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BULLETIN

PsychotherapyO F F I C I A L P U B L I C A T I O N O F T H E S O C I E T YFOR THE ADVANCEMENT OF PSYCHOTHERAPYOF THE AMERICAN PSYCHOLOGICAL ASSOCIATION

www.societyforpsychotherapy.orgIn This Issue

Special FeaturesReflections From an American Psychological Association/American Psychological Foundation Gold Medal Award

Recipient for Life Achievement in the Application of Psychology: An Interview with Marvin Goldfried

The Business of Psychotherapy Practice: Reflections and Lessons Learned in the Trenches

SpecIal SecTIon: TurnIng poInTS

clinical notes With Dr. JFrom Psychologist to “Whose Father Is This?”:

Transitioning Into Fatherhood as a Psychotherapist

public Interest and Social JusticeA Personal Perspective on Systemic Change

DiversityChoosing to Work for a Community Health Center:

A Career Turning Point

education and TrainingThe Uphill Climb:

A Student’s Guide to Gaining Relevant Skills for Acceptanceto Clinical/Counseling Psychology Doctoral Programs

psychotherapy practicePractice Recommendations for Psychotherapy

With Gender Diverse Clients

early careerAssessing the Needs and Interests of Our Early

Career Psychologist Members

ethics in psychotherapyKnowing What You Don’t Know: Addressing Professional Competence

2018 VOLUME 53, NUMBER 2

PresidentMichael J. Constantino, PhDDepartment of Psychological and Brain Sci-ences612 Tobin Hall - 135 Hicks WayUniversity of MassachusettsAmherst, MA 01003-9271Ofc: 413-545-1388 E-mail: [email protected]

President-electNancy Murdock, PhDUniversity of Missouri-Kansas City215 Education Building5100 Rockhill RoadKansas City, MO [email protected]: 816-235-2495 fax: 816-235-6925E-mail: [email protected]

Secretary Rebecca M. Ametrano, Ph.D., 2018-2020Office of Patient Centered CareVA Boston Healthcare System1400 VFW Parkway West Roxbury, MA 02132Ofc: 857-203-5394E-mail: [email protected]

TreasurerJesse J. Owen, PhD, 2016-2018University of DenverMorgridge College of EducationCounseling Psychology Department1999 E Evans Ave Denver CO 80208Ofc: 303-871-2482E-mail: [email protected]

Past PresidentJeffrey Zimmerman, PhD 29 Todd Rd.Katonah, NY 10536Phone: 203-271-1990E-mail: [email protected]

Domain RepresentativesPublic Interest and Social Justice Lavita Nadkarni, PhD, 2018-2020Director of Forensic StudiesUniversity of Denver-GSPP2450 South Vine StreetDenver, CO 80208Ofc: 303-871-3877E-mail: [email protected]

Psychotherapy PracticeBarbara Thompson, PhD, 2016-20183355 St. Johns Lane, Suite F.Ellicott City, MD 21042Ofc: 443-629-3761E-mail: [email protected]

Education and TrainingJennifer Callahan, PhD, 2016-2018UNT Department of PsychologyTerrill Hall, Room 3761155 Union Circle #311280Denton, TX 76203-5017Ofc: 940-369-8229E-mail: [email protected]

MembershipJean Birbilis, PhD, 2016-2018University of St. Thomas1000 LaSalle Ave., MOH 217Minneapolis, Minnesota 55403Ofc: 651-962-4654 fax: 651-962-4651E-mail: [email protected]

Early CareerLeigh Ann Carter, PsyD, 2017-2019Towson University8000 York RoadWard & West - Counseling CenterBaltimore, MD 21252Ofc: 443-470-5434E-mail: [email protected]

Science and ScholarshipSusan S. Woodhouse, PhD, 2017-2019Department of Education and Human Serv-ices Lehigh University111 Research DriveBethlehem, PA 18015Ofc: 610-758-3269 Fax: 610-758-3227E-mail: [email protected]

DiversityRosemary Phelps, PhD, 2017-2019University of Georgia402 Aderhold Hall Athens, GA Ofc: (706) 542-1812E-mail: [email protected]

DiversityGary Howell, PsyD, 2018Center for Psychological Growth2109 E. Palm Avenue, Suite 201Tampa, FL 33605Ofc: 813-419-7793 Fax: 866-627-1040E-mail: [email protected]

International AffairsFrederick Leong, Ph.D. 2018-2020Michigan State UniversityDepartment of PsychologyEast Lansing, MI 48824Ofc: 517-353-9925; Fax: 517-353-1652E-mail: [email protected]

APA Council RepresentativesLillian Comas-Diaz, PhD, 2017-2019908 New Hampshire Ave NW Ste 700 Washington, DC Business: (202) 775-1938E-mail: [email protected]

Elizabeth Nutt Williams, PhD, 2017-2019St. Mary’s College of Maryland18952 E. Fisher Rd.St. Mary’s City, MD 20686Ofc: 240- 895-4467 Fax: 240-895-2234E-mail: [email protected].

Student RepresentativeNicholas R. Morrison, MS, 2017-2019University of MassachusettsDepartment of Psychological &Brain Sciences

602 Tobin Hall | 135 Hicks WayAmherst, MA 01003Phone: 413-345-2924E-mail: [email protected]

Continuing EducationTony Rousmaniere, PsyDStudent Health and Counseling CenterUniversity of Alaska, Fairbanks612 N. Chandalar Drive, PO Box 755580Fairbanks, AK 99775-5580Phone: (907) 474-7043E-mail: [email protected]

DiversityChair: Astrea Greig, PsyDBoston Healthcare for the Homeless Program780 Albany St, Rm 3107Boston MA 02118 Ofc: 857-654-1324E-mail: [email protected]

Early Career PsychologistsChair: Kimberly A. Arditte Hall, PhDNational Center for PTSDVA Boston Healthcare System150 South Huntington Ave (116B-3)Boston, MA 02130Phone: 857-364-6232E-mail: [email protected]

Education & TrainingChair: Rayna D. Markin, PhDDepartment of Education and Counseling302 Saint Augustine Center800 Lancaster AveVillanova, PA 19075Ofc: 610-519-3078E-mail: [email protected]

FellowsChair: Robert L. Hatcher, PhDWellness Center / Graduate CenterCity University of New York365 Fifth AvenueNew York, NY 10016Ofc: 212-817-7029E-mail: [email protected]

FinanceChair: Jeff Reese, PhDUniversity of Kentucky College of EdDept of Educational, School, Couns Psych245 Dickey HallLexington, KY 40506-0017Ofc: 859-257-4909E-mail: [email protected]

International AffairsChangming Duan, PhDDept. of Psychology & Research in EducationUniversity of KansasLawrence, KS 66054Ofc:785 864-2426 Fax:785 864-3820E-mail: [email protected]

MembershipRosemary Adam-Terem, PhD1833 Kalakaua Avenue, Suite 800Honolulu, HI 96815Ofc: 808-955-7372 Fax: 808-981-9282E-mail: [email protected]

Nominations and ElectionsChair: Nancy Murdock, PhDE-mail: [email protected]

Professional AwardsChair: Jeffrey Zimmerman, PhD E-mail: [email protected]

ProgramChair: Gary Howell, PsyD E-mail : [email protected]

Associate Chair : James Boswell, PhD

Society for the advancement of psychotherapy n 2018 governance StructureELECTED BOARD MEMBERS

STANDING COMMITTEES

Standing Committees, Continued on page 73

pSYcHoTHerapY BulleTIn

Published by theSocIeTY For

THe aDVancemenT oF pSYcHoTHerapY

american Psychological association

6557 E. riverdaleMesa, aZ 85215

602-363-9211e-mail: [email protected]

eDITorlynett Henderson Metzger, [email protected]

aSSocIaTe eDITorCara Jacobson, Psy.D.

[email protected]

conTrIBuTIng eDITorS

Diversitygary Howell, Ph.D., and rosemary Phelps, Ph.D.

education and TrainingJennifer Callahan, Ph.D., and

rayna D. Markin, Ph.D.

ethics in psychotherapyapryl alexander, Psy.D.

psychotherapy practiceBarbara Thompson, Ph.D., and

Barbara Vivino, Ph.D.

psychotherapy research, Science and Scholarship

Susan Woodhouse, Ph.D., andJoshua Swift, Ph.D.

public Interest and Social Justicelavita nadkarni, Ph.D., and

linda Campbell, Ph.D.

Washington ScenePatrick Deleon, Ph.D.

early career leigh ann Carter, Psy.D., andKimberly arditte Hall, Ph.D

Student Featuresnicholas Morrison

editorial assistantsSalwa Chowdhury

[email protected]

Cory [email protected]

STaFF

central office administratorTracey Martin

Websitewww.societyforpsychotherapy.org

pSYcHoTHerapY BulleTInOfficial Publication of the Society for the Advancement ofPsychotherapy of the American Psychological Association

2018 Volume 53, number 2

conTenTS

President’s Column ......................................................2Into the First Turn

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

Special FeatureReflections From an American Psychological Association/American Psychological Foundation Gold Medal Award Recipient for Life Achievement in the Application of Psychology: An Interview with Marvin Goldfried ................................................6

The Business of Psychotherapy Practice: Reflections and Lessons Learned in the Trenches ........................14

SPECIal FoCuS: TurnIng PoInTSClinical notes With Dr. J ........................................19

From Psychologist to “Whose Father Is This?”: Transitioning Into Fatherhood as a Psychotherapist

Public Interest and Social Justice ..........................23A Personal Perspective on Systemic Change

Diversity ..................................................................28Choosing to Work for a Community Health Center: A Career Turning Point

Education and Training ..............................................33The Uphill Climb: A Student’s Guide to Gaining Relevant Skills for Acceptance to Clinical/Counseling Psychology Doctoral Programs

2018 Convention Program Summary........................36

Psychotherapy Practice ..............................................44Practice Recommendations for Psychotherapy With Gender Diverse Clients

Early Career ..................................................................49Assessing the Needs and Interests of Our Early Career Psychologist Members

Ethics in Psychotherapy..............................................53Knowing What You Don’t Know: Addressing Professional Competence

Washington Scene........................................................59“Rockin’ Pneumonia”

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n

preSIDenT’S column

Into the First Turn

Michael J. Constantino, PhDUniversity of Massachusetts, Amherst

as I write my secondPresidential Column, theKentucky Derby is fast-approaching (for thoseunaware, it is always thefirst Saturday in May!).as a big fan of the event,I feel compelled to use

horse racing lingo. Thus, whereas myfirst Presidential column was my per-sonal post time at the SaP leadershiphelm, this second column represents thethree-quarter pole of my term (distanceis in reference to the finish line). Stateddifferently, I am well into the first turn(a figuratively literal turning point).

as time tends to do, four months on thejob have gone by quickly! During thistime, SaP not only continues to have itsannual rhythm of events, programs,awards, and publications, but its leadersalso put new initiative balls in the air tobe juggled. I am happy to report thatSaP continues to juggle with skill andprecision, which allows for an excitingblend of the norm and the new. In thiscolumn, I provide an update on severalof the Presidential and Board of Directorinitiatives that I laid out in my previouscolumn, and that have been successfullylaunched or furthered. I also provide abrief look ahead to important transitionsand SaP’s next major event—aPa Con-vention in San Francisco.

a Few updatesas a reminder, SaP engages in numerousinitiatives reflecting the cutting edge ofpsychotherapy research, practice, train-ing, and professional development, andthat in many ways connect to my presi-dential themes of personalized mental

health care and disruptive innovations topsychotherapy training molds and methods.

In a few short weeks, I will representSaP at the May 2018 meeting of the Society for the Exploration of Psy-chotherapy Integration (SEPI) in orderto raise awareness of SaP and to in-crease the active connection betweenthese two organizations who sharemany overlapping missions. In my roleas guest to SEPI (though I am also amember), Tracey Martin, Catherine Eu-banks, and I will meet to discuss inearnest concrete ways to grow the SaP-SEPI collaboration and bidirectionalsupport system. My colleague, Dr. JamesBoswell, and I will also present the re-sults of the two meta-analyses that weconducted for Dr. John norcross’s forth-coming book, Psychotherapy RelationshipsThat Work (3rd ed.)—a project co-spon-sored by SaP. respectively, our meta-analyses focused on the prediction ofpatient posttreatment outcomes fromtheir pre- or early treatment outcome expectation and perceived credibility oftherapist/treatment. We are excited toshare our results, and to raise conscious -ness around the relevance of attendingto pandiagnostic and pantheoretical pa-tient belief variables as a central form ofevidence-based practice (EBP)—a dis-ruptive movement, for sure, away fromconceptualizing EBP solely as elementsof therapist actions in concert with atreatment protocol. We will also presentboth of these works at aPa Conventionin august.

also relevant to the Psychotherapy Rela-tionships That Work (3rd ed.) project,

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Dr. rayna Markin and I have begun production on companion videos to thebook’s chapters. These videos, which willbe cross-posted on the SaP website andthe oxford university Press website, in-volve Dr. Markin asking focused ques-tions to the authors on the trainingimplications of their original meta-analyses on factors that contribute topsychotherapy improvement. I was fortunate to be Dr. Markin’s first inter-viewee, discussing our outcome ex-pectancy chapter, and we look forwardto featuring these videos in the near future. Be on the lookout for these com-panion pieces!

We have now received nominations fortwo new student awards: The StudentExcellence in Practice award and TheStudent Excellence in Teaching/Mentorship award. I am excited to pres-ent these awards to our inaugural win-ners at the SaP award Ceremony atConvention.

Commemorating our 50th anniversary,we have also now received proposals forthe 2018 Society for the advancement ofPsychotherapy 50th anniversary researchgrant, which will provide $30K towardthe advancement of research on psycho -therapy process and/or outcome that willhelp shape the field for the next 50 years.I am also excited to present this award toour winner(s) at our award Ceremony.

I have convened a workgroup, includ-ing nicholas Morrison, Dr. lavita nad-karni, and myself, to develop theadministration and evaluation processfor the two new SaP student posterawards, which will be granted this yearat Convention. our group looks forwardto reviewing abstracts, listening to oralsummaries during the poster sessions,and selecting the inaugural winners.These winners will be announced atSaP’s popular “lunch with the Mas-ters” at Convention.

We will formally extend our successfulpartnership with oriental Insight atConvention, and we remain devoted tothe internationalization of SaP.

Finally, in response to SaP Fellow andPast-President, Dr. Marvin r. goldfried,being awarded the 2018 aPa/aPF goldMedal award for life achievement inthe application of Psychology, our Stu-dent Development Chair, nicholas Mor-rison, interviewed Marv. This piece, forwhich Marv reflects on his illustrious career, will be published in this editionof the Psychotherapy Bulletin. It is wellworth the read. Congratulations, again,Marv! We are all very proud.

TransitionsSpeaking of time flying, Dr. MarkHilsrenroth, our Psychotherapy Editor ex-traordinaire now enters what is akin tothe stretch run of his second and finalterm as Editor. Dr. Hilsenroth’s term willend in 2020. Thus, the SaP Publicationsand Communications Board Chair, Dr.laurie Heatherington, and I have begunworking with aPa on a transition plan.Please see an advertisement for the posi-tion in this issue, and we encourage thoseinterested and qualified to apply. TheJournal has been immensely successfulunder Dr. Hilsenroth’s leadership, andwe look forward to continued excellencewith the selection of his successor.

conventionThe SaP Convention program has beenreleased. Please visit our website to seethe full program. I highlight here just afew events:

n Division 29: Poster Session I (ID: 1229)Thursday (8/9/18): 11am-11:50amlocation: Moscone Center - Halls a, B, C

n Division 29: Poster Session II (ID:1231)Friday (8/10/18): 11:00am-11:50a

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http://societyforpsychotherapy.org/

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location: Moscone Center - Halls a, B, C

n Presidential Symposium: PersonalizingMental Health Care Through Disrup-tive, Evidence-Informed Innovations toPsychotherapy (ID 1187)Saturday (8/11/18): 8am-9:50amlocation: Moscone Center - room 206

also, you are cordially invited to thefollowing SaP special events (all ofwhich will incorporate a celebration ofSaP’s 50th anniversary):

n Division 29: award Ceremony (ID: 1233)Friday (8/10/18): 4pm-4:50pmlocation: Marriott Marquis - Yerba Buena Salons 5 & 6

n Division 29: Social Hour (ID: 1234)Friday (8/10/18): 5pm-5:50pmlocation: Marriott Marquis - Yerba Buena Salons 5 & 6

n Division 29: luncheon with the Masters (ID: 1235)

Saturday (8/11/18): 12pm-1:50pmlocation: Marriott Marquis - goldengate room C2

See you in San Francisco!

In memoriam as most of you are aware, SaP lost anesteemed member, co-founder, and Past-President on March 14, 2018 when Dr.ronald Fox passed away. We were for-tunate to have Drs. Pat Deleon and ronlevant write a touching obituary, whichcan be read here.

a repeat of gratitudeIt bears repeating from my first column:to our Board members, thank you, for allthat you do for SaP. To all SaP members,thank you, for entrusting me to lead thisfine organization in 2018. and for thoseof you who take in the most exciting twominutes in sports, enjoy the KentuckyDerby, Preakness Stakes, and BelmontStakes, as well as a mint julep, black-eyedSusan, and Belmont breeze, respectively(if you are into those sorts of things)!

Find the Society for the Advancement of Psychotherapy at

www.societyforpsychotherapy.org


http://societyforpsychotherapy.org/esteemed-national-leader-dr-ronald-fox/

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We hope this issue findsour readership well,and winding up sum-mer activities/begin-ning to look towardFall.

In this issue, we havetwo Special Features youwon’t want to miss.First, an interview withDr. Marvin goldfried,2018 aPa/aPF goldMedal award for life

achievement in the application of Psy-chology, by nicholas Morrison, Chair ofour Student Development Committee.In addition, Dr. Ben Johnson has writtenan informative piece on the business ofpsychotherapy.

In keeping with our Special Focus of“Turning Points,” we have pieces re-garding transitioning into fatherhood asa clinical psychologist, as well as earlycareer turning points working in correc-tional systems and community healthcenter settings. Early career profession-als should also not miss a submission byour ECP Committee Chair, Dr. Kimberlyarditte Hall, on assessing our ECPmembers’ needs and interests. Student

readers at every stage of their trainingmay find this issue’s “guide to gainingrelevant Skills for acceptance to Clini-cal/Counseling Psychology DoctoralPrograms” useful. all of our readers willwant to take time to learn about practicerecommendations for gender diverseclients and ethical considerationsaround professional competency. Fi-nally, don’t forget to check out the up-coming events, announcements, andmember-specific information and up-dates included in this issue.

our remaining deadlines for the year areaugust 1 and november 1, 2018. Pleasevisit us at http://societyforpsychother-apy.org/bulletin-about/ for our sub-mission guidelines and portal. asalways, feel free to contact either of us,using the contact information below.

lynett Henderson Metzger, JD, PsyDPsychotherapy Bulletin Editoremail:[email protected]: (303) 871-4684

Cara Jacobson, PsyDPsychotherapy Bulletin associate Editor email: [email protected]: (443) 520-2036

Lynett Henderson Metzger, JD, PsyDUniversity of Denver-Graduate School of Professional Psychology

Cara Jacobson, PsyDLoyola University Maryland

eDITorS’ column

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nick: You’ve been se-lected as the recipientof the 2018 aPa/aPFgold medal award forlife achievement in theapplication of psychol-ogy, which recognizesa distinguished careerand enduring contri-bution to the advancedapplication of psychol-ogy through methods,research, and/or application of psychologicaltechniques to important

practical problems. So, as you look backover your career, where do you believethe field has developed or grown mostin those areas and conversely, what arethe biggest challenges in these areas forthe next generation of psychologists?

marv: let me start by referring veryspecifically to my experience with Divi-sion 29, which started I guess around 30years ago. I was on the board and sat inon executive committee meetings, andone of the things that was really strikingwas the split between research and prac-tice among many of the members. Eventhe word “clinical,” which connoted Division 12—and at the time connotedresearch and an anti-clinical attitude—was very evident at the time, and was aremnant of what had been going on formany years. The field of therapy started

not from research but from clinical ex-perience of Freud and his colleagues,and there was an antipathy—and still isin some circles—toward research.

nick: For sure.

marv: I think Division 29 has changedconsiderably. It’s very obvious and thereis no opposition toward the need for research. There may be some tension between researchers and practitionersand I think that continues to exist. So,while in certain circles the gap betweenresearch and practice has been closedsomewhat, I think it`s still a major challenge.

nick: right. That makes a lot of sense.

marv: So that is a continued challenge.To a great extent one of the problems withthe field is that all professionals were peo-ple before they were professionals! Weknow that human behavior is not alwayslogical, so there is bias and distortion thatexists, and there are personal stakes thatone needs to protect. I think this personaland professional bias continues to existand continues to inform, or perhaps attimes misinform, the field.

nick: That makes a lot of sense. That tiesnicely to my next question. The closingof the research and practice gap has ob-

SpecIal FeaTure

reflections From an american psychological association/american psychological Foundation gold medal awardrecipient for life achievement in the application of psychology: an Interview with marvin goldfried

Marvin R. Goldfried, PhD, ABPPStony Brook University

Nicholas R. Morrison, MSUniversity of Massachusetts Amherst

continued on page 7

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viously been an important issue for youand for the field of psychotherapy.When you consider the current state ofthe field, what recommendations wouldyou have, specifically for traineesand/or training programs to foster aspirit of equal emphasis at the outside oftraining?

marv: Well, let me use Stony Brook uni-versity as an example. We have facultysupervising the graduate students whowork in our clinic. We set that up yearsago when we started the clinical pro-gram back in the late [19]60s, becausewe believed in the scientist-practitionermodel, which sounds good, need a lot ofwork to implement practically.

nick: For sure.

marv: But I think at an early stage, stu-dents need to see that it’s not researchversus practice, but the complementaritybetween the two. There are very goodscientific reasons for this. one is thatwhen good research is conducted in ascience, there are usually two stages.There’s the context of discovery, whereyou informally look for a phenomenon.and then there’s the context of justifica-tion or verification, when you controlthe conditions and do research todemonstrate that yes indeed, the phe-nomenon exists.

nick: right.

marv: and good researchers, creative re-searchers in the field—like neil Miller ofDollard and Miller fame—who wonawards for his research has acknowl-edged the importance of these twophases. For example, Miller said that hewasted a lot of time with elegant designsto study something that wasn’t there.and his point was you’ve got to havegood reason to believe that the phenom-enon is there. only then should youcarry out the research to demonstrate to

your colleagues that the phenomenon isthere. This is a roundabout way of say-ing that clinical practice is the context ofdiscovery. We see things clinically andthose are the things that need to be re-searched. Part of the clinical-researchgap in psychotherapy is that researchersare not making good use of the contextof discovery—clinical observation. Forthe context of discovery, researchersneed to talk to clinicians more. and cer-tainly, there exists work that’s beingdone by contemporary researchers thatrecognizes that. But there are still peoplewho blindly follow the rules of research.research is often based on what is fund-able at the time, rather than what mightbe needed clinically. and it’s also be-cause clinicians and researchers live indifferent worlds. and there are differentreinforcers. The clinician gets reinforcedby referrals. The researcher gets rein-forced by citations.

nick: right.

marv: The clinician gets reinforced byreimbursement from third-party payersand the researcher gets reinforced bygrants. So even though they may havestarted out in the same place and in thesame classroom, their worlds begin todiffer. I think that’s part of the problem.and the potential solution is to havegraduate students become keenly awareof this at the early outset. research isflawed by its constrained methodology.Clinical observation is flawed by biasand misinterpretation. Which is pre-cisely why both approaches are needed.and if both approaches, with all theirflaws can come up and say there is aphenomenon here, then you can bepretty sure that there is a phenomenonthere; it survived the distortion of thedifferential biases that are inherent ineach of the methodologies.

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nick: So, when you think about gradu-ate students at the outset of their training,are there any explicit recommendationsthat you would have for addressing thisgap and helping more clinically orientedstudents to see the research side ofthings and vice versa?

marv: Well, it depends on the model ofthe program. It used to be that this wasthe goal of the scientist-practitioner pro-gram. I can speak from my Stony Brook,which of course is my bias. When I dosupervision, these are the same studentsthat were in my research and theory oftherapy classes. They’ve read the re-search, and then in clinical supervisiona couple of years later, we not only talkabout the consistency between the two,but also acknowledge that much of theresearch doesn’t address the issues thatthey’re grappling with clinically.

nick: right.

marv: and one of the things that hap-pens if the supervision is right on, thereare recommendations that are made thatcome from clinical observation, ratherthan clinical trials. The students try itout and it works. and then you can ad-dress the issue: “Well, there’s no re-search on this.” and this is whatresearchers need to do. So there needs tobe a way that when you do clinicalwork, to convey this information to re-searchers. or if you become a researcher,that you go and get the clinical observa-tion. I think the attitude toward clinicalwork and research has to be a broad one.and an open one from early on in one’sprofessional training—from day one.

nick: That makes a lot of sense. The nextquestion that I have is moving beyondthe scope of training. How do you thinkthat Division 29 psychologists can in-crease awareness of the research-prac-tice gap in their research and clinicalcommunities and take steps toward

closing that? I would imagine that’sprobably harder once psychologists areentrenched in whatever their views are,so how do you see that playing out?

marv: I see that as something that needsto involve people. The people behind theprofessionals. There needs to be directcontact, and we have lots of evidencethat prejudice can be overcome by hav-ing people come into direct contact withpeople that are different from them-selves. I think there needs to be contactbetween clinicians and researchers. op-erationally, I think there needs to be on-going liaison and dialogue betweenmembers of Divisions 29 and 12, andparticularly, section 3 of Division 12, So-ciety for a Science of Clinical Psychology(SSCP). In my experience, these are thepeople who need to have the dialoguemost, because there is this bias, andthere’s much that they can learn fromclinical observation.

nick: What would you see as the mosteffective way…so does that mean thatresearchers at the university level aremeeting with adjunct professors? Doesthat mean they’re meeting with folks ofprofessional organizations, like SEPI orDivision 29? How do you see that con-tact getting to occur more frequently?

marv: It could occur at all of those ven-ues and in a wide variety of ways. Divi-sions 29 and 12 have yearly meetings,and at some of these meetings, there areoften presentations on issues that are im-portant. So, presentations on diversityare presented at some of these meetingsof the executive committee. There canalso be presentations of talking withpeople from the other camp. Particu-larly, from the other camp from whichthey want to learn something. and whatis important is the spirit of the venueand the spirit of what’s done. SEPI is a

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good example of that. When we estab-lished SEPI back in the [19]80s, the goalwas not so much to do what was typi-cally done at conferences, where you getpeople from different points of view todialogue and where the goal is to con-vince the other person that they arewrong. The goal of SEPI has been to getpeople from different points of view tolearn something from the other person.That’s a significant change.

nick: Yes, and that makes sense.

marv: I think the issue of the clinical-research gap has become much more serious over the years. The national Institute of Mental Health (nIMH)funding priorities of the research Do-main Criteria (rDoC) are particularlyrelevant here. I’ve documented this inan article appearing in the 2016 issue ofProfessional Psychology, pointing out thatthe goal of rDoC is to develop biomark-ers so that drug companies can developnew medications for the treatment ofpsychological disorders. The professionof psychiatry depends on new and bet-ter medications for its existence, not ontherapy.

nick: right.

marv: The future of psychiatry dependson good meds and this is what is beingfunded, rather than psychotherapy re-search. and while there’s some hopeand there’s some lobbying to get themto expand this mandate, I think that thisis basically a threat from the outside ofpsychotherapy, and that therapy re-searchers and therapy practitioners needto get together to deal with this threat.

nick: are you optimistic that if the twobranches, the practice-oriented folks andthe research-oriented folks are able tocome together, that the rDoC criteriawill expand?

marv: That’s a good question. It’s veryhard to predict what happens. I mean,nobody could have predicted the lastpresidential election. We don’t know.But I’ve got to tell you this, a lot of peo-ple that use social media have been ableto make dramatic changes in the world.revolutions. Elections. Protests againstassault weapons. I think a lot dependson younger professionals who see someof the difficulties in the field of psy-chotherapy, people such as yourself andother students of Divisions 29, 12, andother divisions. If they believe that thefield needs to move in another direction,they have considerably more powerthan they can imagine. It’s not a predic-tion, but an observation.

nick: right. I think that, something thatyou really kind of see even in trainingprograms is either an emphasis on clin-ical work or an emphasis on research,and in some cases an equal emphasis,but it seems like there’s very little em-phasis on training psychologists to beinvolved at the systemic level and be-coming involved in either political is-sues or policy issues related to the field.Do you think that that has any bearingon either where we are now or wherethe field is going?

marv: I think you’ve hit on a very im-portant point. The interesting issue isthat you’re a student, but you’re also afuture professional, which is a little bitdifferent from being “just a student.”You are being trained to work within aprofession and dedicate your time andenergy to that profession, so you havesome right in saying what that profes-sion should look like. graduate studentsdo not realize how much potentialpower they have, because they’re be-holden to the faculty for lots of things.letters of recommendation, all kinds ofother things. But believe me, faculty are

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very concerned about what students be-lieve and want. When graduate studentscome from integrity and state their opin-ions, they become the leaders in the field.

nick: right.

marv: Essentially, I’ve put the ball in yourcourt and that of your fellow students.

nick: (laughs) I’ll do my best with that!So, to kind of pivot a little bit, you talkeda little bit at the outset about the found-ing of SEPI, and you’re recognized asone of the driving forces behind the psy-chotherapy integration movement. asan advocate for psychotherapy integra-tion, what do you regard as the mostcritical aspects of integrative best prac-tices, and as a follow up to that, howwould you encourage current trainees todevelop competencies in psychotherapyintegration?

marv: right. let me start with worstpractices and then move on.

nick: Fair enough!

marv: There are the things to beavoided. When we started the whole in-tegration awareness, which eventuallybecame a movement, one of the ultimategoals was to stop the proliferation of dif-ferent schools of thought and to comeup with principles and processes thatare common. That’s been hard toachieve. as I said before, it’s because be-hind every professional is a person, andthere are some people who are more in-terested in starting a school than in ad-vancing the field. and schools oftherapy are particularly problematic,even schools of integrative therapy. Itadds to the proliferation.

nick: and are there any particular as-pects that you would see as best prac-tices that you would like to see the fieldengage in?

marv: I am particularly drawn to thosethat have a basic research foundation.one example of basic research has beenthat carried out on attribution or misat-tribution of motive. You get angry at apartner, not because of what they did,but because what you think the motivewas behind it.

nick: right.

marv: The attribution of motive is a me-diating variable between what yourpartner says and your emotional reac-tion. If you misinterpret the motive, youmay be angry. If you interpret it cor-rectly, you may be sympathetic to yourpartner. This has been a replicable phe-nomenon experimentally. Moreover, it isa therapeutic heuristic that is extraordi-narily useful when doing clinical work.When your client is angry at somebodyelse and you think of it in terms of a mis-attribution of motive, we have an evi-dence-based guideline on what to doclinically.

nick: right.

marv: It also happens to be the premiseon which behavior therapy was devel-oped years ago as an extrapolation ofbasic findings. In the case of behaviortherapy, it was classical and operantconditioning, and how that can be usedto change people in a therapeutic situa-tion. In many ways, I do think that thatis the kind of evidence, which is farmore valuable from my point of viewthan the evidence of randomized trials,that speaks to the clinician.

nick: I’d like to kind of open it up foryou if you have any more thoughts thatwe didn’t touch on related to random-ized controlled trials (rCTs) and whereyou think the field needs to move interms of expanding beyond the rCT.


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marv: Well, historically when the rCTscame about, which was in the ’80s, therewas a shift at the nIMH. and I knowthis through my colleague, Barry Wolfe,who spent 22 years as a staff member atthe nIMH. His monitoring of researchwas on anxiety disorders. He met withme before I submitted a renewal and hesaid there’s been a major change at thenIMH, which had become much moremedically oriented. This was in the ’80s.He told me that the nIMH was nolonger going to fund my research onhow to reduce examination anxiety orhow we can get people to become moreself-assertive. He said, “We can’t fundyou anymore because the nIMH wantsreal patients with real disorders.” Themodel was the medical model. Whatyou now needed to do is diagnose a dis-order by looking at the pattern of symp-toms that formed a DSM syndrome.and once you’ve made the diagnosis,you then needed to develop a treatmentpackage to treat the disorder. a problemwith this was the heterogeneity withinthe categories, which is (finally) nowrecognized as being problematic. So,someone can be socially anxious be-cause they can’t urinate in a public bath-room, and someone else with the samedisorder is unable to speak to somebodyinterpersonally. or someone who hasdifficulty speaking in front of a group.These are all diagnosed with the samedisorder, so rather than treating the spe-cific problem, you’re treating a concep-tual disorder or a category.

nick: right.

marv: also, using a heterogeneous in-tervention, you don’t know what withinthe intervention may be working withwhat aspect of the clinical problem thatis composing the disorder. This is not theway therapists work. However, this iswhere the field’s systemic issues becomevery important. allen Frances, who was

the chair of the DSM-IV, once had a dia-logue once with Barry Wolfe. Barry said,“Doing the rCTs doesn’t really parallelthe way clinical work is done in realpractice,” to which Frances said, “Don’tworry Barry. one day clinical work willcatch up, and that’s the way clinicalwork will be done in the future—thesame way as in rCTs.”

nick: I think that’s a really amazingpoint. When you see the work that’sbeen done with the rCT and the shapethat’s had on the field, where would youlike to see research really begin to focusover the next decade or so?

marv: I think on psychologicalprocesses. It’s kind of interesting; Imean, this is the way it was in the[19]70s and the early ’80s. It’s interestingthat within rDoC, they are now talkingabout mediators and moderators, andthey’re talking about target behaviors,rather than DSM disorders. In the ’70swe didn’t talk about mediators andmoderators, but we did talk about vari-ables and target behaviors. Perfection-ism, procrastination, unassertiveness.Characteristics that you see clinicallyand are a part of cognitive-affective-be-havioral functioning that humans have.However, with rDoC, you can’t get bio-markers without having psychologicalphenomena. So even though the goalmay be to get biomarkers, research alsoneeds to focus on psychological phe-nomena. It’s interesting that we aregoing back to a pre-DSM model. Thefocus on mediators or moderators wasonce called “determining variables”—which is essentially the same. The lan-guage has changed. Essentially, what isbeing said is that, after three decades,we’re going back to that pre-DSMmodel. So, ironically enough, there maybe something coming out of that.


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nick: So as a field, the pendulum is kindof moving back?

marv: Yes, except it’s being done for adifferent purpose. It’s being done forfinding biomarkers and eventually de-veloping presumably more effectivepsychoactive drugs.

nick: right, okay. That makes sense.

marv: But I do think that the basicprocesses are very important. It’s called“translational research.” We used to callit “extrapolation of basic research.” It’sthe same empirical strategy.

nick: It’s the same kind of principle yousee across theoretical orientations. Thewords shift a little bit, but how fre-quently are we looking at different phe-nomena?

marv: Exactly, yes. and of course, thatcreates a major problem in the fieldwhen words change. Because when youdo a literature search, you do it withwords. If you use the contemporarywords, rather than the earlier words,you’re going to miss a lot of work that’sbeen done on a given topic.

nick: Yes, definitely.

marv: There’s been an enormousamount of clinical and research work onassertiveness and assertiveness training.But nobody searches that anymore, ofcourse they don’t use those terms.

nick: right. When you think about thecurrent state of the field of psychother-apy, what are you most excited aboutand/or most optimistic for, maybe in thecoming decade in terms of clinical re-search, practice, and/or training? Doyou have any thoughts on all three ofthose or any one in particular?

marv: I do think that the principles orprocesses of change are not owned byany school of thought. Clearly, that’swhere the excitement is. all schools ofthought, I believe, make use of the pa-tient’s ability to step back and observewhat is going on with themselves. Wecall it different things. We call it de-cen-tering, we call it metacognition, we callit mindfulness, we call it observing ego,we call it reflective functioning. There’sprobably a few other labels that I’mmissing. Interestingly, Freud said thatthe observing ego has an alliance withthe analyst, and both observe the neu-rotic aspects of the person’s functioning.So, the ability to step back and observeyourself, this increased awareness ofseeing things from a more objectivepoint of view, is a key element in lots offorms of therapy. now, what are the me-diating and moderating variables asso-ciated with that? This is where theresearch should go. If you find a com-monality across different schools ofthought, that can be distorted by virtueof their different theoretical premisesbut nonetheless comes through, thenthat is a robust phenomenon that shouldbe researched.

nick: right, right. any other areas inwhich you’re, maybe even beyond basicprocesses that you’re excited about?

marv: Well it’s not so much the areas,but it’s more the generation of psychol-ogists. Psychologists who see the biggerpicture. These are beginning people,starting in graduate school, who canthink outside the box, who can see if thenature of the system may be interferingwith what needs to be done. I thinkthose individuals should vow to takesteps to make a difference in the field.

nick: Yes, I think that gets back to thoseareas where I feel like there hasn’t been


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enough attention. like to recognize intraining what it’s like to disrupt the fieldor to be able to move forward or to makea comment on policy or how fundingpriorities are shifting.

marv: Yes, yes. as opposed to asking thequestion, “How high shall I jump?”

nick: right, yes. Well, you know, it feelsin a lot of ways, that’s how I feel likewe’re trained. To respond to the bench-marks in place and here’s how to meetthose, and you see that in your own program and probably across differentprograms.

marv: Well, historically in my own de-velopment, this started when I receivedmy degree in January of 1961. This iswhen John F. Kennedy was inauguratedas president. He said something to theeffect that “The torch is being passed toa new generation,” which I kind ofliked. It resonated with me. and then hewent on to add, “any person can makea difference, and every person shouldtry.” and that was very inspirational forme. one of the things I saw as a gradu-ate student was this huge gap betweenresearch and practice. The clinical books,whether they’re on therapy or on the use

of projective techniques, had no citationsof evidence. Whereas, my readings onlearning and perception did. It’s like…this is not right. This should not be. I re-member that as a graduate student.

nick: So, in closing, I’m wondering ifthere any other areas that you wanted totouch on or when you think of this lifeachievement and the application of psy-chology, either where you recognizewhere the field still has yet to move orwhen you think about what’s been mostmeaningful for you in terms of anyshifts. I just want to open the floor toyou aside from the questions that I gen-erated, if there are any thoughts youhave, I’d love to hear them.

marv: How to end? Perhaps there is onemore thing I’d like to underscore. Thelast point is: Make a difference. I thinkthat’s because maybe this is what myrole should be; more inspirational at thispoint. I’m not going to break throughany barriers at this point in my career, soif I can inspire students and profession-als to think a certain way and to thinkoutside the box, and to try to make a dif-ference, then that’s probably a good jus-tification of my award.




I direct a psycho -therapy practice in thenortheastern unitedStates with about 30providers focused onproviding cognitivebehavioral therapy. Wehave two locations and

treat a wide range of adults, teens, andchildren. I ended up in this role becauseI fell in love with the fields ofpsychology and psychotherapy almostthree decades ago.

In this article, I would like to offer somelessons I have learned about thebusiness of psychotherapy. I am goingto imagine writing this as an adviceletter to graduate students and earlycareer professionals who are curiousabout business-of-practice issues. I alsohope that my comments may be ofinterest to others who care about thedissemination and development ofpsychotherapy practice. There is somuch that isn’t taught in graduateschool about practice-relevant businessattitudes and skills that could lead tomuch greater success.

Business Is a Team SportI tend toward the independent side andfeeling like I need to figure everythingout myself. However, I have found thatthe business of psychotherapy is bestconsidered a team sport. You will do

best if you have many different playerson your team. You will need a goodlawyer, a great accountant, a computerfirm, a web design firm, and someonetrustworthy to clean the office. You mayneed a financial advisor, an insuranceagent, and consultants of various types.Most of these players will be central,even if you are in solo practice andcertainly if you have multiple providersin your group. I want you to think aboutbuilding this team as a centralcomponent of the business ofpsychotherapy and crucially-linked todelivering excellent patient care. If youare spending tons of time trying tobalance your books, clean the office, orfigure out how to design a website, youare not taking care of patients orworking “on” your business (versus“in” your business, as the saying goes).Trust me—my wife and I have spent lotsof time running these experiments andlearning the hard way. I have spent sillynumbers of hours dealing withcomputer issues and website issues—which were probably quite far above myhead, despite the fantasy that I could dothem well. For years when our childrenwere young, my wife (and practicemanager) would stay late into the nightevery Thursday doing many taskswhich we only eventually learned to“sub out” to others.

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SpecIal FeaTure

The Business of psychotherapy practice: reflections andlessons learned in the Trenches

Benjamin Johnson, PhD, ABPPPast-President, Rhode Island Psychological AssociationClinical Associate Professor, The Warren Alpert Medical School ofBrown UniversityClinical Psychologist & Director, RICBT Cognitive Behavioral Therapyand Coaching

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customer Service Is KeyCustomer service is a basic concept inbusiness and a central focus in mostindustries. My sense is that it is almostnever discussed in graduate school andother training programs. It means tryingto make it easy, pleasant, and reinforcingto receive services from you. We try toprovide excellent customer service inmany, many ways. We have carefullyhired and trained intake coordinatorswho answer phone calls live and helppatients to feel glad they reached out forhelp. We provide coffee and water in allof our waiting rooms. We accept creditcards and keep them in a secure onlinevault, so that patients don’t need topresent the card at each session. In all ofour dealings with patients we try to beflexible, accommodating, and treatpeople with kindness and empathy. Ifwe make a mistake, we apologize andtry to make it right. I’ve sometimes sentpeople gift cards when our office hasgiven a wrong appointment time ormade a scheduling mistake. I encourageyou to think about what kind ofexperience you want someone to havefinding, signing up for, and receivingyour services. Make it easy for them.Make sure you return messagespromptly or have someone reliableanswering calls and messages frompatients. Don’t be shy about amazingpeople with positive touch-pointsbeyond what you do in the treatmentroom (e.g., establishing a goodtherapeutic alliance and providingproven strategies). How can you amazeand delight your patients?

long-term relationships are central to Business—and lifeanother key idea that is central tobusiness thinking is to develop long-term relationships with your customers.I remember when I first read about thisidea. now it seems obvious. However, itwas new a point-of-focus for me at the

time. Businesses typically succeed in theworld because they develop loyalcustomers. It works much better forbusinesses to provide services to theirexisting customer base than it does tokeep bringing in new customers. Thereis often a significant cost to customeracquisition, such as in marketingdollars. Businesses with little repeatbusiness will usually struggle.

I take and encourage a “primary caredoctor” metaphor in providingpsychotherapy. I convey that I am takingresponsibility for the patient’s mentalhealth care. Much like a primary caredoctor, I will propose we meet morefrequently at first and then taper offgradually. once someone is doing muchbetter, I will see them monthly orquarterly—until we go to a call-me-when-you-need-me plan. I rarely dohard terminations with patients. Thenature of life, depression, anxiety, andstress is the recurrence of issues, stress,and problems. It is much betterhealthcare to remain a resource forpatients, within ethical boundaries, andwe want to avoid forcing on clients thedifficulty of feeling ashamed when theyneed our help again. We want to de-shame and normalize seeking supportand wise counsel. So, I want toencourage you to think about forminglong-term relationships with patients—even if you are trained as a short-term,problem-solving kind of clinician. Iconsider myself very much workingfrom a CBT point of view. This does notpreclude me from having been there formy patients over many life stages. I havehelped people cope with their teenageyears, college, dating, marriage, andparenting. Indeed, seeing someonethrough a crisis if I haven’t seen them ina few years is one of the most gratifyingparts of my work as a psychotherapist.as you develop your practice, plan for


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what you want your relationship withpatients to be over time. Discussexplicitly that you hope to be a resourcefor them in an ongoing way, regardlessof the length of any treatment episode.

Trust Your Value—Deep listening andWise counsel are crucial and rareFor a business to succeed it has to havean excellent product or offering in whichthe people running the business trulybelieve. great customer service can’tmake up for a lousy product. So, ingeneral, how valuable is the service weare trained to offer? There are manypieces of evidence that suggest to methat it is highly valuable. First, decadesof research and many meta-analyseshave shown that psychotherapy isgenerally effective, that differencesbetween active treatments are difficult toshow, and that many patients find it anacceptable service to receive. Indeed,stress and anxiety appear to be at all-time highs—just ask high school orcollege students about how stressedtheir peers seem to be, or how manymental-health related issues theyencounter in school. Shame and stigmaabout both having emotional problemsand receiving help for them appear to bedecreasing. My sense is that is far morecommon now to share that you areseeing a therapist than it was 30 yearsago. With the advent of the smartphoneage, it seems that having someone giveyou undivided attention for 45 minutesis increasingly uncommon in the real-world. We can no longer expect mostpeople to have the kind of friends whowill listen to them well for significantlengths of time and who have theavailability and knowledge to discussissues and guide them skillfully. So, Iwant you to trust your value to yourpatients, even if you don’t fully feelcompetent yet. Show up, be unbelievablygenuine, focus in and help patientsorganize and clarify issues, and work

collaboratively on a game plan for pro -gress. If you are offering psychotherapy,you are likely offering something in -creasingly valuable. It may not feel likeit all the time, because you know thereare many things you don’t know andyour sense of confidence and com -petence may still be forming. However,we also know from decades of researchthat if you can form a strong therapeuticalliance, in which you help the patientfeel warmth from you and trust in you,and you seek agreement on the goalsand tasks of therapy, you will likely helpthem feel and function much better intheir lives.

Don’t Be cheap about TrainingIn the business world, successful com -panies keep innovating and improvingtheir products. They put significant re -sources toward research and develop -ment. They upgrade the food andappearance of the restaurant, the look ofthe website, or the speed and power ofthe iPads they sell. If apple, google, or3M hadn’t kept improving their pro -ducts and inventing new services, theywould have been long defunct. In thestrange industry of psychotherapy, youare largely your product. So, I want youto spend heavily on your training,workshops, and professional develop -ment. Buy and read large numbers of books on the field. go to anembarrassing number of continuingeducation events. Develop areas ofexpertise. Pay for supervision andconsultation. It is okay if it is a bit scaryand feels indulgent. That is the price tagof your research and development. I alsowant you to keep investing in makingyour personal life as pleasant andgrowth-oriented as possible. Try neverto be a hypocrite: If you are pushingyour patients to keep growing andimproving, you need to as well. Youhave my full doctor’s permission to


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experiment with traveling, going to agym, getting a house cleaner, hosting aparty, and changing your hairstylist. It isall part of the field. You can’t really helppeople improve their self-care andgrowth if you aren’t also pushingyourself out of your comfort zone.

You can care Deeply and charge appropriatelySuccessful businesses price strategicallyand seek high margins on their productsand services. They look to differentiatewhat they sell from what their com -petitors sell. They try to avoid pushingcommodities in which the consumer isfocused only on obtaining the lowestprice. Businesses with low margins andpoor business models often fail. Then,they don’t serve any of their customers.Successful businesses need to makereasonable profits for many reasons. asdiscussed previously, they need to keepimproving their products and services.That takes money. They need to have astockpile of cash to weather inevitableupturns and downturns in the market.They need to have money available toseize unique opportunities that emerge.If they sell too cheaply to current cus -tomers, they are harming potentialfuture customers. In the industry ofpsychotherapy, there are severalchallenges. For many of us, the fees wecharge don’t matter much becauseinsurance companies dictate reimburse -ment amounts so heavily. Someclinicians, myself included, find it soeasy to care about people, and they lovework they do so much that they wishthey could do it for free. It feels like it ishardly about the money. others get asense that if they charge patients asignificant fee, it means that they don’treally care about them. I want toencourage you to learn to feel goodabout charging high fees. Stick to themand raise them periodically. Your caringand expertise are valuable and worth

significant remuneration. The more youcan just broadly accept this equation, thebetter off both you and your clients willbe. Being deeply caring doesn’t meanyou should be paid less! It means youshould be paid more—it is your naturalresource and you are offering it forsomeone else’s gain. Furthermore, it is aterribly limited resource. There are onlyso many hours in the day and only somuch emotional energy you have togive to others. You also have a uniquevoice and life experience that informsyour work. no one else comes fromprecisely the same point of view. Interms of the restrictions put on what youget reimbursed by insurance companies,it is tricky. You can try to develop astrong niche and either go out-of-network, or you can try your hand atnegotiating with them. Both scenariosare possible. You can also develop someservices that don’t count as medicalprocedures and for which you can setfees at the level you choose. Forinstance, offering a workshop on thepsychology of money might be a goodnon-insurance service.

Identify Your Ideal customers andend relationships With Your WorstcustomersSuccessful businesses figure out theprofile of their ideal customer. Then,they seek out those customers and try toover-deliver value to them. Businessesthat don’t know which market segmentthey are trying to reach will struggle.Mercedes and Hyundai are trying toplease different segments of the carmarket. If businesses try to pleaseeveryone, they will likely get spread toothin, confuse the marketplace, anddilute their brand message. applemakes it clear that they are trying todeliver a premium product. They are nottrying to reach customers seeking thecheapest device possible. Businesses


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can also get caught up trying toaccommodate their most difficult anddemanding customers. This can taketime and energy away from dealingwith your main customer base. So, Iwant to encourage you to think deeplyabout your strengths and who is so easyfor you to treat that it feels like cheating.The picture of this client will differgreatly between clinicians. My usualexample is that some clinicians don’tlike treating angry men. It makes themnervous and stressed much more than itmight make someone else. Thus, wedon’t give these psychotherapists angrymen to treat, if we can possibly help it.We encourage them to frame theevaluation as an evaluation and to feelempowered to send them to a colleaguewho loves that kind of work, if thematch isn’t right. Keep asking yourselfwhich of your clients make you feelenergized. notice patterns among themand seek them out as much as possible.I know some clinicians who love collegestudents and some who don’t. Yourpreferences are unique and okay. and ifit time to stretch those growth areas,invest in the personal therapy, training,and supervision to do so ethically andeffectively (see above!).

one to five percent of a busy clinician’scaseload can be consuming much oftheir emotional energy and contributedisproportionately to burnout. ThoughI have learned much from working with

that sliver, I would tell my younger selfand other colleagues coming up that itis okay to set limits and to refer morereadily. You need to protect your wholecaseload by protecting yourself sometimes. go the extra mile for patients, butknow when to bring in other providerson a case.

For a small business example, let’s sayan accountant had a general practiceand was preparing taxes for dozens ofindividuals and small businesses. This istheir bread-and-butter work and not toodifficult. If they also had a large medicalpractice they were trying to serve, thatdemanded tons of time from them,created lots of stress, and made it diffi -cult to stay on top of the bookkeeping ofthe rest of the client portfolio, we wouldhave a major problem. It would likelymake sense for them to refer the medicalpractice to a specialist in that area ofaccounting—or perhaps refocus theirown efforts on that niche. Whether for accountants or psychotherapists,stress matters and must be carefullymonitored.

I encourage you to keep learning aboutthe business of practice. The better weget at the business of psychotherapy, themore people we can reach. one of thebest ways of disseminating therapy tothose in need is to disseminate business-positive attitudes and skills that make iteasier to succeed.

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one of the main com-ponents of my job as apsychotherapist is helping my clients navigatetransitions in their lives,such as relocating,marriage, death, andstarting new jobs.

Whether expected or not, life transitionsare often seen as opportunities for men-tal and emotional stress as worry, inse-curities, and fear can develop in thatempty space between the familiar andthe “new.” Many clients put a tremen-dous burden and stress on themselves tonavigate these transitions impeccably,especially given the ways in which soci-ety places great social cache on the appearance of flawlessness (thanks, Beyoncé). not only are we supposed toflawlessly transition through these key“checkpoints” in our lives, but we are alsoare supposed to do so without a hint ofconsternation or fear as these are “wel-comed” events and we should be “happy”about achieving these cultural milestones.But with this pressure comes real worldfears and worries about our abilities toboth fully appreciate and be successful inthese new places. We all want to be suc-cessful parents, partners, and employeesbut to do so takes much work, most ofwhich occurs between the ears.

an aspect of this potential for emotionalstress lies in the very nature of a transi-tion or change. life transitions represent

deviations from the norm and situationswhere a person is required to use eithernew or different skill sets to overcome animportant challenge or to manage a sig-nificant life event. When we ask our-selves to be resourceful and mentally oremotionally flexible it can illuminatesome of our shortcomings and the waysin which we may hold negative opinionsof our fitness to assume titles such as par-ent, boss, partner, or others. Transitionalso has the potential to show us muchabout ourselves, with some of these ob-servations welcomed while some onlyserve to confirm irrational negativethoughts about our capabilities or our-selves. For example, our experience ofgrowing up may positively or negativelyinfluence our feelings regarding assum-ing the role of parent and how a parentshould act in order to cultivate a healthyfamily. as a clinician, my responsibility isto assist the client with being both pres-ent and agile during transition. This po-sition allows the client the opportunity tobe better aware of irrational or inappro-priate thoughts and also more attuned tothe various necessary aspects of thischange. Successful management of atransitional period in someone’s life isvaried but it can often be defined as theclient being able to achieve or come closeto an optimal outcome while also not as-suming any unnecessary residual nega-tive thoughts, feelings, or behaviors.



clInIcal noTeS WITH Dr. J

From psychologist to “Whose Father is This?”: Transitioning Into Fatherhood as a psychotherapist

Jonathan Jenkins, PsyDMassachusetts General HospitalAssistant in Child and Adolescent PsychiatryHarvard Medical School Instructor in Psychology (Psychiatry)

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There are many factors that contributeto the current stress associated with get-ting married, getting that next great job,or having children, with aspects of thisbeing associated with the proliferationof social media. our expectations of par-enting, marriage, and other life transi-tions can be artificially augmented byhow we view others in our social circlespresenting their successes and chal-lenges on social media. What we mayfail to remember is that social media isoften a one-sided window into a per-son’s life where their true struggles ordifficulties are often glanced over infavor of projecting a sense of fluidity,control, and mastery to the outside com-munity. research has also consistentlydemonstrated the potential negative im-pact of emotional over-reliance on socialmedia and the ways in which it can posegenuine mental health risks to both theindividual and those who read the posts(Fagan, 2015). as psychotherapists, wetoo must be aware of the impact of so-cial media on the expectations that wemay consciously and unconsciouslyplace on our clients. given our exposureto examples of members of our commu-nity navigating these life events on so-cial media, we may lose sight of theoften-real challenges that exist whensomeone is in the midst of a transitionand attempting to do so with a presentfocus and with authenticity. We also runthe risk of experiencing the same or sim-ilar challenges as our clients when itcomes to the negative impacts of socialmedia (Middleton, 2015). Cliniciansthemselves are not immune to the chal-lenges of managing transitions. oftentimes, some of the most vulnerabletimes for a clinician to provide effica-cious care can be during these expectedand unexpected times of great joy orsadness in their lives.

I am going to be a father in September.My fiancée and I discovered at the be-

ginning of the year that we were goingto be parents and we were both elated.The thought of bringing a child into ourrelationship was one that was met withjoy and happiness for our entire com-munity and us as a couple. To under-stand the depth of the emotionssurrounding my fiancée’s pregnancy,one would require greater understand-ing of my own unique familial experi-ence and narrative surroundingparenthood and pregnancy. When myparents were young and in love, they,too, decided to embark on parenthoodand attempt to have children. Withoutgetting too much into the specifics oftheir situation, they had to endure ap-proximately seven years of unfruitfulpregnancy attempts in order to receiveclearance to seek professional medicalassistance. after seeking this assistance,my parents were able to conceive bothmy brother and I, with one miscarriageoccurring in between. This story aboutthe difficulties my parents endured ontheir quest to become parents has beena story that has always been a part of mylife narrative and an aspect of my laterthinking as my fiancée and I seriouslyconsidered having biological children.Some of the stress and anxiety that myparents felt in their experience seem-ingly traveled across space and time toland here in my own experience of thistransition. My experience of their preg-nancy in my life narrative has had atremendous impact on my view of fam-ily, parenting, and pregnancy. one obvi-ous way in which this narrativecontributed to my experience of this lifetransition was in my awareness of infer-tility and the difficulties that some ex-perience when attempting to conceive.When we were able to confirm my fi-ancée’s pregnancy, my heart skipped abeat, but my mind also went to those inour social circle who have struggled tobecome parents. The questions as to


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why we had been so lucky with our con-ception while others have struggled andendured tremendous stress caused meto think about how to communicate ourjoy to those members of our communitythat might find this news exciting butalso reinforcing of their own pain. Thissignificantly influenced how we com-municated this news to friends and fam-ily while wanting to be sensitive to thosewe knew and did not know were copingwith fertility challenges. one example ofthis has been the lack of the typical Face-book or Instagram playful baby an-nouncement as we are aware of theunintended pain that has caused someof our friends in the past. This struggleto celebrate this news but also be mind-ful of others was difficult and somethingthat I struggled with and continue to explore. another example where myspecific life narrative impacted my tran-sition into fatherhood has been the joy-ful response of my parents to ourpregnancy. Beyond being excited for us,it seems as though there is a palpablesense of relief that we were not subjectedto similar challenges with having chil-dren, given how my parents understandhow impactful that can be to a relation-ship and to an individual’s psyche.Their joy brought us happiness and wewere well aware of how they reveled inour joy and how they were excited aboutbeing grandparents.

In addition to this providing me withthe opportunity to better understand myadult clients who are going through sim-ilar transitions in their lives, my entryinto fatherhood has also helped me bet-ter understand some of the stressors ofparenting. although some speak aboutparenting as something that happensonce the baby is born, the act of parent-ing and the emotional connection withyour child starts much earlier. Duringmy fiancée’s pregnancy, we have en-countered both the usual pregnancy

stressors and several that were unex-pected. Encountering the unexpectedwas challenging, as this was unchartedterritory for us and we were surroundedby similar pregnant couples who wereexperiencing stress-free pregnancies ac-cording to social media. But this was notnecessarily true. as we began to confidein close friends, we realized how com-mon pregnancy medical stress was andhow many of our friends experiencedsimilar sleepless nights and concernedlooks from doctors. In this case, we fellvictim to similar misleading informationfrom social media in terms of adoptingthe assumption of a carefree pregnancyand not having a sense of the normalbumps in the road that many face whilepregnant. When speaking to my fatherabout these events, I remember tellinghim about all of the times he and mymother told my brother and I that wewould not understand certain thingsuntil we were parents. During this re-cent conversation, I playfully joked tomy father by telling him, “I get it. I get it.I get it. I get it now.” With that declara-tion, I both thanked him and my motherfor the tireless efforts they selflessly ded-icated to raising my brother and I, whilealso acknowledging the arduous roadahead in terms of growing into the fa-ther my child needs me to be—and thefather I want to be for my child. This ex-perience then helped me better under-stand the level of love and dedicationthat most parents have for their chil-dren, especially the children I have thepleasure of working with in therapy.

Becoming a father may also help me better appreciate the ways in which parenting is similar to being a good psy-chotherapist. according to Firestone(2010), there are numerous commonali-ties between successful parenting andguiding a client through the therapeuticprocess. Dr. Firestone highlights several


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commonalities, including equality, goodlistening, and investment in creating afair and balanced atmosphere forgrowth and frank communication (Fire-stone, 2010). reviewing this article mademe realize how building a healthy ther-apeutic alliance is similar to buildinghealthy family connections as a parent.although parenting and therapy differin many noteworthy and importantways, the ability for the two identities ofparent and psychotherapist to positivelyinfluence each other is something that Iam looking forward to enjoying. Simi-larly, I am confident that my experiencesas a psychologist will better prepare mefor my role as a father. Besides the aca-demic knowledge regarding develop-mental stages, moral development, andlearning disabilities, psychology hastaught me how to focus on relationshipsand quiet the noise around me that maydistract from that human moment be-tween two people. My hope is that I canincorporate those same skills to help metarget my full and undivided attentiontoward our child as the child grows anddevelops. Similar to how I want myclients to feel like they have my full at-tention from the time they are in my of-fice until they leave, I also want mychild and my partner to feel like timespent with them is intentional and pur-poseful as opposed to just circumstan-tial and inconsequential.

So, as I embark on a journey filled withdirty diapers and sleepless nights, I lookforward to this life transition with bothnervousness and joy. There has been nogreater joy in my life than finding mypartner and beginning to start my fam-ily and I cannot wait to add the title of“dad” to my list of names.

referencesFagan, K. (May 7, 2015). Split image.

ESPN W. retrieved fromhttp://www.espn.com/espn/fea-ture/story/_/id/12833146/insta-gram-account-university-pennsylvania-runner-showed-only-part-story

Firestone, l. (october 31, 2010). Being agood therapist and being a good par-ent require the same skills: Being agood parent is like being a goodtherapist. Psychology Today. retrievedfrom https://www.psychologyto-day.com/us/blog/compassion-mat-ters/201010/being-good-therapist-and-being-good-parent-require-the-same-skills

Middleton, E. J. (December 21, 2015).The Millennial therapist: How socialmedia affect our lives & work.Time2Track Blog. retrieved fromhttp://blog.time2track.com/the-mil-lennial-therapist-how-social-media-affects-our-lives-and-our-work

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I have approached lifeand my career with agenuine enthusiasmfor adventure. I havealso found my richestexperiences in life tocome from learning tobe comfortable with

the uncomfortable. Being asked to writeabout my career turning points as a rel-atively new psychologist evoked thisuncomfortable feeling. Do I really havesomething to write about that otherscare to read? My desire to end humansuffering and promote values of equal-ity and justice is a widely shared goalamong many in the field. However, I amgrateful for this opportunity to share mythoughts on the need for larger systemicchange within criminal justice and behavioral health settings.

Thus far, my most significant careerturning point was matching for pre-doc-toral internship at nYu Bellevue Hospi-tal as part of the Forensic Track. It wasone of the best training years of my life,and I was fortunate to be surrounded byarguably one of the top intern cohortsBellevue has ever seen. obviously, I ama bit biased, but the rigorous trainingyear was somehow muffled by thelaughter and support. unlike many ofmy colleagues, I chose to apply for jobsafter internship rather than a postdoc. Iwas fortunate and accepted the positionas the Team leader for the BrooklynForensic assertive Community Treat-ment (FaCT) team at the Center for al-

ternative Sentencing and EmploymentServices (CaSES). This mobile-basedmental health team was designed tohelp individuals with severe mental ill-ness and criminal justice involvementlive sustainable lives in the community.our clients were some of the Brooklyn’smost vulnerable and marginalizedmembers. Each one of them had seen theinside of a psychiatric hospital, emer-gency room, prison cell and/or court-room far too many times. Manystruggled with primary psychotic ill-nesses with co-occurring substanceabuse disorders. Their lives were ladenwith trauma, ruptured relationships,and homelessness. as you can imagine,it was a steep learning curve- overnightI went from an intern to a manager, ad-ministrator, and clinical supervisor. For-tunately, I was starting with a strongfoundation of training and experiencecoming from Bellevue and the univer-sity of Denver’s graduate School of Professional Psychology.

like many things in this world, my firstjob was a mix of privilege, timing, andluck. I mention privilege given my abilityto train at Bellevue and live in new YorkCity with the support of family, despitelarge student loan debt. an internship atBellevue Hospital afforded me excep-tional clinical training and an expandednetwork of clinicians and mentors. Tim-ing in sense of right place, right time.new York City wanted to build five


puBlIc InTereST anD SocIal JuSTIce

a personal perspective on Systemic change

Rachele Vogel, PsyDBrooklyn MindsBrooklyn, New York


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borough specific FaCT teams and a for-mer Bellevue graduate was looking foreager psychologists to staff the teams.lastly, I say luck because I will alwaysbelieve in non-scientific based thingssuch as luck or karma. Yes, there wereyears of hard work and perseveranceleading up to it, but in that moment,luck, karma, or something bigger showedup and helped me get my first job as aclinical psychologist.

The need for changeas the Team leader for the first Brook-lyn Forensic aCT team, I felt connectedto something much greater than just myteam, our clients, or CaSES. I felt con-nected to the movement in new YorkCity to end mass incarceration, to stopthe rotating door between psychiatrichospitals and correctional facilities, andto increase access to mental health treat-ment for marginalized communitymembers. It was life changing- chal-lenging, of course, but the type of chal-lenging that motivated me to do better,work harder, and learn more. I workedalongside deeply inspiring, passionatepeople from all disciplines and back-grounds. Together we were fighting fora solution, determined to see changewithin the system. However, it did nottake long to feel hindered by the slowbureaucratic issues that made changefeel almost impossible

In order to lead a group of eager and rel-atively new social workers, I had to firstbring my attention to the here andnow—distract my mind from wander-ing to the aspirational intersection ofmental health and criminal justice. as ateam, we needed to work together to getthrough each day. We encouraged eachother to take joy in every win, no matterhow small or seemingly insignificant.We focused on supporting one another,creating a place where people’s strengthswere utilized, and searching for ways to

improve how we delivered treatment toour clients. We did the best we couldwith what we were given. We stressedthe importance of self-care and work/life balance, as part of our job entailedliving and reliving the traumas enduredby many of our clients. In order to con-tinue showing up for them, we neededto first show up for ourselves. It was ourjob to meet our clients where they wereat in their recovery with hope, compas-sion, and enthusiasm.

From working this population, I havedeveloped some strong opinions. To me,it is pretty simple: People managing men-tal health issues get better in the com-munity, not in jail or prison. It is awidely known that for years our crimi-nal justice system has functioned as a series of ill-equipped psychiatric treat-ment centers- not designed to treat andheal, but rather to punish and suppos-edly deter. our criminal justice systemis disproportionally harsh on communi-ties of color, especially those with men-tal illness, substance abuse, and lowersocioeconomic backgrounds. For many,there are traumas associated with incar-ceration and extreme psychological difficulties when reentering the commu-nity. Within the bubble I choose to live,psychologists, social workers, psychia-trists, and those passionate about thistopic are well-versed in the layers of sys-temic atrocities—numbed, outraged,and deeply saddened, though not sur-prised, when horrific stories like KaliefBrowder are brought forth in the news.

From my experience working in newYork City, change is happening. Themovement for mental health treatmentbehind locked doors and barbed wire isimproving, but the rate of victimizationwithin the criminal justice system is stilltoo high. Many of our clients shared thetraumas they endured while awaiting


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sentencing at rikers Island or servingtime upstate. These are stories filledwith violence and abuse. The number ofyoung Black men who endured theirfirst psychotic break while in segrega-tion was far too many. I heard about theexperiences of men who would neverwear the color green [one of the prisonjumpsuit colors] because it brought backvivid memories of events they wouldprefer to forget forever. I listened to theexperiences of women who enduredphysical, psychological, and emotionaltrauma while losing their children to thesystem, uncertain if they would ever beable to hold them again. People’s liveswere forever changed by incarceration,which exacerbated their mental illnessesand made reentry into life in the com-munity much more difficult.

What can We Do?as a nation, we need to intervenesooner, strengthen our diversion pro-grams, and increase access to mentalhealth for all community members. Weneed to expand our mental health, drug,and specialty courts systems and givejuveniles and adults an opportunity forrecovery sooner. I will never forget theday I witnessed our first mental healthcourt client be un-handcuffed and re-leased to our program. I was fortunateto bear witness to this many times, andfor those who were able to manage lifein the community with their availablesupports, it was remarkable to see theirprogress and positive interaction withthe legal system. They felt the judgecared about them and their lives. Theyalso felt pride and a sense of accom-plishment once they finished. after ob-serving the different mental health courtsystems in new York City, I becameaware of the politics and the dance thatoccurred in and outside of the court-room, between courtroom players, ad-vocates, and judges. There were politicsbehind the cases that were accepted, the

cases that were rejected, and conditionsfor sentencing. There were also strongopposing viewpoints and variable levelsof understanding about mental healthamong legal professionals. To me, thisintersection is the perfect place for psy-chology to influence change, if we arewilling to develop the necessary skills.We need to learn to speak the languageand participate in the dance. We need tolearn to articulate the challenges andoverlap between mental illness, crim-inogenic risk, and risk assessment. Weneed to learn to explain dynamic andstatic risk factors through a clinical lens,the role of strengths and protective fac-tors, and how risk can be mitigatedthrough appropriate community basedintervention. Simply, we need to con-tinue educating our court systems andlegal professionals on mental health andcommunity-based treatment.

on a united front, we need to increaseaccess to all mental health services forour community members. Interventionneeds to happen as soon as possible andwe need to be creative and dynamic inour approach. This requires qualified,trauma informed professionals in thesepositions to change an individual’s firstexperience with the mental health sys-tem. our clients had years of negativeexperiences with mental health, and itwas our job to change that. We weregiven service dollars and told to beimaginative. We viewed our clientsthrough a person-centered lens and metthem where they were at in their recov-ery. assertive Community Treatment(aCT) changes the walls of treatmentand awards individuals a different ex-perience with mental health. Why doesit take repeated hospitalizations, pat-terns of not taking psychiatric medica-tions, and criminal justice involvementto get a FaCT team? Might some peopleneed a mobile team from the beginning?


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I wonder: Can we identify the needs ofour community members and developtreatment around those points, ratherthan having people mold to the model ofmental health we most commonly know?

We need to open more discussions be-tween corrections and mental health andpush through the resistant barriers tochange through platforms, discussions,and trainings. We need to improve howwe communicate with and understandone another. The movement is alive andwell, and change is slowly happeningbut we must keep talking. on our team,we witnessed insignificant parole viola-tions with short-term incarceration jeop-ardize a client’s place of residence, afteryears of living in the shelter system andworking toward stable housing. We ob-served parole officers who were under-standing and compassionate towardsthe ebb and flow of stability, and thosewho were not. If you have never been toa new York City shelter, pay a visit toone, and try to put yourself in the resi-dent’s shoes. How are individuals withsevere, complex trauma backgrounds,managing severe mental illness and sub-stance abuse, supposed to see hope intreatment if they don’t have a safe envi-ronment in which to live? How are theyable to meet every demand the criminaljustice systems puts on them while livingin the community in such conditions?

Developing peer support models. addition-ally, we need to grow the peer move-ment. Peers are individuals who sharebackground experience of mentalhealth, substance abuse, or criminal jus-tice involvement with the people theyserve. They are able to provide support,validation, and empowerment througha different lens than medical personnel,psychologists, or social workers. Peersbring a valuable perspective to the dis-cussion, one that I believe needs to beheard more often. I will never forget

when my team was grappling with thethought of a client returning to jail dueto a parole violation related to smokingmarijuana. The parole officer agreed tosubstance abuse treatment; however,our client wanted to serve time. We as ateam had blinders on, only focused onthe re-traumatization that might occurby returning to jail. My staff searched,advocated, and fought for a place to ac-cept our client, believing he wouldchange his mind. It wasn’t until the peerspecialist on our team shared his per-ceptive that we understood how thischoice could be empowering. How atsome point you are simply exhaustedfrom running and you just want thechase to be over. Within this movement,we also need to learn how to best support our peers, through supervisionand workload expectations. I watchedtoo many peers come through our team, struggling to manage their ownhardships, while giving a large part of themselves to others.

Working effectively with other support sys-tems. We need to continue the conversa-tion between hospitals and communitybased treatment. To be honest, I wasstruck by my own learning curve, andhow much I did not know until I ran theBrooklyn FaCT team. I want to chal-lenge hospitals to reevaluate their ap-proach to medication and think aboutwhat happens after a client leaves thosehospital walls. Discharging a homelesspatient from a psychiatric hospital witha bag of oral medication, required to betaken multiple times a day, without dis-cussing the option of injectable medica-tion seems ineffective and potentiallyharmful. I have spoken to psychiatristsabout this particular concern. They reas-sure me that these conversations arehappening, and the case I am referenc-ing is an outlier. Injectable medicationnot only decreases risk for the client, but


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also for the community. I believe thatone’s approach and choice of words canempower an individual in making a de-cision about a medication regimen thatworks for them. It is also important tosee what might be lost in the dialogue.For example, I had a client who requireda translator during our sessions. Despitemy experience working with translatorsand attempts to explain this concept, Iwas flabbergasted when I realized hewas refusing injectable medication be-cause he believed he would be stuckwith a needle every day. I could havesworn I did a good job explaining it—clearly something was being missed.

The challenges that accompany hospitalsystems are complex, and I recognize Ihave only been exposed to few. How-ever, I see the importance of more dis-cussion on complex topics such asmedicating substance abuse, traumaticbrain injury, and trauma with antipsy-chotics and mood stabilizers, occur-rences that were far too common amongour clients.

conclusionnow more than ever, strong leadershipwithin behavioral health, criminal jus-tice, and state government is paramountin this movement for change. I want tochallenge reformers to understand theissues of front line staff and stakehold-ers by bringing them to the discussionbefore developing and implementingprograms. ask questions, listen, thenask some more. They are filled withknowledge and a unique perspective. Itis one thing to develop a program that

sounds good on paper, and another todo it by knowing what works and whatdoes not. By excluding these voices fromthe discussion, I believe we do a dis-service to our community, wasting time,money, and effort in the process. atevery level we can be working forchange, but our leaders sent the tone.long-term change occurs from the topand works its way down.

lastly, we need to shift the culturewithin mental health to one which pri-oritizes staff wellbeing. By valuing staff,we are taking better care of our institu-tions, agencies, and clients. Culturewithin public mental health needs tosupport both productivity and wellness.let’s face it; I don’t think there will everbe a time when the workload will evenlymatch the allotted timeframe. The cul-ture needs to value the individual em-ployee and promote growth, similar tohow assertive Community Treatment(aCT) takes a person-centered ap-proach. Within this culture, we need toincrease lines of communication, ac-knowledge individual efforts, and offeremployee programs that promote ahealthy work/life balance, from physi-cal to mental health, to social, financial,and spiritual wellbeing. I witnessed howburnout and compassion fatigue atevery level can lead staff to look for adifferent job. It eventually got the best ofme. I recently left my job as the Brook-lyn FaCT Team leader for some time toreflect on my next steps … Time to fig-ure out how I can reenter the system ina way that supports larger change inalignment with my viewpoints.

like everyone else Iworked hard to get towhere I am today, sowhy decline an offerfrom a prestigious hos-pital with an academicappointment to workat a community health

center? There are a number of reasonswhy someone may want to work for acommunity health center including in-terest in working with serious or chronicmental health needs, interest in workingwith people experiencing poverty andracial and ethnic minority groups, inter-est in working for a small non-profit or-ganization, and the ability to use stateand federal loan repayment programs,among others.

Why a cHc?Community health centers (CHCs) andcommunity mental health centers weredeveloped in the late 1960s and 1970sthrough a federal initiative. CHCs aredesigned to cater to the community inwhich they are located. Furthermore,they provide care to underinsured anduninsured persons, provide care to com-munities with a shortage of health careoptions and act as a health care safetynet, and have a governing board wherea majority of members are clients of theCHC (Taylor, 2004).

The majority of clients who seek healthcare from community health centers areuninsured and fall within lower socioeco-

nomic status brackets. CHCs serve un-derserved populations and are located infederally designated medically under-served areas or serve a federally desig-nated medically underserved population.as such, CHCs make up part of theunited State’s health care safety net. Formany CHCs, Medicaid is the most oftenused insurance payer and persons areseen regardless of ability to pay (Taylor,2004). For psychologists interested in pro-viding care to persons with lower accessto care and/or to persons with low-in-come or who are economically marginal-ized, CHCs offer a means to work withthese populations. Before working at aCHC, I was mostly interested in seriousmental illness and psychosis. Meanwhile,through this work, I began to come acrossmore instances of my clients’ strugglingwith poverty. This germinated my inter-est in economically marginalized popula-tions. In addition, CHCs provide servicesfor a racially, ethnically, and linguisticallydiverse client population. More than halfof CHC clients are persons of color and athird are provided services in languagesother than English (Taylor, 2004). asidefrom my interest in serious mental illness,I’ve also always had interest in diversityand racial and/or ethnic discrimination.given that many persons of color also ex-perience economic marginalization, thiswas another way that I naturally devel-oped interests in the mental health seque-lae of living in poverty.


DIVerSITY

choosing to Work for a community Health center: a career Turning point

Astrea Greig, PsyDBoston Health Care for the HomelessBoston, Massachusetts


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often, persons experiencing povertywithstand multiple life stressors and ad-versities and have a high prevalence ofmental health disorders (american Psy-chological association, 2017). Some-times, as is often the case with seriousmental illness, one’s symptoms can leadto economic hardship and therefore low-socioeconomic status (Stansfeld, Clark,rodgers, Caldwell, & Power, 2011).other times, the stressors of poverty cor-relate to the development of mentalhealth symptoms later in life (Javanbaktet al., 2015). given this, communityhealth centers are a great way to workwith persons with serious mental illnessand/or chronic mental health needs, anumber of whom would go unserved inother settings. While working at a CHCI have been able to witness firsthandhow societal inequities influence peo-ple’s physical and mental health. Manyof my clients are painfully aware ofthese inequities, often voicing their frus-tration with how the lack of financial se-curity or stable housing worsens theirmental health status.

Benefits and challenges of Working for a cHcCHCs may be relatively small in scale incomparison to other health care organi-zations such as hospitals, with the bene-fits that working for a smallerorganization can offer, such as a close-knit community, the ability to easilycommunicate and collaborate with oth-ers, and the ability for psychologists tointegrate their training and liaison withother disciplines. as CHCs are requiredto have comprehensive primary care,this is an opportunity for psychologiststo work closely with those providersand establish high quality integrationbetween behavioral health and primarycare. While working at a CHC I havehad the ability to learn much about primary care and even communicatewith my primary care colleagues more

regularly than with my mental healthcolleagues.

Many community health centers, if notmost, qualify for national Health Serv-ice Corps (nHSC) loan repayment pro-grams. The nHSC offers non-taxed loanrepayment to psychologists and othermental health professionals who workin federally qualified health professionalshortage areas. These health profes-sional shortage areas are defined by theu.S. Health resources and Services ad-ministration and are often CHCs. nHSCprovides up to $50,000 dollars in loan re-payment funding for two-year contractswhich can be renewed afterward on ayearly basis. For early career psycholo-gists and other health care professionals,this is a great way to manage the costsof education. I am extremely gratefulthat this program exists; visithttps://nhsc.hrsa.gov/ for the most up-to-date information on the nHSC.

While being drawn to communityhealth centers due to my interests in se-rious mental illness, economically mar-ginalized populations, racial and ethnicdiversity, and for the loan repaymentopportunities, I have struggled with thelack of an academic focus at CHCs, andhave noticed myself missing the rich ed-ucational opportunities and experiencesthat could help expand my career if Iworked for an academic institution.However, this is not the case for all com-munity health centers. Some communityhealth centers have a partnership withlocal hospitals and academic institu-tions. It does not hurt to try to forgepartnerships like this in order to get thebest of both worlds. I am fortunate thatmy current organization is partneredwith a large hospital where I have a clin-ical appointment and can therefore useresources like their medical library andgrand rounds for continuing education.


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Moreover, I get to participate in enrich-ing activities like membership in variouscommittees and networking opportuni-ties with others with similar interests.Psychologists and mental health profes-sionals can additionally partner withlocal colleges and universities to obtainacademic appointments and work on re-search and teaching activities. likewise,psychotherapists working at CHCs canpartner with nearby doctoral and mas-ters level psychology, social work, andmental health counseling graduate pro-grams to foster supervision experiencesand provide practicum and internshiptraining to future generations of psy-chotherapists.

Psychotherapists at CHCs can con-tribute their unique clinical experiencesto initiatives focused on research and/orpolicy. Community health centers alsobenefit from having psychologists aspart of their multidisciplinary team.Psychologists’ training offers a skill setthat benefits the clientele of communityhealth centers. Psychologists are trainednot only in evidence based interventionsand psychological testing but also likelyhave training and/or experience in lead-ership roles (Carr & Miller, 2017).

my Decision to StayDespite all of the rewards of working incommunity health centers, I began tostruggle with inadequate salary andfeeling like my CHC did not fully un-derstand or value my skill set as a psy-chologist. So, even though I loved thepopulation, I took time to interview elsewhere to keep my options open.Meanwhile, using my leadership andcommunication skills, I worked to in-form my CHC of both my career needsand how being able to get these needsmet would benefit the organization.Though I was blessed to be given offersat nearby well-known organizationswith academic affiliations and related

benefits, I ultimately chose to remain atmy CHC for two main reasons. First,nHSC loan repayment is a compellingfactor. Second, my CHC and I were ableto work together to address the aspectsof my experience that I felt were lacking.

This was a difficult decision. Some of mycolleagues to this day do not understandwhy I chose to remain with the CHC,and others reading this may feel thesame. This highlighted another issue Ihave experienced when sharing withothers that I work at a CHC. I have felt anegative bias directed towards myselfand other psychologists and psy-chotherapists who work at CHCs. I feelat times that others judge my training,my knowledge, and my capabilities as a psychologist based on the fact that I work at a CHC. It feels as if others assume that I may be poorly trained orunable to make the cut to work at a moreprestigious organization. But whyshould I let unfounded assumptionsfrom others deter my career choices anddivert me from my interests? This wasmy turning point. When examining myneeds and wants, I decided that, as longas I am able to follow my passion interms of my clinical and research inter-ests, obtain adequate career develop-ment opportunities, and get my loanspaid off, then I am fine. In the end, manyof these items would have been met inmy current position or in a new setting;however, nHSC loan repayment tippedthe balance. It has truly been a lifesaverfor me as I entered graduate school dur-ing the height of the recent economic re-cession. When I obtained student loansduring this time, interest rates skyrock-eted to all-time highs. However, in thepast three years I was able to wipe outhalf of my loans! To me, that is definitelyworth dealing with the occasional nega-tive judgment from peers who have bi-ases about CHCs. now, I plan to retire


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the rest of my loans while working witha highly underserved population withmental health needs that fascinate me,all the while working for a cause that Ifind highly rewarding.

referencesamerican Psychological association.

(2017). Stress and health disparities:Contexts, mechanisms, and interven-tions among racial/ethnic minority andlow-socioeconomic status populations.retrieved fromhttp://www.apa.org/pi/health-dis-parities/resources/stress-report.aspx

Carr, E, r., & Miller, r. (2017). Expand-ing our reach: Increasing the role ofpsychologists in public and commu-nity mental health, Psychological Services, 14(3), 352-360. doi:10.1037/ser0000094

Javanbakht, a., King, a. P., Evans, g.W., Swain, J. E., angstadt, M., Phan,

K. l., & liberzon, I. (2015). Child-hood poverty predicts adult amyg-dala and frontal activity andconnectivity in response to emo-tional faces. Frontiers in BehavioralNeuroscience, 9, 1-8. doi:10.3389/fnbeh.2015.00154

national Health Service Corps. (n.d.).https://nhsc.hrsa.gov/

Stansfeld, S, a., Clark, C., rodgers, B.,Caldwell, T., Power, C. (2011). re-peated exposure to socioeconomicdisadvantage and health selection aslife course pathways to mid-life de-pressive and anxiety disorders. SocialPsychiatry and Psychiatric Epidemiol-ogy, 46(7), 549-558. doi:10.1007/s00127-010-0221-3

Taylor, J. (2004, august 31). The funda-mentals of community health centers.retrieved from https://www.nhpf.org/library/details.cfm/2461




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This article details theauthors’ experiencespertaining to applyingto counseling and clinical PhD programs,and offers advice for stu-dents, particularly thosecoming from smaller un-dergraduate institutionsor institutions lackingclinical psychology pro-grams, who may be considering a similartraining path.

IntroductionsHeather Muir gradu-

ated with a Ba in psychology from theuniversity of new Hampshire in 2014.She then worked as a research coordina-tor in a social psychology lab. Subse-quently, she worked as a behaviortechnician and program manager forchildren with diagnoses on the autismSpectrum before applying and acceptingadmittance to a clinical psychology PhDprogram at the university of Massachu-setts amherst.

alyssa Clements-Hickman graduatedwith a BS in psychology from augustauniversity (formerly augusta State uni-versity). Immediately after earning herbachelor’s degree, she enrolled in theClinical Psychology Master’s Program

at augusta university. She worked atthe university counseling center and as a research assistant after earning hermaster’s degree. She worked for twoyears with her master’s degree beforeapplying for and accepting admittanceinto the Counseling Psychology PhDProgram at the university of Kentucky.

undergraduate Yearsas students pursue their undergraduateeducations, there are a number of stepsthey can take to help position them-selves on a career trajectory that in-cludes doctoral-level training incounseling or clinical psychology. a fewsuggestions are outlined below.

Join psychology clubs/organizations.Heather: getting involved in psychol-ogy clubs or organizations is somethingstudents can do early in their under-graduate careers to determine pathwaysfor success. Clubs such as Psi Chi HonorSociety, a psychology club, active Minds,and other psychology related organiza-tions on campus are helpful in learningabout psychology careers and makingconnections with more experienced stu-dents. These student mentors can guidenewer students to specific research labsand classes, as well as offer suggestionson topics ranging from how to do an

eDucaTIon anD TraInIng

The uphill climb: a Student’s guide to gaining relevant Skills for acceptance to clinical/counseling psychology Doctoral programs

Heather Muir, BAClinical Psychology PhD ProgramUniversity of Massachusetts, Amherst

Alyssa Clements-Hickman, MACounseling Psychology PhD ProgramUniversity of Kentucky


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honors thesis to how to apply to gradu-ate school. Making connections withother students is valuable in orientingyourself to a specific program.

Join labs. Heather: getting involved inresearch is one of the best things you cando to increase your chances of gettinginto a doctoral program (littleford, Bux-ton, Bucher, Simon-Dack, & Yang, 2018).However, locating research opportuni-ties at a smaller university is a challengewe both experienced. We recommendbeing open to opportunities that may beoutside of your area of interest. For ex-ample, to gain research experience Iworked in a social psychology lab study-ing celebrity worship throughout my un-dergraduate program. While the researchwas clearly not clinical in nature, work-ing in this lab helped me learn how toplan and execute a study. Working in thislab also helped me obtain my first posterpresentation for a professional confer-ence, where I was able to meet severalclinical and counseling psychologists.

Find a good mentor. alyssa: It is also im-portant to form close relationships withprofessors and professionals in the field.Mentors can have a strong impact onour future career paths. Mentors serveseveral psychosocial functions, includ-ing role modeling, acceptance, and guid-ance. I was fortunate to have severalgreat mentors who guided me throughthe process of applying to doctoral pro-grams. The best mentors with whom Ihave worked provided me with unwa-vering support and encouragement tohelp me reach my goals. They also pro-vided me with honest feedback aboutmy standing, which helped me make in-formed decisions throughout theprocess. This honesty should be bi-di-rectional in nature. That is, it is impor-tant to find a mentor with whom youfeel comfortable being open and honest.additionally, I have found that a good

mentor is available and dedicated tohelping students achieve their goals.one of the mentors I appreciate the mostmet with me weekly, and helped memake crucial decisions about my careeroptions, such as whether to pursue amaster’s degree.

postbaccalaureate YearsSome students may matriculate directlyinto doctoral programs; for those whodo not, there are a variety of optionsavailable to make good use of the timein between earning a baccalaureate de-gree and applying to a doctoral pro-gram. We will each share our ownexperiences with this process below.

Obtain a master’s degree. alyssa: aftercompleting my bachelor’s degree inpsychology, I was unsure whether or notI wanted to pursue doctoral training. Ialso knew that I had not yet acquired thecredentials to be a competitive candidatefor doctoral programs and felt unsureregarding the best path to take. I ulti-mately decided to enroll in a clinicalpsychology master’s program. In my ex-perience, taking the master’s route hasthe potential to strengthen an applica-tion, but the time and energy spent earn-ing the degree must be used wisely.

Master’s degrees are generally viewedpositively by doctoral programs (little-ford, et al., 2018). nevertheless, it seemsimportant to mention that obtaining amaster’s degree is more likely to in-crease the chances of being admittedinto a counseling PhD program com-pared to a clinical program (littleford etal., 2018). Yet, both clinical and counsel-ing PhD programs value research expe-rience (Pashak, Handal, & ubinger,2012). attending a master’s programthat cultivates positive attitudes towardresearch has the potential to increaseconfidence and future research activity.


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Thus, I recommend that prospective ap-plicants look for a master’s programsthat will provide plenty of opportunitiesto obtain formal research experience.My master’s program offered a researchsequence, which focused on helping stu-dents learn to plan and execute an em-pirical study. We were also encouragedto assist with faculty research projectsand attend research conferences. Theseexperiences during my master’s pro-gram allowed me to narrow down myresearch interest, which was helpful forapplying to doctoral programs.

on the other hand, acquiring additionaldebt prior to starting a doctoral programcan be a hindrance to future plans. Thus,a potential downside to earning a mas-ter’s degree is the additional cost. Somemaster’s programs offer funding, which Ibelieve should be an important factor forpeople considering this path. The pro-gram I attended offered various researchand teaching assistantships that coveredtuition and included a stipend. I was ableto work as a teaching assistant for assess-ment courses, which allowed me to gainadditional professional experience.

I was also able to transfer several of mycourses from my master’s program,which has saved me time and moneythroughout my doctoral training. Impor-tantly, not all doctoral programs are will-ing to transfer credits; thus, I recommendthat prospective students keep this inmind when considering this route.

Taking time “off” to get research experience.Heather: Taking time to work after com-pletion of one’s bachelor’s degree, if uti-lized with intention, can serve as oneway to make oneself a stronger appli-cant for clinical or counseling doctoralprograms. I took three years to work be-fore going on to my PhD. The first yearI worked as a research coordinator in asocial psychology lab researching rela-

tionships. This was the same lab inwhich I had volunteered during my un-dergraduate career. although it was nota clinical lab, I earned a few co-author-ships on publications and learned muchmore about psychology research. Ide-ally, before applying to a clinical pro-gram, one would have clinical researchexperience. If this is not a possibility,psychology research of any kind canonly strengthen your application. re-search experience is vital to getting intoa clinical or counseling PhD program.

after working as a research coordinator,I felt satisfied with my research experi-ence and wanted to switch my focus togaining more clinical experience beforeapplying to a clinical program. I spenttwo years working with children withautism Spectrum diagnoses. First, as alead behavior technician working one-on-one with children providing appliedbehavior analysis therapy, then as a pro-gram manager in the same clinic utiliz-ing more clinical oversight skills.Working with a clinical population canhelp you determine if you are still inter-ested in clinical psychology and will addto your application.

Taking time “off” to get clinical experience.Heather: although, it has been foundthat PhD programs place less impor-tance on prior clinical experience thanPsyD programs, attaining some back-ground in clinical work prior to apply-ing to doctoral programs in clinical orcounseling psychology can help makefor stronger applications (Pashak et al.,2012). “Clinical experience” is a broadterm. This can range from working as asecretary in a psychological services cen-ter, to working in a research lab using aclinical population as participants (e.g.an aDHD lab), to working as a behaviortechnician, to working with a clinicalhomeless population as an assistant case


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THURSDAY, AUGUST 9THSymposium: rcT Data on psychotherapy With Transgender clients—Feasibility, outcomes, and minority Stress8:00 aM - 8:50 aM • Moscone Center room 160 44chair

Stephanie l. Budge, PhDparticipant/1stauthor

Stephanie l. Budge, PhDMorgan T. Sinnard, MEdEzra Mauk, BS

DiscussantElliot a. Tebbe, PhD

Symposium: Supervision—master Supervisors Show and

Discuss Their Supervision Session Videos9:00 aM - 10:50 aM • Moscone Center room 215cochair

arpana g. Inman, PhDHanna levenson, PhD

participant/1stauthorlaura S. Brown, PhDJoan E. Sarnat, PhDBeatriz Craven, PhD

DiscussantDaniel Marom, PhD

poster Session: psychotherapy—Science, practice, and advances—Session I11:00 aM - 11:50 aM • Moscone Center Halls aBCparticipant/1stauthor

Daniel lydon, MaKaren l. Steinberg, PhDCara l. Solness, BSJeremy J. Coleman, MaBrian TaeHyuk Keum, MaCheri l. Marmarosh, PhDBrett l. opelt, MSHannah K. Muetzelfeld, MEdChelsea atlas, MEdDaniella M. Vasquez, MaKathryn Mcgill, MaYourim Kim, Baashley C. DeMarco, PhDStacy J. Kim, BaJohn H. Diepold, PhDDerek D. Caperton, MSKeoshia Harris, Ba

SocIeTY For THe aDVancemenT oF pSYcHoTHerapY • apa DIVISIon 29

2018 convention program Summary

Michael J. Tanana, PhDJade Clemons, MSalyssa Clements-Hickman, MSChristina S. Soma, Baamy D. Smith, BaKelley Quirk, PhDPressley a. Chakales, BSJean M. Birbilis, PhDBediha Ipekci, MSJennifer a. Schager, MaCraig a. Warlick, MSJansey lagdamen, BSMichelle a. Blose, MSBarbara l. Vivino, PhDlen Jennings, PhD

Thursday, August 9th, continued on page 37

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Symposium: existential-Humanistic Therapy as a Basis for effective Therapy—are Training Directors listening?12:00 PM - 12:50 PM • Moscone Center room 216cochair

Kirk J. Schneider, PhDorah Krug, PhD

participant/1stauthorKirk J. Schneider, PhD gilbert newman, PhDorah Krug, PhD

Discussantnadine J. Kaslow, PhD

Invited Symposium: Keeping psychologists in the Driver’s Seat—multiple perspectives on Quality Improvement1:00 PM - 1:50 PM • Moscone Center room 10412, 17, 42, APA Committee on Early Career Psychologists, APAGSchair

Caroline Vaile Wright, PhDparticipant/1stauthor

Caroline Vaile Wright, PhD Tony g. rousmaniere, PsyDJames F. Boswell, PhD

DiscussantCarol D. goodheart, EdD

Symposium: When Faith matters more Than Sexual orientation—challenges in ethics, Training, and psychotherapy2:00 PM - 3:50 PM • Moscone Center room 15912, 17, 44, APA Committee on Sexual Orientation and Gender Identitychair

armand r. Cerbone, PhDparticipant/1stauthor

armand r. Cerbone, PhD Jeffrey Paul, MaJoshua Wolff, PsyD

DiscussantJudith Classgold, PsyD

Symposium: clinical Supervision around the globe—culture, Values and Best practice3:00 PM - 3:50 PM • Moscone Center room 214chair

Carol a. Falender, PhDparticipant/1stauthor

Fatima r. al-Darmaki, PhD Yelda Kagnici, PhDMaria del Pilar grazioso, PhD Xiaoming Jia, PhDKeeyeon Bang, PhD

Discussantrodney K. goodyear, PhD

Conference Program Summary, continued on page 38

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FRIDAY, AUGUST 10THSymposium: psychotherapy relationships That Work—Translating meta-analytic results Into clinical practices8:00 aM - 9:50 aM • Moscone Center room 104chair

John C. norcross, PhDparticipant/1stauthor

Myrna l. Friedlander, PhD Paul r. Peluso, PhDMichael J. Constantino, PhD alice E. Coyne, MS

Symposium: Self-care in the Seasons of a psychology career—ethics and Best practices9:00 aM - 9:50 aM • Moscone Center room 21612, 17, 42, APA Ethics Committeechair

Jeffrey E. Barnett, PsyDparticipant/1stauthor

Jeffrey E. Barnett, PsyD Debbie Joffe Ellis, DPhilErin E. ayala, PhD gerald Corey, EdDW. Brad Johnson, PhD

Skill-Building Session: Deliberate practice and the expertise—Development model of Supervision and consultation10:00 aM - 11:50 aM • Moscone Center room 152 13chair

rodney K. goodyear, PhDparticipant/1stauthor

Michael V. Ellis, PhDTony g. rousmaniere, PsyD

poster Session: II—-psychotherapy: Science, practice, and advances—multicultural and International contributions11:00 aM - 11:50 aM • Moscone Center Halls aBCparticipant/1stauthor

na Fu, PhD nour M. abdelghani, MaHui Xu, PhD Sang-Hee Hong, MaFeihan li, PhD Minnah W. Farook, Ma, EdSlinyuan Deng, PhD Tania Valente, MaXiang Zhou, Ma Patty B. Kuo, MEdDong Xie, PhD Jarice n. Carr, PhDakshay Kumar, PhD, Ma Keoshia Harris, BaMirela a. aldea, PhD amy D. Smith, BaKayoko Yokoyama, PhD Jean M. Birbilis, PhDYuye Zhang, MSW Beilei li, PhDJazmin M. gonzalez, MEd Shitao Chen, PhDXiubin lin, Ma Ha Yan an, PhDJennifer a. Schager, Ma adijat Bola adams, PhD, MEd

Friday, August 10th, continued on page 39

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Symposium: case Formulation as a Tool for Individualizing psychotherapy11:00 aM - 11:50 aM • Moscone Center room 306chair

george Silberschatz, PhDparticipant/1stauthor

John T. Curtis, PhDlorna S. Benjamin, PhD

DiscussantHanna levenson, PhD

Business meeting: Journal editor Invited luncheon12:00 PM - 12:50 PM • San Francisco Marriott Marquis Hotel Pacific room B

Business meeting: awards ceremony4:00 PM - 4:50 PM • San Francisco Marriott Marquis Hotel Yerba Buena Salons 5 and 6

Business meeting: and awards reception5:00 PM - 5:50 PM • San Francisco Marriott Marquis Hotel Yerba Buena Salons 5 and 6

SATURDAY, AUGUST 11THSymposium: personalizing mental Health care Through Disruptive, evidence-Informed Innovations to psychotherapy8:00 aM - 9:50 aM • Moscone Center room 20612, 17, 42, APA Committee on Early Career Psychologists, APAGSchair

Michael J. Constantino, PhDparticipant/1stauthor

Michael J. Constantino, PhDJesse owen, PhDZac E. Imel, PhD

Discussantnancy l. Murdock, PhD

Symposium: pulling psychotherapy Into the Big Data research era10:00 aM - 10:50 aM • Moscone Center room 307 43chair

Stevan lars nielsen, PhDparticipant/1stauthor

P. Scott richards, PhDDavid M. Erekson, PhDMindi n. Thompson, PhDPhilip Brownell, PsyDTyler Pedersen, PhD

Discussantraymond Digiuseppe, PhD

Saturday, August 11th, continued on page 40

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Social Hour luncheon With the masters12:00 PM - 1:50 PM • San Francisco Marriott Marquis Hotel golden gate room C2

Symposium: client-Focused psychotherapy research—advancing our understanding of process and outcome in Therapy4:00 PM - 4:50 PM • Moscone Center room 206cochair

Jairo n. Fuertes, PhDElizabeth nutt Williams, PhD

participant/1stauthorJairo n. Fuertes, PhDChangming Duan, PhDZac E. Imel, PhDCraig n. Shealy, PhD

DiscussantCharles J. gelso, PhD

Symposium: evidence-Based responsiveness—personalizing psychotherapy to the Individual patient5:00 PM - 5:50 PM • Moscone Center room 21412, 17, 42, APA Committee on Early Career Psychologists, APAGSchair

John C. norcross, PhDparticipant/1stauthor

Kenneth n. levy, PhDPaul Krebs, PhDSatoko Kimpara, PhDalberto Soto, PhDlaura E. Captari, Ma

40th Annual Running Psychologists “Ray’s Race” 5k Run & WalkRegister NOW!! for the 40th Annual Running Psychologists “Ray’s Race” 5k Run andWalk This year’s race will be held at Crissy Field on Saturday, August 11, 2018 at 7a.m. You won’t want to miss this run along San Francisco Bay, complete with iconicviews of the Golden Gate Bridge, Alcatraz, and the Marin Headlands!

The Annual Ray’s Race is an APA tradition started by, former APA President and CEO, RayFowler, over 40 years ago! It’s a great opportunity to get some exercise during the con-vention, network with likeminded colleagues, and see a beautiful part of our host city.

Registration is $40 for APA Members, Family, & Friends; $30 for Students. A shuttle willbe provided to and from the race site. All participants will receive a t-shirt. Prizes will beoffered in all age categories for runners and walkers. This year’s race also features awardsfor the fastest Division and the Division with the most participants.

To register, click on the following link: https://register.chronotrack.com/r/38749

HAPPY RUNNING!

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SUNDAY, AUGUST 12THSymposium (a): considerations for providing excellent Supervision—From Social Justice to Deliberate practice8:00 aM - 8:50 aM • Moscone Center room 307chair

robert Jeff reese, PhDparticipant/1stauthor

Carolyn Meiller, MS Douglas a. Spiker, MaTodd ryser-oatman, MS alyssa Clements-Hickman, MS

Symposium (a): Social class in psychotherapy research—considerations for measurement, Design, and analysis9:00 aM - 9:50 aM • Moscone Center room 207chair

Mindi n. Thompson, PhDparticipant/1stauthor

Simon B. goldberg, PhD rachel nitzarim, PhDanna Fetter, MEd

Symposium (a): Hope in psychotherapy—Therapist and client perspectives9:00 aM - 9:50 aM • Moscone Center room 208chair

Theodore T. Bartholomew, PhDparticipant/1stauthor

Eileen E. Joy, Ma Huaying li, BaEllice Kang, BS

DiscussantMichael J. Scheel, PhD

conversation Hour (a): Did That Just Happen? responding to microaggressions committed by psychotherapy clients in Session10:00 aM - 10:50 aM • Moscone Center room 2005 45, 56cochair

Marilyn Cornish, PhDMelisa Martinez, Ma

participant/1stauthorMelisa Martinez, MalaVarius Harris, BS

Symposium (a): multicultural psychotherapy research in college mental Health11:00 aM - 11:50 aM • Moscone Center rooms 310 and 311 45chair

allison J. lockard, PhDparticipant/1stauthor

Theodore T. Bartholomew, PhD allison J. lockard, PhDandres E. Pérez-rojas, PhD

DiscussantBenjamin D. locke, PhD

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manager. although it may seem daunt-ing to find one of these positions with-out a master’s degree, it is possible. anyformal interaction you have with a clin-ical population, including volunteerwork, may strengthen your application,if you are able to highlight the skills andinsights you gained. Sometimes suchpositions are not listed on job sites and itis wise to reach out to directors to ask ifany jobs or volunteer positions are avail-able. It is possible that a volunteer posi-tion could be created for you; it neverhurts to ask! Be proactive.

application preparationWhen the time comes to apply to a doc-toral program, it is important to keep afew useful strategies in mind.

Be realistic. Heather & alyssa: Counsel-ing and clinical psychology PhD pro-grams are extremely popular. Thismakes them more difficult, statistically,to get accepted into than other psychol-ogy programs (norcross, Ellis, & Sayette,2010). It was important for us to remainoptimistic yet realistic about our chancesof getting in directly after graduationfrom our respective undergraduate in-stitutions. Many who apply to these pro-grams will have high gPas, relativelygood grE scores, ample clinical re-search experience, outstanding letters ofrecommendation, and clinical experi-ence of some sort. Being strategic whileconsidering when to submit applica-tions is important, because completingtesting, applications, and interviews canbe emotionally and cognitively taxingand financially burdensome. Both of usspent a few years between our under-graduate careers and our PhD programsensuring that we met these standards be-fore applying. It is definitely possible toget accepted right out of your under-graduate program, if you have a com-petitive application. Coming from asmaller undergraduate institution or a

research institution without a clinicalprogram meant it took a bit longer to“check these boxes” for us. There arevarious routes one could take to achievethe needed credentials and competen-cies, including pursuit of a master’s de-gree or obtaining research and clinicalexperiences other ways.

Prior to applying, we also recommenddoing some research about the pro-grams in which you are interested to beinformed about your likelihood of beingaccepted. The Insider’s Guide to GraduatePrograms in Clinical and Counseling Psy-chology (norcross, Mayne, & Sayette,2018), which provides in-depth profileson hundreds of programs, is a good re-source.

Prepare for the GRE. alyssa: The graduaterecords Exam (grE) is a requirementacross most clinician and counselingdoctoral programs (littleford et al.,2018). unfortunately, it is also a fre-quently cited barrier to being admittedinto a doctoral program (littleford et al.,2018). Programs typically post averagegrE scores of successful applicants,which can be useful for knowing whatscores for which to aim. I took the grEnumerous times before earning a scorethat would make me competitive fordoctoral programs. It was difficult forme to find a study method that workedfor me. I found Magoosh’s grE prepcourse and Manhattan Prep’s grE flashcards to be the most helpful resources. Itseems important to mention that thesematerials will likely not work for every-one, and I recommend researching thenumerous test materials that are cur-rently available. additionally, test prepprograms such as Magoosh should notbe a substitute for working through ac-tual Educational Testing Service prob-lems. Finally, some schools require orrecommend that applicants take the


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grE psychology test. unlike the generalgrE, which is offered regularly, grEsubject tests are only offered three timesa year (i.e., September, october, andapril). Thus, it is important to planahead for this test.

Connect your experiences. Heather: WhenI applied to clinical psychology doctoralprograms, I had no clinical research ex-perience due to the opportunities I hadbeen given during my undergraduatecareer and after graduation. I was awarethat this would be a negative aspect ofmy application when applying, espe-cially when many of the other applicantshad these credentials. With this in mind,I was strategic with my essays and in se-lecting the professors to which I appliedfor mentorship. I had ample research ex-perience in the romantic relationshipsrealm of social psychology. I was inter-ested in relationships in general and in-terpersonal factors in clinical psychology.I applied to programs that housed fac-ulty whose research examines the thera-peutic relationship. My experiences inromantic relationships research hadsome overlapping features with thework these labs were pursuing. It wasimportant for me to highlight these over-laps and explain why the skills I hadwould add to the research these facultywere already doing. Fitting my socialpsychology background with a specificclinical psychology lab is likely one as-pect of my application that counteractedthe fact that I had only social psychologyresearch experience. Homing in on spe-cific faculty, reading up on their research,and writing your cover letters in waysthat tailor your experiences to fit theirparticular interests, are important waysto stand out to clinical and counselingpsychology PhD programs.

conclusionHowever a student gets there, the pathto a successful clinical or counselingpsychology admission is a long andchallenging one. By thinking strategi-cally about the process, students at eachstage of their educational journey can setthemselves up for future success. ourhope is that these suggestions will helpstudents pursuing graduate clinicaltraining in achieving their career goals.

referenceslittleford, l. n., Buxton, K., Bucher, M.

a., Simon-Dack, S. l., & Yang, K. l.(2018). Psychology doctoral programadmissions: What master’s and un-dergraduate-level students need toknow. Teaching of Psychology, 45(1),75-83. doi:10.1177/0098628317745453

norcross, J. C., Ellis, J. l., & Sayette, M.a. (2010). getting in and gettingmoney: a comparative analysis ofadmission standards, acceptancerates, and financial assistance acrossthe research practice continuum inclinical psychology programs. Training and Education in ProfessionalPsychology, 4(2), 99-104. doi:10.1037/a0014880

norcross, J. C., Mayne, T. J., & Sayette,M. a. (2018). Insider’s guide to gradu-ate programs in clinical and counselingpsychology (2018 ⁄ 2019 ed.). newYork, nY: guilford Press.

Pashak, T. J., Handal, P. J., & ubinger,M. (2012). Practicing what wepreach: How are admissions deci-sions made for clinical psychologygraduate programs, and what dostudents need to know? Psychology,3(1), 1-6. doi:10.4236/psych.2012.31001

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recently, the popula-tion of people whoidentify as transgenderor gender diverse hasbecome more visible inu.S. society. likewise,there have been callsby psychologists andcounselors for more re-search and scholarshiprelated to gender iden-tity and issues thatpeople who identify asgender diverse mightface or present with intherapy. Psychothera-

pists have a number of guidelines andresources to assist in providing affirma-tive work with gender diverse clients.For example, the american Psychologi-cal association (aPa) published theguidelines for Psychological Practicewith Transgender and gender noncon-forming People (aPa, 2015). The asso-ciation for lesbian, gay, Bisexual, andTransgender Issues in Counseling (al-gBTIC) developed their Competenciesfor Counseling Transgender Clients in2009. The World Professional associa-tion for Transgender Health (WPaTH)published its Standards of Care for theHealth of Transsexual, Transgender, andgender nonconforming People in 2011(SoC 7.0) and is currently working onmaking revisions for SoC 8.0. a number

of helpful articles and books to assisttherapists have been published in recentyears, such as Hendricks and Testa’s(2012) framework for clinical work withtransgender and gender nonconformingclients; Singh and dickey’s (2017) text onaffirmative counseling and psychologi-cal practice, as well as their instructionalvideo on the topic (2018); and Budge’s(2015) article on writing letters for trans-gender clients.

It is beyond the scope of this article toprovide a thorough, extensive review ofthe literature that is available. Instead,we pull from our own clinical experi-ences working with gender diverseclients and discuss some of the commonthemes and issues we frequently see. acaveat is that this article is based on ourown experiences, which are limited toclients we have seen in the last approxi-mately 10 years in rural, suburban, andurban areas of the Midwest and South-west regions of the u.S. our experienceshave included private practice, collegecounseling centers, medical/hospitalsettings, public schools, and locallgBTQ centers. Therapists in regionssuch as the east and west coasts or whopractice in different settings may havedifferent experiences, and clients mayneed different types of resources, or may


pSYcHoTHerapY pracTIce

practice recommendations for psychotherapy With gender Diverse clients

Julie M. Koch, PhDSchool of Community Health Sciences,Counseling and Counseling PsychologyOklahoma State University

Douglas Knutson, PhDDepartment of PsychologySouthern Illinois University—Carbondale

have better access to resources than ourclients have. This article is based on ourown professional opinions, is not ex-haustive, and we are sure we havemissed some things—we welcome oth-ers to share their own unique experi-ences in future publications.

To us, one of the first and most impor-tant things for therapists to understandis the importance of language whenworking with transgender or gender di-verse clients. as recently as 2015, whenthe aPa guidelines were developed, theterm gender non-conforming was used.More recently, it seems that the term gen-der diverse may be preferred as an um-brella term for anyone who does notidentify as cisgender. The term cisgenderrefers to an individual whose sex as-signed at birth is congruent with theirgender identity. The term non-binary alsoappears to be more frequently used nowthan it was five years ago. However,some individuals may find terms likenon-binary and non-conforming to beproblematic, given that they define pop-ulations in relationship to societal ex-pectations or based on who theseindividuals are not, as opposed to whothey are. Thus, it is important for thera-pists to invite their clients to self-iden-tify, and for therapists to share their ownidentities as well. Simple steps such asbeginning to refer to gender identitiesrather than to gender identity providesverbal confirmation that the therapistviews gender as reaching beyond fixed,binary categories.

Sensitivity to gender diversity has manyimplications for clinical practice. For ex-ample, clinical paperwork may need tobe reconsidered. Having an open spaceon an intake form such as “gender:_______” rather than offering choicesmight allow a client to use the languagethat is most appropriate. We prefer thisto offering choices such as Male/Female/other because this can be “oth-

ering.” Therapists should also initiatediscussions about gender to fully un-derstand how their clients identifyrather than simply what terms theirclients use to express their gender iden-tities. We suggest that therapists self-ed-ucate and interact with transgendercommunities to stay current and com-petent. For example, simply watchingonline videos by transgender bloggersmay provide valuable insight andgrowth. a great resource for therapiststo keep up with terminology is the na-tional Center for Transgender Equality(transequality.org). We also really likeForgE, which is based in Wisconsin butprovides wonderful resources and pub-lications that are applicable across theu.S. (forge-forward.org). The book TransBodies, Trans Selves: A Resource for theTransgender Community is also a valuableresource for clinicians wishing to gaininsight and understanding about manydimensions of transgender experience(Erickson-Schroth, 2014).

another issue that therapists should beaware of is the use of pronouns.Throughout this article, we use the pro-nouns “they/them/their” to refer to asingular client in examples. again, werecommend that rather than assumingthat a client who identifies as femalewould use she/her/hers pronouns, thetherapist ask the client what the pre-ferred pronouns are. This may also beincluded on an intake form with anopen-ended response option such as“Pronouns: ______.” We also encouragetherapists to offer their own pronouns atthe beginning of a therapeutic relation-ship with a client. Demonstratingawareness that the clinician’s own pro-nouns are salient (and may not be as-sumed) communicates to the client thatthe therapist is thoughtful about thesalience of gender identities in the ther-apeutic process.


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use of pronouns seems to vary by geo-graphic area, current trends, and age ofthe client. We have found that our olderclients tend to prefer more traditionalhe/him/her, she/her/hers, and they/them/their pronouns. Younger clients,and clients in larger cities or on the east orwest coasts, may use pronouns such asze/zim/zirs or ey/em/eirs. The websiteswe mentioned previously also have greatcharts and fact sheets about pronouns.Therapists may worry about getting pro-nouns “right,” or may accidentally useincorrect pronouns. like any error madein therapy, we believe it is best to have atransparent conversation about this,apologize, and make a conscientious ef-fort to do better next time. We stronglyadvise against the use of terms like “pre-ferred” or “chosen” gender or pronouns;this implies that gender identity is cho-sen in some way. as we know from trans-gender scholarship, gender identity is nota choiceand implying that it is may cre-ate considerable fractures in the thera-peutic relationship.

another term that therapists may hearin relation to this population is transitionor more accurately transitions becausethe singular form of this word assumesthat one type or process of transition ap-plies to all transgender populations. It isimportant to know that while peoplewho identify as transgender may chooseto transition, many do not. also, transi-tion is a completely individual experi-ence: no two transitions are alike. aspart of transition, some clients maychange their names. Whether a legalname change has happened or not, it isimportant that the therapist use theclient’s identified name and offer a placeon the intake form for this information.We understand that for some legal pur-poses, such as insurance billing, it maybe necessary to track two names simul-taneously; we do not feel this is anundue burden for the therapist. We have

worked with clients who have wantedto experiment with how different names“felt” over time, and who have asked usto use multiple different names overtime. We reflect this in our case notesand refer to clients using their current,identified name and pronouns.

For many clients who transition, it ishelpful to put together a timeline or plan,including financial cost or resources. It isimportant to remember that transitionsmay occur on a variety of levels or withina variety of life domains. Social transi-tions may occur interpersonally betweentransgender people and their loved ones,family, and friends. legal transitions in-volve name and gender marker changeson government documents. Some transi-tion-related actions may include comingout to family members, friends, orcoworkers; legal name change; gendermarker change on identification and gov-ernment documents; wardrobe change;and therapy, if required for hormone re-placement therapy or for gender affirma-tion surgery. For clients who identify asmale, other aspects of transition could in-clude binding or packing. For clients whoidentify as female, transition might in-clude removal of body hair through elec-trolysis, practicing voice (sometimesthrough coaching), or wearing breastprosthetics. Within the context of clinicalwork, therapists may benefit from know-ing the extent to which a client has tran-sitioned or plans to transition. Therapistsmay feel the need to ask deeply personalquestions about aspects of physical tran-sition. We encourage therapists to recog-nize how invasive these questions maybe and how trusted and privileged ther-apists are as they engage in these conver-sations. Such questions should never bemade out of personal interest or outsideof the therapeutic interaction, and theseconversations should be led by the client.


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For any client who is transitioning,being misgendered is a frequent sourceof frustration, hurt, sadness, and anger.In our experience, clients are more for-giving of strangers who might misgen-der them (although this, too, isfrustrating), while being misgenderedby their close family and friends is par-ticularly hurtful and rejecting. Familymembers and friends often misgender,either deliberately or by accident, evenafter multiple reminders. When a clienttells a therapist about an experience ofbeing misgendered and the hurt relatedto this, it is important for therapists tovalidate this experience. These clientsmay get messages such as “you’re mak-ing a big deal of this,” or “you will al-ways be my little boy/girl,” or “don’t beso sensitive,” so it is crucial for thera-pists to listen and empathize. on theother hand, we have also had clientswho have attempted to diminish theseexperiences in therapy, and for whom ittook a while to recognize the pain theseexperiences were causing.

Therapists may wonder what therapyshould actually look like. The approachthat therapists take does not need to dif-fer from the approach they may takewith other clients, but should be affir-mative in nature. We recommend thatany therapist who works with genderdiverse clients fully familiarize them-selves with the aPa guidelines, the al-gBTIC competencies, and the WPaTHstandards of care, at a minimum. It isimportant to note that clients who iden-tify as transgender or gender diversemay present with other concerns, andgender identity may not be their fore-most concern. The therapist shouldwork collaboratively with the client in aclient-centered manner. For example, ifa client transitioned years ago, and pres-ents with concerns related to her currentromantic relationship, then the therapistshould focus on the romantic relation-

ship as the presenting concern, ratherthan the transgender identity. on theother hand, if a client states that theywant to work toward transition and arehoping for a letter of recommendationfrom the therapist, it is important for thetherapist to assist with that. Therapistswho are unable to write letters of sup-port or to aid the client in transition-re-lated actions must be upfront about thisat intake. We have heard stories fromclients and community members whosaw therapists for months before dis-covering that their therapists would notprovide supporting letters. This can bedevastating for a client because it has thepossibility of setting their transitionback and may separate them from nec-essary and/or life-saving services.

Consider this example of affirmativetherapy: Imagine that Sam is your client.Sam is a 22-year old male-identifiedclient who was assigned female at birth.Sam uses they/them/their pronouns.Sam tells you that they reached out tomake an appointment with you becausethey are feeling frustrated with theirprevious therapist. Sam tells you thatthey are limiting and controlling foodintake. Sam has periods of depressionand suicidality and uses substances tocope. Sam also states that they are expe-riencing high levels of gender dyspho-ria. In this case, how would you proceedwith the client? Would you focus on thedisordered eating? Would you focus onthe depression and suicidal thoughts?The client states that they think aboutdying or suicide more days than not.Does the client need treatment for sub-stance abuse before going forward withpsychotherapy? Would you recommendthe client receive hormone therapy?

Clearly, it is important to consider theclient’s safety. If a client is imminently indanger, then appropriate steps/precau-


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tions have to be taken. However, in ourclinical judgment and experience, ap-proaching the client as someone who isautonomous and who knows them-selves as a gender diverse personshould be foremost in the therapist’smind. Budge (2015) provides an excel-lent discussion about the gatekeepingrole that therapists are currently askedto play and whether this fits with ourethical code and moral principles.

With this client, as you explore issues re-lated to gender, you learn that they arelimiting food intake because experienc-ing menstrual periods heightens genderdysphoria and, subsequently, depres-sive symptoms. You learn that Sam’sfamily has rejected them completely sothey are working 30 hours per weekwhile maintaining a full course load atcollege. We recommend working withthe client to explore gender, the currentliving situation, and to put gender firstas a priority, while also doing frequentcheck-ins regarding suicidality and eat-ing. WPaTH (2011) guidelines stronglyestablish that being allowed to transi-tion, and starting hormone replacementtherapy, reduces depressive symptomsand improves mental health. Further-more, starting hormone replacementtherapy could reduce or halt menstrualcycles, which could also diminish gen-der dysphoria experienced by this client.

Though we have only been able to brushover the many themes and presentingconcerns that may arise in work withgender diverse communities, we hopethat this brief overview will provide afirst step for therapists who wish to in-crease their competence with gender di-verse clients. The body of literatureregarding transgender and gender di-verse affirmative practice is growing ex-ponentially and therapists have the opportunity to reach this community in informed and thoughtful ways likenever before. We hope you will choose

to incorporate transgender affirmativeawareness into your own practice.


(2015). guidelines for psychologicalpractice with transgender and gendernonconforming people. AmericanPsychologist, 70(9), 832-864. doi:10.1037/a0039906

association of lesbian, gay, Bisexual,and Transgender Issues in Counseling.(2009). Competencies for counselingwith transgender clients. alexandria,Va: author.

Budge, S. (2015). Psychotherapists asgatekeepers: an evidence-based casestudy highlighting the role andprocess of letter writing for trans-gender clients. Psychotherapy, 52(3),287-297. doi: 10.1037/pst0000034

Dickey, l. M., & Singh, a. a. (2018). Af-firmative counseling with transgenderand gender diverse clients [DVD].united States: american Psychologi-cal association.

Erickson-Schroth, l. (2014). Trans bod-ies, trans selves: A resource for thetransgender community. new York,nY: oxford university Press.

Hendricks, M. l., & Testa, r. J. (2012).a conceptual framework for clinicalwork with transgender and gender nonconforming clients: an adaptation ofthe Minority Stress Model. ProfessionalPsychology: Research and Practice, 43,460-467. doi: 10.1037/a0029597

Singh, a., & dickey, l. m. (Eds.). (2017).Perspectives on sexual orientation anddiversity. Affirmative counseling andpsychological practice with transgenderand gender nonconforming clients.Washington, DC: american Psycho-logical association.

World Professional association forTransgender Health (2011). Standardsof care for the health of transsexual,transgender, and gender nonconformingpeople: 7th Version. retrieved fromhttp://www.wpath.org

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This year marks the50th anniversary of theSociety for the Advance-ment of Psychotherapy(Division 29). I mustadmit, however, thatmy own experiencewith the division has

been much briefer. Indeed, this is myfirst year as a member. My limited his-tory with the division precludes mefrom reflecting much on its history, butas an early career psychologist (ECP)and Chair of the ECP Committee, I ambetter positioned to consider its future.

over the past few months I have had theprivilege of hearing from other new andmore longstanding members about thegoals, initiatives, and future directionsthey have for the division. These con-versations have helped to shape myown thoughts, particularly regardingour ECP members, their engagementwith the division, and the roles they willplay as the division moves forward.Through these conversations I have alsorealized that in order to develop a planfor where we are headed, we must firsttake stock of where we have been andwhat we already know. In this article, Ioffer a brief review of previous researchexamining ECPs as a population. I alsoreport on two studies from other aPaDivisions that sought to better under-stand the perceptions, needs, and inter-ests of their ECP members. I discuss thelessons learned from this previous re-search and offer an update on the goalsof this year’s ECP Committee. It is my

hope that the work we accomplish thisyear will help to usher in the next 50years of Division 29.

Traditionally, psychologists within sevenyears of their doctoral degree have beenclassified as “early career,” though morerecently the classification has been ex-panded to include anyone within 10years of graduation (american Psycho-logical association [aPa], 2016). ECPsare an increasingly diverse group of in-dividuals. We come from a variety ofdifferent backgrounds, have trained in avariety of different programs, and workin a variety of different professional set-tings. Despite this diversity, there areseveral themes that have emerged fromresearch on ECPs. as a group, we arewell-resourced when it comes to thelatest professional knowledge, our fa-

miliarity with technology, and our en-thusiasm and energy (Dorociak, rupert,& Zahniser, 2017). However, we alsoface several challenges. Many ECPshave high levels of educational debt,which may cause us to delay milestones,such as marriage, buying a house, orhaving children, or lead us to take onmultiple professional roles in an attemptto increase our income (arora, Brown,Harris, & Sullivan, 2017; green & Haw-ley, 2009). Evidence also suggests thatECPs are more likely to struggle withwork-life balance and less likely to en-gage in regular self-care as compared toour more senior colleagues (arora et al.,2017; Dorociak et al., 2017). Perhaps dueto these factors, ECPs appear to be at


earlY career

assessing the needs and Interests of our early career psychologist members

Kimberly A. Arditte Hall, PhDVA National Center for PTSD andBoston University School of Medicine

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increased risk for burnout. Indeed,Dorociak and colleagues (2017) foundthat, as compared to later-career psy-chologists, ECPs were more likely to en-dorse emotional exhaustion and lesslikely to endorse personal accomplish-ment related to their professional lives.These challenges are further compli-cated by the fact that they occur at a timewhen ECPs are transitioning from stu-dents to professionals and thus still dis-covering who we are and what we wantour careers to be.

understanding the resources ECPsbring to the table, as well as the uniquechallenges we face has important impli-cations for aPa and its divisions, in-cluding Division 29. ECPs have,historically, been underrepresentedwithin aPa membership, and particu-larly within division membership(arora et al., 2017). Previous researchfound that only 12% of ECPs endorsedparticipating in a subspecialty divisionof aPa (Westefield, 2011), though thereis also reason to believe that rates of di-vision membership among ECPs may beon the rise (Forrest, 2012). The value ofrecruiting and retaining active ECPmembers into Division 29 is undeniable.as we look toward the next 50 years ofthe organization, we can expect those ofus who are currently ECPs to have alarge role in shaping its future. Increas-ing the engagement of ECPs is a worth-while endeavor for Division 29, but itwill also require us to develop an un-derstanding of what our ECP membersare looking for and the ways in whichwe can best serve them.

Since starting my position as Chair ofthe ECP Committee, I have talked withDivision 29 colleagues about the possi-bility of developing a systematic assess-ment of our own ECP members.Through these discussions, I quickly re-alized how little I knew about the topics

we were trying to assess. So, doing whatI normally would do, I decided to turnto the literature. Though relatively littleresearch on the perceptions and needs ofECPs exists, multiple aPa Divisionshave undertaken similar needs assess-ments and there is much we can learnfrom their efforts.

Perhaps the most comprehensive ECPassessment that has been conducted andpublished, to date, was the one con-ducted by Smith and colleagues (2012).This assessment included 70 ECP mem-bers of aPa’s Society of Counseling Psy-chology (Division 17). results revealedthat perceptions of Division 17 differedquite drastically between ECP memberswith primarily academic appointmentsand ECP members with primarily clinical appointments. as compared tomembers with clinical appointments,members with academic appointmentsreported division membership to bemore useful to their careers and morehelpful for finding mentors and net-working with professional peers. In contrast, members with clinical appoint-ments were more likely to report thatthey did not have time to be involvedwith the division. Though somewhatdisheartening for our clinical colleagues,results of the survey informed severalspecific recommendations put forth bythe authors to promote the needs of all ofthe division’s ECP members. These rec-ommendations included: developing amore formal mentoring program, dedi-cating conference hours to early careerprogramming, highlighting activities ofECP members on the Division’s website,creating additional awards in nontradi-tional areas, and dedicating at least oneECP seat on each committee.

More recently, arora and colleagues(2017) published their own survey of


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ECP members within aPa’s Division 16:School Psychology. In contrast to thestudy by Smith and colleagues (2012),which focused primarily on ECPs’ per-ceptions of division membership, thissurvey focused on the professional de-velopment needs and training interestsof its ECP members. across members,the most commonly endorsed develop-mental needs were short- and long-termcareer development planning, cultivat-ing mentors, publishing, licensure, andself-care/work-life balance. not sur-prisingly, however, differences emergedbetween ECP members with primarilyapplied versus primarily academic ap-points. For example, when asked abouttheir training interests, ECPs with pri-marily applied positions were mostlikely to endorse developing a special-ization, navigating interpersonal and/orpolitical issues in schools, and ethical is-sues, whereas ECPs with primarily aca-demic positions were most likely toendorse developing research collabora-tions, training in methodology and sta-tistics, obtaining research funding, andteaching. Both groups identified super-vision of trainees as an area of interest.

What can we take away from these stud-ies? Some professional developmentneeds and interests appear to be sharedamong ECPs and, for many people, par-ticipating in an aPa division can be afruitful way to receive training and men-torship in these areas. It is also importantto remember that our divisions representa diverse group of people and to providetraining and resources that meet theneeds of ECPs from a variety of back-grounds and who work across manyprofessional settings. In particular, itseems that greater emphasis needs to beplaced on resources that are relevant toECPs who are in applied clinical settings.

This year, one of the Division 29 ECPCommittee’s primary goals is to conduct

our own needs assessment for our ECPmembers. as is, hopefully, clear, wehave been hard at work, reflecting onthe goals of the survey and the gaps inour knowledge. We have begun build-ing the anonymous survey, and antici-pate circulating it through the Division’slistserv sometime in the coming months.results will be compiled and shared atthe subsequent Division 29 board meet-ing. We hope that this assessment will bean important first step into the next 50years of the division. It will inform ourunderstanding of how the division re-cruits and retains ECPs and will guideus as we look to serve all our ECP mem-bers better. So, if you identify as an ECP,keep an eye out for the survey in yourinbox–we want to hear from you! Whatattracted you to join Division 29? Whatwould you like to see from the divisionover the coming years? What divisionresources would be most helpful tomeeting your professional developmentgoals and interests? What are the biggestchallenges you face at this stage of yourcareer? Is there support—practical oremotional—that could help you navi-gate these challenges more easily? Yourvoices are not only essential to the ECPCommittee and its future endeavors, butalso to Division 29 as a whole.

author’s note: Kimberly a. arditte Hall,PhD, is an oaa advanced research Fel-low in Women’s Health at the Va na-tional Center for PTSD at the Va BostonHealthcare System. The views expressedin this article are those of the author anddo not necessarily represent the views ofthe Department of Veterans affairs orthe united States government.


(2016). Early career. retrieved fromhttp://www.apa.org/careers/early-career/.


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arora, P. g., Brown, J., Harris, B., &Sullivan, a. (2017). Professional de-velopment needs and training inter-ests: a survey of early career schoolpsychologists. Contemporary SchoolPsychology, 21(1), 49-57. doi:10.1007/s40688-016-0108-8

Dorociak, K. E., rupert, P. a., & Zah-niser, E. (2017). Work life, well-being,and self-care across the professionallifespan of psychologists. ProfessionalPsychology: Research and Practice,48(6), 429-437. doi:10.1037/pro0000160

Forrest, l. (2012). Early career psychol-ogists: untapped talent and savvy.The Counseling Psychologist, 40(6),826-834. doi:10.1177/0011000012438418

green, a. g., & Hawley, g. C. (2009).Early career psychologists: under-standing, engaging, and mentoringtomorrow’s leaders. Professional Psy-chology: Research and Practice, 40(2),206-212.

Smith, n. g., Keller, B. K., Mollen, D.,Bledsoe, M. l., Buhin, l., Edwards,l. M., …Yakushko, o. (2012). Voicesof early career psychologists in Divi-sion 17, the Society for CounselingPsychology. The Counseling Psycholo-gist, 40(6), 794-825. doi:10.1177/0011000011417145

Westefield, J. (2011, august). Under-standing division membership. Presen-tation at the american Psychologicalassociation annual Convention,Washington, DC.




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recently in one of mycourses, I lectured onethics in forensic psy-chological assessment.a case example wasprovided involving apsychologist who pro-vided testimony citing

non-existent risk and risk assessment lit-erature in a death penalty case, whichlater resulted in the case being over-turned. one of my students inquiredabout the repercussions of psychologistsproviding false expert testimony in foren-sic contexts—especially having read theamerican Psychological association(aPa) Ethical Principles of Psychologistsand Code of Conduct (Code of Ethics;2017) and articles on the implications ofhigh-stakes testing at the beginning of thecourse (Sackett, Borneman, & Connelly,2008; Sackett, Schmitt, Ellingson, &Kabin, 2001). Was there a state licensingboard complaint? Follow-up interven-tion? Was the person’s license revoked?What happens to the prior cases in whichthis person provided testimony? Profes-sional competence is a critical discussiontopic in professional ethics in psycholog-ical practice.

professional competence Competence has been defined as theknowledge and skills, and attitudes, val-ues, and judgment needed to performthe work of a psychologist (Barnett,Doll, Younggren, & rubin, 2007; rodolfaet al., 2005). Epstein and Hundert (2002)further expand “[professional compe-tence is] the habitual and judicious useof communication, knowledge, technical

skills, clinical reasoning, emotions, val-ues, and reflection in daily practice forthe benefit of the individual and com-munity being served” (p. 227).

Competence is considered both an aspi-rational and enforceable standard. TheaPa began requiring ethics in doctoralcurricula in 1979 (Bashe, anderson,Handelsman, & Klevansky, 2007). Edu-cation in psychology shifted to compe-tency-based education and training(Kaslow et al., 2004). However, obtain-ing a graduate degree in psychology ispresumed to be entry-level competence(Johnson, Barnett, Elman, Forrest, &Kaslow, 2012). Indeed, board certifica-tion exists for psychologists to demon-strate a higher level of competence indifferent specialties within psychology,although only 3% of psychologists haveboard certification (Johnson et al., 2012).

Boundaries of competencePsychologists are encouraged to practicewithin their areas of competence. Stan-dard 2.01 (Boundaries of Competence)of the aPa Code of Ethics (2017) states,

Psychologists provide services,teach, and conduct research withpopulations and in areas onlywithin the boundaries of their com-petence, based on their education,training, supervised experience,consultation, study, or professionalexperience. (p. 4)

For instance, if a psychologist in privatepractice has spent her early career work-ing primarily with adults with severe


eTHIcS In pSYcHoTHerapY

Knowing What You Don’t Know: addressing professional competence

Apryl Alexander, PsyDUniversity of Denver

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and persistent mental illness, shifting tochild custody cases could potentially beworking outside her area of competence.Therefore, this person would need to re-ceive training (i.e., further graduatecourses, professional seminars) and su-pervision and consultation prior to en-gaging in such professional activities.

Practicing within boundaries of compe-tence is particularly important in highstakes contexts where the implicationsand potential for harm is heightened(Sackett et al., 2001; 2008). High stakecontexts could include educational as-sessments, civil and criminal forensictreatment and assessments (e.g., childcustody, death penalty, sexual harass-ment litigation), and dangerous practicesettings. Practicing outside areas ofcompetence can lead to significant fi-nancial, personal, emotional, and phys-ical consequences.

problems in professional competenceElman and Forrest (2004) coined theterm problems of professional competence(PPC). Many factors can contribute toPPC, including deficits in current edu-cation, training, and experience, per-sonal distress or illness, or cognitivedecline (Johnson et al., 2012). Further, career-related stressors such as compas-sion fatigue and vicarious traumatiza-tion can further contribute to PPC(Johnson, Barnett, Elman, Forrest, &Kaslow, 2013). Practicing while im-paired can result in harm to both psy-chologists and to their clients. Standard3.04 (avoiding Harm) of the aPa Codeof Ethics (2017) notes that psychologistsshould “take reasonable steps” to mini-mize foreseeable harm with their clientsand others. noticing PPC in oneself re-quires a great degree self-reflection.Bashe et al. (2007) note, “Students andpracticing professionals need to reflectactively and decide how much of theirown personal morality can be adapted

to their growing knowledge and appre-ciation of the ethical culture of psychol-ogy” (p. 61).

Much of the literature regarding im-paired professional practice focuses onstudents and trainees, and there is guid-ance on how to address PPC from grad-uate training to the post-doctoral level(Bamonti et al., 2014; Forrest, Shen-Miller, & Elman, 2008; Johnson et al.,2008; McCutcheon, 2008; oliver, Bern-stein, anderson, Blashfield, & roberts,2004; Wester, Christianson, Fouad, &Santiago-rivera, 2008). Interestingly, ina study assessing ethical violations, stu-dents endorsed PPC among their faculty(January et al., 2014). Students citedpractice issues such as lack of skill-basedcompetence and lack of cultural compe-tency/multicultural sensitivity. There-fore, it is important for students, faculty,and supervisors to assess their profes-sional competence across all areas ofprofessional work—teaching, supervi-sion, research, and clinical practice.

psychology and the general public Problems in professional competencecan have a broader impact. There are nu-merous myths about psychological sci-ence in the general public and media. Itis the role of a psychologist to uphold ascientific and professional standardwhen interacting in public spaces. Hereis a case example loosely based on recenttestimony I witnessed:

a state is considering legislationthat would prohibit lgBTQ parentsfrom adopting children. a licensedpsychologist testifies that allowinglgBTQ parents to adopt would beharmful to the child (stating “re-search says…”) and would limitadoption agencies in exercisingtheir religious freedom.


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Standard 2.04 (Bases for Scientific andProfessional Judgements) of the aPaCode of Ethics (2017) notes work shouldbe based upon “established scientificand professional knowledge of the disci-pline” (p. 5). In this case example, thisstandard is not being met. In 2004, theaPa adopted a policy resolution provid-ing a summary of research supportingadoption for gay and lesbian parents andciting literature noting no adverse im-pact of their parenting on their childrenwhen compared to children with oppo-site-sex parents (Paige, 2005; Patterson,2005). Therefore, personal biases may be impeding on scientific knowledge,which is detrimental when providingtestimony regarding public policy. Thisexample also elucidates the importanceof remaining current on professionalpractice standards and literature.

Psychologists should be cautious abouthow they disseminate psychologicalknowledge and research to the generalpublic. accuracy and completeness oflanguage and information, avoidance ofbeing overly confident, highlightinglimitations to research and outcomes,and avoidance of pseudoscience shouldall be noted (Cederberg, 2017). again,Standard 3.04 (avoiding Harm), as wellas Principle B (Fidelity and responsi-bility) of the aPa Code of Ethics (2017)discusses avoiding harm and beingaware of the “professional and scientificresponsibilities to society and to thespecific communities in which theywork” (p. 3). Cederberg (2017) notes itis impossible for a psychologist to be anexpert in all facets of the profession.Professional judgement, self-awareness,and humility are important in main-taining professional competence andethical practice.

How do you address a colleague? ac-cording to Johnson et al. (2013), the aPaCode of Ethics does not require psy-

chologists to assist when another psy-chologist in the community suffers fromPPC. Further, the authors indicated thatmany psychologists reported being re-luctant to intervene when they notice animpaired colleague. Some jurisdictionshave Colleague assistance Programs;however, some have been discontinueddue to mandatory reporting concernsand psychologists not seeking help infear of being labeled impaired or incom-petent (Barnett & Hillard, 2001). Somemay want to be more direct but needmore guidance on how to do so sensi-tively, respectfully, and professionally.Brodsky and McKinzey (2002) offersample letters to address an unethicalcolleague when such a scenario arises.These samples facilitate a dialogue withthe person that is polite, respectful, anddevoid of shame. However, the authorsultimately note that complaints mayoften best be handled by the state li-censing board in order to be effective.

continuing education and competence Self-assessment of competence shouldbegin early in training and continuethrough the lifespan. roberts, Borden,Christiansen, and lopez (2005) outline amodel for the assessment of competencewhich can be used at different stagesthroughout one’s trainee and career.Standard 2.03 (Maintaining Competence)notes psychologists “undertake ongoingefforts to develop and maintain theircompetence” (aPa, 2017, p. 5). Bothmaintaining and enhancing one’s com-petence is essential (Barnett et al., 2007).

How do you know what you don’tknow? Barnett et al. (2007) note that self-assessment requires a personal aware-ness that one has a deficit in education,training, and self-directed learning. Thisis particularly challenging, as it is often


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difficult for individuals to identify theirblind spots. The reason why issues ofprofessional competence are often dis-cussed during graduate-level training isstudents are under the watchful eye oftheir supervisors, professors, and men-tors. However, psychologists often donot have that luxury of oversight andsupport. Peer consultation may be anarena in which this work can continue.Continuing professional education isalso essential. Continuing professionaleducation has been defined as a “looselyfederated assortment of professional ac-tivities, roles, and responsibilities thatprovide opportunities for psychologiststo engage in new learning and to keeppace with the increasingly rapid changesin their fields” (neimeyer, Taylor, & Cox,2012, p. 476). at the time of their writing,neimeyer and colleagues noted 44 jurisdictions in the united States havemandated some continuing educationrequirement for licensure renewal. In ad-dition, some have proposed further ed-ucation and credentialing as a potentialsolution to ensuring professional com-petence (Kaslow et al., 2004; nelson,2007), which could be in the form of cer-tifications and board certification. How-ever, as previously stated, only a smallpercentage of psychologists have boardcertification (Johnson et al., 2012).

Personal stressors can also impact pro-fessional competence. Trainees and psy-chologists are not immune to thestressors of life and illness. Bamonti andcolleagues (2014) suggest self-care shouldbe an aspect of professional competency,citing Standard 2.05 (Personal Problemsand Conflicts) and Principle a (Benefi-cence and nonmaleficience) of the aPaCode of Ethics (2017) as rationale.

conclusionPsychologists are held to a high stan-dard of professional competence giventhe sensitive nature of their work and

the potential for high-stakes impact.Problems in professional competencenot only impact direct service to clientsbut can impact the public’s perceptionsof the field of psychology. Professionalcompetence requires regular self-assess-ment and self-reflection on acquisitionand maintenance of the skills, abilities,and training needed to perform effec-tively as a psychologist throughoutone’s training and career.


(2017). Ethical principles of psycholo-gists and code of Conduct. retrievedfrom http://www.apa.org/ethics/code/

Bamonti, P. M., Keelan, C. M., larson,n., Mentrikoski, J. M., randall, C. l.,Sly, S. K.,… Mcneil, D. W. (2014).Promoting ethical behavior by culti-vating a culture of self-care duringgraduate training: a call to action.Training and Education in ProfessionalPsychology, 8(4), 253-260. doi:10.1037/tep0000056

Barnett, J. E., Doll, B., Younggren, J. n.,& rubin, n. J. (2007). Clinical compe-tence for practicing psychologists:Clearly a work in progress. Profes-sional Psychology: Research and Prac-tice, 38(5), 510-517. doi:10.1037/0735-7028.38.5.510

Barnett, J. E., & Hillard, D. (2001). Psy-chologist distress and impairment:The availability, nature, and use ofcolleague assistance programs forpsychologists. Professional Psychology:Research and Practice, 32(2), 205-210.doi: 10.1037/0735-7028.32.2.205

Bashe, a., anderson, S. K., Handels-man, M. M., & Klevansky, r. (2007).an acculturation model for ethicstraining: The ethics autobiographyand beyond. Professional Psychology:Research and Practice, 38(1), 60-67.


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doi: 10.1037/0735-7028.38.1.60 Brodsky, S. l., & McKinzey, r. K.

(2002). The ethical confrontation ofthe unethical forensic colleague. Pro-fessional Psychology: Research andPractice, 33(3), 307-309. doi:10.1037//0735-7028.33.3.307

Cederberg, C. D. (2017). Personalbranding for psychologists: Ethicallynavigating an emerging vocationaltrend. Professional Psychology: Re-search and Practice, 48(3), 183-190. doi:10.1037/pro0000129

Elman, n. S., & Forrest, l. (2004). Psy-chotherapy in the remediation ofpsychology trainees: Exploratory in-terviews with training directors. Pro-fessional Psychology: Research andPractice, 35(2), 123-130. doi:10.1037/0735-7028.35.2.123

Epstein, r. M., & Hundert, E. M.(2002). Defining and assessing pro-fessional competence. JAMA: Journalof the American Medical Association,287(2), 226-235. doi:10.1001/jama.287.2.226

Forrest, l., Shen-Miller, D., & Elman,n. S. (2008). Psychology traineeswith competence problems: From in-dividual to ecological conceptualiza-tions. Training and Education inProfessional Psychology, 2(4), 183-192.doi: 10.1037/1931-3918.2.4.183

January, a. M., Meyerson, D. a.,reddy, l. F., Docherty, a. r., &Klonoff, E. a. (2014). Impressions ofmisconduct: graduate students’ per-ception of faculty ethical violationsin scientist-practitioner clinical psy-chology programs. Training and Edu-cation in Professional Psychology, 8(4),261-268. doi: 10.1037/tep0000059

Johnson, W. B., Barnett, J. E., Elman, n.S., Forrest, l., & Kaslow, n. J. (2012).The competent community: Towarda vital reformulation of professionalethics. American Psychologist, 67(7),557-569. doi: 10.1037/a0027206.

Johnson, W. B., Barnett, J. E., Elman, n.S., Forrest, l., & Kaslow, n. J. (2013).The competence constellation model:a communitarian approach to sup-port professional competence. Profes-sional Psychology: Research andPractice, 44(5), 343-354. doi:10.1037/a0033131

Johnson, W. B., Elman, n. S., Forrest,l., robiner, W. n., rodolfa, E., &Schaffer, J. B. (2008). addressing pro-fessional competence problems intrainees: Some ethical considera-tions. Professional Psychology: Researchand Practice, 39(6), 589-599. doi:10.1037/a0014264

Kaslow, n. J., Borden, K. a., Collins, F.l., Jr., Forrest, l., Illfelder-Kaye, J.,nelson, P. D.,… Willmuth, M.E.(2004). Competencies conference: Future directions in education andcredentialing in professional psy-chology. Journal of Clinical Psychology,60(7), 699-712. doi: 10.1002/jclp.20016

McCutcheon, S. r. (2008). addressingproblems of insufficient competenceduring the internship year. Trainingand Education in Professional Psychol-ogy, 2(4), 210-214. doi:10.1037/a0013535

neimeyer, g. J., Taylor, J. M., & Cox, D.r. (2012). on hope and possibility:Does continuing professional devel-opment contribute to ongoing pro-fessional competence? ProfessionalPsychology: Research and Practice,43(5), 476-486. doi: 10.1037/a0029613

nelson, P. D. (2007). Striving for com-petence in the assessment of compe-tence: Psychology’s professionaleducation and credentialing journeyof public accountability. Training andEducation in Professional Psychology,1(1), 3-12. doi: 10.1037/1931-3918.1.1.3

oliver, M. n. I., Bernstein, J. H., ander-son, K. g., Blashfield, r .K., &


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roberts, M. C. (2004). an exploratoryexamination of student attitudes to-ward “impaired” peers in clinicalpsychology training programs. Pro-fessional Psychology: Research andPractice, 35(2), 141-147. doi:10.1037/0735-7028.35.2.141

Paige, r. u. (2005). Proceedings of theamerican Psychological associationfor the legislative year 2004: Minutesof the annual meeting of the Councilof representatives, February 20-22,2004, Washington, DC, and July 28and 30, 2004, Honolulu, Hawaii, andminutes of the February, april, June,august, october, and December 2004meetings of the Board of Directors.American Psychologist, 60(5), 436-511.doi: 10.1037/0003-066X.60.5.436

Patterson, C. J. (2005). lesbian and gayparents and their children: Summaryof research findings. In americanPsychological association, Lesbian &gay parenting (pp. 6-22). retrievedfrom http:// http://www.apa.org/pi/lgbt/resources/parenting-full.pdf

roberts, M. C., Borden, K. a., Chris-tiansen, M. D., & lopez, S. J. (2005).Fostering a culture shift: assessmentof competence in the education andcareers of professional psychologists.Professional Psychology: Research andPractice, 36(4), 355-361. doi:

http://dx.doi.org/10.1037/0735-7028.36.4.355

rodolfa, E., Bent, r., Eisman, E., nel-son, P., rehm, l., & ritchie, P. (2005).a cube model for competency devel-opment: Implications for psychologyeducators and regulators. ProfessionalPsychology: Research and Practice,36(4), 347-354.

Sackett, P. r., Borneman, M. J., & Con-nelly, B. S. (2008). High stakes testingin higher education and employ-ment: appraising the evidence forvalidity and fairness. American Psy-chologist, 63(4), 215-227. doi:10.1037/0003-066X.63.4.215

Sackett, P. r., Schmitt, n., Ellingson, J.E., & Kabin, M. B. (2001). High-stakes testing in employment, cre-dentialing, and higher education:Prospects in a post-affirmative-actionworld. American Psychologist, 56(4),302-318. doi: 10.1037/0003-066X.56.4.302

Wester, S. r., Christianson, H. F.,Fouad, n. a., & Santiago-rivera, a.l. (2008). Information processing asproblem solving: a collaborative ap-proach to dealing with students ex-hibiting insufficient competence.Training and Education in ProfessionalPsychology, 2(4), 193-201. doi:10.1037/1931-3918.2.4.193

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advancing practiceTogetherJust prior to the lastwinter blast strikingour nation’s Capital, I was very fortunate to be able to attend the 35th annual aPaPo

Practice leadership conference, alongwith former aPa Presidents James Brayand Carol goodheart. These gatheringsare always the highlight of my profes-sional year and it was especially excitingthis year to experience the genuine en-thusiasm generated by so many firsttime attendees and aPagS students.Katherine nordal will be leaving aPaafter a decade of service, not to mentionserving in a variety of roles, including asan aPa Congressional Fellow. The 350attendees were constantly expressingtheir gratitude for all that she had ac-complished and her willingness tostrategically “disrupt” our thinking sothat collectively, we could seek greaterheights. as Katherine would say duringthe opening reception, psychology canmake a real difference to so many peo-ple and we should appreciate that we dosave lives. It was a particular delightthat President Jessica Henderson Danielpresented long-time state associationadvocate Mike Sullivan with an aPaCitizen Psychologist Presidential Cita-tion. This is a well-deserved tribute. Danabrahamson and Susan lazaroff did anoutstanding job. The future is bright.

Integrated-Interprofessional Health careone of the foundations of Presidentobama’s Patient Protection and afford-

able Care act (aCa) was a visionaryemphasis upon fostering team-based in-terprofessional care, with behavioralhealth being increasingly integrated intoprimary care. linda Campbell was oneof the original architects of a quality psy-chopharmacology training program forthose interested in obtaining prescriptive(rxP) authority. She worked closely withher pharmacy colleagues at the univer-sity of georgia—a training model thatcontinues to serve psychology ad-mirably. linda’s report on her most re-cent initiative: “In 2016, I joined with Dr.Edward Delgado-romero and Dr. lindalogan who are faculty at the universityof georgia to begin an integrated behav-ioral health practicum at Mercy HealthCenter in atlanta, georgia. Dr. Delgado-romero and I are counseling psychologyfaculty members and Dr. logan is aSchool of Pharmacy and College of Edu-cation faculty member. Prior to the in-ception of this integrated trainingexperience, we worked together in thedepartment’s training clinic for 10 years,developing an integrated training modelfor doctoral and masters students. Thedepartment training clinic includes ad-vanced nursing students from the au-gusta School of nursing. This programis still growing and is a popular rotationfor pharmacy and nursing students.

“Mercy Health Center is a health careclinic for the underserved populationswho have no insurance; no Medicare,Medicaid, or any other means of payingfor health care. Except for a small em-ployee staff, over 70 physicians, dentists,and other medical specialists devote pro

WaSHIngTon Scene

“rockin’ pneumonia”

Pat DeLeon, PhDFormer APA President


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bono time to serve the population. Wetook our model from the departmenttraining clinic to Mercy where we workwith Kristi gilleland, the Whole PersonHealth Coordinator, and Tracy Thomp-son, CEo. Together, we have developedan integrated staffing of pharmacy, so-cial work, legal consultation, nutrition,and specialty medical services. Thetraining model includes individual be-havioral health services, chronic illnessgroups, and pre- and post-therapygroups to ensure health promoting be-haviors are secured before termination.all patients are rural and low SES (so-cioeconomic status), but additionallyabout 30% are Spanish speaking patientswho are seen by Spanish speaking doc-toral students supervised by Dr. Del-gado-romero. Dr. logan providesconsultation for all patients seen in themodel training program and I providesupervision for English speaking pa-tients primarily and focus on the lowSES population.

“our program is a win-win becausehundreds of patients are receiving be-havioral health services, students arebeing trained in an integrated model,and the faculty are collecting data to de-termine the added effectiveness of be-havioral health within primary careservices. The clinical training programand the research training program arecalled IMPaCT. The faculty, Mercy staff,and students are totally committed tomake this impact happen.”

aPa appreciates the significance of thisevolution for education and practice.Jim Diaz-granados: “The Education Di-rectorate recognizes the value of inter-professional education and training.This is evidenced by our active partici-pation in a number of interprofessionalorganizations. The aPa is a liaisonmember on the Federation of associa-tions of Schools of the Health Profes-

sions that serves as a forum to encour-age effective collaboration among healthprofessions in education and practice.The Directorate is also a member of thenational academy of Medicine’s globalForum on Innovations in Health Profes-sions Education, an ongoing conveningactivity that brings together stakehold-ers from multiple nations and profes-sions to network, discuss and illuminateissues within health professional educa-tion with a focus on interprofessionaleducation. In 2016, aPa joined the In-terprofessional Education Collaboration(IPEC). The IPEC was formed in 2009 bysix organizations committed to advanc-ing interprofessional learning experi-ences and promoting team-based care.In 2016, IPEC appointed 14 additionalmembers, including the aPa. our CEoarthur Evans and aPa Presidents TonyPuente, Susan McDaniel, and JessicaHenderson Daniel have accompaniedthe Education Directorate leadership tothe IPEC biannual council meetings.

“Similarly, in april 2017, the aPa Com-mission on accreditation joined theHealth Professions accreditors Collabo-rative (HPaC). The HCaP was foundedin 2014 by the accreditors for medicine,pharmacy, nursing, dentistry, and pub-lic health and expanded in 2017 to include 17 additional organizationscommitted to working together to ad-vance interprofessional education, practice, and quality. In addition tomembership in key interprofessionalgroups, under the leadership of thenaPa President Susan McDaniel, the cur-riculum for an Interprofessional Semi-nar on Integrated Primary Care (IS-IPC)was developed. The IS-IPC is a resourcethat can be used to develop educationalexperiences for an interprofessionalgroup of learners about the competen-cies needed to work together in a suc-cessful and integrated healthcare team.


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The next opportunity on the horizon isthat of interprofessional continuing ed-ucation. Currently, the Joint accredita-tion for Interprofessional ContinuingEducation offers organizations to be si-multaneously approved to providemedical, nursing, pharmacy, and op-tometry continuing education. In theEducation Directorate we are currentlyexploring the possibility of adding psy-chology to the mix.”

prescriptive authority (rxp)as psychology becomes more involvedin integrated and interprofessional care,we are confident that the movement to-wards obtaining rxP will increasinglymature. at the aPaPo Practice leader-ship conference Beth rom-rymerchaired the concurrent workshop “Therevolution in Health Care: PrescribingPsychologists” where the five successfulstate associations described how each oftheir approaches reflected unique needsand circumstances. Subsequently, ar-mand Cerbone reflected upon their jour-ney in Illinois: “In 2004 when I becamePresident of the Illinois Psychologicalassociation (IPa), the rxP initiative waslanguishing. Having already obtainedhis authorization in new Mexico, for-mer IPa President Marlin Hoover wasthe rxP chief advocate. Yet he found lit-tle traction among our Council repre-sentatives. He indicated he was losinghis enthusiasm. Believing that rxP wasimportant, even critical, to the future ofpsychology, I met with Marlin to bolsterhis commitment and to plot to advancehis proposal and to encourage him topress our Council further.

“Together we engaged the IPa Councilin debate over a motion to adopt as its#1 legislative priority seeking rxP forIllinois psychologists. There was consid-erable resistance among Council mem-bers citing negative changes to theprofession and its values and concernsfor the medicalization of psychology.

There were anxieties that prescribingwould open the door to abuse of pre-scriptive authority by unprincipled psy-chologists interested only in financialgain. Those who favored such an initia-tive noted remedies for persons not ableto afford or access psychiatric care, im-proved care stemming from the advan-tages of consulting with a psychologistwith similar training than with a med-ical doctor, and improving competitive-ness in the marketplace. one proponentof rxP argued that prescriptive author-ity would broaden a ‘safety net of care’for clients and patients.

“given that in 2005 our Council wascomposed of middle- to late-career pro-fessionals, I polled our IPagS represen-tative for his opinion. His support forrxP was clear. rxP would provide op-portunities for new psychologists andstrengthen professional credibility inmedical settings. In remarking that therewas already considerable emphasis onthe biological bases to behavioral healthhe said it seemed smart to consider howrxP could open doors to the future. I be-lieve the voice of young people, new toor entering the profession, swayed thefence-straddlers among the representa-tives. When the vote was called, the mo-tion carried by a clear majority. IPa wasnow committed to rxP.

“over the next few years Marlin devel-oped a video of interviews with psy-chologists who had or were pursuingrxP and one Illinois psychiatrist whosupported the movement for psycholo-gists. While the video captured impor-tant arguments, it lacked productionvalues that reduced its effectiveness.More importantly, psychologists of colorwere noticeably absent. Much waslearned from those initial efforts. Itwould require more financial and polit-ical resources than IPa had at the time.


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and passing rxP legislation in theaMa’s backyard would be daunting.

“When Beth rom-rymer assumed theleadership of IPa, she provided the de-termination and political savvy the ini-tiative needed. IPa’s commitment hadn’twavered but needed the single-mindedenergy Beth brought. Beth was also ableto pull together from sundry sources theessential financial resources to hire well-established and respected lobbyists towork exclusively for the passage of rxPlegislation in the Illinois legislature. I re-member one fund-raising event at herhome for the reelection of a Democraticgovernor who was likely to sign anyrxP legislation that passed the legisla-ture. Traveling around the state, Bethmet with anyone who would meet withher to garner support for rxP and tocalm the dubious and rebut the opposed.

“That rxP is law in Illinois is a measureof Beth’s skill as a resourceful and effec-tive leader. Illinois would not be amongthe states with prescriptive authoritywere it not for her efforts. adding Illi-nois to the roster surely provides en-couragement and momentum to thenational movement. Beth was able tocapitalize on ground that had beentilled. What resistance she encounteredwas from the rank and file who neededthe education and leadership she pro-vided. Several important factorsemerged from Illinois’ experience. asmuch as vision, unwavering commit-ment, and capable leadership are criti-cal, it is equally important – at timeseven more important – to have a graspof local politics and the financial re-sources adequate to the objective. Set-backs happen; movements can stall.Keep your eyes ever on the prize.”

Investing in our next generationDuring this year’s deliberations on theFY 2018 appropriations bill for the De-partment of Health and Human Servicesincreased funding was provided for twoprograms within the Health resourcesand Services administration whichshould be of particular interest to thosecolleagues concerned about our nation’schildren. Ten million dollars was in-cluded for a new initiative to expand ac-cess to behavioral health services inpediatric primary care by developing pe-diatric mental health care telehealth ac-cess programs. and, $22.3 million wasprovided for EMSC. on its 10th anniver-sary, C. Everett Koop noted: “I ampleased to remember that in 1984, whileI was u.S. Surgeon general, the unitedStates Congress passed legislation to im-prove emergency medical services forchildren (EMSC). It received my full sup-port and that of many of my colleagues,because critically ill and injured childrenwere not receiving the same high qualityof emergency health care we providedfor adults. But this is not unusual;throughout history children have notbeen our first priority.” neither initiativewas in the administration’s budget.

on March 24th my wife and I joined asurprising number of neighbors at alocal senior retirement communitymarching on behalf of the next genera-tion (“March for our lives”). It was in-spiring to see the number of elderlywalking with their canes and/or a bitslower with their walkers, many withproud grandchildren alongside them.The signs were clear “Protect children,not guns!” as we went along a majorthoroughfare, an impressive number ofpassing cars enthusiastically expressedtheir support. “roll over Beethoven.”

aloha.

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2018 professional awards

Distinguished psychologist award Jacques Barber

Jacques P. Barber, Ph.D., aBPP is Professor and Dean, gordon FDerner School of Psychology formerly the Institute of advancedStudies in Psychology at adelphi university. He is professor ofpsychology in the Department of Psychiatry and in the Psychol-ogy graduate group at the university of Pennsylvania. He is

also adjunct Professor of Psychiatry at new York university School of Medicine.He is past president of the International Society for Psychotherapy research andwas a recipient of its early career award in 1996 and its Distinguished research Ca-reer award in 2014. He has been visiting professor at the Department of Clinicalneuroscience of the Karolinska Institute in Stockholm. He is a licensed clinical psy-chologist in new York and Pennsylvania.

His research focuses on the outcome and process of psychodynamic and cognitivetherapies for depression, panic disorder, substance dependence and personalitydisorders. He has been funded by nIMH and nIDa to conduct randomized clini-cal trials involving psychodynamic and cognitive therapy. guided by conceptualmodels emphasizing both relational and technical factors, his psychotherapyprocess research examines the impact of the therapeutic alliance and of therapists’use of theoretically relevant interventions on the outcome of different therapies.outside of treatment research, he has also conducted research on individual coreconflicts and metacognitiion in different populations including Children of Holo-caust Survivors. He has published more than 250 papers, chapters and books in thefield of psychotherapy and personality. He is mostly proud of the students andpost docs he has mentored during his career.

among his recent books are “Psychodynamic Therapy: A Guide to Evidence-Based Prac-tice” and “Practicing Psychodynamic Therapy: A Casebook (2014) both with richardSummers; Visions in Psychotherapy Research and Practice: Reflections from the presi-dents of the society for psychotherapy research edited with Bernhard Strauss and LouisGeorges Castonguay. “Echoes of the Trauma: Relationship Themes and Emotions in theNarratives of the Children of Holocaust Survivors” co-authored with Hadas Wiseman,and The Therapeutic Alliance: An Evidence-Based Approach to Practice, co-edited withChristopher Muran. n

congraTulaTIonS To THe SocIeTY For THe aDVancemenT oF pSYcHoTHerapY

2018 aWarD WInnerS anD granT recIpIenTS!


Sap/apF early career awardcatherine eubanks

Catherine F. Eubanks is associate Professor of Clinical Psychologyat the Ferkauf graduate School of Psychology of Yeshiva univer-sity. She also serves as associate Director of the Mount Sinai-BethIsrael Brief Psychotherapy research Program. Dr. Eubanks’s re-search interests are in the area of psychotherapy process and out-come, in particular negotiating therapeutic alliance ruptures with patients withpersonality disorder features. The goals of her research program are to identifytherapist skills and characteristics that are linked to effectiveness across varioustheoretical orientations, and to explore how therapists’ skills can be enhancedthrough training.

Dr. Eubanks received the Dissertation award from the Society for the Explorationof Psychotherapy Integration (SEPI) in 2007 and the outstanding Early Careerachievement award from the Society for Psychotherapy research (SPr) in 2015.Dr. Eubanks currently serves as President-Elect of SEPI, and recently completed afive-year term as Executive officer of the north american chapter of SPr. Dr.Eubanks is an associate Editor for two journals, the Journal of Consulting and

Clinical Psychology and Psychotherapy Research. She also serves on the editorial boardof the Journal of Psychotherapy Integration. n

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2018 Professional Awards, continued

Sap/apF early career awardTony rousmaniere

Tony rousmaniere is Clinical Faculty at the university of Wash-ington and has a private practice in Seattle. He hosts the clinicaltraining website www.dpfortherapists.com, and is the author/editor of four books on clinical training: Deliberate Practice for Psychotherapists, The Cycle of Excellence: Using Deliberate Practice toImprove Supervision and Training, Using Technology to Enhance

Counseling Training and Supervision: A Practical Handbook, and the forthcoming Build-ing Psychological Capacity: A Deliberate Practice Handbook. In 2017 Dr. rousmanierepublished an article in The Atlantic Monthly (“What your therapist doesn’t know”).Dr. rousmaniere provides workshops, webinars, and advanced clinical trainingand supervision to clinicians in the united States, the united Kingdom, Europe,asia, and australia. Dr. rousmaniere supports the open-data movement and pub-lishes his aggregated clinical outcome data, in de-identified form, on his website atwww.drtonyr.com/outcome-data. Dr. rousmaniere is an active member of the Society for advancement of Psychotherapy (SaP), the Society for Psychotherapyresearch (SPr), and the Society for Exploration of Psychotherapy Integration(SEPI). He was previously associate Director of Counseling and Director of Train-ing at the university of alaska Fairbanks Student Health and Counseling associa-tion. More about Dr. rousmaniere can be found at www.drtonyr.com n

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2018 Student awards

Sap Student Diversity paper awardKatherine morales

Katherine Morales is a rising third year doctoral student in theCounseling Psychology program at the university of Maryland,College Park. She and her advisor, Dr. Dennis Kivlighan, Jr., havecollaboratively developed research projects that integrate his ex-pertise in process and outcome of psychotherapy and her interests

in the experiences of racial ethnic minorities. Her research interests include thestudy of the therapeutic alliance, cultural humility, and multicultural competency.In her leisure time, she loves to read, explore new foods, and travel. n

2018 Professional Awards, continued

Distinguished award for the International advancement of psychotherapyrod goodyear

rod goodyear, PhD., Counseling Psychology, university ofIllinois at Champaign-urbana) is a Professor at the univer-sity of redlands as well as Emeritus Professor of CounselingPsychology, university of Southern California and was the2015 President of the Society for the advancement of Psychotherapy where hisPresidential initiative concerned more fully internationalizing the Society. Hisscholarship has focused primarily on processes and outcomes in supervision andtraining, and secondarily on professional identity in counseling psychology. Hisbook with Janine Bernard (Fundamentals of Clinical Supervision), in its sixth edi-tion, is arguably the most widely used supervision book. His recent work has fo-cused on the potential of deliberate practice for therapists (see rousmaniere,goodyear, Miller and Wampold’s The Cycle of Excellence).

He was a member of the american Psychological associations’ task group that de-veloped the association’s clinical supervision guidelines; and he received theamerican Psychological association’s 2015 award for Distinguished lifetime Con-tributions to Education and Training. In the past five years his work has become in-creasingly international, with collaborations and training projects in latin america,China, South Korea, and the u.K. n

Sap Donald K. Freedheim Student Development paper awardBrian TaeHyuk Keum

Brian TaeHyuk Keum is a PhD candidate in Counseling Psychol-ogy at the university of Maryland-College Park studying underDr. Matthew J. Miller. Prior to beginning his PhD program, he re-ceived his Ma in Counseling Psychology from Teachers College, Columbia uni-versity. His research interests include contemporary issues of discrimination andmental health correlates (such as online racism and gendered racism), stigma re-


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2018 Student Awards—Brian TaeHyuk Keum, continued

duction and promotion of psychological help-seeking, psychotherapy process andoutcome research on clients of color, and group perspectives in counselor training.Brian started his counselor training during his Master’s at a community outpatientagency in lower east side of new York City serving primarily low-income immi-grant clientele. Since then, he transitioned to providing counseling to college stu-dents and community-based clientele in the DMV area for the past four years. Brianis applying for his pre-doctoral internship this upcoming academic year. n

Sap Jeffrey e. Barnett psychotherapy research paper awardmichael Katz

Michael Katz is a rising fourth year doctoral student in ClinicalPsychology at the Derner School of Psychology, adelphi uni-versity. Michael began his research training with a focus on

lgBTQ mental health as an Ma student at the academic College of Tel aviv-Yaffo,under the supervision of Dr. ofer Fein. His current research, under the mentorshipof Dr. Mark Hilsenroth of adelphi university, focuses on psychotherapy processand on the relationship between technique use, flexibility, and outcome within psy-chodynamic psychotherapy. Michael divides his time and attention between hisgrowing second home in new York and his close family and friends in his homecountry, Israel. n

Sap mathilda B. canter education and Training paper awardTaylor groth

Taylor groth will begin her third year in the Doctoral Programat the Derner School of Psychology at adelphi university in thefall. Her Master’s Thesis assessed psychologists’ willingness totreat suicidal clients, and her dissertation will look at treatmentoutcome of adolescents with eating disorders. In the future, Taylor hopes to workwith children and adolescents, as well as continue to do research. aside from psychology, in her free time she likes to play soccer and spend time with her dogand family. n

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2018 Student Awards, continued

Sap Student excellence in practice awardmariafé panizo Jansana

Mariafé Panizo is a doctoral student in the Combined Inte-grated Clinical and School Psychology program at JamesMadison university, Virginia. She is writing a dissertation onthe Interpersonal reconstructive Therapy (IrT)’s conceptu-alization and treatment of personality disorders, under thesupervision of Dr. Ken Critchfield. During her doctoral train-ing, Mariafé has practiced at several clinical sites, includingWestern State Hospital, where she is developing an IrT curriculum for group therapywith patients with severe mental disorders. In the future, she wishes to continueworking with severely mentally ill adults and other vulnerable populations. Mariaféis originally from Perú, where she obtained a Bachelor’s degree in Philosophy. In2010, she moved to the uSa to pursue a Master’s in Psychological Sciences at JamesMadison university. n

Sap Division 29 Student excellence in Teaching/mentorship awardalice coyne

alice Coyne is a rising fifth year graduate student in ClinicalPsychology at the university of Massachusetts amherst. Since

beginning graduate school, she has worked in Dr. Michael Constantino’s Psy-chotherapy research lab. alice’s research focuses broadly on psychotherapyprocess, outcome, and integration, common treatment factors, dyadic analysis ofthe patient-therapist relationship, therapist effects, psychotherapy training, and inter-personal theory. This work has been disseminated at several professional confer-ences and in empirical peer-reviewed publications. During her time as a graduatestudent, alice has served as a teaching assistant for two undergraduate and twograduate courses. She has also served as a co-mentor for four undergraduate hon-ors students who completed empirical projects focused on psychotherapy processand outcome research. alice has also served as a methodology consultant for theCenter for research on Families at the university of Massachusetts amherst. n




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2018 grant recipients

50th anniversary grant Simon goldberg

Dr. Simon goldberg completed his PhD in counseling psychol-ogy at the university of Wisconsin - Madison under the mentor-ship of Drs. William Hoyt and Bruce Wampold. He completed hisclinical internship at the Seattle Va and received postdoctoraltraining in health services research at the Seattle Va and the

university of Washington. Simon will begin a position as assistant professor in theDepartment of Counseling Psychology at the university of Wisconsin - Madison inaugust, 2018. Simon’s work focuses on factors common across psychotherapies,with a particular emphasis on therapists’ contribution to outcome. He is also in-terested in the effects of mindfulness- and meditation-based interventions and mil-itary veteran mental health.

Dr. goldberg will be using the 50th anniversary grant to examine correlates oftherapist differences (i.e., therapist effects) in naturalistic psychotherapy. His studywill involve assessment of a variety of candidate therapist characteristics, includ-ing administering several non-self-report behavioral and performance tasks. Thesemeasures will be used to predict the outcomes of patients treated by these thera-pists. He hopes to provide information regarding therapist factors that are associ-ated with superior outcomes in psychotherapy that can be used to inform personnelselection and training. n

2018 norine Johnson research grantSigal Zilcha-mano

Sigal Zilcha-Mano is a licensed clinical psychologist, associate Pro-fessor of Clinical Psychology at the Department of Psychology, uni-versity of Haifa, and a Visiting associate Professor at the Healthyaging and late life Brain Disorders Program, Columbia univer-sity. She heads the Psychotherapy research lab at the Department

of Psychology, university of Haifa. She is associate Editor of the Journal of Counsel-ing Psychology, and on the editorial board of Psychotherapy, and of Psychotherapyresearch. Her research focuses on active ingredients in psychotherapy and in theplacebo effect, which bring about therapeutic change, including the working allianceand the expectancy regarding treatment progress. She investigates the distinct rolesthese active ingredients may play in different treatments and for different patients,with the aim of laying the foundation for evidence-based, patient-tailored treatment.

Dr. Zilcha-Mano is the recipient of the International Society for Psychotherapy re-search outstanding Early Career achievement award, and the Dusty and EttieMiller Fellowship for outstanding Young Scholars. She has received several re-search grants to support her work, including the Fulbright Fellowship (workingwith Jacques Barber at adelphi university), as well as research and equipmentgrants from the Israel Science Foundation and from the u.S.-Israel Binational Sci-ence Foundation (BSF). The norine Johnson, PhD, Psychotherapy research grantgives her the opportunity to investigate the effects of therapist’s use of techniquesto counter and complement the patient’s attachment orientations, and to examineits potential contribution to optimizing the efficacy of treatments for depression. n

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Sigal Zilcha-mano

Please see bio on page 68.

robinder (rob) p. Bedi

Dr. robinder (rob) P. Bedi is an associate professor ofcounselling psychology In the Department of Educa-tional and Counselling Psychology and Special Edu-cation at the university of British Columbia. He hasbeen designated a Senior research Fellow of the In-dian Council of Cultural relations and a university ofBritish Columbia leading Edge Scholar. Dr. Bedi’scurrent research interests include multicultural and cross-cultural counselling andpsychotherapy, particularly in India or with individuals of asian Indian descentand he conducts research both in India and in north america. n

2018 charles J. gelso, ph.D., psychotherapy research grantsThree recipients in 2018

elizabeth Demeusy

Elizabeth Demeusy, M.a. is a doctoral candidate in the Clin-ical Psychology program at the university of rochester. Herresearch interests broadly focus on evidence-based preven-tion and intervention programs for high-risk youth, specifi-cally those impoverished and with experiences of trauma. Inparticular, she is interested in child maltreatment preventionand the development of externalizing behavior problems inyoung children.

With this grant, Elizabeth plans to conduct a follow-up study on a multi-componentpreventative intervention designed to prevent child maltreatment and supporthealthy development in newborns of young mothers, for her dissertation. Follow-ing graduation, she hopes to continue this line of research by pursuing a career thatfocuses on the dissemination and implementation of evidence-based practices fordisadvantaged children and families. n

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International research grant for Students and early career professionals

Yuye Zhang

Yuye Zhang is a third-year doctoral student in counselingpsychology at Ball State university. originally from China,she is interested in the counseling process with Chineseclients, especially the Chinese cultural influences on clients’emotional experience in psychotherapy. She is keen on bridg-ing the research-practice gap. n

Diversty research grants

Shondolyn Sanders

Shondolyn is a fourth year Counseling Psychology doctoralstudent at the university of Memphis. She received a M.S inCounseling (Clinical rehabilitation) from the university ofMemphis and a B.a. in Psychology from the university ofarkansas at Fayetteville. She was born and raised in WestMemphis, ar and is the oldest of 5. Her research areas ofinterest include multicultural supervision and training,chronic illness adjustment, the transitioning of children withdisabilities to adulthood, and health disparities specific to ethnic/racial minorityindividuals. Her dissertation focuses on the supervision experiences of ethnicminority psychology graduate students. She is currently a pre-doctoral intern at theuniversity of oklahoma Health Sciences Center-Va track. Her favorite pastime isbeing the best aunt ever. n

Joey Sergi

Joey Sergi is a fourth year Clinical Psychology doctoral stu-dent at Ferkauf graduate School of Psychology, Yeshiva uni-versity. She holds a Master’s degree in Clinical Psychologyfrom Ferkauf and a Bachelor’s degree in anthropology fromWagner College. She is currently a pre-doctoral extern at theManhattan Veterans affairs Medical Center where she isworking on developing an integrative approach to treatmentthat balances the common factors across therapeutic ap-

proaches. Joey’s research interests include the therapeutic alliance, therapeutic rup-ture and repair, and multicultural and cross-cultural psychotherapy, especially withindividuals who identity as sexual minorities. Her dissertation will explore the im-pact of therapist-committed microaggressions on the therapeutic alliance forlgBTQ individuals. Through this project, she will examine the effect of therapistattempts to acknowledge and resolve these difficult moments when they occur insession. ultimately, Joey hopes that the findings of her study will contribute to en-hancing therapeutic outcomes for clients of diverse backgrounds by allowing herto develop an empirically-supported and culturally sensitive rupture-repair frame-work to aid clinicians in working cross-culturally. n

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The Editor would lead a very active and able group of Associate Editors and ad hoc re-viewers.

Qualifications include:n Open-mindedness and respect for contributions from all facets of (training, practice,

theory, research) and vantage points on (e.g., theoretical orientation, treatment modality, patient population) psychotherapy

n Extensive experience with the peer-review process at different levels of administration(e.g., ad hoc, editorial board, associate editor)

n Creative vision for the journal's short- and long-term futuren Strong leadership, staff selection, and communication skillsn Member of Division 29, in good standing throughout the term of the contract

This will be a 5-year term. Candidates should be available to start receiving manuscriptsas the Incoming Editor on January 1, 2020 to prepare for issues published beginning2021, when their editorial office will assume the masthead. The current editorial office willbe responsible for publishing the 2020 volume (57).The new editor will receive manuscripts through December 31, 2024, publishing in theyears 2021 (volume 58) through 2025 (volume 62).Editorial responsibilities take 15–20 hours/week.An honorarium, office expenses, and APA support are provided.Please note that the Society for the Advancement of Psychotherapy encourages participationby members of underrepresented groups in the publication process and would particularlywelcome such nominees. Self-nominations are also encouraged.Laurie Heatherington, PhD, Division 29 Publication Board Chair, will chair the search.Please address inquiries to her.Please go to APA's Editor Search website to enter the candidate's name and a brief statement of support.The deadline for accepting nominations is August 1, 2018, when initial reviews will begin.The search committee will contact nominees to assess interest and request additionalmaterials by mid August, Skype interviews will be conducted at the end of the secondweek in September, and, if needed, in-person interviews will occur in February.Final decisions will be announced by March 1, 2019.ABOUT THE JOURNALPsychotherapy is a highly ranked clinical psychology journal, published quarterly. It pub-lishes a wide variety of articles relevant to the field of psychotherapy.Encompassing the many essential elements of psychotherapy, the journal strives to fostercontributions from and interactions among individuals involved with training, practice, the-ory, and research. Thus, articles in Psychotherapy include theoretical contributions, origi-nal research, novel ideas, and examples of practice-relevant issues that would stimulatedialogue and/or debate among theorists, therapists, and researchers.

The journal includes the widest scope of orientations to inform the readership. Seethe Psychotherapy website for more information.

http://www.apa.org/pubs/authors/call-for-nominations.aspx

APA Division 29 (Society for the Advancement of Psychotherapy)has opened nominations for the editorship of

the Division journal, Psychotherapy

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Name ___________________________________________ Degree ____________________Address ___________________________________________________________________City _______________________________________ State ________ ZIP________________Phone _________________________________ FAX ________________________________Email _______________________________________________Member Type: q Regular q Fellow q Associate q Non-APA Psychologist Affiliate q Student ($29)q Check q Visa q MasterCardCard # __________________________________________________ Exp Date _____/_____Signature ___________________________________________

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

The Society for the Advancement of Psychotherapy’s Central Office,6557 E. Riverdale St., Mesa, AZ 85215

You can also join the Division online at: www.societyforpsychotherapy.org

FREE SUBSCRIPTIONS TO:PsychotherapyThis quarterly journal features up-to-date articles on psychotherapy. Contributors include researchers, practitioners, and educators with diverse approaches.Psychotherapy BulletinQuarterly newsletter contains the latest newsabout Society activities, helpful articles on training, research, and practice. Available tomembers only.

EARN CE CREDITSJournal LearningYou can earn Continuing Education (CE) credit from the comfort of your home or office—at your own pace—when it’s convenientfor you. Members earn CE credit by reading specific articles published in Psychotherapyand completing quizzes.

DIVISION 29 PROGRAMSWe offer exceptional programs at the APAconvention featuring leaders in the field of psychotherapy. Learn from the experts in personal settings and earn CE credits at reduced rates.

SOCIETY INITIATIVESProfit from the Society initiatives such as

the APA Psychotherapy Videotape Series, History of Psychotherapy book, and Psychotherapy Relationships that Work.

NETWORKING & REFERRAL SOURCESConnect with other psychotherapists so

that 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 of ourchosen field. There are many opportunities toserve on a wide range of Society committees and task forces.

DIVISION 29 LISTSERVAs a member, you have access to our

Society listserv, where you can exchange information with other professionals.

VISIT OUR WEBSITEwww.societyforpsychotherapy.org

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

If APA member, please provide membership #

SOCIET Y FOR TH E AD VANC EMENT OF PSYCH OTH ERAPYTHE ONLY APA DIVISION SOLELY DEDICATED TO ADVANCING PSYCHOTHERAPY

M E M B E R S H I P A P P L I C A T I O NThe Society meets the unique needs of psychologists interested in psychotherapy.

By joining the Society for the Advancement of Psychotherapy, you become part of a family of practitioners, scholars, and students who exchange ideas in order to advance psychotherapy.The Society is comprised of psychologists and students who are interested in psychotherapy.

Although the Society is a division of the American Psychological Association (APA), APA membership is not required for membership in the Society.

JOIN THE SOCIETY AND GET THESE BENEFITS!

Society for the advancement 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 the Society for the advancement of Psychotherapy of the american Psychological association. Published online four times each year(spring, summer, fall, winter), Psychotherapy Bulletin is designed to: 1) inform the membership of Division 29 about relevant events, awards, and professional opportunities; 2) provide articles and commentary regarding the range of issues that are of interest to psychotherapy theorists, researchers, practitioners, and trainers; 3) establish a forum for students and new members to offer their contributions; and, 4) facilitate opportunities for dialogue and collaboration among the diverse members of our association.

Psychotherapy Bulletin welcomes articles, interviews, commentaries, letters to the editor, book re-views, and SaP-related announcements. Please ensure that articles conform to aPa style; graphics,tables, or photos submitted with articles must be of print quality and in high resolution. CompleteSubmission guidelines and the online submission portal can be found at http://society forpsy-chotherapy.org/bulletin-about/ (for questions or additional information, please email [email protected] with the subject header line Psychotherapy Bulletin). Deadlines forsubmission are as follows: February 1 (#1); May 1 (#2); august 1 (#3); november 1 (#4). Past is-sues of Psychotherapy Bulletin may be viewed at our website: www.societyforpsycho -therapy.org.other inquiries regarding Psychotherapy Bulletin (e.g., advertising) or the Society should be di-rected to Tracey Martin at the the Society’s Central office ([email protected] or 602-363-9211).

Standing Committees, continuedPsychotherapy PracticeChair: Barbara Vivino, PhD921 The Alameda #109Berkeley, CA 94707Ofc: 510-303-6650E-mail: [email protected]

Psychotherapy ResearchChair: Joshua Swift, PhDDepartment of PsychologyUniversity of Alaska Anchorage3211 Providence Drive, SSB214Anchorage, Alaska 99508 Phone: 907-786-1726E-mail: [email protected]

Social JusticeLinda Campbell, PhDDept of Counseling & Human DevelopmentUniversity of Georgia 402 Aderhold Hall Athens, GA 30602Ofc: 706-542-8508 Fax: 770-594-9441E-mail: [email protected]

PUBLICATIONS BOARDChair: Laurie Heatherington, PhD, 2018Dept of Psychology / Williams CollegeWilliamstown, MA 01267Ofc: 413-597-2442 | Fax: 413-597-2085E-mail: [email protected]

Lillian Comas-Diaz, PhD, 2014-2019908 New Hampshire Ave., NW Suite 700Washington, D.C. 20037Ofc: 202-775-1938E-mail: [email protected]

Steven Gold, PhD, 2013-2018Center for Psychological StudiesNova Southeastern University3301 College AveFort Lauderdale , FL 33314Ofc: 954-262-5714 | Fax: 954-262-3857

Publications Board, continuedRobert Hatcher, PhD, 2015-2020Wellness Center / Graduate CenterCity University of New York365 Fifth AvenueNew York, NY 10016Ofc: 212-817-7029E-mail: [email protected]

Heather Lyons, PhD, 2014-2019Department of Psychology – Loyola University Maryland4501 N. Charles St.Baltimore, MD 21210Ofc: 410-617-2309E-mail: [email protected]

Terrence Tracey, PhD 2018-2023College of Integrative Science & Arts / Arizona State University446 Payne Hall, mc-870811Tempe, AZ 85287-0811Office: 480-965-6159Email: [email protected]

Brien Goodwin (2017-2019) – Student Representative

\EDITORSPsychotherapy Journal EditorMark J. Hilsenroth, PhD, 2011-2020Derner Institute of Advanced Psych Studies220 Weinberg Bldg.158 Cambridge Ave.Adelphi UniversityGarden City, NY 11530Ofc: (516) 877-4748 Fax (516) 877-4805E-mail: [email protected]

Psychotherapy Bulletin Editor, 2014-2019Lynett Henderson Metzger, JD, PsyDUniversity of Denver-GSPP2460 South Vine StreetDenver, CO 80208Ofc: 303-871-4684E-mail: [email protected]

Internet EditorAmy Ellis, PhDAlbizu University2173 NW 99 AvenueMiami, Florida 33172-2209Ofc: 305-593-1223 x3233E-mail: [email protected]

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