassion displayedin the work of our Division members.

We also had a lot going on for our stu-dents and early career professionals, in-

cluding a wide array of Hospitality Suiteprograms. For example, Jeff Barnettpresented on issues of self-disclosureand multiple relationships, and SusanWoodhouse presented on CVs and get-ting licensed. The Lunch with the Mas-ters was again a huge success. I wouldlike to thank Rachel Smook and SusanWoodhouse for their work in puttingthe event together, and I would like tothank our masters for participating: Lil-ian Comas-Dias, Charlie Gelso, ClaraHill, and Jeffrey Magnavita. We werealso able to highlight some of our stu-dents throughout the convention. Forexample, one of my undergraduate stu-dents (Irene Opabajo) served as discus-sant for the presidential symposium,one of our graduate student presenters,Jerry Walker from the Florida State Uni-versity, was selected to present his workon “The Effects of Counselors’ Use ofGesturing and Smiling on Client Im-pressions and Preferences” at DataBlitz(only 20 posters from all divisions werechosen), and we gave out four studentawards at our Awards Ceremony.Specifically, I would like to congratulateLaura Athey-Lloyd (who won The Jef-frey E. Barnett Psychotherapy ResearchStudent Paper Award), Dana Lea B.Nelson (who won the Student DiversityAward), Jenelle Slavin-Mulford (whowon the Donald K. Freedheim StudentDevelopment Award), and Lotte Smith-Hansen (who won the Mathilda B. Can-ter Education and Training Award).

At our Awards Ceremony, we also hon-ored our colleagues: Jack Anchin (Dis-tinguished Psychologist Award), JeffreyBarnett (Award for Distinguished Con-tributions to Teaching and Mentoring),

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Andres Del Los Reyes (Early CareerAward), and Nadine Kaslow (RosaleeG. Weiss Lecture for Outstanding Lead-ers in Psychology). We also awarded theDivision of Psychotherapy Award forBest Empirical Research Article in 2010(an award co-sponsored by John Wileyand Sons, who have generously fundedthis award for five years) to Louis Castonguay, James Boswell, SannoZack, Sally Baker, Mary Boutselis,Nancy Chiswick, Diana Damer, NealHemmelstein, Jeffrey Jackson, MarolynMorford, Stephen Ragusea, J. GowenRoper, Catherine Spayd, Tara Weiszer,Thomas Borkovec, and Martin GrosseHoltforth for their article “Helpful andHindering Events in Psychotherapy: APractice Research Network Study” inPsychotherapy.

We had the good fortune to be able toaward two prestigious research grantsthis year. The first, the Charles J. GelsoPsychotherapy Research Grant, provid-ing $2,000 toward the advancement ofresearch on psychotherapy process oroutcome, went to Mike Constantino forhis proposal on patients’ perceptions ofcorrective experiences in individual psy-chotherapy. Second, for the first timethis year, the Division awarded a $20,000research grant in honor of Norine John-son, for research projects in the area ofresearch on psychotherapist factors thatmay impact treatment effectiveness andoutcomes. The first Norine Johnson Psy-chotherapy Research Grant wasawarded to Charlie Gelso and ClaraHill for their work examining three par-ticular therapist variables associatedwith process and outcome: training, at-tachment styles, and countertransfer-ence. We in Division 29 are truly thrilledto be able to actively support psy-chotherapy research endeavors and lookforward to continuing our support of re-searchers in the future.

At the Awards Ceremony, we also hon-

ored our 2010 Fellows (Ann Doucetteand Glenn Good) and our outgoingBoard members (Rosie Adam-Teremand Jeff Younggren). We also presenteda Presidential Citation to Steve Sobelmanfor his exceptional service to the Divi-sion as he stepped in to assist with ourwebsite while we were between InternetEditors. We were then able to celebrateall of our accomplishments together atthe Social Hour. I was delighted to meetseveral past presidents of the Divisionand to greet incoming Board members(such as President-elect Designate BillStiles and incoming Domain Represen-tative for Public Interest & Social JusticeArmand Cerbone). I think my favoritepart of the social hour, though, waslearning that the father of one of our student award winners (Laura Athey-Lloyd) not only attended the AwardsCeremony but that it was his birthday.This seamless and celebrational blend-ing of the personal and the professionalis one of the things Division 29 does best.

While the convention programming,suite programming, and award andgrant selections occupied much of ourtime in past months, we have severalother ongoing projects of which I wantyou to be aware. First, the Division hascontinued to engage in strategic plan-ning. Both the Domain Representatives(Norm Abeles, Rosie Adam-Terem,Miguel Gallardo, Annie Judge, SarahKnox, Erica Lee, Caryn Rodgers andSusan Woodhouse), joined by our Student Representative (Doug Wilson),and the Executive Committee (JeffreyBarnett, Marv Goldfried, Jeffrey Magnavita, Steve Sobelman, JeffYounggren and myself), joined by our Council Representatives (LindaCampbell and John Norcross), createdseparate SWOT analyses (e.g., strengths,weaknesses, opportunities and threats).I have pulled the two analyses together

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and will be asking the Board to reviewthe report and set Divisional prioritiesbased on the strategic plan at the FallBoard meeting (October 14-15, 2011). I will give a full overview of the processand outcomes in the final Bulletin of the year.

Second, the Division has endorsedDoug Haldeman for APA President.Please see Dr. Haldeman’s informationon our website (www.divisionof-psychotherapy.org). We are delighted to endorse a longstanding member ofthe Division and someone who has doneso much to further the development ofpsychotherapy.

Third, we continue to add updates toour web page (and have started postingmore frequently to Facebook and Twit-ter) thanks to our new Internet EditorIan Goncher. I would also like to thankLavita Nadkarni for the continued vibrancy of our Bulletin and MarkHilsenroth for his exceptional leader-ship of our Journal Psychotherapy. Ourpublications are what we do best andwhat keep us connected.

Fourth, we are already planning for the coming year. President-Elect MarvGoldfried has made committee chair ap-pointments which have been ratified bythe Board of Directors. President-ElectDesignate Bill Stileswill soon begin, withthe help of the Nominations and ElectionsCommittee, to approach Division mem-bers to run for office (President-Elect,Treasurer, and Domain Representativesfor Professional Practice, Diversity, Edu-cation & Training, and Membership). If you are interested in running for office,I encourage you to contact me (libbynutt-

[email protected]) or Dr. Stiles([email protected]).

Fifth, we have been more active lately inproviding divisional commentary as re-quested by APA boards and committees.For example, our Education and TraningCommittee, chaired by Jairo Fuertes andassisted by our Domain RepresentativeSarah Knox, led the division in draftinga comment about masters level trainingin psychology, our Practice and ScienceCommittee Chairs and Domain Repre-sentatives (Barb Thompson, MiguelGallardo, Jim Fauth, and Norm Abeles)helped the Division draft comments onprevention guidelines, and our Telepsy-chotherapy task force (Annie Judge,Norm Abeles, Shane Davis, Rosie Adam-Terem, and Jeff Younggren) drafted areport that is now posted to our web-page. All of this work reflects the en-gagement of our Division in APA policyissues and concerns of our broader pro-fession, focusing on our role as advo-cates for all things psychotherapy.

I end this column with my feet tiredfrom walking all over DC, my heart lightfrom connecting with friends and col-leagues, my mind focused ahead on ourstrategic planning efforts, and my spiritfilled with the accomplishments andpromise of our Division. I hope you, too,find yourselves tired from good work,refreshed from making creative, intellec-tual, and personal connections, and in-spired by the tasks facing you this fall. Iwish you a wonderful, productive andrestorative fall season.

All my best,Libby Nutt WilliamsPresident

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The Psychotherapy Bulletin is Going Green: Click on www.divisionofpsychotherapy.org/members/gogreen/

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This issue of the Bul-letin, arriving on theheels of the APA Con-vention in D.C., allowsDivision 29 membersthe opportunity to cel-ebrate with the awardwinners (thank you forthe photos Tracey!),fondly recall col-leagues seen and pre-sentations heard, andconsider avenues forgreater involvement in

the Division. As Libby Nutt Williamsstated in her Presidential column, thereare exciting opportunities available forbecoming involved in the governance ofthe Division.

If you missed the APA Convention, thePresidential column will provide youwith a wonderful recap of the high-lights. This issue also includes athoughtful article on social and culturaldimensions of psychotherapy integra-tion, an extremely useful piece on super-visee experiences of corrective feedback,a skill enhancing article on motivational

interviewing with an older adult popu-lation, and a “must-read” article on re-sources for managing graduate studentdebt (written by our interns!). Onceagain, the contribution from Early Ca-reer is an interesting read, with an awe-some title. Our Ethics contribution forthis issue examines the similarities anddifferences of two Ethics Codes. Finally,the Washington Scene contribution, asusual, includes up to date informationrelated to psychology and politics.

We are absolutely thrilled that almost allof the articles in this issue of the Bulletinwere authored or co-authored by stu-dents. This is a promising sign for ourDivision and our field. We encourage allreaders to go green! And, as usual,please continue sending us your ideas,questions, comments, suggestions, andsubmissions.

Lavita Nadkarni (303-871-3877, [email protected]) and Lynett Henderson Metzger (303-871-4684, [email protected]).

Lavita Nadkarni, Ph.D.Lynett Henderson Metzger, Psy.D.University of Denver – Graduate School of Professional Psychology

EDITORS’ COLUMN

To this point, the pri-mary focus of psy-chotherapy integrationefforts has been on integrating differenttheoretical paradigmsand their related pro-cedures. We have no intention here of mini-mizing the value or importance of these efforts. Indeed, one ofus has devoted a gooddeal of his career

working on these issues (e.g., Wachtel,1997, 2011). But, we do believe it is im-portant to notice and acknowledge thatthere are other aspects and dimensionsto the integrative agenda which have re-ceived much less attention but that areequally significant and worthy of fur-ther development. In particular, we areinterested in discussing here the ways inwhich issues such as culture, race, eth-nicity, and gender contribute to andshape both the problems patients bringto us and the path that the therapeuticeffort takes (see, for example, Frank &Frank, 1993). Psychotherapy is an in-evitably value-laden and culturallyshaped enterprise, and the larger socioe-conomic, cultural, and historical contextwithin which it is conducted and withinwhich we all lead our lives plays a pow-erful role in determining what therapistsdo, how patients experience it, and howwell things turn out.

There exists, of course, a very large liter-ature on issues of race, class, gender, andso forth, and even corresponding divi-sions of APA to address them. We are by

no means interested in re-inventing thewheel, much less pretending that thewheel has not yet been invented. Rather,our aim is to move towards a frame-work where social and cultural perspec-tives are thought of not as “add-ons” (tobe relegated to a specific course on “diversity training” or “culture andtherapy”) but rather as intrinsic to thefunctioning of personality and to theprocess of psychotherapy. That is, ouraim is to contribute to the process of inte-grating these dimensions into the main-stream of psychotherapy. Integration, atits best, is “seamless,” (Wachtel, 1991). It brings things together sufficiently thoroughly that the previous “other” per-spective is woven into the warp andwoof of one’s original point of view.

We will first briefly provide a theoreticalframework for integrating these dimen-sions of personality dynamics and development, approached through con-sideration of three common myths (the“true” self, the acontextual caregiver,and the only social). We will then turn totwo moments or examples of integra-tion, and conclude with implications formoving forward.

The Myth of the Autonomous, “True” (and Acontextual) SelfThink for a moment about the commonsaying, “I’m going off to find myself.” Itpresumes both a self that is “mine” to“find” (and, alternatively, to lose), andthat one must “go off” in order to find it.What is confused, and perhaps ironic, isthe impossibility of the two assump-tions. If there is a pre-existing “self,” I

PSYCHOTHERAPY INTEGRATIONSocial and Cultural Dimensions of Psychotherapy IntegrationHannah Wallerstein, B.A. and Paul L. Wachtel, Ph.D.City College and Graduate Center, City University of New York

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cannot possibly need to go off, outsideof me, in order to acquire it. The “goingoff,” in the idea we are critically callingattention to is an attempt to find one’s“true” self, to be rid of the “distortions”of external context. Hence the commonchoice of many self-seekers to travel tothe most “foreign” or “exotic” land theycan imagine—by becoming out-of-place,the seeker attempts to locate a self thatis separate from context, a self that isfully one’s own.

But the self is never without context,never sui generis (Mitchell, 1988, 1997;Stolorow, 2009; Wachtel, 1995, 2008).From early infancy, the very origins of asense of “self” lie in interaction with another. Scholars of many different orien-tations have emphasized the intersub-jective nature of subject-formation, theways in which we begin to construct asense of self in relation to the ways thatothers construct their sense of who weare. This process does not end when in-fancy does but proceeds throughout thelife cycle.

Returning to the self-seeker who travelsfar, it is not the acontextual nature of“going off” that makes it informative,but instead the opposite. It is preciselybecause the self is always contextual that entering new contexts allows us toexperience new aspects of who we are.Indeed—and importantly for the psy-chotherapist—it is not necessary totravel thousands of miles to do this.What the experience of a good therapydoes is much the same—both by creat-ing a new context right in the room thatbrings forth new aspects of the patient’spotential ways of being and by helpingthe patient to change his interactionswith others in ways that create a newcontext with new possibilities. We do, ina sense, go off to find ourselves, but thegoing off is always a coming to, fromour first caregivers to travels abroad.

The Myth of the Autonomous, Acontextual Caregiver or FamilyMany who emphasize that the childcomes into being in relation to thosewho care for her fall prey to anothermyth—imbuing the family with totalpower and failing to appreciate the im-pact of the larger social system withinwhich the family is embedded. It is inthis myth that we find our “blame theparents” syndromes, our universalist (inthe U.S., usually white, upper-middleclass, American) theories of good par-enting, and our band-aid social serviceprograms in the face of structural in-equity. Regarding the latter, useful pro-grams such as Head Start are oftenasked to do more than they are capableof—and sometimes falsely seem to failin the process—because they are not fol-lowed up with programs to address theinequities and prejudices that continueto confront many disadvantaged chil-dren long after they have “graduated”from Head Start. Early interventions(conceived, if one probes even a bit, as“compensation” for families perceivedas unable to provide the child what amiddle class family can provide) are in-troduced as “inoculations” against thecircumstances of their early environ-ment, as if the child, once made strongand healthy, is no longer subject to theway society is structured or to pervasivetendencies in the society to perceivesome people differently than others onthe basis of skin color, accent, or someother socially selected characteristic (seeWachtel, 1999).

Early experiences do contribute power-fully to who the person becomes andhow she perceives and feels about her-self. But the mother who, as noted ear-lier, contributes so powerfully to thechild’s emerging sense of self and to thechild’s capacities or vulnerabilities, isnot simply an independent bearer ofmeaning; she is herself a social being,

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shaped by and shaping the worldaround her. The infant may “come intobeing” first through her ministrationsand her words, but those words are notpurely her own. When she says “mybaby,” she uses language—common,shared, public—to do so. Her very un-derstanding of what feelings there are inthe child to name and contain comesfrom the social world she inhabits. In-deed, if she made up her own significa-tion system, she would likely be viewedas psychotic or malicious, and consid-ered a serious threat to her child’s devel-opment. It is precisely because herwords carry socio-cultural meaning thatthey transition the child into the worldof selfhood or subject-hood, because theemerging subjectivity of the infant or de-veloping child is, inevitably, a subjectiv-ity that exists and must function withina society.

The Myth of the Only-SocialAs the “true,” “intrinsic” self, deeperand more genuine than the social andthe socially constructed, becomes re-vealed as an untenable concept, it maybe tempting to swing the other way,finding “truth” in social forces and so-cial construction alone. In this view, allwe are is the social mirror in which weare seen. Our pain can be explained asthe product of racism, capitalism, orgender stereotyping, and there is noneed to go further. However, to say thatthe social (race, gender, class, ethnicity,etc.) is enormously meaningful for all ofus is not to say it means the same thingfor all of us. Two points seem importantto note here. First, each person reacts tothe same experience in his or her ownspecific way (hence, for example, the di-versity of roles expressed in a singlefamily system). Second, even where themanifest response to the situation looks“the same,” the very same behavioral re-action can have different subjectivemeanings for each person and, depend-ing on the person’s context, can have

very different meanings to those aroundhim or her. I can “forget” the cord for mylaptop, for example, because of an un-conscious desire to be disconnected, acompulsion to fail, or an enactment ofthe chaotic female archetype with whichI am unwittingly identifying (or, of course,as a consequence of all of these—andmore—affecting my behavior and expe-rience in different combination in differ-ent contexts).

Both the meaning of events or reactionsand their ultimate impact—for example,the often spiraling sequences that canlead people into therapist’s offices filledwith bewilderment and despair—areneither exclusively individual/intrapsy-chic/a product of a diagnostic categorynor exclusively social/situational/aproduct of society and circumstances.Each person’s life, each person’sstrengths, vulnerabilities, pleasures, andpains rather thoroughly reflect bothsides of this false dichotomy. Each per-son’s difficulties are a product of his orher psychodynamics, schemas, learninghistory and his or her environment, so-cial context, and social role. Moreover,as we shall further elaborate, it is not amatter of adding two independent cate-gories, each separately contributing tothe outcome. Rather, each is only reallyproperly understood in relation to theother. Each interweaves with, interpene-trates, and very significantly defines andconstitutes the other.

So we are left with a self whose subject-hood is deeply individual while simul-taneously socially created. Thedistinctive characteristics we may ob-serve in any individual and his or herway of life reflect a shifting, dynamic,and reciprocal specificity, a continuallyevolving product of congenital attrib-utes, the ways those are shaped by—andshape—the responses of caregivers and

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then peers and others in the growingchild’s (and then adult’s) life, and the so-cial context that itself both shapes and isshaped by the intersection of the formertwo dimensions. If our work as psy-chotherapists is to honor the subject inall of his or her complexity, we must notchoose between the individual, the care-givers or others with whom he or she in-teracts in the sphere of intimateinteraction, or the larger social contextand its values, assumptions, and influ-ences; rather, we must hold them all inmind and attend to their dynamic inter-sections. We turn now to two examplesof what this integration might look like.

Why Therapists Don’t Talk about Race and Why They ShouldOne arena in which rejecting the impactof the social is particularly prominent isthat of race and racism in America. Onedoes not have to look far to see the im-pact of race in this country. Everythingfrom health (Galea, Tracy, Hoggatt et al.,2011) to employment (US Bureau ofLabor Statistics, 2011) to class and edu-cational attainment (US Census Bureau2010, 2011) is informed by deep in-equities between white people and peo-ple of color. In our field, disparities inmental health care for people of colorhave been well documented (Harris, Ed-lund, & Larson, 2005).

Yet acknowledging the importance ofrace and racism in the US proves limitedat best. Bonilla- Silva (2003) found thatthe majority of whites (77 percent) and40 percent of blacks operate from an atleast partially “colorblind” ideology. Asmental health practitioners, our trackrecord is no better. Gushue and Con-stantine (2007) point out that whilewhite practitioners are often comfort-able considering how “cultural” dimen-sions such as ethnicity, religion, ornational origin influence their own iden-tities and shape their approach to treat-ment, many are less comfortable when

it comes to race. In addition, researchers,educators and administrators havepointed to the failure of therapists to ad-dress race in treatment as a potentialsource of variability in the treatmentoutcomes of people of color (van Ryn &Fu, 2003). So what gets in the way of ad-dressing race with our patients, andwhat is the impact of refraining fromdoing so?

Kimberlyn Leary presents a compellingargument for the reason and cost ofleaving race outside of treatment (1997,2000, 2007). In referencing the work ofsocial psychologists Mazharin Banaji,Anthony Greenwald and Brian Nosekwith the Implicit Association Test, Learypoints to the automatic preference forfaces with European American pheno-types over those with African Americanfeatures for white and black participantseven in those who profess nonracist val-ues and ideologies (Greenwald & Banjali1995, cited in Leary 2007). Race hereshows to be not simply a conscious, intentional set of meanings, but somesort of “cultural form” that “operatesthrough people” (p. 545, Leary 2007) in the form of often unrecognized or un-acknowledged enactments. For exam-ple, an African-American colleaguepainfully discusses being mistaken for astore worker when she goes to buy gro-ceries in her upper-middle class neigh-borhood. Here, that which cannot bespoken (in this instance, race) isnonetheless powerfully influential inunintentional, socially significant, anddeeply painful ways—ways that arelikely to be significant for the experienceand sense of self of many of our patients,whether brought up explicitly in thetherapy or not.

These kinds of experiences are oftencompounded further when the recipro-cal roles and perceptions that makethemselves felt through such emotion-

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ally loaded socio-cultural enactments,and the historical meanings on whichthey are based, are experienced as tooscary to come to grips with. One or bothparties are likely to feel shame, each of adifferent sort, at what has transpired,but neither may be able to acknowledgethe shame or talk about it. In turn, as theunacknowledged pain and discomfortmake effective and authentic communi-cation more difficult, real contact andcommunication may diminish, sowingthe ground for still more “misunder-standings,” with again similar results(Wachtel, 1999).

The impact of such processes on psy-chotherapy treatment is to make usworse listeners. Leary refers to this beau-tifully in her account of a case presenta-tion at a psychoanalytic conference inwhich an explicitly racialized dream wasshared without being interpreted or re-sponded to (p. 544-45, 1997). Explorationof what the dream reflected about the pa-tient’s experience was limited by an in-ability to address the racial meanings herpsyche called upon in expressing that ex-perience. When race functions for us as aspace of disavowed or unacknowledgedexperience, its reference in treatment willnot only fall on deaf ears, it will turn ourears deaf. Thus, opening ourselves to en-gage with our own personal and socialexperience of race becomes imperativenot just to being “culturally” sensitivetherapists, but to being sensitive thera-pists more generally.

“At Home, a Stranger”: Working with Foreign-born PatientsHaving grown up on the border be-tween Mexico and Texas, cultural theo-rist Gloria Anzaldua shares a poignantstory of being sent to the back of herTexas elementary school classroom for“talking back” when she was attemptingto correct her teacher’s pronunciation ofher name (p. 53, 1987). She was told to“speak American” and that if she

wouldn’t she should go back to Mexicowhere she belongs. In this brief momentAnzaldua describes, her sense of belong-ing, home, identity and self are broughtinto focus and called into question. Lit-erally not allowed her name the way shespeaks it, Anzaldua is made to acceptthat a part of herself does not (cannot)belong, and is not allowed to be seen.

Immigration is never just about physicalmovement. It often involves leavingfamily members, making class shifts,learning new languages, and shapingnew identities. With current immigra-tion rates higher than ever (roughly 40million people living in the US are for-eign-born, making up 13 percent of theentire population) most of us will treatforeign-born patients in our practices.Thus, how the lived experience of mi-grating to the US shapes and is shapedby psychic process is an important ques-tion to explore.

Anzaldua conceives of the in-betweenspace of immigration as a Borderland—a place in which competing culturalframes meet and must be negotiated.When one has more than one languageand more than one cultural frame of ref-erence, it can be confusing, but it canalso open up creative channels thatwould not be available if one did nothave multiple perspectives on which todraw. As psychotherapists we are oftenconcerned with aspects of the self thatare cast off as forbidden, unacceptable,or unknowable. Some of what is cast off,however, to allude to a point made ear-lier, is cast off in a particular context.What was acceptable, what made sensein one’s country of origin does not feellike it belongs “here.” Part of our task astherapists is to help the patient integratethe two parts of herself, to make the“different” in her work here as well, tofind a way both to affirm it and to re-work it, so that it “fits” but also enriches


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with something new and different fromwhat is already here. But, if the therapisthas not herself experienced the disloca-tion of immigration, her encounter withthe immigrant’s biculturality, with itscombination of conflict and pain on theone hand, and multi-perspective cul-tural wisdom on the other, may be chal-lenging. She may be tempted, in what isexperienced as a generous or embracingstance, to see the patient as “one of us”or to persuade herself that she under-stands the patient in moments that shedoes not.

In such instances, the therapist, forget-ting how thoroughly a person’s subjec-tive experience and sense of self areintertwined with place, culture, and lan-guage, may actually do the patient a dis-service by “understanding.” We do notmean, of course, that the therapistshould not strive to understand, nor dowe mean she cannot understand. Rather,our point is that deeper understandingflows from including in the process anawareness of when (if only temporarily)one does not understand, and from tol-erating that experience of not under-standing so that it can be a path towardan understanding that more fully en-compasses the patient’s past and the as-pects of the patient’s self that may beless culturally normative in their newcountry. Put differently, too quickly andone-dimensionally accepting the patientas “one of us” may prevent both thera-pist and patient from accepting her aswho she is, often a richer and more com-plex amalgam than can fit in a uni-cul-tural package. In contrast, being open toand acknowledging experiences of loss,difference, and incomprehensibility maycreate room for difference and allow theforging of something new, collaborative,and perhaps transformative.

Concluding CommentsIn matters such as race, class, or ethnic-ity, the therapist who differs from his or

her patient must reach across the gap of“otherness” to find the common groundthat unites them. This is, of course, an el-ement in all psychotherapeutic work.Even if the patient belongs to one’s owngroup (however the therapist defines it)there will, inevitably, be significant dif-ferences between the personality, values,and life experiences of patient and ther-apist. The challenges, then, of workingwith people of different ethnic, cultural,or racial backgrounds, or of reachingacross differences in gender or sexualorientation, are ultimately variants of achallenge that faces every therapist withevery case. We must see and attend toboth the common humanity that unitesus and the differences in history, values,and circumstance that divide us.

However, because the set of differenceswe are discussing here is often set apartas more “cultural” or “political”—be-cause, on first glance, these differenceslook more like the differences that arediscussed in evening newscasts andelection campaigns than they look likethe issues that come up between friendsor intimate partners—it can be harder tosee that they are very much of a piecewith all the other ways that therapistsreach across difference in virtually everysession, regardless of whether patient ortherapist belong to “the same group.”Addressing these differences then getsperceived as an isolated task rather thanas part and parcel of the process of thetherapy itself.

In an important way, any integrativetherapist faces a similar task to that of the therapist working with someoneof another cultural group. On close in-spection, the disagreements betweenmembers of different therapeutic orien-tations—psychodynamic, cognitive-be-havioral, etc—resemble quite strikinglythe relations between and differencesamong ethnic groups (Wachtel, 2010,


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2011). Despite being posed, by each side,as strictly theoretical or empirical disagreements, resolvable by data or byrational argument, a clear-eyed exami-nation of the conflicts and controversiesreveals such “quasi-ethnic” phenomenaas stereotyping, us-them thinking, theentanglement of one’s identity withmembership in the group, the percep-tion that “they” have a peculiar way ofdoing things, and an emotional attach-ment to the language of one’s owngroup and tendency to hear the other asspeaking a strange, alienating language.To be an effective integrative therapist,one must already have the capacity toimaginatively and empathically crossthe bridge across the divide, to see what

“makes sense” in the world view of “theother.” In that sense, the challenge of in-tegrating elements such as race, class, orethnicity is one already consonant withthe agenda of the integrative therapist.It is our intention in this article to call at-tention to this dimension of integrativework in a way that both highlights itsimportance and illuminates the ways inwhich it is a natural and necessary out-growth of the enlightened pursuit of in-tegrated knowledge and practice.

References for this article can be foundin the on-line version of the Psy-chotherapy Bulletin published on theDivision 29 website.

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Supervision plays an integral role in counselordevelopment and is widelybelieved to be at the heartof training for mentalhealth professionals(Bernard & Goodyear,

2009; Campbell, 2006; Clark, 2005;Stoltenberg & Delworth, 1987). In fact,some professionals view clinical super-vision as critical to a successful transi-tion from educational coursework toclinical practice (Atkins, 1981), for su-pervisors provide valuable knowledgeto enhance supervisees’ professionalskills, allowing supervisees to eventu-ally function independently as mentalhealth practitioners (Bernard &Goodyear, 2009; Loganbill, Hardy &Delworth, 1982).

One of the key components of supervi-sion is evaluation, the primary vehicle bywhich supervisors impart knowledge(Bernard & Goodyear, 2009). Evaluationconsists primarily of two components:(1) goal setting, which involves identify-ing the competencies a supervisee willwork toward and may also include aplan of action and time frame for attain-ing goals; and (2) feedback, the latter ofwhich is the focus of this paper. Broadlydefined, feedback is information that oneperson provides to another regardingtask performance relative to a certainstandard (Claiborn, Goodyear, & Horner,2001). For the purposes of this review,feedback is defined as information thatsupervisors communicate to superviseesthat indicates whether or not superviseesare moving toward competence (Fried-lander, Siegel, & Brenock, 1989).

Feedback has been further conceptual-ized in a number of different ways. Per-haps most commonly, feedback isconceptualized as communicating apositive (i.e., affirming) or a negative(i.e., corrective) evaluation of the super-visee. Positive feedback, then, has beendescribed as those instances when su-pervisors affirm that supervisees are onthe right track (e.g., “Nice choice of in-tervention”), while negative feedback(also referred to as corrective feedback)is described as communication in whicha supervisor notes that a supervisee isoff track and should consider making achange (e.g., “I’m not sure that was thebest choice of intervention”). Accordingto Bernard and Goodyear (2009), feed-back is a “central activity of clinical su-pervision and the core of evaluation” (p.30), and it may be the best way of trans-mitting knowledge and developingcompetent counselors (Hoffman, Hill,Holmes, & Freitas, 2005).

Attesting to the important role of feed-back in supervision, when asked to re-flect on the quality of their supervisionexperiences, supervisees most oftennoted the quality and quantity of feed-back they received (Bernard &Goodyear, 2009). Previous research alsosuggests that both positive and correc-tive feedback is highly correlated withsupervisee satisfaction in supervision(Lehrman-Waterman & Ladany, 2001).Yet, despite the purported importanceof feedback in the theoretical literatureon supervision, as well as empirical ev-idence to suggest that supervisees de-sire both positive and corrective


EDUCATION & TRAINING—STUDENT FEATURESupervisee Experiences of Corrective Feedback in Clinical SupervisionDavid L. Phelps, M.A., Marquette University

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feedback, a review of the supervision literature reveals a dearth of empiricalinvestigation regarding corrective feed-back within clinical supervision. Thislack of research regarding correctivefeedback is surprising, given the integralrole that feedback plays in training mental health professionals and helpingsupervisees bridge educational course-work and clinical practice.

The research on feedback in clinical su-pervision that has been conducted haspredominately focused on supervisors’experience in providing various types offeedback to supervisees (Burkard, Knox,Clarke, Phelps, & Inman, 2009; Hoff-man, et al., 2005; Robiner, Saltzman,Hoberman, & Schirvar, 1997). As will be-come evident in the review of literaturethat follows, evidence suggests thatwhile supervisees desire feedback, su-pervisors may be reluctant to providefeedback, especially that which is correc-tive (Robiner, Saltzman, Hoberman, &Schirvar, 1997). The few investigationsinto supervisee experiences of supervi-sion have focused on perceptions of su-pervision in general, rather thanfocusing on feedback (Allen, Szollos, &Williams, 1986; Magnuson, Wilcoxon, &Norem, 2000; Robiner et al., 1993), witheven less devoted to corrective feedback.This gap in the supervision researchleaves the mental health field with littleempirical information examining super-visee experiences, be they positive ornegative, of corrective feedback events.

Failure to investigate corrective feed-back in clinical supervision leaves themental health field without a clear un-derstanding of this integral process inclinical supervision. If little is knownempirically about how supervisees ex-perience corrective feedback in supervi-sion, how can we be sure thatsupervisors are effectively deliveringsuch feedback to supervisees? Further-more, how can we know the impact of

such feedback on supervisees’ clinicalgrowth? A better understanding of su-pervisee experiences of corrective feed-back may lead to improved trainingexperiences of supervisees. Moreover,increased clarity regarding superviseeexperiences of corrective feedback mayalso help guide current supervisors inproviding a type of feedback that, as thefollowing literature review indicates,they may initially be reluctant to pro-vide. The profession would benefit,then, from greater attention to super-visee experiences of corrective feedbackin clinical supervision. In an effort tobring increased attention to correctivefeedback in clinical supervision, I beginwith a brief review of the theoretical lit-erature in this area. I then review theempirical literature on feedback in clin-ical supervision, and conclude with adiscussion of the importance of focusingon supervisee experiences of correctivefeedback in future research.

Feedback in SupervisionTheoretical literatureThe theoretical literature regarding feed-back has largely focused on how super-visors should provide feedback tomaximize supervisee learning and skillacquisition (Bernard & Goodyear, 2009).As a result, a number of guidelines havebeen suggested for supervisors in termsof providing feedback to supervisees, in-cluding feedback that is corrective. Forinstance, feedback should be based onthose goals identified by the supervisorand supervisee in the supervision con-tract (Chur-Hansen & McLean, 2006;Farnill, Gordon, & Sansom, 1997). Feed-back should also be direct and clear,preferably based on behaviors that su-pervisees are able to modify, and shouldoccur continuously over the course ofsupervision rather than only at the con-clusion of supervision (Bernard &Goodyear, 2009; Farnill et al., 1997). Fi-


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nally, feedback should be both positiveand corrective. Despite the anxiety thatcorrective feedback may elicit, super-visees desire this type of feedback and,in conjunction with positive feedback, ithas a stronger effect on behavior changethan positive feedback alone (Sapyta,Riemer, & Bickman, 2005). Thus, thereare many recommendations for the pro-vision of feedback in clinical supervisionwithin the theoretical literature.

Empirical literatureIn perhaps one of the most referencedinvestigations into feedback in clinicalsupervision, Friedlander et al. (1989)had external judges view supervisionsessions and classify behaviors that occurred during the sessions. Nine su-pervision sessions with different super-visor/supervisee pairings ranging inlength from 45 to 60 minutes were re-viewed. Among all of these data, only 14speaking turns contained feedback, witheight of these feedback exchanges occur-ring in the final two sessions, and threeof the nine sessions containing no feed-back. Of the 14 feedback responses, 71%were classified as global rather than specific, and 71% of the feedback waspositive. Only four feedback responseswere corrective, and just two containedreferences to ideas or behaviors relatedto specific therapist interventions (Friedlander et al., 1989). Ladany andMelincoff (1999) found that 98% of supervisors of graduate student coun-selors admitted to withholding feedbackfrom their supervisees; supervisors’ neg-ative reactions to their supervisees’counseling performance was among themost common types of feedback super-visors withheld. Thus, in both studies it appears that in practice, supervisorsdid not incorporate recommendationsmade in the theoretical literature into thefeedback they provided, and insteadprovided global and predominantlypositive feedback.

Supervisors’ discomfort with their roleas evaluator may explain why they arereluctant to provide corrective feedbackin clinical supervision. Such discomfortmay lead to supervisor leniency bias, orthe tendency to rate individuals morepositively than is warranted based onobjective data. According to Robiner andcolleagues (1997), 59% of supervisors in-dicated that their own ratings of super-visees were biased, with only 11%indicating that their evaluations of supervisees were accurate and withoutbias. Most common biases were a ten-dency toward leniency (39%), with only16% reporting a tendency toward strict-ness. Findings such as these have ledsome to conclude that professional psy-chology should acknowledge that biasin the assessment of trainees is likelyquite common and significant (Gon-salvez & Freestone, 2007).

The supervisor role of evaluator and theassociated duty of providing correctivefeedback might, as asserted by Haber(1996), be incompatible with supervi-sors’ professional identity, for as thera-pists they are trained to be accepting ofclients’ limitations, and may then findthe supervisory demand that they notalways provide unconditional positiveregard to supervisees quite challenging(Hahn & Molnar, 1991). Additionally, su-pervisors may believe that providingcorrective feedback interferes with de-veloping a strong supervision relation-ship, leading to dissonance thatsupervisors alleviate through not pro-viding corrective feedback (Bernard &Goodyear, 2009).

Interestingly, a lack of feedback from su-pervisors, including corrective feedback,is associated with supervisees’ percep-tions of poor supervision experiences. Ina mixed-methods study of clinical andcounseling psychology graduate student


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supervisees’ perceptions of feedback andevaluation, infrequent feedback wasnoted as the most frequent superviseeconcern regarding their supervision ex-periences (Heckman-Stone, 2003). The re-searcher concluded that based onsupervisee desire for corrective feedback,supervisor use of this type of feedback islow relative to its perceived effectiveness.In addition, Allen et al. (1986) reportedthat supervisors who provided little feed-back and structure in supervision wereassociated with lower levels of super-visee satisfaction than those who pro-vided both positive and correctivefeedback. According to Robiner et al.(1993), predoctoral psychology internsdesired feedback about their strengthsand weaknesses in order to know if theywere progressing towards goals, and theresearchers hypothesized that internsmay feel that they were betrayed by su-pervisors if deprived of opportunities toaddress areas for improvement.

In a qualitative study of supervisors’ ex-perience in providing easy, difficult, orno feedback to supervisees, supervisorsindicated that feedback about clinical is-sues (especially if the feedback was ob-jective rather than subjective) was easierto give than feedback concerning super-visee personality or professional behav-ior, because supervisors wonderedabout boundary issues and whetherfeedback in these areas would transitionfrom supervision to therapy (Hoffmanet al., 2005). Interestingly, Hoffman et al.(2005) contextualized these data in termsof an earlier study conducted byLehrman-Waterman and Ladany (2001),in which feedback and the supervisionrelationship were mutually reinforcing,with feedback and openness regardinggoals and expectations facilitating astronger supervision relationship, whichin turn made it easier for supervisors toprovide feedback to supervisees. The notion that the supervision relation-

ship influences supervisors’ delivery offeedback is not universally supported inthe empirical literature, however. In aqualitative examination of supervisors’experiences in providing difficult (de-fined as feedback that the supervisorwas hesitant to provide, yet not neces-sarily corrective in nature) feedbackabout multicultural concerns in cross-cultural supervision relationships, thequality of the supervision relationshipprior to the difficult feedback event didnot always correspond to the quality ofthe relationship following the difficultfeedback (Burkard, Knox, Clarke,Phelps, & Inman, 2009). In fact, such dif-ficult feedback events often led to an im-passe in supervision, and only rarely didthe difficult feedback lead to a more en-gaged and open supervision relation-ship. While both the Hoffman et al.(2005) and Burkard et al. (2009) studiesprovide important information aboutfeedback in clinical supervision, neitherfocused on corrective feedback, nor didthey examine corrective feedback fromthe supervisee’s perspective.

This review of the empirical literature onfeedback reveals that while there are anumber of factors that facilitate (e.g.,when feedback is objective, feedback related to clinical issues, a strong super-vision relationship) or hinder (e.g., feed-back about supervisee personality,difficult feedback about multiculturaltopics, when feedback is corrective) su-pervisors providing feedback in super-vision, supervisees desire both positiveand corrective feedback. Moreover, su-pervisee perceptions of corrective feed-back influence supervisees’ reflectionson the quality of their supervision expe-riences. However, despite empirical ev-idence that supervisees desire correctivefeedback, the literature suggests that su-pervisors are reluctant to provide thistype of feedback. While a few studies


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have examined the topic of feedback insupervision from a supervisor’s per-spective, no study has provided in-depth examination of how superviseesexperience corrective feedback and itsperceived impact.

Conclusions: Focusing on SuperviseeExperiences of Corrective Feedback inClinical SupervisionFurthering the profession’s understand-ing of supervisee experiences of correc-tive feedback in clinical supervisionwould provide valuable information re-garding a critical component of the su-pervision process. A review of thesupervision literature reveals that littleresearch has been conducted in the areaof corrective feedback within clinical su-pervision, and that supervisee experi-ences of corrective feedback have notbeen a focus of this research. This lack ofempirical attention is surprising, giventhe theoretical literature on clinical su-pervision highlighting evaluation as theprimary vehicle through which supervi-sors share their knowledge and expert-ise with supervisees, and feedback asthe core of evaluation (Bernard &Goodyear, 2009; Loganbill et al., 1982).Thus, this failure to investigate super-visees’ perspectives on corrective feed-back leaves the mental health field

without a clear understanding of this in-tegral process in clinical supervision.

Among the questions ripe for investiga-tion are supervisee views of the purposeof corrective feedback, what makes cor-rective feedback easy to hear, what makescorrective feedback difficult to hear, andhow corrective feedback affects super-visees, the supervision relationship, andclient care. A deeper understanding ofhow supervisees experience correctivefeedback may demystify a type of feed-back that research suggests supervisorsmay avoid providing. At an individuallevel, a better understanding of super-visee experiences of corrective feedbackcould stimulate supervisors to examineand refine their supervisory skills, espe-cially in the area of corrective feedback.Supervisor reflection on the process offeedback may lead to more effective su-pervision, increased supervisee satisfac-tion with supervision, and improvedtraining experiences, ultimately leadingto more competent supervisees who maygo on to become supervisors for futuregenerations of supervisees.


NOTICE TO READERS

References for articles appearing in this issue can be foundin the on-line version of Psychotherapy Bulletin published

on the Division 29 website.

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Micki FriedlanderChair, Fellows Committee

The Division of Psychotherapy is now accepting applications from individualswho would like to nominate themselves or recommend a deserving colleaguefor Fellow status with the Division of Psychotherapy. Fellow status in APA isawarded to psychologists in recognition of outstanding contributions to psychol-ogy. Division 29 is eager to honor those members of our division who have dis-tinguished themselves by exceptional contributions to psychotherapy in a varietyof ways such as through research, practice, and teaching.

The minimum standards for Fellowship under APA Bylaws are:• The receipt of a doctoral degree based in part upon a psychological dissertation, or from a program primarily psychological in nature;

• Prior membership as an APA Member for at least one year and a Member of the division through which the nomination is made;

• Active engagement at the time of nomination in the advancement of psychology in any of its aspects;

• Five years of acceptable professional experience subsequent to the granting of the doctoral degree;

• Evidence of unusual and outstanding contribution or performance in the field of psychology; and

• Nomination by one of the divisions which member status is held.

There are two paths to fellowship. For those who are not currently Fellows ofAPA, you must apply for Initial Fellowship through the Division, which thensends applications for approval to the APA Membership Committee and to theAPA Council of Representatives. The following are the requirements for initialFellow applicants:• Completion of the Uniform Fellow Blank;• A detailed curriculum vitae;• A self-nominating letter (which should also be sent to your endorsers);• Three (or more) letters of endorsement of your work by APA Fellows (at least two must be Division 29 Fellows) who can attest to the fact that your “recognition” has been beyond the local level of psychology;

• A cover letter, together with your CV and self-nominating letter, to each endorser.

Division 29 members who have already attained Fellow status through anotherdivision may pursue a direct application for Division 29 Fellow by sending acurriculum vitae and a letter to the Division 29 Fellows Committee, indicatingspecifically how you meet the Division 29 criteria for Fellowship.

CALL FOR FELLOWSHIP APPLICATIONS Division 29—Psychotherapy


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Initial Fellow Applications can be attained online at:http://apa.org/membership/fellows/

You may also contact Tracey Martin at APA: Tracey MartinDivision of Psychotherapy6557 E. Riverdale St.Mesa, AZ 85215Phone: 602-363-9211Fax: 480 854-8966Email: [email protected]

DEADLINE FOR SUBMISSION:The deadline for submission to be considered for 2012 is December 15, 2011.

Initial nominees (those who are not yet Fellows of APA in any Division) mustsubmit the following electronically as a packet:

(a) a cover letter, (b) the Uniform Fellow Application, (b) a self-nominatingletter, (c) three (or more) letters of endorsement from current APA Fellows (at least two Division 29 Fellows), and (d) an updated CV.

Current Fellows of APA who want to become a Fellow of Division 29 need onlysend a letter attesting to their qualifications with a current CV.

Completed (electronic) applications should be sent by the nominee directly to:Micki FriedlanderChair, Division 29 Fellows [email protected](phone: 518-442-5049)

Incomplete submission packets after the deadline cannot be considered for this year.

Please feel free to contact Micki Friedlander or other Fellows of Division 29 ifyou think you might qualify and you are interested in discussing your qualifica-tions or the Fellow process. Also, Fellows of our Division who want to recom-mend deserving colleagues should contact Micki with their names.

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Doctoral psychology stu-dents often leave theirprograms with a shiningnew degree in hand andchains of debt aroundtheir ankles. As they embark on their careersthey are immediatelyfaced with the often over-whelming prospect offiguring out how to payback the student debtthey acquired in pursuitof their dream.

The range of total debtcarried by psychology students variesconsiderably and may be anywherefrom zero or minimal debt up to$250,000 or more. Wicherski, Michalski,& Kohout (2009) surveyed graduate stu-dents in psychology and determinedthat 56% of students reporting debtowed more than $80,000 after graduat-ing. Total debt levels have risen drasti-cally in the past decade. In 2007, mediandebt level was around $100,000 whereasin 1997, the median debt was approxi-mately $53,000 (Munsey, 2009). Themost recent survey by the Association ofPsychology Postdoctoral and InternshipCenters (APPIC) in 2011 revealed Appli-cants’ mean reported debt load relatedto graduate level study in psychologywas $85,545 (SD = 73,572, median =$80,000), a 9.8% increase from 2010. Ap-proximately 44% reported debt of$100,000 or higher (compared to 39% in2010), while 22% reported debt exceed-

ing $150,000 (compared to 18% in 2010)(APPIC, 2011).

Because students in Ph.D. programs areoften funded (eg. by research grants),while Psy.D. students generally receivemore limited financial support fromtheir academic programs (since theygraduate into applied careers, similar tolaw and medicine where the expecta-tions for salaries is higher) it is likelythat the student debt accumulated byPsy.D. students is often higher thanPh.D. students. Statistics show thatwhile 60% of research students receiveduniversity funding only 28% of healthservice students received similar finan-cial support. Additionally, while only13% of research students report havingto take out student loans while in grad-uate school, 37% of health service stu-


PROFESSIONAL PRACTICEDoctoral Psychology Student Indebtedness: Current Status and ResourcesHeather Twitty, Ous Badwan, Alec Baker, Neal Brugman, Gina Carlson, Cari Cornish, Sara Garrido, Stephen Ginsberg, Jamie Matthews, Tatiana Rohlfs, Eva Szucs, and Elizabeth WawrekUniversity of Denver Graduate School of Professional Psychology

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dents report taking out loans to covertheir graduate school expenses (Wicher-ski, Michalski & Kohout, 2009). Datafrom the 2011 APPIC survey further in-dicates that debt for PhD students aver-ages $53,160 (median = $40,000, SD =$58,932), while the debt for PsyD stu-dents averages $123,787 (median =$123,787, SD = $70,013), and notes that“the mean debt load for PhD studentshas increased by $2,043 (4.0%) since2008, while Psy.D. students have experi-enced an increase in debt of $14,253(13%) in that same time period” (APPIC,2011). In addition, “virtually all appli-cants will remain in training for at least18 months (including the internshipyear) after the completion of this surveyand may incur additional debt duringthat period” (APPIC, 2011).

When students borrow, they have anumber of different options at the start.According to a March 2011 article by theInstitute for Higher Education,

“When borrowing, students have anumber of choices, including a rangeof federal student loans as well asnon-federal alternatives. The majorityof borrowers obtain loans through thefederal Stafford loan program; ofthese borrowers, 86 percent borrowedthrough the subsidized loan program,64 percent through the unsubsidizedprogram, and 50 percent from both(National Center for Education Statis-tics, 2008). Graduate students can borrow through the Grad PLUS pro-gram. Each of these loan types hasdifferent terms and conditions, andsome are more favorable to the bor-rower than others.” (Cunnigham &Kienzl, 2011, pg. 14).

In addition, students may choose to takeout private loans which often havehigher interest rates than federal loans.Different types of loans have differentimplications for repayment.

Faced with the prospect of paying backup to six figures of student loan debt,some graduates find they simply cannotmake enough to pay their debt and/orchoose not to pay it back. About 15% ofstudent loan borrowers in the USA be-come delinquent (i.e., fail to make pay-ments within 60 days of the due date)and default on their loans within thefirst five years of repayment (Cun-nigham & Kienzl, 2011). After 270 daysin delinquency the borrower is consid-ered to be in default. “More than 2 outof 5 borrowers who entered repaymentin 2005 became delinquent in repaymentat some point after graduation” (Cun-ningham & Kienzl, 2011, pg. 9).

How can you avoid becoming one of thestudents above who suffers the conse-quences of delinquency or default? Howcan you manage to make student loanpayments and still enjoy a reasonablelife style? This article aims to assist stu-dents in understanding their loans andplanning for their repayment. The authors of this article are psychology in-terns who seek to assist other psychol-ogy students in understanding theiroptions for repayment of student loans.We are obviously not qualified to pro-vide financial advice and we recom-mend that students consult withfinancial advisors to review their ownsituations in addition to understandingtheir options. Knowledge is power, andthe first step to freedom from your stu-dent debt. With the information fromthis article in hand students will be offto a good start in understanding how tofree themselves from their debt.

Loan RepaymentThere are many options to consider inthe financial plan for an early career psy-chologist. The first step is to take stockof your total student indebtedness. Tofind out your total federal loan debt youcan go to www.nslds.ed.gov. Your


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FAFSA pin is needed to pull up yourpersonal information. To find out yourprivate loan debt you need to contact theindividual lenders for each private loan.Fortunately you have a little time to dothis before most of your loans are due,in the form of a grace period. However,it is certainly recommended for all stu-dents to be aware of their debt through-out graduate school, so that there are nosurprises upon graduation.

Grace PeriodFortunately, most lenders understandthat it takes some time to get a job, getsettled and begin receiving a paycheck.You are therefore offered a grace periodfor many loans, during which time youdo not need to make any payments. Youare entitled to one grace period for Directand Perkins loans. Many private loansalso allow a grace period. Typically graceperiods are six months for Direct or pri-vate loans and nine months for Perkins.Your grace period begins immediatelyfollowing the day you stop attendingschool at least half-time and ends on theday before the repayment period begins.For subsidized loans the interest is paidby the federal government during yourgrace period. On unsubsidized loans,you are responsible for the interest, andthe unpaid interest is capitalized (addedto the loan principal) at the time of re-payment. It is important to keep in mindthat you only get one grace period perloan. If a borrower returns to school afterthe grace period has expired for a loan,that loan qualifies for deferment whilethe student is enrolled. The loan returnsimmediately to repayment upon gradu-ation. This means that any undergradu-ate loans that were not fully paid prior tograduate school will immediately enterrepayment upon graduation from grad-uate school. However, any new loanstaken out for graduate school will have agrace period given. It is important tonote that consolidated loans do not get agrace period. If you want a grace period

you must use it first and consolidateloans after the grace period is up.

Of course, the grace period eventuallyends, and the time begins to start payingback the loan. There are many options topay back loans, or have them forgiven.One option is to set up a repayment planwith your lender that clearly delineateshow much and when you pay eachmonth. Below are several options fortypes of repayment plans:

Standard RepaymentStandard repayment consists of a fixedpayment each month based on yourprincipal and interest. Standard repay-ment is the least expensive repaymentplan available in the long term and typ-ically has a repayment term of 10 years.

Graduated RepaymentGraduated Repayment entails lowerpayment amounts per month at the be-ginning of repayment. Then over time,payments increase and become stan-dard. This is a helpful option for gradu-ates who need time to establish theircareers and build a financial base.Monthly payments must cover at leastthe interest due. The repayment termcannot exceed 25 years. Though thereare many benefits to this in the shortterm, borrowers end up paying a greatdeal more in total over time due to theincreased amount of interest.

Income Based RepaymentIncome based repayment plans allowmonthly payments that are based onyour annual income and remaining out-standing loan balance. Loan paymentsgenerally equal 15% of discretionary an-nual income (adjusted gross incomeminus 150% of the federal poverty rate),split into monthly payments.

Income Contingent RepaymentIncome contingent repayment plans involve paying 20% of your annual


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discretionary income, split into monthlyloan payments.

Extended RepaymentExtended repayment plans assist withGraduate PLUS loans totaling more than$30,000, This plan offers a choice of fixedor graduated payments over a period ofup to 25 years. Because repayment isstretched beyond the standard 10 yearterm, the total amount paid is higher.

Loan ConsolidationLoan consolidation allows the borrowerto roll all federal loans into one lumpsum. This may reduce size of monthlypayments and extend the loan repay-ment time period. Private loans cannotbe consolidated with federal loans andyou will have to set up repayment planseparately for each private loan youhave taken out. The best approach toprivate loans is to speak with yourlender directly about options they offer.More information is available athttp://directconsolidationloans.com/.You may also want to look athttp://www.finaid.org/calculators/loanpayments.phtml to crunch the num-bers on what your payments would looklike with different plans before you com-mit to one repayment plan.

Deferments and CancellationsPaying back loans immediately or for arelatively short period of time may notbe possible due to limited income orother factors. In addition to repaymentplans, you may be eligible for loan for-giveness or cancellation in certain cases,which can help reduce the total amountyou owe.

Deferments Borrowers may be able to defer (tem-porarily suspend) loan payments undercertain conditions: if they meet certaincriteria, including enrolling at least halftime in school, or experiencing eco-nomic hardship or unemployment.

Deferments can begin after you haveused your grace period and the end datewill be determined by your lender. Bor-rowers do not have to make paymentson the loan principal until the defermentends. The interest payments on subsi-dized Stafford loans are made by thefederal government during the defer-ment period. Unsubsidized Staffordloan interest payments can be paidmonthly or deferred, but are typicallyadded to the principal balance at the endof the deferment period.

Forbearance At their discretion, lenders may grant aforbearance that temporarily suspends aborrower’s payments. Forbearances aretypically granted in three- or six-monthincrements up to a limit of five years. Aforbearance is generally a more expen-sive option than deferment because in-terest continues to accrue, even onsubsidized loans. The borrower does notmake principal payments; he or she canmake interest-only payments or havethe interest capitalized and added to theprincipal when the forbearance expires(Institute for Higher Education, pg. 19).

Programs for Loan Reduction or ForgivenessSome graduates may be eligible orchoose to participate in special pro-grams that assist with loan reduction, re-payment, or forgiveness. Often theseprograms involve working in publicservice and/or working at a low wagein exchange for receiving loan forgive-ness or repayment.

National Health Service CorpsMental health clinicians can receive asmuch as $170,000 for 5 years of full-timeservice, or $60,000 for the minimum 2years caring for patients at an approvedfacility in an underserved area. Part-time clinicians can receive $60,000 for 4years or $30,000 for 2 years. In some


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cases clinicians may be eligible to haveALL of their debt repaid if they committo more than 6 years of service. To par-ticipate in this program you must be a US citizen, be a licensed mental health professional (psychologist orLPC) in the state in which you intend toserve and work in a facility that is ap-proved by the National Health ServiceCorp. More information is available athttp://nhsc.hrsa.gov/.

Indian Health ServiceThe mission of the Indian Health Service(IHS) is to “raise the physical, mental,social and spiritual health of AmericanIndians and Alaska Natives to the high-est level” (Indian Health Service, LoanRepayment Program page). The LRPwas created to support this mission byproviding health professionals with fi-nancial assistance. The LRP awards upto $20,000 per year for the repayment ofyour qualified student loans in exchangefor an initial two-year service obligationto practice full time at an Indian healthprogram site. More information is available on their website:http://www.ihs.gov/JobsCareerDe-velop/DHPS/lrp/faq.cfm.

Public Service Loan Forgiveness (PSLF)The Public Service Loan ForgivenessProgram was created to encourage indi-viduals to enter and continue to workfull-time in public service jobs. Underthis program, individuals may qualifyfor forgiveness of the remaining balancedue on eligible federal student loansafter 120 payments have been made onloans under certain repayment planswhile employed full time by certainpublic service employers. Only non-de-faulted loans made under the William D.Ford Direct Loan ProgramSM are eligiblefor loan forgiveness. The Direct LoanProgram includes Federal DirectStafford Loans (Direct SubsidizedLoans), Federal Direct UnsubsidizedStafford Loans (Direct Unsubsidized

Loans), Federal Direct PLUS Loans (Di-rect Grad PLUS Loans) and Federal Di-rect Consolidation Loans (DirectConsolidation Loans. There are a widevariety of Public Service jobs that qualifyunder the criteria. For additional infor-mation on PSLF, check outhttp://www.finaid.org/loans/public-service.phtml.

Military ServiceSeveral military branches offer studentloan forgiveness or repayment as a benefitfor enlisting. For the National Guard psy-chologists may receive $75,000 over threeyears, paid at $25,000 a year for a threeyear commitment. By joining the Army,clinical psychologists may receive studentloan repayment of up to $50,000 overthree years through the Healthcare Pro-fessionals Loan Repayment Program(HPLR). The Healthcare ProfessionalsLoan Repayment Program also workswith clinical psychologists who elect toenter other branches of the military. Moreinformation is typically available by con-tacting recruiters for the branch you aremost interested in. Options are availablefor professionals who elect to pursue ei-ther active duty or reserve duty.

Maximum Repayment PeriodThe maximum repayment period forfederal loans is 25 years. After 25 yearsof payments, any remaining debt is for-given. Under current law, the amount ofdebt forgiven after 25 years is treated astaxable income. Therefore you will haveto pay income taxes on the amount ofdebt forgiven the year it is discharged.But the savings can be significant forstudents who wish to pursue careers inpublic service. With the recent HealthCare Reforms, the repayment periodwill be 20 years for students who takeout loans after July 22, 2014.

Perkins Loan CancellationIn certain cases, all or a portion of yourPerkins Loan can be cancelled. These


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cases include service as a full-timeteacher in certain underserved areas, afull-time librarian, law enforcement,public defender, firefighter, full-timenurse or medical technician, full-timefamily service provider, for certain mili-tary service and for Peace Corps or ACTION volunteers.

Student Loan DefaultPsychology students have a legal, ethi-cal, and professional obligation to haveto repay their student loans. However,in a worse case scenario, some will de-fault. If you find yourself in default youmay expect one or more of the followingconsequences: Tax refund withholding,paycheck garnishment, federal benefitswithheld, or law suits. Defaulting hasdevastating personal consequences andstudents are advised to take steps earlyto ensure they can avoid this. Studentloan lenders are motivated to help youcreate a plan for repayment and mostwill happily work with you to make thishappen. However, the burden for takingcharge of your student loans and work-ing to create feasible repayment optionsis up to you. Remember, knowledge ispower- so learn about your personal fi-nancial picture, seek information fromqualified professionals (CPA’s or otherfinancial advisors) and ask questions!Often university financial aide officeshave resources relevant to your local forfinding qualified professionals who canguide and assist you. Another option fora self help guide to dealing with finan-cial difficulties, is Solve Your Money Trou-bles: Debt, Credit & Bankruptcy, by RobinLeonard and Margaret Reiter.

ConclusionsDoctoral students in psychology arededicated and caring professionals.Most undergo grueling graduate schoolprograms because they believe that bydoing so they will be able to use their ca-reers to contribute to society in positiveways. Finances are typically not at the

top of the list of their concerns whenthey enter doctoral programs. However,after finishing their education this mat-ter has often become a higher priority.

Financial implications of graduateschool education are significant; beforestudents apply to psychology graduateprograms, it is important for them to un-derstand the potential costs of education(including various student loan optionsand interest rates). Academic programsare urged to be transparent in terms ofaverage student debt, as well as averageentry (and longer term) salaries to assiststudents in understanding the real im-pact this will have on their ability towork in their chosen field and maintaina decent standard of living. Studentsmust also work to stay educated on theirdebt as they progress through school,and are advised to use their loans onlyfor education and not other purposes.Although debt incurred from studentloans for a doctoral degree can certainlyrepresent a huge burden, there are manyoptions to consider in repayment plansas indicated above.

As students enter their repayment pe-riod, it is hoped they will keep the fol-lowing two thoughts in mind: (1) usecommon sense, and (2) knowledge ispower. A common sense approach tomoney and financial matters is likely tobe the first step. Understand what re-sources you have coming in, what isgoing out and what you can live with-out. Some of the authors of this articlehave found using Mint.com to be help-ful in initial financial assessments and intracking ongoing finances. For morecomplicated matters it may be helpful toobtain more knowledge and guidance.For this we recommend consulting witha professional financial consultant.

We, the authors, hope that the informa-tion provided in this article will be help-


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ful to current and future students. Wewish you all the best in your financialand career goals.


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NOTICE TO READERS

References for articles appearing in this issue can be foundin the on-line version of Psychotherapy Bulletin published

on the Division 29 website.

FIRST DIVISION 29 NORINE JOHNSON RESEARCH GRANT AWARDED

The Division 29 Norine Johnson Psychotherapy Research Grant has been awarded to Drs. Clara Hilland Charles Gelso for their proposed study of ther-apist effects on psychotherapy outcome. Specifically,the grant research will examine certain variablesproposed to foster the development of effective psychotherapists, including training, attachmentstyles, and countertransference. We are delighted toaward this first-ever $20,000 grant from the Division.We would like to congratulate Drs. Hill and Gelso,and thank the review committee members Drs.Norm Abeles, Jeff Barnett, Jim Fauth, BeverlyGreene, and Mark Hilsenroth for their work in making the selection among such excellent grantproposals. There were a large number of outstandingsubmissions, and we thank all those who submittedapplications.

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When evaluating thesimilarities and differ-ences between theEthics Codes of theAmerican CounselingAssociation (ACA)and the American Psy-

chological Association (APA) it is impor-tant to understand the differenceswithin these two professions. This canhelp professionals within the counselingand psychology fields to enhance theirunderstanding of how to effectively uti-lize both ethics codes to promote princi-pled practice.

The ACA recently updated its conceptu-alization of counseling as being “a pro-fessional relationship that empowersdiverse individuals, families, andgroups to accomplish mental health,wellness, education, and career goals”(Rollins, 2010). The APA describes theprofession of psychology as a diverse discipline, grounded in sci-ence, but with nearly boundless ap-plications in everyday life. Somepsychologists do basic research…Other psychologists apply the disci-pline’s scientific knowledge to helppeople, organizations and communi-ties function better… Psychology is adoctoral-level profession. Psycholo-gists study both normal and abnor-mal functioning and treat patientswith mental and emotional problems.APA, Definition of psychology, n.d.

An analysis of the general characteristicsof both the ACA (2005) and APA (2010)

Ethics Codes suggests that there aremore similarities than differences be-tween the two documents. This is un-derstandable because counseling isconsidered to be a subset of psychology.The principal differences between theAPA (2010) and ACA (2005) EthicsCodes lie in their detail and length. TheACA Code contains more specific appli-cations and descriptions, whereas theAPA Code is more broad and general, al-lowing for more interpretation frompsychologists.

General Similarities and Differencesbetween the APA and ACA EthicsCodesOne of the main general differences isthe way in which each association or-ganizes and describes its Ethics Code. Inits description, the APA (2010) begins bylisting five General Principles, which areaspirational goals meant to serve as asource of guidance for psychologists.Principle A, Beneficence and Nonmalefi-cence, states that psychologists strive tobenefit and to not cause harm to thosewith whom they work. Principle B, Fi-delity and Responsibility, exists when trustis established in the relationships psy-chologists make through their profes-sion. Their standards of conduct andprofessional responsibilities are upheld.Principle C, Integrity, implies that psy-chologists seek to promote accuracy,honesty and truthfulness in the science,teaching, and practice of psychology.Principle D, Justice, exists when psychol-ogists understand that the benefits from


ETHICS IN PSYCHOTHERAPYSimilarities and Differences in the Ethics Codes of The American Psychological Association and The AmericanCounseling Association: The Application of CompetenceJessica Greeney, M.A.University of Denver Graduate School of Professional Psychology

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the contributions of psychology are enti-tled to all persons based on fairness andjustice. Principle E, Respect for People’sRights and Dignity, establishes that psy-chologists need to respect the dignityand rights of all individuals. They striveto be nonbiased and do not knowinglyparticipate in, or condone, activities ofothers based on prejudices.

In comparison, the ACA (2005) EthicsCode has introductory statements foreach of eight sections, describing generalguidelines pertaining to that particularsection. For example, in Section C, Profes-sional Responsibility, the introductionstates, “Counselors aspire to open, hon-est, and accurate communication in deal-ing with the public and otherprofessionals. They practice in a nondis-criminatory manner within the bound-aries of professional and personalcompetence and have a responsibility toabide by the ACA Code of Ethics” (p. 9).The Code goes on to describe that coun-selors engage in activities to improvetheir development and advocacy, and en-gage in counseling practices that arebased on “rigorous research methodolo-gies” (p. 9), as well as engagement in self-care. This introduction section is differentfrom the APA Ethical Guidelines in thatit is more specific, but it does cover gen-eral guidelines for counselors to follow.

The main similarities occur between theten Standards of the APA (2002) and theeight sections of the ACA (2005) EthicsCodes (see Appendix A). For example,Section C of the ACA Ethical Codes, Pro-fessional Responsibility, corresponds toStandard 2 of the APA, Competence (seeAppendix A).

CompetenceWise (2008) reports that competence isthe cornerstone of the ethical principlesof psychologists, while Knapp and Van-decreek (2006) argue that competence is

based on the moral principles of benefi-cence and nonmaleficence: That is, thatpsychologists should work to benefit,and to avoid harming, those with whomthey work. Remaining within one’s fieldof competence helps maximize the po-tential to make positive changes in thelives of others, and going beyond one’sarea of competence can increase the riskfor harm (Koocher & Keith-Spiegel,2008; Naggy, 2011). Koocher and Keith-Spiegel (2008) write that obtaining aconsensus on the definition of compe-tence has been impossible, both withinand across health and mental health dis-ciplines, and Knapp and Vandecreek(2006) state there is often debate aboutthe specific skills that define compe-tence. Competence is a particularly im-portant Ethical Standard because it isoften cited when ethics complaints arebrought against psychologists (Naggy,2011). Truly competent professionals areable to recognize their limitations andweaknesses, as well as their strengthsand skills (Koocher & Keith-Spiegel,2008). Maintaining and enhancing com-petence is a widely shared commitmentamong psychologists, but there is debatewithin the multiple fields of psychologyregarding how best to accomplish thisgoal (Wise et al., 2010).

Differences Between the APA & ACA Ethics Codes The APA’s (2010) description of bound-aries of competence states that, “whenassuming forensic roles, psychologistsare or become reasonably familiar withthe judicial or administrative rules gov-erning their roles” (p. 4). Unlike psy-chologists, counselors do not performforensic duties. Therefore, the ACA(2005) Ethics Code does not elucidateforensic roles.

In addition, delegation of work to others(2.05) and providing services in emergen-


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cies (2.02) are part of the Ethics Code ofthe APA, but not the ACA. Due to thefact that professional psychologists needto obtain a doctorate degree, they areoften in more authoritative roles thancounselors. They will often spearheadresearch experiments, occupy supervi-sory roles, or manage organizations.When psychologists are in these roles itis important that they follow ethicalguidelines so they do not take advan-tage of others. It is also important forpsychologists to understand it is accept-able to provide mental health services inareas where the necessary training hasnot been met to ensure services are notdenied in emergency situations. Coun-selors do not deal with these profes-sional roles as often, which is why theyare not mentioned specifically in theACA Ethics Code. If counselors were totake on these roles it would be impor-tant for them to follow the Ethics Codeof the APA (2010).

Application of Competence Competence is described in the ACA(2005) Ethics Code under Section C, Pro-fessional Responsibilities, in subset C.2.,Professional Competence. The APA (2010)addresses this area of the Ethics Code inStandard 2, Competence. Both the ACA(2005) and APA (2010) Ethics Codes dis-cuss the boundaries of competence, stat-ing that psychologists can only workwithin areas of competency “based ontheir education, training, supervised ex-perience, consultation, study, or profes-sional experience” (Boundaries ofCompetence, C.2.a; Boundaries of Compe-tence, 20.1). The ACA (2005) includes“state and national professional creden-tials” in this description, while the APAdoes not. The ACA mentions credential-ing requirements because they vary con-siderably for counselors based on stateand national standards. This is not thecase with psychologists. While profes-sional psychologists do need to be li-

censed within the state in which theypractice, their licensure status does nottypically depend upon legal nuances tothe same degree as does credentialingfor counselors.

The APA (2010) Standard 2.03, Maintain-ing Competence, states, “psychologistsundertake ongoing efforts to developand maintain their competence” (p.1064). The ACA (2005) Section C.2.f,Continuing Education, states that coun-selors recognize the need for continuingtheir education to stay up-to-date ontechniques and take steps to maintaintheir competence in the techniques theyuse. Wise et al. (2010) suggests that im-proving “education to stay current withdevelopments sharpens our clinicalskills and serves to maintain our com-mitment to and enthusiasm for practice”(p. 636). Wise (2008) goes on to discussthe importance of professional develop-ment and how integral it is in maintain-ing competence levels. Nagy (2011)reports that maintaining competence isan ongoing process rather than a staticgoal based on knowledge learned dur-ing initial training.

Wise et al. (2010) argue that considerableattention is given to the content andquality of the initial professional train-ing, but that more focus needs to begiven to life-long learning. While life-long learning is somewhat integratedinto education, training and professionaldevelopment, the current system of con-tinuing education in psychology is“fragmented and provides little guid-ance for the professional to develop aplan to ensure competency” (p. 292).

Competence needs to be taken seriouslyby both counselors and psychologists.One cannot help others if not trained orcapable of doing so. This is, in essence,why mental health practitioners obtain


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higher degrees of education; not just be-cause specific licensures are needed ona state and national level to practice, butalso because counselors and psycholo-gists must be well trained and educatedto effectively help others. Furthermore,clinicians must actively maintain thiscompetence as they progress throughouttheir careers. The APA (2010) and ACA(2005) have similar views on compe-tence; the only differences pertain to cre-dentialing and licensure distinctions.

What these Ethics Codes need is moreguidance and continuity on the defini-tion of competence, and guidelines forhow counselors and psychologists canadequately maintain this competencethroughout their professional careers.


Appendix AAmerican Psychological Association (APA)General Principles of the APA Ethics Code1 Beneficence and Nonmalefience2 Fidelity and Responsibility3 Integrity4 Justice5 Respect for People’s Rights and Dignity

Standards of APA Ethics Code1 Resolving Ethical Issues2 Competence3 Human Relations4 Privacy & Confidentiality5 Advertising and Other Public Statements 6 Record Keeping & Fees7 Education & Training8 Research & Publication9 Assessment10 Therapy

American Counseling Association (ACA)Sections of the ACA Ethics CodeA The Counseling RelationshipB Confidentiality, Privileged Communication, and PrivacyC Professional ResponsibilityD Relationships with Other ProfessionalsE Evaluations, Assessment, & InterpretationF Supervision, Training, & TeachingG Research & PublicationH Resolving Ethical Issues

Resolving Ethical IssuesACA Section H, Resolving ethical issuesAPA Standard 1 Resolving Ethical Issues


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Supervision Training & TeachingACA Section F; Supervision, Training & TeachingAPA Standard 7; Education and Training

ConfidentialityACA Section B; Confidentiality, privileged communication and privacyAPA Standard 4; Privacy & Confidentiality

AssessmentACA Section E; Evaluations, Assessment & Interpretation APA Standard 9; Assessment

RelationshipsACA Section A; The Counseling RelationshipAPA Standard 10: Therapy

ACA Section D; Relationships with other professionalsAPA Standard 3; Human Relations

FeesACA; Section A: Counseling relationship:

A.10. Fees and Bartering A.10APA Standard 6: Record Keeping & Fees

RecordsACA Section B; Confidentiality, Privileged Communication, and Privacy

B.6. RecordsAPA Standard 6; Record keeping & Fees

CompetenceACA Section C; Professional Responsibility

C.2. CompetenceAPA Standard 2; Competence

AdvertisingACA Section C; Professional Responsibility

C.3. Advertising and Soliciting ClientsAPA Standard 5; Advertising and other public statements

Public Statements ACA Section C; Professional Responsibility

C.7. Responsibility to other ProfessionalsC.7.a. Personal Public Statements

APA Standard 5; Advertising and other public statements

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As a post doctoralgraduate embarkingon psychology licen-sure, teaching a grad-uate level course inprofessional ethicsand supervising stu-

dents in practicum wasn’t something Ihad planned for when I began my expe-rience working in the mental health fieldtwenty-five years ago. When I enter aclassroom or work with clients, I amkeenly aware of the notion that thiswork is in many respects quite familiarto me, while at the same time vastlynew. In writing this article, I contem-plate the meaning of the phrase “earlycareer psychologist.”

While the ink is drying on my doctoraldegree, understanding who I am as apsychologist in early career status re-quires a synthesis of the experiences thathave led up to this point. As an under-graduate psychology major, I answereda classified ad for a receptionist in acommunity mental health center. I wasa good typist and the job included tran-scribing psychological evaluations – itpaid well, and like any student, I neededthe money. It was not anticipated thatthis clerical experience would be the be-ginning of a decades-long journey to be-coming a psychologist. Working on thefrontlines of a mental health deliverysystem—answering calls, encounteringpeople in crisis, interacting with varioustypes of clinicians, mastering thespelling of a number of psychologicalterms and medications, as well as theproper formatting for any formidable

psychological report, proved to be a sig-nificant influence on who I am, how Iconduct my business, and how I ap-proach my work today. I was fortunateto witness first-hand the process of men-tal health service in a dynamic and de-manding setting. I also recognized thatmany of the clinicians with whom Iworked at the time seemed to be trulycommitted to their work; they showedrespect and compassion for their clients,and were genuinely concerned abouttheir welfare. This made an impressionon me, and approaching my work andtreating my clients in a similar fashion issomething that I will strive to carry for-ward in my own work as a psychologist.

Graduating as a psychology majorbrought on the usual challenges, such ashow to effectively utilize a bachelor’sdegree so I could earn a livable income.I continued my post-bachelor’s careerpath as a behavior therapist in a thera-peutic day treatment setting workingwith children. I learned about mostthings related to applied behavior analy-sis, developed some assessment skills,and was challenged to meet the needs ofclients in the trenches of a highly struc-tured and demanding therapeutic set-ting. This eventually segued intograduate training as a school counselor,where I continued to work primarilywith children and families. Later, my ca-reer path morphed into teaching under-graduate psychology courses at a localtwo year college. Midlife changes even-tually impacted my decision to returnfor a doctoral degree. The desire to

EARLY CAREERRed Convertible vs. Doctoral Degree: Reflections on being a Midlife Early Career PsychologistSaundra Welter Bacon, Psy.D.University of St. Thomas, Minneapolis, MN


broaden my own career developmentseemed more important as my spousebecame a dislocated worker from theairline industry following September 11,and my daughter was beginning school.I was drawn back to my original interestin studying psychology and felt a desireto pursue work as independent practi-tioner—something that seemed onlypossible by completing a doctoral degree and pursuing licensure as a psychologist.

Seven years later, course work and doc-toral internship complete, and I am nowpresented with the task of how to com-bine my past experience with newknowledge and skills acquired duringthe doctoral training process. I havequestioned just what it is I have beenable to learn and develop from the expe-rience, and how it will be synthesizedinto my work in the latter portion of mywork life. The system in which we pro-vide psychological services to others haschanged since 1986. Being a licensedpsychologist with a terminal degreeseems to afford a variety of opportuni-ties in which I might utilize my skillsand experience, either by practicingtherapy, teaching or providing supervi-sion. At the same time, it’s interesting toconsider what I might be writing at thistime if I had completed doctoral studiestwenty years earlier. Hypotheticallyspeaking, I might be discussing howsure I am about my philosophy of thehuman experience, or which specificarea of practice I plan to spend the nexttwenty years of my work. Would I betalking about the most recent wave ofrecommendations for working with aparticular population or diagnosticproblem, or a newly developed treat-ment method or approach to psy-chotherapy?

Aside from such speculation, I must ap-proach the next era in my career life in avastly different way than I might have if

I had followed a traditional course.Working with clients as a therapistmeans something different to me nowthan it did ten or twenty years ago. Ear-lier, I may have been more invested inthe idea of being a therapist; portrayingthe persona of a therapist. I may have fo-cused more on performing specific func-tions, such as research, therapy andassessment, or in developing a specifictherapeutic technique. These areas con-tinue to carry some significance to me asa developing practitioner, but seem totake on more qualitative meaning thanbefore. At present, I find the emphasis ofmy work to be that of continued growthas a person in the profession, boththrough the service of providing psy-chotherapy, as well as through teachingand supervising therapists in training.What I’ve learned from having the op-portunity to extend my training and ex-perience as a clinician has also stemmedinto developing my skills as a supervi-sor. This new added function of my roleas a clinician is something I find to beequally challenging and rewarding. If Ihad to select a salient feature of whatI’ve been able to conceptualize from theexperience of combining clinical work,supervision and teaching—it’s the inter-connectedness of each of these areas. Ithas allowed me a 360 degree view of thedevelopmental process of becoming apsychologist. As I look forward to fur-ther developing talents in these capaci-ties, I’m focused more on what I canshare with others. Through teaching, Ihave the opportunity to integrate practi-cal knowledge and extend it to the class-room. From a clinical perspective, Istand to appreciate even more the un-derpinnings of critical research thatserves to guide and inform my work.The opportunity to provide supervisionhas presented itself as an unexpectedbut welcome challenge and privilege.


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

Overall, the focus of my future work asa psychologist at this point in time hastaken on a different emphasis—that ofwhich allows me to continue learningfrom others through consultation andtraining, as well as what I might be ableto effectively share. It has become aGestalt process, something that holdsbigger meaning than all of the compo-nent parts of being a psychologist. Ihope to benefit from the opportunities

and privileges that licensure affords meas I continue to develop my therapeuticpractice, teaching and supervising. Hav-ing been rewarded from substantial ex-periences with positively influentialteachers, supervisors and mentors, I alsohope to be able to give back to the pro-fession what it has provided me—life-long growth and opportunity in an everchanging field of study and practice.

The Psychotherapy Bulletin is Going Green: Click on www.divisionofpsychotherapy.org/members/gogreen/

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STUDENT FEATUREMotivational Interviewing with Older Adults: Enhancing Health Behavior ChangeStacy A. Ogbeide, MSThe School of Professional Psychology at Forest Institute

The population ofolder adults is on therise. Currently, thereare 37 million individ-uals in the UnitedStates who are 65years or older. By 2030,this population will

grow to about 80 million (Cummings,Cooper, & Cassie, 2009). Aging is some-times coupled with an increase in acuteand chronic illness which can also affectpsychosocial functioning. The leadingcauses of death in individuals ages 65and older are the following: heart dis-ease, cancer, and stroke. Other chronicconditions that can cause impairment in-clude diabetes and chronic obstructivepulmonary disease (COPD). Many ill-nesses that are experienced by this pop-ulation can be managed through the useof lifestyle and behavioral modifications.Lifestyle habits that can predict disabilityin older adults include smoking, diet,lack of exercise, and alcohol consump-tion. Motivational interviewing (MI) isan intervention that can be used to en-hance behavior change in the older adultwho may be faced with a chronic condi-tion. Although there is literature thatsuggests the effectiveness of MI, much ofthe literature does not focus on olderadults. The purpose of this paper is to ex-amine the existing literature on MI in theolder adult population as a means ofpromoting health behavior change.

Motivational Interviewing with Older AdultsMotivational interviewing is aimed atincreasing self-efficacy and reducingambivalence in order to enable behavior

change (Cummings, Cooper & Cassie,2009). According to this approach, theindividual experiences internal conflictregarding the pros and cons of behaviorchange. As a result, the internal conflict,or ambivalence, must be resolved inorder for the individual to engage in be-havior change. The role of the behav-ioral health professional is to help theindividual “overcome his or her nega-tive perception of change in favor of apositive recognition of the benefits ofchange” (p. 198). Current literature en-courages the use of cognitive-behavioraltherapy (CBT) or interpersonal psy-chotherapy (IPT) when working witholder adults (Bugelli & Crowther, 2008).Both of these therapies employ collabo-ration with the client in order to elicitchange. Motivational interviewing,which also emphasizes collaboration,can be used in conjunction with CBT orIPT or used as a standalone treatment.When using MI for the older adult, it isimportant to consider physical, psycho-logical, cognitive, social, developmental,and environmental factors. For example,the psychologist will need to employflexibility in treatment planning, withthe goals of treatment clearly defined bythe client and psychologist. Facilitatingtreatment with phone calls, letters, orhospital visits may also be beneficial. Itis important to work with other health-care providers as well as caregivers con-cerning the older adult’s healthcare.During therapy, working at a slowerpace and using repetition may be help-ful with the retention of information.


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Diet, Exercise, and Weight ManagementWest, DiLillo, Bursac, Gore, and Greened(2007) examined women with type II di-abetes. Two groups were used in thisstudy: an MI group and an attention-onlycontrol group. Results of the studyshowed that both groups lost weight anddemonstrated improved glycemic controlbut participants in the MI group showedsignificantly better improvement thanthe attention-only control group. The au-thors reported that MI was less effectivefor the African-American participants,but substantial conclusions for this find-ing were not drawn.

Two smaller studies were also con-ducted examining the use of MI withtype II diabetes in older adults. Smith,Heckenmeyer, Kratt, and Mason (1997)examined the effect of MI on adherenceto a weight control program in olderwomen with type II diabetes. The twogroups received weekly standard care,with the treatment group also receivingweekly MI sessions with a psychologisttrained in MI. The results showed thatthe treatment group showed significantimprovement in glucose control as well as program attendance, food diary completion, and blood glucosemonitoring. In a second study, Jackson,Asimakopoulou, and Scammell (2007)examined the effect of MI on physicalactivity in older adults in the UnitedKingdom. Similarly, both groups re-ceived standard care, but the treatmentgroup also received face-to-face MI ses-sions with a dietician trained in MI.After six weeks of the intervention, par-ticipants in both groups reported an in-crease in physical activity, but thefrequency and duration of physical ac-tivity were significantly higher in the MItreatment group.

In a second study, Kreman et al. (2006)examined the use of telephone-based MIin older adults with high cholesterol.

When compared to the treatment as usualgroup, the participants who received MIshowed an increase in physical activitylevels as well as a decrease in total choles-terol levels. Similar studies using tele-phone-based MI, as well as face-to-faceMI sessions in different chronic diseasepopulations have found similar results(Bennett, Lyons, Winters-Stone, Nail &Scherer, 2007; Hoglund, Sadovsky, &Classie, 2009; Kolt, Schofield, Kerse, Gar-rett, & Oliver, 2007; Sims, Smith, Duffy, &Hilton, 1998). Bennett, Young, Nail, Win-ters-Stone, and Hanson (2008) found thatalthough MI did not increase physical ac-tivity levels, self-efficacy for physical ac-tivity was increased.

Chronic Disease ManagementHyman, Pavilk, Taylor, Goodrick, andMoye (2007) examined the effect of MIon health behaviors (smoking, diet, andexercise) in an African-American popu-lation with hypertension and an in-creased risk of cardiovascular disease.Three groups were used in this study: simultaneous-treatment, sequential treat-ment, and usual-care. Results showedthat the simultaneous-treatment groupdemonstrated more success when com-pared to the other two groups. The simul-taneous-treatment also demonstrated agreater decrease in sodium intake as wellas higher levels of smoking cessation.

McHugh et al. (2001) also examined theeffects of MI on health behavior changein a sample of older adults awaitingcoronary bypass graft surgery. Results ofthis study showed that participants inthe treatment group receiving MI (com-pared to the treatment as usual group)demonstrated better health outcomes inthe areas of smoking cessation, weight,physical activity, and blood pressure.Bennett et al. (2005) examined the effectof MI on the following conditions: dia-betes, lung disease, heart disease, arthri-


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tis, and neuromuscular disease. Thestudy included a treatment as usualgroup and an intervention group whichreceived telephone-based MI lasting 3-45minutes over a six-month period. At thestart of the program, the MI calls werelonger and progressively were shortenedas the program continued. The results in-dicated that the intervention group re-ported less “health distress” and less“illness intrusiveness” when comparedto the control group (p. 193).

In addition to health behavior change toimprove the management of chronicconditions, medication adherence canalso become problematic in the olderadult population. Solomon et al. (2010)examined the use of MI to improve ad-herence to osteoporosis medication. Theintervention is based on prior medica-tion adherence studies (DiIorio et al.,2008; Ogedegbe et al., 2007), with thedifference being that the current study isusing a telephone-based MI approach.Two groups were used in this study: anintervention group who received tele-phone-based MI and educational mate-rials through the mail and the controlgroup who only received educationalmaterials through the mail. The authorsindicated that this intervention is cur-rently being tested in a randomized con-trol trial and hope that this will be anovel intervention for medication ad-herence in the older adult population.

Smoking Cessation and Alcohol UseWakefield, Olver, Whitford, and Rosen-feld (2004) examined smoking cessationrates in older individuals with cancer.Two groups were used in this study:treatment as usual and a treatmentgroup receiving 11 face-to-face sessionsof MI. Each group received written mate-rials concerning smoking cessation aswell. Participants in the treatment (MI)group who smoked more than 15 ciga-rettes per were also offered nicotine re-placement therapy (NRT). Results

showed that, six months after the com-pletion of the intervention, the treatmentgroup had an increased likelihood ofusing NRT and reviewing the writtenmaterials that were provided to them,but no significant differences were foundin cessation rates between the MI-treat-ment and treatment as usual groups.

Other studies have found differing re-sults. Hokanson, Anderson, Hennrikus,Lando, and Kendall (2006) randomly as-signed participants from a diabetes cen-ter to treatment as usual and anintervention group who received an ini-tial face-to-face MI session and three tosix follow-up telephone-based MI ses-sions. Those who expressed interest insmoking cessation received more phonecalls than participants who did not ex-press interest. Nicotine replacementtherapy was also offered to those in theintervention group who were interested.Results showed that those in the inter-vention group had lower smoking rateswhen compared to the treatment asusual group three months after the com-pletion of the intervention. At sixmonths post-intervention, the differ-ences between the intervention groupand the treatment as usual group werenot significant.

Borrelli et al. (2005) found similar re-sults. The treatment group receiving MI(three face-to-face sessions as well as fol-low-up telephone-based MI) reportedmore attempts towards the cessation ofsmoking and a “decrease in the numberof cigarettes smoked daily when com-pared with the control group” (p. 201).Treatment group participants were alsomore likely to report continuous absti-nence when compared to the controlgroup. The difference between thisstudy and the Hokanson study was thelasting effect of the MI treatment—Bor-relli reported significant differences 12months after the completion of the inter-


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vention between the treatment and thecontrol groups.

Although most older adults consumeless alcohol than younger adults, manyolder adults have problems with alcoholuse. Individuals who are identified asearly-onset drinkers (before 60 year ofage) make up two-thirds of the olderadult population who experience alco-hol-related problems (Hanson &Gutheil, 2004). It is estimated that 10%of the older adult population “have aleast one alcohol-related problem, and8% meet diagnostic criteria for alcoholdependence” (p. 365). Gordon et al.(2003) examined the effects of MI onhazardous drinking behaviors in theolder adult population. Three treatmentgroups were used: MI, brief advice, andstandard care. Results from this studyindicated that there was decreased alco-hol consumption among all groups andboth interventions were not significantlydifferent from standard care.

SummaryMotivational interviewing is a therapeu-tic approach that has been used to ad-dress a number of different healthbehaviors. This approach has been usedin different age populations and has alsobeen found to enhance behavior changein areas such as weight management,chronic disease management, and smok-ing cessation in older adults. Althougheffective, some studies found conflictingresults in terms of achieving long termbehavior change. The current literatureindicates a need for future research on MIin this population in order to determinethe variations in treatment effectiveness(e.g., frequency of treatment, amount ofMI training of the interventionist) as wellas the manner in which MI is utilized(e.g., telephone vs. face-to-face sessions).


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Dr. Jeffrey Barnett with a few of the students he has taught and mentored throughout his distinguished career

DR. JEFFREY BARNETT RECEIVES THE DIVISION 29AWARD FOR DISTINGUISHED CONTRIBUTIONS TOTEACHING AND MENTORING

Women’s PreventiveHealth Care:As our na-tion experiences thesteady implementationof President Obama’slandmark health carereform legislation, the

Patient Protection and Affordable CareAct [PPACA], over the next 5 to 10 years,it is important for psychology to appre-ciate the significance of KatherineNordal’s State Leadership charge to “getpersonally involved.” The underlyinglegislation is broadly written, endorsingimportant long-range objectives, whileproviding the States and the Adminis-tration with considerable flexibility tocraft the implementing details. Thissummer, the Institute of Medicine (IOM)released its recommendations to the De-partment of Health and Human Services(HHS), Clinical Preventive Services forWomen: Closing the Gaps. According tothe Committee Chairperson and formerDirector of the National Institute for Oc-cupational Safety and Health:

The Patient Protection and AffordableCare Act of 2010 has afforded us anhistoric occasion. For the first time,prevention plays a central role withinthe scope of new health insuranceplans in the United States. Also, anongoing focus on women’s preven-tive services is expected to be in-cluded in these efforts. Given thehistory of inadequate attention towomen’s health research and preven-tive services noted by many, (includ-ing previous IOM committees), I amtruly optimistic that gains in women’shealth and well-being will ensue.With the multiple roles that women

play in society, to invest in the healthand well-being of women is to investin progress for all.

Exciting opportunities….The preventive services and screeningsspecified in PPACA, and ultimately ex-panded by HHS, will be fully coveredwithout patient copayment. The threesets of guidelines currently being uti-lized to define “preventive services” in-clude recommendations made by theU.S. Preventive Services Task Force, theBright Futures for Adolescents of theAmerican Academy of Pediatrics, andthe Centers for Disease Control and Prevention’s Advisory Committee onImmunization Practices. The IOM wascharged with convening “an expertcommittee to review what preventiveservices are necessary for women’shealth and well-being and should beconsidered in the development of com-prehensive guidelines for preventiveservices for women” as well as provid-ing “guidance on a process for regularlyupdating the preventive screenings andservices to be considered.” Issues to beexplored included:• What is the scope of preventive serv-ices not included?

• What additional screening and pre-ventive services have been shown tobe effective for women?

• What services and screenings areneeded to fill gaps in recommendedpreventive services for women?

• What models could HHS and its agen-cies use to coordinate regular updatesof the comprehensive guidelines forpreventive services and screenings forwomen and adolescent girls?

WASHINGTON SCENE

If You Miss The Train I’m On...Pat DeLeon, Ph.D.Former APA President


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In fulfilling its mission, the IOM soughtto identify preventive measures thatwere aimed at filling the gaps that it hadidentified. In most cases these measureshad already been proposed in the guide-lines of other professional organizations.Those preventive measures that wereclearly not developed, tested, or knownwell enough to have a measurable im-pact were eliminated from considera-tion. Fundamentally, the IOM exploredwhether high-quality systematic evi-dence demonstrates the effectiveness ofthe measure, whether it has been identi-fied as a federal priority in women’s pre-ventive services, and whether existingfederal, state, or international practices,professional guidelines, or federal reim-bursement policies support its use.

The IOM noted that prevention is awidely-recognized, effective tool in im-proving health and well-being and hasbeen shown to be cost effective in ad-dressing many conditions early. Histori-cally, the many disparate components ofthe U.S. health care system have reliedmore on responding to acute problemsand the urgent needs of patients than onprevention, despite almost two decade’sworth of research suggesting that nearlyhalf of all deaths in the U.S. are causedby modifiable health behaviors and thatan increase in the use of clinical preven-tive services in the U.S. could result inthe saving of more than 2 million life-years annually. Compared with a systemthat prevents avoidable conditions early,a system that responds to the acutehealth care needs of patients can be inef-ficient and costly, and a focus on re-sponse instead of prevention is a majorbarrier to the enactment of optimalhealth and well-being by Americans.

On average, women tend to use morepreventive care than men, owing to re-productive and gender-specific condi-tions, causing significant out-of-pocketexpenditures. This creates a particular

challenge to women, who typically earnless than men and who disproportion-ately have lower incomes. BeforePPACA, there was little standardizationof the preventive services offered byboth private and public payers. Medi-caid, for which the benefits are essen-tially crafted at the State level, offerscoverage for many preventive servicesfor its approximately 66 million benefici-aries, including 30 million children. Inour judgment, it is unfortunate that psy-chology did not have the foresight toseek express recognition under the fed-eral Medicaid statute prior to the enact-ment of PPACA.

Although none of the IOM committeemembers were psychologists, one of theimportant “Identified Gaps” addressedby the IOM was mental health care. Mental health issues are increasingly becoming a part of primary care, in partbecause of increased physician education.Depression, for example, is a conditioncommonly encountered in primary carebecause those with major depressive dis-order tend to utilize health care at higherrates. This disorder affects approximately121 million people world wide and hasbeen identified to be 1 of the top 10 lead-ing causes of disease burden. It is also di-agnosed twice as often in women as inmen. Between 10% and 20% of mothersexperience postpartum depression withinthe first year after giving birth, which hassignificant consequences for both thechild’s development and the mother’swell-being. Depression may lead to suici-dal ideation and actions, with suiciderates in women the highest within the agerange of 45 to 54 years. Across the lifespan, women may develop depressionmore often or more prominently aroundthe time of certain reproductive events,such as menstruation, pregnancy, loss of ababy, birth of a baby, infertility, andmenopause.


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The primary gap in prevention servicesrecognized by the IOM is that the cur-rent recommendation for depressionscreening and follow-up does not ad-dress suicide and postpartum depres-sion as related conditions to beevaluated. We would postulate that ifpsychology had been more actively en-gaged in this important IOM study, asignificantly broader recommendationwould have evolved. As KatherineNordal emphatically stressed, our na-tion’s health care system is undergoingunprecedented change and would sig-nificantly benefit from psychology’sconcerted presence.

MACPAC: One of the most satisfyingaspects of serving in the public policyarena is the opportunity to work closelywith our nation’s next generation ofpublic servants. Coming from varyingbackgrounds, these leaders of tomorroware extraordinary bright, enthusiastic,and dedicated. Hopefully, as they ma-ture into seasoned professionals, theywill retain these defining traits. “Only ayear out of my undergraduate studiesand interning in Washington, DC, forthe first time, I have found myself div-ing head first into a veritable sea of com-plex issues I had never had to look moreclosely at than the articles in my localnewspaper. I have been fortunateenough to have the opportunity to workclosely on many different health-relatedissues during my short tenure here andam struck by the inseparable bond exist-ing between the health issues I studyand the debt talks going on all aroundme. As the struggle to reform healthcareand balance the Federal budget contin-ues, the U.S. is increasingly looking atpatient-centered and team-based ap-proaches as a more effective way to notonly treat patients, but also to managetheir long-term care. With so muchchange being implemented on the sys-tem as a whole, the role of the psycholo-gist within the new healthcare system is

also evolving. On the one hand, recentstudies show the tremendous psycho-logical effect of expanded Medicaid oraccess to medical insurance. Evidencefrom the first year of the Oregon HealthInsurance Experiment indicates that‘when poor people are given medical in-surance, they not only find regular doc-tors and see doctors more often but theyalso feel better, are less depressed andare better able to maintain financial sta-bility.’ On the other hand is the problemof finding adequate funding to supportthese initiatives.

“Persons requiring mental health serv-ices, while representing a comparativelysmall portion of the Medicaid recipientpopulation, also incur a disproportion-ately high level of associated cost. TheAPA reports that most Medicaid benefi-ciaries are not entitled to psychologicalservices. With the exception of childrenunder the age of 21, who are covered byMedicaid as part of the Early and Peri-odic Screening, Diagnostic and Treat-ment (EPSDT) benefits for psychologicalservices, access for low-income familiesand disabled persons varies from stateto state. Because it is considered an ‘op-tional benefit,’ only 50% of the statesoffer psychological services through in-dependent practices while the other halfmay cover services in certain situationsonly, such as through a hospital, accord-ing to the APA. However, in those cir-cumstances, psychologists are not ableto bill Medicaid directly. States’ policieson psychological treatment as an ‘op-tional benefit’ vary considerably and areat risk for cuts as states facing budgetshortfalls must make tough choices.

“In an effort to confront the nationalgoal of cutting spending while improv-ing the care management necessary forthis population’s complex needs, stateshave been increasingly trending away


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from fee-for-service and towards man-aged care in Medicaid, a movement that islikely to continue, according to the Medi-caid and CHIP Payment and AccessCommission’s (MACPAC’s) recent Re-port to Congress: The Evolution of Man-aged Care in Medicaid.Managed care canbe used to define many different arrange-ments for delivering and financing healthcare services, though the main threearrangements are comprehensive risk-based plans, primary care case manage-ment programs, and limited benefit plans.While each state takes a slightly differentapproach, 48 states and the District of Co-lumbia now use some combination ofmanaged care, incorporating 71% of allMedicaid enrollees.

“This being said, another paradox existsregarding Medicaid and behavioralhealth patients. Medicaid enrollees gen-erally tend to have a higher prevalenceof behavioral health issues than thegreater population; and further, mentalhealth conditions can exacerbate otherexisting medical conditions. Conversely,behavioral health services are often themost ‘carved out’ services in Medicaidprograms, causing enrollees to have tostruggle with a complex system and co-ordinating services. These problems arefurther compounded when, in somestates, the behavioral health services are‘carved out’ of the plan benefit packagebut the pharmaceutical costs associatedwith them are included. Other stateshave taken a more limited-benefit ap-proach to their plans and have contractsto manage the subset of benefits andservices required for particular subpop-ulations, such as individuals in need ofinpatient mental health services.

“The particular and increasing relevanceof managed care in Medicaid comes notfrom its apparent discrepancies or fromthe challenges it has had in securingprovider participation, but rather fromPPACA, which is expected to be fully

implemented by 2014. Notably, this Actwill require the states to establish cover-age for nonelderly parents, childlessadults, and adults with disabilities withincomes up to 138% of poverty. It alsocalls for the creation of AccountableCare Organizations (ACOs), which arenetworks of hospitals, doctors, andother health professionals that agree toshare responsibility for the care receivedby patients. Falling under the broadercategory of ‘other professionals,’ psy-chologists and other behavioral healthspecialists will undoubtedly play an in-tegral role as part of these health teams.Perhaps as we look to the future ofhealthcare reform in this country, theneed for psychologists to be more thanjust ‘other professionals’ legislativelywill become more apparent and both thegovernment and the psychological com-munity will be called upon to provideboth the funding and the necessary pro-fessionals to meet the needs of theAmerican people” (Anna Borris, Internfor U.S. Senator Daniel K. Inouye).

Conditions of Participation for Com-munity Mental Health Centers: ThisSummer HHS proposed regulations forcommunity mental health centers whichwould require comprehensive patientassessments by a physician-led interdis-ciplinary team in consultation with theclient’s primary health care provider, ifany. The interdisciplinary team wouldbe composed of a doctor of medicine, os-teopathy or psychiatry, a psychiatric reg-istered nurse, clinical psychologist, aclinical social worker, an occupationaltherapist, and other licensed mentalhealth counselors, as necessary.

The required psychiatric evaluationmust be “completed by a psychiatrist orpsychologist with physician counter sig-nature, that includes the medical historyand severity of symptoms.” In addition,


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the CMHC must designate a physician-led interdisciplinary treatment team thatis responsible, with the client, for direct-ing, coordinating, and managing thecare and services furnished for eachclient. The interdisciplinary treatmentteam is composed of individuals whowork together to meet the physical,medical, psychosocial, emotional, andtherapeutic needs of CMHC clients.

We would suggest that Katherine’s mes-sage is extraordinarily important if psy-chology is to remain an independenthealth care profession under PPACA. Iwill soon be retiring from the U.S. Sen-ate staff after 38+ years of a fascinatingjourney. “If you miss the train I’m on,you will know that I am gone. You canhear the whistle blow a hundred miles.”Aloha,

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Dr. Steve Sobelmanreceived a special citation from President Libby NuttWilliams for hiscontributions to thedivision’s website.

DR. STEVE SOBELMAN RECEIVES THE DIVISION 29 PRESIDENTIAL CITATION

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

MEMBERSHIP APPLICATIONDivision 29 meets the unique needs of psychologists interested in psychotherapy.

By joining the Division of Psychotherapy, you become part of a family of practitioners, scholars, and students who exchange ideas in order to advance psychotherapy.

Division 29 is comprised of psychologists and students who are interested in psychotherapy. Although Division 29 is a division of the AmericanPsychological Association (APA), APA membership is not required for membership in the Division.

JOIN DIVISION 29 AND GET THESE BENEFITS!

Name ____________________________________________ Degree ____________________

Address _____________________________________________________________________

City _______________________________________ State ________ ZIP________________

Phone _________________________________ FAX ________________________________

Email _______________________________________________

Member Type: � Regular � Fellow � Associate

� Non-APA Psychologist Affiliate � Student ($29)

� Check � Visa � MasterCard

Card # ________________________________________________ Exp Date _____/_____

Signature ___________________________________________

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

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

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

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

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

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

NETWORKING & REFERRAL SOURCESConnect with other psychotherapists sothat you may network, make or receive referrals, and hear the latest important information that affects the profession.

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

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

VISIT OUR WEBSITEwww.divisionofpsychotherapy.org

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

If APA member, please provide membership #

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

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

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

PUBLICATIONS BOARDChair : Jeffrey E. Barnett, Psy.D., ABPP Department of PsychologyLoyola University Maryland4501 N.Charles StreetBaltimore, MD 21210(410)-617-5382Email: [email protected]

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

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

Jonathan Mohr, Ph.D., 2008-2012Department of PsychologyBiology-Psychology BuildingUniversity of MarylandCollege Park, MD 20742-4411Ofc: 301-405-5907 Fax: 301-314-5966Email: [email protected]

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

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

On sabbatical: Jean Carter, Ph.D.

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

PPssyycchhootthheerraappyy BBuulllleettiinn EEddiittoorrLavita Nadkarni, Ph.D.Director of Forensic StudiesUniversity of Denver-GSPP2450 South Vine StreetDenver, CO 80208Ofc: 303-871-3877Email: [email protected]

Associate EditorLynett Henderson Metzger, Psy.D.University of Denver GSPP2460 S. Vine St.Denver, CO 80208Ofc: 303-871-4684Email: [email protected]

Internet Web EditorIan Goncher [email protected]

DDiivviissiioonn ooff PPssyycchhootthheerraappyy IInntteerrnneett EEddiittoorrIan Goncher405 Lake Vista Circle Apt JCockeysville, MD 21030Ofc: 814-244-4486Email: [email protected]

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