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PAIDPermit No. 1467Ft. Worth, Texas

Summer 2004Volume 55, Issue 2

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Texas Psychologist 1SUMMER 2004

Features

7 Evidence-Based Practice and the Endeavor of PsychotherapyCarol D. Goodheart, EdD

11 How Will Texas Implement Atkins?Ollie J. Seay, PhD

12 Sunset Committee ReportMelba Vasquez, PhD

13 Local Area Society UpdatesDallas, Houston, El Paso and Southeast Texas

16 “Lab Work” at McKenna HospitalAllison R. Williams, BS

Ollie J. Seay, PhD

18 CE Credit Home Study - The Therapeutic ContractEric Marine, American Professional Agency

25 Never Stand in Front of Flowing Lava—RxP on the MovePat DeLeon, PhD

Departments

2 From the EditorElizabeth L. Richeson, PhD

4 From the PresidentC. Alan Hopewell, PhD

6 From TPA HeadquartersDavid White, CAE, Executive Director

26 LAW

27 2004 PSY-PAC Contributors

28 2004 Texas Psychological Fund Contributors

28 2003 Sunrise Fund Contributors

28 New Members

29 Classified Advertising

30 Disaster Response Network

Elizabeth Richeson, PhDEditor

David White, CAEExecutive Director

Lynda KeenExecutive Assistant

Sherry ReismanDirector of Convention & Non-Dues

TPA BOARD OF TRUSTEES

C. Alan Hopewell, PhDPresident

Paul Burney, PhDPresident-Elect

Melba J. T. Vasquez, PhDPresident-Elect Designate

Deanna F. Yates, PhDPast-President

Board MembersRon Cohorn, PhD

Donna Davenport, PhDRichard Fulbright, PhDCharlotte Kimmel, PhD

Kimberly McClanahan, PhDRobert McPherson, PhD

Suzanne Mouton-Odum, PhDRoberta L. Nutt, PhD

Dean Paret, PhDM. David Rudd, PhD

Ollie Seay, PhD

EX-OFFICIO BOARD MEMBERS

Randy Noblitt, PhDFederal Advocacy Coordinator

Melba J. T. VasquezCAPP Representative

Lane Ogden, PhDTexas Psychological Foundation President

Richard M. McGraw, PhDBusiness of Practice Network Representative

LaDonna SaxonStudent Division Director

PUBLISHERRector-Duncan & Associates

P.O. Box 14667Austin, TX 78761

512-454-5262

Stephanie ShawManaging Editor

Lance LawhonAdvertising Manager

Megan MollerProduction Coordinator

The Texas Psychological Association islocated at 1011 Meredith Drive, Suite 4,Austin, Texas 78748. TexasPsychologist (ISSN 0749-3185) is theofficial publication of TPA and ispublished quarterly.

www.texaspsyc.org

SUMMER 2004 VOLUME 55, ISSUE 2

This issue of the Texas Psychologistaffords us a perfect opportunity to

share some of the many exciting

things that are happening with psychologyaround Texas. There was a good response

from some of our Local Area Societies

(LAS) updating us as to what their specific

accomplishments and foci are at present as

well as their plans for the future. In thisissue you’ll read about the LAS of Dallas, El

Paso, Houston, and Southeast Texas. It is

my hope that these articles will inspire us allwith ideas that we can incorporate into our

own cities and towns as we continue to

make psychology a household word and

proceed with our grassroots agenda forSunset review.

After reading Ms. Allison Williams and

Dr. Seay’s article introducing us to Annie,

the therapy dog, I gave Winnie our Springer

Spaniel an extra hug for her therapeutic

value in our household. There is no

question the therapeutic value of our pets,

and Williams and Seay share the story of a

very successful program using a therapy dog

in Texas. Attorney Sam Houston has

provided us with a very timely article

regarding duty to discuss adverse effects of

psychotropic medications with our patients.

This is an especially well-timed article giventhe recent press regarding suicide and

antidepressant medications. Additional

timely and pertinent information can befound in Dr. Melba Vasquez’s article that

provides a report from the March 23rd

formal testimony to the Sunset Committee

in which she participated.

Also in this issue is an opportunity forinterested psychologists to become a part of

the Disaster Response Network (DRN) in

Texas. Please see the “Call for TPAPsychologists to Disaster Response” by the

two Texas DRN Coordinators, Drs. Judith

Andrews and Rita Justice.

The Texas Implementation of the

Supreme Court Decision in Atkins v.Virginia (Mental Retardation & Death

Penalty) is given a final review by Dr. Ollie

Seay, the TPA Public Policy Chair,

bringing us up to date on this critically

important issue.

In addition to reading what is going on

around Texas, Dr. Pat DeLeon, Past

President of APA, gives us an updated

global picture about prescriptive authority

in his article “Never Stand in Front of

Flowing Lava—RxP on the Move.” Dr.

Carol D. Goodheart of New Jersey, a

Member of the Board of Directors at APA,

provides a thought-provoking article,

“Evidence-based Practice and the Endeavor

of Psychotherapy,” which addresses an area

of national significant interest today.

As always, reading our regular columns“From the President” (Dr. Alan Hopewell)

and “From TPA Headquarters” (David

White, CAE, Executive Director) allows usto stay on top of the developments in

psychology in Texas. I want to reiterateDavid White’s recommendation to go tothe Web site at www.sunset.state.tx.us toreview the information on the SunsetCommission and further recommend youfamiliarize yourself with this site in orderto follow the developments of SunsetLegislation as they unfold.

Please send articles for consideration to

elricheson@earthlik.net or Dr. Elizabeth L.

Richeson, 600 Sunland Park Drive, 6-400,

El Paso, TX 79912. I look forward tohearing from you. ✯

2 Texas Psychologist SUMMER 2004

FROM THE EDITOR

Elizabeth L. Richeson, PhD, MS PsyPharm

Our next issue of the Texas Psychologist is the fall pre-convention issue and will feature information on

the convention. The format of the journal will change to an online newsletter beginning with the fall

pre-convention issue. As we make this leap into the 21st century, we hope to reach even more

psychologists, students and others across Texas or anywhere in the world. Additionally, this will give

us the opportunity to include more timely articles because our production time is greatly decreased. If

you are not receiving email from TPA and want to receive the new version of our newsletter, please

email newsletter@texaspsyc.org. There is no need to email us if you are already receiving informational

emails from TPA. We are excited to offer this service to psychologists in the state of Texas!

Texas Psychologist 3SUMMER 2004

4 Texas Psychologist SUMMER 2004

Following a Board retreat and a busy

Board meeting in Fort Worth

during January, several members

attended the State Leadership Conference

in Washington, D.C. This proved to be one

of the busiest conferences ever as there was

much to do and the Texas delegation was

actively involved in more presentations and

meetings than ever before. For the first

time, central office staff member Sherry

Reisman presented at one of the programs.

David White helped network with groups

like the Pennsylvania delegation, which

sparked a number of helpful ideas we can

use in Texas. Bob McPherson, Rick

McGraw, Dee Yates, and Paul Burney had

special assignments. Lane Ogden and

Randy Noblitt accepted appointments as

Federal Advocacy Coordinators and have

been hard at work on my “Legislative 181

Project,” in which we are coordinating our

psychologist/legislator liaison network

throughout the state as we build our

legislative relationships. Working with

them on this is Walt Cubberly, who is

serving as State Advocacy Coordinator for

the Houston area. We were also pleased to

have Celia Servin-Lopez as our diversity

delegate. Many of us braved freezing rain

and even light snow on our “Hill Day,”

when we visited our representatives and

urged them to vote for mental health parity

against insurance plans, which could opt-

out of state laws and mental health

coverage, and for an extension of mental

illness court demonstration projects.

Our March Board meeting was held in

the Woodlands in conjunction with a very

well-attended Spring Professional

Education Conference, sponsored by the

Houston LAS. The conference focused on

practice, legal, and ethical issues, and also

highlighted the quality of work which

continues throughout the year by our local

area societies. Other LASs have also been

busy with Fort Worth preparing an

invitation for many of the Tarrant County

representatives to address legislative issues.

Don Wolff of Collin County LAS

sponsored a TPA update made by me, but

his wife was posted to Germany, so Bob

Weiner carried on into 2004 as Past-

President.

Also, with our large military

population, the War on Terror continues to

present challenges to us here in Texas.

Nationwide, we have had some of our

Reserve colleagues report for active service,

including some of our TPA members for

both stateside and overseas duty

assignments. Especially at Ft. Hood, we

have had a year with large numbers of

military families with spouses overseas,

many of them just now returning with the

inevitable stress-related and adjustment

issues. The war is not yet over, but we

already owe our military and our first

FROM THE PRESIDENT

C. Alan Hopewell, PhD, MS, Psypharm, ABPP

The Texas Psychological Association, Board of Trustees, and the Central Office met a flurry of activity

in the beginning of 2004. Of paramount importance, our Sunset Committee worked steadily and then

responded to the initial round of formal inquiries made by the Legislative Sunset Commission. In

March, the Committee, along with the Board of Examiners, represented the views of TPA when they

gave formal testimony at the public hearing of the Commission. The Sunset Committee, with the help

of our legislative consultant Chris Shields and co-chairs Melba Vasquez, PhD, and David Rudd, PhD,

worked extremely hard and did a very good job. Thanks to the work of the Committee and the support

we have received from TPA members, we believe we are well positioned as we enter the Sunset

process. As expected, anything can happen during this time. We need to remain vigilant and work

together to ensure that our licensing law is renewed as we wish to define it and not as those untrained

in psychology would wish it to be defined.

Texas Psychologist 5SUMMER 2004

responders more than we can ever really repay. We as psychologists

can also do much to help avoid some of the problems that we had

when veterans previously returned from Vietnam. Even in doing

routine rehabilitation work, I am surprised at how often a patient has

a relative in the service (often it is a grandparent who brings their

picture to the hospital room). Additional stressors can often interact

with depression, pain, and other syndromes. Interested TPA

members may also want to work with the APA Resilience Program

or coordinate with our Disaster Response Network. If you see a first

responder or military member while at the store or gas station,

simply telling them that you appreciate their service goes a long way.

And finally, congratulations to all students who are graduating this

spring and to those who are also receiving military commissions and

entering service to the country. ✯

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6 Texas Psychologist SUMMER 2004

SUNSET LEGISLATION

In the Summer 2003 issue of the Texas

Psychologist, I shared with you the

process that the Texas State Board of

Examiners of Psychology must undergo to

determine if the state will continue to

license psychologists. Since that time we

have met with the Sunset Commission staff

and developed position papers on behalf of

the profession, outlining what our concerns

and desires are for psychology and, in

particular, TSBEP. As the state of Texas

continues to deal with budget issues, one

strategy under consideration, and in some

cases implementation, is state agency

consolidation in which several boards will

be collapsed into one. Many types of

consolidation have been discussed ranging

from internal functions to actual policy and

rulemaking consolidation. The Sunset

Advisory Commission staff has completed

their recommendations, which they have

presented to the 10-member panel of the

Sunset Commission. I would STRONGLY

encourage you to look at these

recommendations at www.sunset.state.tx.us.

Their recommendations were presented

to the Commission on March 23, 2004 at

which time our TPA leaders had the

opportunity to testify about these

recommendations. You can view the actual

testimony by going to www.senate.

state.tx.us/75r/Senate/AVarch.htm and

selecting the “March 23 – Sunset Advisory

Committee.” (TSBEP was the first agency to

testify so it will be the beginning of this tape.)

As you know, the licensed psychological

associates have been working on gaining the

status of independent practitioners, and as we

learned at this testimony, they will try again

next session. If you are not engaged in this

process by either contacting your legislator,

joining and participating in your LAS, or

joining TPA, you are risking a change in your

current right to practice psychology. I cannot

impress upon you the need to ACT and

ACT NOW. Your profession is at stake.

MEDICARE/MEDICAIDAs many of you know, during the last

legislative session a bill passed that took

away Medicaid “optional services.” Well,

we are getting hit again. In the next

couple of weeks, the Medicare Advisory

Committee will be discussing yet another

cut in reimbursement which would

significantly lower by 20 to 30 percent

the reimbursement for physicians,

psychologists, and nursing facilities and

other providers of health care services to

dually eligible Medicare-Medicaid

beneficiaries. The majority of nursing

home residents are dually eligible

beneficiaries, and health care providers

might drop services to this group if the fee

cut is severe. Those receiving mental

health services are especially affected

because Medicare pays only 50 percent

(not the standard 80 percent) for mental

health; thus the fee cut for these services

will be even worse. We need

psychologists to speak out against these

cuts. We need to stand up as a profession

and let the bureaucrats understand the

impact these cuts will have on citizens of

this state. Please monitor the TPA Web

site and look for legislative alerts for

the action you can take regarding these

issues. ✯

Capital Update

In the past, I have taken the opportunity to share with you the importance of getting involved in the

legislative process by encouraging you to get to know your legislator and make contact with him/her

on behalf of TPA to share the critical issues that are facing the profession. Well, let me give you an

update on where we are on some legislative issues and what we need from you.

FROM TPA HEADQUARTERS

David White, CAE ,TPA Executive Director

Texas Psychologist 7SUMMER 2004

Many of us who are clinicians

want to broaden the

discussion of evidence-based

psychotherapy. We want to move beyond

the basics of the easy to measure efficacy

studies and into a more complex realm. In

today’s climate, it is a challenge for practicing

psychologists to balance the needs to develop

and maintain a personally effective

therapeutic voice, translate multiple streams

of evidence into meaningful interventions,

offer safe and confidential therapeutic

relationships, and practice in the real world.

Disparate voices carry conflicting messages

about the need for psychotherapy and its

costs, worth, components, allowable

interventions, and effectiveness. These forces,

both within the discipline of psychology and

outside in the health care system, compete for

supremacy and the attention of clinicians.

It is important for clinicians to join in

the discussion and to share information on

practices that contribute to good results for

patients. Our discipline needs a

bidirectional conversation between clinical

scientists and clinical practitioners. Our

academic colleagues are giving us

information daily about specific treatments

and elements of the therapeutic relationship

that work. We need to give them

information about the problems we identify

in our communities, the ways we approach

those problems, and the outcomes.

This article gives an overview of our

knowledge about psychotherapy: the

endeavor of psychotherapy, the evidence we

use for its underpinnings, and the resources

we turn to for guidance in the absence of

hard research findings.

EvidenceWhat do we mean when we talk about

evidence? The foundation for psychology is

science, of course. The practice of

psychology is built upon that base,

although clinicians are faced also with

problems that go beyond what the research

has yet been able to describe, measure, or

ameliorate.

The Institute of Medicine defines

Evidence-Based Practice as: “the integration

of the best research evidence with clinical

expertise and patient values” (Sackett et al.,

2000). The APA document, Criteria for

evaluating treatment guidelines, integrates the

same three components: empirical research,

clinical judgment and expertise, and

acceptability to the patient (American

Psychological Association, 2002).

Most knowledgeable psychologists

support this kind of broad scientific

Evidence-Based Practice and the Endeavor of Psychotherapy

Carol D. Goodheart, EdDIndependent PracticePrinceton, New Jersey

Member Board of Directors, APA

8 Texas Psychologist SUMMER 2004

definition for psychotherapy. There are,

however, some who would like to minimize

or eliminate the roles of clinical observation,

and judgment and patient values. That is a

mistake, if one considers the nature of

psychotherapy and the resources available

that contribute to its success.

EndeavorPsychotherapy is first and foremost a

human endeavor. It is messy. It is not solely a

scientific endeavor, nor can it be reduced to a

technical mechanistic enterprise. The

triumvirate of factors that contribute to

psychotherapy outcome is: the patient’s

personal factors (e.g. motivation), the

therapist’s personal factors (e.g., capacity for

empathy), and the interventions offered.

Keep in mind that specific techniques

contribute only 5 percent to 15 percent to the

outcome (Norcross, 2002). Therapist effects

are greater than treatment effects (Wampold,

2001). People get a substantial benefit from

psychotherapy and no one modality is shown

to be better than all the others (Seligman,

1995). We know that suffering is a part of

the human experience, and we know that

psychotherapy is effective in easing that

suffering, no matter how you define it.

Psychotherapy is a rich process. It is an

attempt to reach understanding, ease pain,

solve problems, and find meaning within the

context of a trusting relationship. Our

patients want to be heard and understood.

They want respectful help in obtaining

relief, making sense out of their experiences

and improving their lives. Each wants to be

treated as a whole person, not a diagnosis or

a case. Real world psychotherapy involves

working in the face of a few variables one

can control and with the knowledge that

there are many one cannot control. This is

where clinical experience, judgment, and

the ability to use creative combinations and

adaptations of interventions come into play.

Psychotherapy draws on many theories,

including behavioral, cognitive behavioral,

family systems, feminist, humanistic,

psychodynamic, and cultural competency

orientations. Perhaps not surprisingly,

different patients make different theories

look good, depending on the “fit” in

language and world view between the person

seeking help and the person providing it. In

practices across the country, underlying

theories may differ but experienced clinicians

look quite similar. They offer proven

interventions, a solid therapeutic

relationship, and a shared expectation with

the patient for a positive outcome. Good

clinicians borrow what works from each

other. There are few differences among bona

fide therapies, widely practiced over time,

that have a coherent theoretical structure and

a research underpinning (Wampold, 2001;

Messer, 1995).

Psychotherapy is an art as well as a

science. It is a fluid, mutual, and interactive

process. Each participant shapes and is

shaped by the other. Good clinicians

respond to the nuances of language, both

verbal and bodily expressions. They are

masters of tact and timing, of when to push

and when to be patient. They are creative in

finding paths to understanding, in

matching an intervention to a need.

Psychotherapy is complex. Our patients’

biological predispositions, personalities,

preferences, developmental level, and

psychological functioning intertwine with

their life circumstances and stressors. The

great preponderance of psychotherapy

patients have cross diagnostic issues and

comorbid conditions. Dual diagnosis is

common. We know that individually

tailored interventions can be as much as

100 percent more effective than

standardized ones (Azur, 1999).

ResourcesWhere do clinicians turn for guidance

to make decisions and treatment choices for

psychotherapy? Psychologists use a

combination of tools to do meaningful and

effective psychotherapy. We use research

evidence where it exists, modify it where

necessary, and create new interventions in

the field on a case by case basis, often by

combining accepted techniques from

different areas in novel ways. We seek

feedback and guidance from multiple

sources on how it is working and how it can

be improved. Where the research evidence

is spotty, we draw upon evidence from our

clinical experience and expertise.

Here is a brief list of some of the

sources of guidance valuable to clinicians:

1. Doctoral Training Program and Internship

It is humbling to learn publicly in front

of one-way mirrors with supervisors and

fellow students how to do an intake; build an

alliance; develop working hypotheses about a

patient; make a diagnosis; offer trial

interventions appropriate to the person and

the situation; appraise the response; continue

or change course; and come to a mutual

agreement on a treatment plan, goals, and

termination. The training period is also the

initiation into a practitioner work ethic that

values openness about one’s work and builds

in an ongoing expectation of feedback.

2. Observation

Observation, both in session and over

time, is a powerful tool. It includes four

types of observational skills: objective (from

the outside), participant (including

awareness of the reciprocal effects on

observer and observed), subjective

(empathic and intuitive), and self (self-

examination) (Shakow, 1976). A therapist

functions as a finely tuned instrument and

thinking person, not as a technician

following a script.

3. Experience

Clinicians turn frequently to their own

experience for guidance. Faced with a

difficult or murky psychotherapy situation,

clinicians sort through their own

experiences and expertise for a way to move

the treatment forward. Often this process is

associative, rather than linear. Clinical

judgment is necessary. Sometimes we make

mistakes, but then we learn from them and

add to our expertise.

Texas Psychologist 9SUMMER 2004

4. Patient Report

Patients are a primary source of

information about how psychotherapy is

progressing. An attuned clinician gains

valuable feedback about improvements or

setbacks that are taking place outside the

treatment room in the patient’s everyday life.

5. Third Party Report

It is not only the patient who gives

feedback to the clinician, but it may be a

spouse or parent who contributes

observations about changes in the patient. In

some particular circumstances, it may be the

patient’s physician, attorney, or employer.

6. Consultations and Peer Discussion

Regular consultations and case

discussions shed light on our thinking and

broaden our perspective. They push us to talk

about cases that are puzzling, or not going

well, or that may have one aspect that is

bothersome or unique. Group consensus may

not always be correct, but it is a valuable tool.

7. Continuing Education

Some programs are skill based, such as

a workshop that teaches specific techniques

for use with pain. Some programs might

better be characterized as focused on

attitude and growth, such as the “Difficult

Dialog” workshops held at the APA

Multicultural Conference last year.

8. Professional Literature

Often clinicians do not read journal

articles that address research directly

applicable to clinical problems. They do read

books of clinical relevance to their practices,

and they value the journals that are most

helpful to clinicians, such as Professional

Psychology: Research and Practice and the

Clinicians Research Digest.

9. Internet

Clinicians have benefited greatly from

internet access, which did not exist when

some of us started practice. From our

offices we can gain needed information

quickly, without taking time away from

practice to go to the nearest university or

medical school library.

10. The Patient’s Impact

This variable in the therapeutic

relationship was described first in

psychoanalytic theory as countertransference.

It is an important psychotherapy

phenomenon and is now recognized across

other theoretical orientations, based on a

somewhat limited but growing body of

empirical research that shows its effects on

treatment (Gelso & Hayes, 2002). It helps us

all to recognize the impact of working in

psychotherapy with people who are distressed

and may be quite disturbing.

11. Outcome Assessment

This may be a formal or informal

process used for guidance. More clinicians

seem to use informal evaluations rather than

formal methods at the end of psychotherapy,

although this is changing. It is quite

straightforward to ascertain information

about global improvement and symptom

reduction. It can be harder to tease out the

multiple variables that have contributed to

the result. Outcome measures are an

excellent source of guidance for clinicians

and a wonderful reinforcement for work well

done. We can also use our outcomes to show

the world psychotherapy works.

ConclusionsClinicians need and prize evidence. We

learn over time to use evidence and

guidance without subscribing to artificially

constructed hierarchies about which

evidence is most important because

usefulness varies widely. Our “best

practices” are built on a foundation of

empirical research; comprehensible and

reasoned theories; clinical observation

and expertise; and our patient’s values,

contributions, and responses. ✯

ReferencesAmerican Psychological Association. (2002).

Criteria for evaluating treatment guidelines.

American Psychologist, 57 (12), 1052-1059.

Azur, B. (1999). Tailored interventions prove

more effective. APA Monitor, 30 (6), 38-9.

Gelso, C. J., & Hayes, J. A. (2002). The

management of countertransference, In:

Norcross, J.C. (ed). Psychotherapy relationships

that work. New York: Oxford University Press.

Messer, S.B. (2002). Empirically supported

treatments: Cautionary notes. Medscape

General Medicine 4(4). http://www.

medscape.com/viewarticle/445082

Norcross, J.C. (2002). Empirically supported

relationships. In: Norcross, J.C. (ed).

Psychotherapy relationships that work. New

York: Oxford University Press.

Sackett, D. L., Strauss S. E., Richardson, W.

S., Rosenberg, W., & Haynes, R.B. (2000).

Evidence based medicine: How to practice and

teach EBM. Second Edition. London,

England: Churchill, Livingston.

Seligman, M. E.P. (1995). The effectiveness

of psychotherapy: The Consumer Reports

Study. American Psychologist, 50, (12),

965-974.

Shakow, D. (1976). What is clinical

psychology? American Psychologist, 31,

553-560.

Wampold, B.E. (2001). The great

psychotherapy debate: Models, methods, and

findings. Mahwah, NJ: Erlbaum.

10 Texas Psychologist SUMMER 2004

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Programs for Anorexia and Bulimia • www.remudaranch.com

1-800-445-1900

In response to the growing trend of younger and younger girls being

afflicted with eating disorders, Remuda Ranch has developed an

innovative new treatment program. The Children’s Intensive Program

will address the unique needs of girls under the age of 13 struggling

with anorexia, bulimia and related issues.

As with Remuda’s other Biblically based intensive programs, patients

will receive individualized care in a safe, secure ranch setting. Our mul-

tidisciplinary treatment team will include a Child Psychiatrist, Primary

Care Provider, Psychologist, Masters Level Therapist, Family Therapist,

Registered Dietitian, Registered Nurse and an Education Coordinator.

The Children’s Intensive Program at Remuda Ranch will open in

May of 2004.

Announcing the Children’s Intensive Program at Remuda Ranch.

Bring up the Death Penalty in any

large group and you can be assured of

finding a difference of opinion.

Bring up the Death Penalty in the Texas

Legislature and you’d better hang on to your

hat! For at least the last three sessions, at least

one bill has been introduced to address a ban

on the execution of criminals who have

mental retardation. Yet as of today, Texas is no

closer to implementing a law in this area

despite the Supreme Court ruling in Atkins v.

Virginia in June 2002.

There are two points of view in the

legislature as reflected in the bills presented

by Sen. Rodney Ellis (D-Houston) and Rep.

Terry Keel (R-Austin) during the last session.

The biggest difference in the bills has to do

with the timing of the determination of

mental retardation and who will hear the case

for this phase. In Sen. Ellis’ bill, the issue of

mental retardation would be

decided before a capital trial was

pursued and would allow the

jury to be waived by the

defendant such that a judge

could make the determination

after hearing testimony from

experts. In Rep. Keel’s bill, the

same jury that heard the capital

case would make the decision on

mental retardation after a

defendant had been found

guilty.

In March of this year,

Capacity for Justice, a non-

profit organization that

addresses competency issues for

respondents and defendants

with mental illness, mental

retardation or concurrent

mental and substance use

disorders, held the first of what should be

several meetings on implementing the

Atkins decision in Texas. They invited TPA

and representatives of other professional

organizations, attorneys, service

organizations and advocates to help make

recommendations to the Legislature. One

approach is to find areas in which we can

agree first, then see what we can negotiate on

the timing issue. The other issues to be

discussed include the definition of mental

retardation, who should conduct the

assessment of mental retardation, and what

factors should be considered in the

evaluation and included in the report.

An update will be included in the next

issue of the Texas Psychologist. The adjacent

Position Statement was adopted by the TPA

Board of Trustees at their March 26, 2004

meeting:

How Will Texas Implement Atkins?

Ollie J. Seay, PhDTPA Public Policy Chair

Texas Psychologist 11SUMMER 2004

TPA Position Statement

Texas Implementation of the Supreme

Court Decision in Atkins v. Virginia

(Mental Retardation & Death Penalty)

March 26, 2004

In issues relating to the Death Penalty,

the Texas Psychological Association supports

legislation that provides a clear definition of

mental retardation that is consistent with

nationally accepted professional standards.

Such a definition of mental retardation

requires three elements: significantly

subaverage general intellectual functioning,

limitations in adaptive behavior, and

origination during the developmental period.

Significantly subaverage general

intellectual functioning in this definition

refers to measured intelligence on a

standardized psychometric instrument of two

or more standard deviations below the age

group mean for the test used. Adaptive

behavior means the effectiveness or degree to

which a person meets the generally

recognized standards of personal

independence and social responsibility.

Developmental period refers to the period

from birth to age eighteen. Any further

qualification of the definition should be

clearly articulated so that the result is

measurable and necessary.

Licensed psychologists, particularly

those with appropriate training and

experience in diagnosing mental retardation,

are the most qualified professionals to

determine mental retardation through use of

psychometric instruments and assessment

techniques. There are already precedents for

the use of licensed psychologists in other laws

relating to forensic assessment of competence

to stand trial and juvenile fitness. In addition,

other state statutes on determination of

mental retardation specify the use of licensed

psychologists. While collaboration with

experts from other professions may assist in

such areas as historical data collection, the

resulting diagnostic determination must be

made by the licensed psychologist.✯

12 Texas Psychologist SUMMER 2004

On Tuesday, March 23, 2004, the Texas Psychological Association provided testimony to the Legislative Sunset Review

Commission. The Texas State Board of Examiners of Psychologists was the first of the scheduled groups to provide testimony

during a two-day hearing. Drs. David Rudd and Melba Vasquez, who have served as co-chairs of the TPA Sunset Review

Committee, provided testimony that focused on the critical points to address in the Sunset Advisory Commission Staff Report during their

allotted five minutes of presentation. Dr. Robert McPherson, TPA’s Director of Professional Affairs, provided response to testimony from

Psychological Associates who made a request for the independent practice of psychology. Dr. Paul Burney, TPA President-Elect, was available

as a resource. Chris Shields, TPA lobbyist, and David White, TPA Executive Director, were also in attendance. The Sunset Review

Commission will provide its recommendations to the legislature on May 18 and 19.

TPA will continue to monitor information, and continue to provide input as appropriate. A draft summary of the commentary is

included below.

Sunset Committee Report

Melba Vasquez, PhD

TPA would like to thank the members of the Sunset

Commission for the opportunity to offer public testimony here

today. We would also like to acknowledge and thank the staff for

their exceptional efforts and gracious assistance during this process.

The staff has responded in courteous and timely fashion to our

requests, allowing us ample time to review and respond to issues

raised.

1. TPA supports continuing the Psychology Board as an independent

state agency and regulatory body.

• For over 30 years the Psychology Board has served and

protected the people of Texas as an independent state agency

and regulatory body.

• Given the complexity of professional psychology, an

independent board provides critical public and professional

representation, which is essential to the public.

• A board provides protection in terms of both licensing

qualified psychologists and enforcing rules of practice.

• If reorganization is pursued at some point or the possibility of

consolidation is discussed, TPA respectfully requests the

opportunity to provide additional input and offer further

testimony as the need arises.

2. TPA supports continuation of the Board’s oral examination for

psychologist licensure candidates, for three main reasons:

• It ensures that all candidates meet minimal competency

standards for practice. Most importantly, it protects the public

from those few that do not possess the basic skills necessary for

entry-level independent practice, including those skills that

cannot be assessed by traditional paper and pencil exams.

• It is a cost neutral activity for the Texas State Board of Examiners

of Psychologists.

• The oral examination is the national standard in licensure of

psychologists. Continuing the oral examination allows Texas to

participate in the national reciprocity agreement, as well as

future options for reciprocity; it ensures Texas can continue in

the multi-state agreement to ease the licensure process for

psychologists moving from one state to another.

3. Texas Psychological Association strongly concurs with the

recommendation of the Commission staff to dissolve the

Psychological Associate Advisory Committee (PAAC):

• Funding for the PAAC has been eliminated and the Committee

has achieved its mission as originally conceptualized.

• Current regulatory language regarding the roles of psychologists

and psychological associates is clear and unambiguous. ✯

TPA Testimony

Texas Psychologist 13SUMMER 2004

Dallas Psychological AssociationGetting to Know Us

Michael McLane, PsyD

Through its active and dedicated membership, the Dallas

Psychological Association (DPA) has for almost 50 years played an

integral role in serving the mental health needs of residents in North

Texas and in providing psychologists with opportunities for ongoing

professional development.

Early in 1956, Dr. Joseph Siegel invited a small group of Dallas

psychologists to form a local professional psychological association.

From those humble beginnings, DPA’s membership has grown to

approximately 200 psychologists of diverse backgrounds.

There are many benefits to being a member of DPA.

Professional membership in the DPA affords a variety of learning

opportunities. For instance, special interest groups have been

established in diverse areas, such as geropsychology, forensics, or

child and adolescent issues, so members can collaborate with local

experts. Members can also request to be contacted in their area of

expertise when local media contact DPA for referrals. Each year,

DPA sponsors multiple workshops on a range of topics, such as

ethics, health psychology, geropsychology, cultural issues, and

borderline personality disorder. DPA members pay a reduced

registration fee for these workshops.

Like the boards of most non-profit organizations, DPA’s

Executive Committee has worked hard to keep costs low without

sacrificing quality of services. For instance, thanks to the generosity

of the Texas Scottish Rite Hospital for Children, a local non-profit

hospital that allows DPA to use their facilities at no charge, overhead

for workshops is reduced. In return, DPA strongly encourages

Scottish Rite employees to attend workshops for free. This ongoing

partnership with Scottish Rite presents a “win-win” situation for all

involved. Other creative methods to curtail expenses include

replacing our local physical administrative office with a virtual one

through our association with DKW Associates. Through the

leadership of David White, DKW Associates has assisted DPA by

providing secretarial support to answer general phone queries and by

developing a highly functional Web site that allows online renewal

of membership, workshop registration, and viewing of monthly

DPA newsletters. Those who visit DPA’s official Web site,

http://dallaspsychologists.org, can also obtain information about

the professional services of its members. Through these and other

cost saving measures, there has been dramatic improvement in

DPA’s balance sheet over the past few years without sacrificing the

high quality of services provided to members and the community.

Three times each year, DPA welcomes current and new

members to gather informally at social events for networking,

eating, drinking, and being merry. Supporting excellence in

psychology is a high priority of DPA; therefore, the organization

offers three awards each year: the Distinguished Psychologist award

to honor the accomplishments of an outstanding psychologist, the

Pam Blumenthal Community Service award to recognize a

psychologist devoted to under served minorities, and the

Dissertation award to acknowledge excellence in research.

Learn more about the exciting opportunities for ongoing

professional development that membership brings by visiting our

Web site http://dallaspsychologists.org or by calling DPA at 800-

306-8886.

El Paso County Psychological Society

From the Ashes

Elizabeth L. Richeson, PhD, MS PsyPharm

It was difficult to decide what or even whether to write about

this LAS. Having concluded there are always lessons to learn, I felt

I would be remiss in not sharing this story.

The El Paso County Psychological Society (EPCPS) once

existed as the El Paso Psychological Association (EPPA)—a much

easier acronym. Due to events too tedious and ancient to revisit,

suffice it to say, it was reborn. Since that time it has struggled to

maintain its membership. El Paso has a relatively small number of

psychologists—21 clinical practitioners listed in the phone book

and 25 academicians at the University of Texas at El Paso—with

little growth in our professional community. However, there is a

small core of psychologists that remain dedicated, and it is about

them that I wish to write.

Perhaps it is the greater distance from Austin that contributes

to the limited insight for some psychologists in El Paso about the

importance of legislative issues and their impact on psychology.

However, the EPCPS works hard to ensure its support is felt even in

Austin. It is this small but dedicated group that contributes

financially as a group to the TPA PAC every single year. While the

$500 contribution (there have been years in which it has been a

$1000) may not seem like much to a large LAS, it is significant

given the size of EPCPS. Additionally, the El Paso LAS historically

held monthly brown bag lunch meetings that offered didactic

LOCAL AREA SOCIETY UPDATES

14 Texas Psychologist SUMMER 2004

presentations in conjunction with the UTEP Psychology

Department. In some years, there were also some very well attended

area conventions that offered CEUs of interest to a wide variety of

mental health practitioners.

Most recently it has been difficult to maintain the organization

at all. There was not an election last year, since those dedicated to

the LAS have served as officers in the organization multiple times

and now refuse to do so. At our last social meeting, there were a few

that agreed to run (most likely unopposed) as board members if

three members were willing to run for board officers. I have been

working behind the scenes to identify those psychologists who do

not want this most important organization to simply slip away.

When I first moved to El Paso in 1982, it was the EPPA that

welcomed me and encouraged me to get involved with the LAS

and TPA. With their support I held the office of Secretary, Vice-

President and President before I moved on to my work with TPA.

I worked on the Health Services Committee for six years as Chair

of the Hospital Admitting Privileges Committee and three years as

a member of the Prescriptive Privileges Committee. Supported by

the LAS, I went on to become President of the PAC, Chair of the

Special Interest Group in Psychopharmacology, Member of the

Board of Trustees of TPA, and now Editor of the Texas Psychologist.

I continue to maintain my position of Liaison Officer with the

LAS keeping them informed of the developments within TPA.

None of this would have been possible without the support of the

El Paso LAS.

Our fundraisers have not always been well attended but they

have, nonetheless, made a political statement and served us well.

Even our psychology socials have worked to keep us in touch with

each other and updated on the most pressing issues of our

profession. However, in order to be heard, we must reestablish

ourselves as a professional organization.

Whether it’s to support individuals in our professional

community or to protect our licenses as we MUST do in Sunset, I

cannot impress upon you the importance of a strong LAS in each

and every community in Texas. This is the way we can make our

voices heard. Over the years, there have been other LASs that have

ceased their existence, most often in small communities. I encourage

each and every one of you in communities that do not have

an LAS to revisit the opportunity to create or reestablish

your LAS for all the benefits listed here and those that are

simply in our imaginations.

I am pleased to announce that the EPCPS will be active

again. We have the numbers needed for the much overdue

election and will be up and running in the near future.

Making psychology a household word can only be

accomplished with efforts in each and every community in

this state and across the country. It is the grassroots effort

that ultimately makes the difference.

Houston PsychologicalAssociation

Educational Opportunities Abound

Julie Landis, PhD

If you are a psychologist in Houston, there is no lack of

things to do! We are a very busy professional organization

offering a wealth of activities for psychologists to attend.

During February, members attended a film series,

“Mental Health and the Law,” with the Museum of Fine

Arts. This series presented four films selected for their

interpretations of the legal consequences surrounding

sociopolitical issues and mental illness. Panel discussions

led by local area psychologists followed each screening.

Texas Psychologist 15SUMMER 2004

HPA was also lucky to benefit from some local area expertise. J.

Ray Hays, PhD, JD, presented an ethics workshop on February

20, titled “Privacy for Couples, Families, and Groups: Split

Alliances, Dual Duties, and Trust,” that resulted in a record

turnout of psychologists meeting their three hours of continuing

education in ethics requirement for license renewal. After the early

morning workshop, we held our regular monthly luncheon

meeting with featured speaker, Patrick Brady, PhD, who spoke on

“Appropriate Interventions and Referrals for Addressing

Addictions in Private Practice.” In March, instead of our usual

monthly luncheon, we encouraged our members to attend TPA’s

Professional Education Conference in the nearby Woodlands.

Those who attended benefited from the practice tips and

information offered.

Members of our executive committee were very busy in

preparation for HPA’s Annual Spring Conference held May 14 and

15. As we are all aware “about 1.5 million children experience the

divorce of their parents each year—ultimately 40 percent of all

children” (National Center for Health Statistics, 1995). While most

adapt well, 20-25 percent suffer significant adjustment problems as

children and teenagers. The negative impact often persists into

adulthood, resulting in nearly twice the normal prevalence of

mental health problems and impaired educational attainment,

socioeconomic and family well being (NIH news release, 2002).

Much more needs to be done at the community and practice level

to strengthen the family unit so that they can adequately care for

their children.

For the previous two years, HPA presented very successful

conferences, titled “Violence: Prevention, Intervention, Activism”

in 2002 and “Violence 2: Prevention-Resilience” in 2003. These

conferences were designed to provide the community with the

knowledge and ability to confront and respond to the increasing

level of violence in our society. This year, HPA has shifted the

focus to individual practice and education to develop and

enhance our therapeutic skills so that we may better address the

needs of our clients. To this end, we brought Michele Weiner-

Davis, MSW, to Houston to present workshops for mental health

professionals and the public. Michele was in Houston May 14,

2004 at the Derek Hotel to present a seminar, “Putting ‘Marriage’

Back into Marriage Therapy: Divorce Busting.” In this seminar,

mental health professionals learned a new model of working with

couples with very challenging problems so that they will be better

able to help couples “resolve their differences rather than dissolve

their marriages.”

Also included in the conference was a day intended for the

benefit of the Houston community at large. On Saturday, May 15,

Ms. Weiner-Davis offered her seminar, “Keeping Love Alive,” to

couples and individuals. This workshop is designed to teach

relationship skills to improve a couple’s ability to communicate,

parent, and negotiate differences. This event was held at the Christ

Church Cathedral downtown. Childcare was available. For more

details and registration information about future workshops, check

out our Web site at www.hpaonline.org.

Finally, I wanted to let you know that I have represented

HPA at meetings of the newly formed Houston Area Suicide

Prevention Coalition. It is composed of many area agencies

providing services to prevent and respond to people in crisis.

They have asked us to put together a list of professionals

specializing in suicide response and trauma who would like to be

identified as providing services in this area.

Southeast Texas Psychological Association

Reorganized and Going Strong

Charlotte M. Kimmel, PhD

The Southeast Texas Psychological Association has been

meeting every month since last year. This group of approximately

20 members includes psychologists from the Golden Triangle area

of Beaumont, Port Arthur, and Orange, Texas. This chapter had

been inactive for several years until approximately one year ago.

Bob Meier, PhD, was integral in contacting all the local

psychologists and arranging a lunch meeting. Since that time,

the association members have continued to meet at a local

restaurant during the lunch hour to network and share ideas.

Current officers are President Bob Meier, PhD; Vice President/

Secretary Charlotte M. Kimmel, PhD; Treasurer Cristina

Serrano, PhD; and Past President Andrew W. Griffin, PhD.

Members have agreed to have a monthly program and speaker.

Programs during the current year have included information on

the following topics: Psychology Services in the Federal Prison by

Jim Mann, PhD; Diagnosis and Treatment of Substance Abuse in

Older Adults by Andrew Griffin, PhD; Differential Diagnosis

and Treatment of Children: ADHD or Bipolar Disorder; and

Ethics Issues by Bob Meier, PhD.

The group also keeps current with legislative issues through

legislative alerts posted to the group members via e-mail by

Charlotte M. Kimmel, PhD, who is a Texas Psychological

Association Board Member at Large and receives frequent updates

of issues relevant to the practice of psychology in Texas. Several

local members have been active in contacting their legislators

about these issues to ensure that local representatives are informed

about these concerns. ✯

16 Texas Psychologist SUMMER 2004

“Lab Work” at McKenna Hospital

Allison R. Williams, BSOllie J. Seay, PhD

Three years ago, Annie and Tim

went through six weeks of

obedience training with the Delta

Society in Portland, Oregon. Delta Society’s

mission is “to improve human health

through service and therapy animals.” The

society has three main goals: “to expand

awareness of the positive effect animals can

have on human health and development, to

remove barriers that prevent involvement of

animals in everyday life, and to expand the

therapeutic and service role of animals in

human health, service, and education.” The

Delta Society helped establish the Standards

of Practice in Animal-Assisted Activities and

Animal-Assisted Therapy and provides

guidance on the administrative structure

of AAA/AAT programs, including such areas

as the selection of animals, personnel

training, treatment plan development,

documentation, and more. Annie would fall

into the Animal-Assisted Activities category

since there are no specific treatment goals

planned that include her—the handlers are

not required to take detailed notes—and

Annie’s visits are spontaneous and last for as

long or as little as is needed for each patient.

Annie spent an additional six weeks

with the trainer who would be guiding her

as she made her rounds in the rehabilitation

ward. This allowed her to become

acquainted with her supervisors at the

hospital and helped her learn what duties

and behavior would be expected of her.

Annie is well trained to follow hand

motions, and staff had to learn these, as well

as to not to leave food lying around for her

to eat. In her three years on staff at

McKenna Hospital, Annie has primarily

worked with patients in rehabilitation who

are in the hospital for an extended period,

usually after a complicated surgery or

stroke. Annie assists these patients in

reacclimating into the world.

One of the tasks that Annie helps

patients cope with is being reintroduced to

basic functions. If these patients need to

learn how to do simple things such as

brushing their hair again, they can brush

Annie’s hair for practice. Tim Brierty said

that some people have a better connection

with the animal than with people, and if

they do not react well to a therapist, then

Annie can assist them in getting the help

they need.

Another job that Annie performs is

being a friend who comforts patients by

spending time with them. “Some people

can’t get out of bed, so we are trying to

What qualities or characteristics are necessary to create and offer a healthy workplace? Granted, there are

numerous ways to do this, but Tim Brierty, CEO of McKenna Memorial Hospital, enlightened us on a key element that

helped establish a healthy environment for both workers and patients. McKenna Health Systems, with its strong

anchor, McKenna Hospital of New Braunfels, Texas, received the Healthy Workplace Award from the Texas

Psychological Association (TPA) in 2003. The development of the environment for both patients and employees is

partially accredited to a four-legged Labrador Retriever named Annie.

Texas Psychologist 17SUMMER 2004

patient who was recovering from surgery on

his knees was particularly happy to see

Annie and grabbed her with both arms to

give her a great big hug. He did not want

her to leave with us, so as we said goodbye,

Annie stayed in his group rehabilitation

session to keep him company.

After making the rounds with Annie,

we could see that she was indeed an

essential worker and that she gave her heart

to each patient she saw helping them feel a

little better in what could have been just

another hospital stay. Given the benefits

observed for everyone at McKenna

Hospital, it is surprising that more hospitals

do not follow their example. It is easy to see

why TPA chose them for the Healthy

Workplace award. Theirs is definitely a

healthy workplace, for people and for a dog

named Annie. ✯

Annie—and that was not just the patients.

Staff members’ demeanors changed when

Annie walked in the room. Everyone

seemed glad to see her. Mr. Brierty took us

to the different rehabilitation rooms to

show us Annie in action. He made sure to

ask permission to bring Annie into each

patient’s room. While there was no

requirement to see her, most patients said,

“Sure, bring her in.” We saw how the

patients’ faces lit when Annie entered their

rooms. We encountered one woman who

was using a walker to go down the hall, and

she became very animated and excited when

she saw this big black dog enter the door.

Annie went up to a man who did not have

much control of his arm, but he used that

arm to pet her and was surprised that such

an ordinary response to an animal could

help him learn to reuse the limb. Another

break down their depression, and Annie

will hop up in the bed, always with

permission, and most of the time you can

find Annie lying perfectly still in someone’s

bed because they have fallen asleep with

her,” says Brierty. For some patients, Annie

is a replacement dog for the one they had to

leave behind while they are staying in the

hospital. She becomes their new

companion. In addition, some patients

must relearn how to take care of their

animals, and Annie becomes their

“training” dog. Annie works with a variety

of patients and is adaptable to meet the

patients’ different needs.

Annie is basically an alternative

therapy, providing emotional support in

ways that other forms of therapy cannot.

“Sometimes the patients actually heal

faster because their hearts and spirits are

getting better,” says Brierty. Although no

research has been conducted concerning

Annie’s role at the hospital, it is evident in

the response from past and present

patients that she has helped improve

patient care. Many former patients return

to McKenna Hospital just to see Annie,

and sometimes she even receives Christmas

presents. Brierty said that his research is

based on the reactions people have and the

fact that so many of them come back to see

her once they have been rehabilitated.

Some return patients come just to see

Annie because they say she “saved their

lives.” In addition, staff members have told

him that patients who were either

depressed or unwilling to cooperate in

therapy changed once they met Annie.

Despite the lack of formal research, Tim

Brierty’s intuition tells him that Annie

works. During our visit, we could tell by

the way that he talked that he knew having

Annie at McKenna Hospital had increased

the morale of patients and staff members

alike.

As we were walking Annie to the

rehabilitation floor, the people we met

seemed much happier when they saw

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18 Texas Psychologist SUMMER 2004

CE Credit Home StudyThe Therapeutic ContractEric Marine, American Professional Agency

One of the fundamental elements

of the therapeutic process is the

contract for services between the

patient and therapist. This is generally

referred to as the therapeutic contract. In the

past, this document was very rarely written

down. While verbal, it still contained the

basic provisions for the services the therapist

would provide to the patient. It was an

evolving agreement. As the therapy

progressed, the therapist would explain what

was going on and what would happen next.

Since it was assumed that the treatment

would always be delivered in good faith, it

was infrequently written down.

Yesterday was a different world than

today. In the past, therapists would hardly

ever encounter the legal system. The

relationship with the patient was intimate

and private. The patient would never want

their therapy made public and that was the

end of that.

The world we now live in is quite

different. In the past 20 years, therapy has

been recognized as mainstream health care.

The client base has expanded and changed.

It has become multi-cultural and quite

diverse. The mental health profession has

acquired the court system as a client and

referral source. While the historic principles

that make up the therapeutic process have

been altered and adjusted, the underlying

concepts have remained constant.

One of the most profound changes to

the therapeutic process is the advent of the

consumer revolution. In all other forms of

commerce, consumerism has met with

some resistance by the manufacturers and

purveyors of goods and services. In the

therapy community, it has been met with

outrage and misunderstanding. Also, the

consumer protection apparatus has little

understanding of the services they have the

responsibility to regulate. This confluence

of events has led us to where we are today.

A place where most therapists try and carry

on with limited understanding of the forces

that operate around and inside the practice

of therapy.

As we go through some of the elements

that have changed or become preeminent in

the modern practice of psychotherapy,

certain areas will be highlighted and

discussed in detail. It is from these areas that

the elements of a new treatment contract

will be crafted. The scope of practice and

client base for psychotherapy has changed

dramatically in the past 100 years. The rules

for the provision of the services have also

radically been altered. We will attempt to

create a framework to remove the anxiety

from practice in the future.

LICENCED OR CERTIFIEDThe first step in the societal

recognition process for therapy was the

requirement for the licensure or

certification of the professional. This was

completed in the past 10 years in all states.

It is important to note the license or

certification does not make the professional

a therapist, which is done with education

and experience. The license or certification

allows only those individuals duly approved

by the various states to use protected terms,

such as psychologist, social worker,

counselor or marriage and family therapist.

The laws protect the terms and allow only

those individuals to call themselves what

the license or certificate refers to them as. It

also defines the type and extent of the

services that can be performed by the duly

licensed or certified practitioner. This

protects the public from unqualified

individuals using the protected titles and

thereby deceiving the public into receiving

sub-standard or unqualified care.

Directions: To receive one hour of ethics continuing education credit for psychologists, licensed

psychological associates, licensed professional counselors and licensed social workers, for this TPA

sponsored home study assignment, you must:

1.) Read the article in its entirety;

2.) Take the test at the end of the article;

Mail the test along with $25 (TPA Members) or $50 (Non-TPA Members) to the TPA Central Office at 1011

Meredith Drive, Ste. 4, Austin, TX 78748 or you can fax back to 512-280-4334.

Texas Psychologist 19SUMMER 2004

The prior paragraph not withstanding,

the license or certificate is a permission to

conduct a business in the state. It defines

what services may be provided and by

whom. It is intended to inform the

consumers of the state what they might

expect should they see the therapist. It also

gives the state the right to regulate the

practice in order to protect the consumer.

Therefore, there is a presumption that the

consumer is always right. It is this

presumption that the therapist encounters

when a complaint is made to the state

regulatory board. It is the same operative

presumption that the therapist would have

going for them should they make a

consumer complaint against another

provider of state regulated services, such as

an automobile dealership.

Historically, there were few complaints

made against therapists to the various state

regulatory agencies. This was probably

because the patient did not wish to have the

fact that they were in therapy known to any

one. This self-limiting factor stopped many

clients from even considering bringing a

complaint. This is not the world in which

we live today. States advertise the services of

the various consumer protection boards.

Some even require the therapist to inform

the patient directly about the existence and

procedures of the boards. Other states

require the therapist to post in their lobby a

copy of the approved “Patient’s Bill of

Rights.” These are examples of the

consumer protection mandate of the state.

The basic nature of psychotherapy

works against the therapist when a

complaint is made. Because the services are

delivered in private, there is little evidence

of the actual quality of the service provided.

Generally, the word of the patient is given at

least equal value as that of the therapist as to

what occurred during the therapeutic

process. From this premise the state will

begin an investigatory process. The reason is

to find out why a consumer is unhappy

with the services received. The United

States Constitution provides for a

presumption of innocence in criminal

investigations and prosecutions. The state

regulatory law does not contain that same

presumption. Additionally, the state may

use the services of the Attorney General’s

office to act as the primary investigatory

and prosecution personnel. These

individuals are used to protecting the

citizens of the state from criminal activity.

They bring the same mindset and zeal to

the regulatory process. While on the surface

this energy may be laudable, it fails to take

into consideration the special circumstances

of mental health care.

When the mental health professional

achieves either licensure or certification, the

state will provide a copy of the regulations

that govern the license. Each time that

license or certificate is renewed, the therapist

signs a statement that they are familiar with

all the regulations and are in compliance

with them. If an investigation is begun, the

state is empowered to not only investigate

the complaint, but any compliance issue

they choose to look into. This means a

therapist may be exonerated from the

original complaint, but found in violation of

something discovered during the initial

investigation. This may have nothing to do

with the reason for the complaint, but the

state can apply penalties nonetheless.

An example of this is record keeping.

Contained within the state mental health or

public health law or the actual licensure or

certification statute is a specific requirement

for record keeping. Each time the therapist

renews the license or certificate, they

warrant that they are keeping records in

accordance with the requirement. If the

investigation turns up a deficiency in this

area, the therapist will face disciplinary

action even though the complaint made by

the consumer is dismissed. This may not

seem fair, but the therapist had agreed that

he/she was complying with all the rules, but

the investigation showed a lack of

compliance. Further, compliance with a

national organization’s requirements may

not provide sufficient protection from the

regulatory process. Where the organization’s

rules and state law come into conflict, the

state has primacy.

A further example of the rise of

consumerism is the varying state

requirements for disclosure and informed

consent. The mental health community has,

for years, been less than forthcoming about

the therapeutic process. The education and

experience required to become conversant

with the process is formidable. For years,

the only information given out about the

process was the admonition to “trust me.”

In today’s world, the full disclosure of all

information generated by the therapist is

almost a universal mandate. If a patient,

former patient or a guardian of either of the

previous two groups requests treatment

information, it must be given.

This has not always been the practice

of the therapy profession. Treatment notes

and information were guarded to protect

the patient’s confidentiality. If the

information was released, it was generally

done in the form of a treatment summary or

report. For a long time, this was acceptable.

Today, it is not.

While the state laws that govern the

practice of therapy still require the therapist

to maintain the patient’s confidentiality,

they recognize it is the patient that controls

the record. Confidentiality is the duty owed

to the patient. Privilege is the right of the

patient to keep confidential those

communications made with the therapist. It

is similar to the privilege provided between

an attorney and a client. The patient

controls this aspect. If the patient does not

wish to waive privilege, the therapist cannot

breach the patient’s confidentiality. There

are, of course, exceptions to this rule—

abuse, suicide and dangerousness being the

most notable.

There are many other aspects of any state

licensure or certification law. They deal with

who may sit for the state examination and the

20 Texas Psychologist SUMMER 2004

general principles of what makes up an ethical

and moral practice. Some are more spelled

out, while others are less defined and open to

interpretation. Keep in mind that the

consumer may use a different interpretation

of the state law to instigate a complaint. The

state will attempt to see the situation from the

point of view of the consumer.

INFORMED CONSENTThe concept of informed consent has a

long history in the medical profession. It is

intended to allow the patient to participate

in the treatment decisions that most directly

affect the patient. The physician has to

explain what is going to be done and why.

The patient must consent to the course of

treatment outlined. The patient always has

the right to refuse the treatment. This

refusal would be based upon all relevant

information being provided about the

treatment and the possible negative

outcomes if the treatment is not performed.

Therapy has no such history of the

application of informed consent. For the

most part, the therapist has worked with the

patient in a one-way relationship. The

patient participated in the therapy but was

not completely informed of the modalities

to be used, the time frame expected for the

problem, or, in some cases, the actual

diagnosis. With the advent of consumerism

and regulation of the therapy profession,

the changes have already begun.

Informed consent means that the

patient has been fully informed of the

problem being worked upon, the modality of

treatment being used, the known positive

and negative aspects of the modality,

alternative treatments and the prospects of

success. If a certain modality is the subject of

controversy, such as hypnotherapy, the

controversy must be explained. If there are

alternatives to the method used by the

therapist, these must also be explored and

explained. The expected time frame of the

treatment must be outlined and agreed

upon.

While this may seem an unwarranted

step in the therapeutic process, it is gaining

support with the various states’ licensing

authorities. Since this step would allow the

consumer (patient) to participate in the

treatment process and exhibit control over

treatment, some states have mandated the use

of informed consent documents. Managed

care facilities have long required the provider

of services to use a form of informed consent

documentation in the intake process. It can be

expected by state mandate or best practice

recommendation that some type of informed

consent documentation will be required from

all patients before the therapeutic process

can begin.

While the clinical area of therapy can

be enhanced by the use of informed consent

documentation, it is extremely helpful in

forensic practice. When a client visits a

therapist, there are certain preconceived

notions at work. Foremost is the notion of

therapist-client confidentiality. A client can

reasonably expect the information

developed in therapy will remain sacrosanct.

The client must specifically release the

therapist to allow for dissemination of the

client’s information.

In a forensic setting, the information is

being developed for release. Usually, the

client is there as a result of some order from

an authority figure. That figure has been

asked to settle a dispute for the client. This

is the premise of a court action. The court

has been asked to rule on a question

brought to court at least partially by the

client. The court has determined that in

order to provide the best answer some help

is needed. Therefore, the court will refer the

person to a forensic expert. The most

common reason for forensic evaluation is in

the area of child custody.

In a typical child custody situation, the

parents or guardians cannot or will not

agree on the best location for children of the

marriage to live. Additionally, they may not

agree on what degree of access one of the

parents is to have to the children. In order

to make the best decision for the children;

the court will often order a custody

evaluation by a mental health professional.

By this order, the fundamental relationship

of the client and the therapist is set. It is not

the traditional one that any client might

expect.

While the change dictated by a

forensic examination would appear to be

obvious, it may not be. In order to make

sure all parties know exactly what will

happen and what to expect, using an

informed consent document can be of

immense help. It removes areas of

confusion and specifically covers any

problematic features, such as

confidentiality.

In the January 1997 issue of the

California Board of Psychology Update,

Bruce W. Ebert, PhD, JD, wrote, “Every

psychologist has a duty to obtain informed

consent from each patient or client to whom

he or she provides services in the

professional capacity.” While this quote is

from a psychologist, it is instructional for all

mental health professionals. It should be

noted that Dr. Ebert is the chairman of the

California Board of Psychological

Examiners. His comments are quite

instructional regarding the view of a state

licensure board with regard to informed

consent.

Dr. Ebert goes further, in the same

article, “The most important question is

what information the client should receive

in order to obtain thorough informed

consent. It is recommended that the client

be informed of:

1. Limits of confidentiality;

2. Nature and extent of your record

keeping system;

3. Your title, training, experience and

areas of special expertise or any areas

in which you are not adequately

trained to provide services to

clients;

4. Probable length of services;

Texas Psychologist 21SUMMER 2004

5. Risks involved with the services you

are providing;

6. Alternatives to the services you are

scheduled to provide;

7. Your fee, as well as relevant billing

practices;

8. The rights of the person receiving

services;

9. The rights of not proceeding with

anticipated services;

10. Emergency access to you or

someone who can respond to a

psychological crisis, if applicable.”

The previous recommendations should

be looked at as the absolute minimum

requirements of any informed consent

document. As previously pointed out, if the

services are forensic in nature, special care

should be taken to point this fact out. It is

the true informed consent of the patient

and the empowerment that comes with

consent that are powerful deterrents to

allegations of professional negligence.

SAMPLE CONTRACTSThe following are examples of types of

disclosure statements that my be combined

in a contract. These are neither the

definitive nor the only possible wordings

that may be used. They should be modified

to meet the needs of your individual

situation.

The use of these examples is no

guarantee that legal action will be neither

taken or successful. They are given merely

to assist in the preparation of a treatment

contract. An attorney, to ensure their

conformity to the laws of your locality,

should review all legal documents.

SAMPLE OF AN INFORMED CONSENT DISCLOSURE AND TREATMENT CONTRACT

Welcome to the therapy practice of _______________. I am a (Licensed/Certified) ___(profession)_______________. I have been

licensed in this state since ______. While I would like to be an expert in all things, I try and limit my practice to ______________. This is

because I have a great deal of training and experience in this area. If you would like, I will provide you with a copy of my Cirriculum Vitae.

CONFIDENTIALITYIt is axiomatic that all communications made during any therapy visit are to be kept confidential. I will endeavor to follow your wishes

on this subject, as you are the one who generally controls this information. However, I must make you aware of those few circumstances

where I am compelled to breach this important promise.

In the event that our therapy session reveals any information concerning the abuse of either children or senior citizens, I am mandated

by law to make a report to the proper authorities. By the signing of this document, you acknowledge your awareness of these facts.

Additionally, if the course of therapy reveals any intent to harm either yourself or others, you acknowledge my legal and moral duty to

prevent you from bringing this harm about. I specifically have your irrevocable permission to warn those parties that I feel may be harmed.

If you reveal an intent to harm yourself, I have your permission, also irrevocable, to prevent you from accomplishing your intent.

As an attachment to this document, there is a release to be signed by you that will allow me to discuss your case with your other health

care providers. This will include your psychiatrist, if you have one, and any prior treating therapist. I may also request a copy of the treatment

records from these individuals. I will inform you if I feel the need to get this information.

If you have been referred to this practice by a managed care or insurance company, you should be aware of this arrangement. As a

requirement of the referring organization, I may be required to provide them with a complete copy of the records generated by your therapy.

Once these records are in the possession of the referring organization, I cannot guaranty their continued confidentiality.

RECORDSIt is a state law that I maintain a record of the treatment given to you. This record will contain the information that will allow me to

chart the course of your therapy. I will use it only for that purpose. It is my intent that no one will ever see what is contained in the file. You

may get a copy of the file only by providing me with a signed and notarized release of information request. I may provide you with a synopsis

of the course of treatment and outcome in lieu of the actual record. You agree you will pay, in advance, for either the copying cost of the

actual record or the time required for the preparation of a treatment summary. This includes providing copies or reports to any court or legal

representative or designate. In the event of your death, these requirements will be binding on any heirs, successors or executor(s).

If the therapy sessions contain more than one patient, you agree that no one person may get the complete treatment file. I will attempt

to maintain a separate record on each patient. However, only that individual is entitled to his/her own record. You agree I may synopsize the

22 Texas Psychologist SUMMER 2004

course of each individual’s treatment as opposed to providing a copy of what notes may have been made during any therapy session.

The laws of this state require that your record be maintained for a period of ____ years. I will maintain them for that period of time.

At the end of that period, they will be destroyed.

If you have been referred by an insurance plan, company or managed care organization; you must be aware that you may have waived

your right to confidentiality as it pertains to the referring organization. If I am an approved provider for this organization, I may have to

share all the information you provide with this organization. I will do so as required to get you all the treatment that is appropriate. You

should be aware that the organization is not bound by my ethical and legal requirements on maintaining the confidentiality your treatment

may require. By providing the required reports, you understand that I have no control over the use of the information made by the referring

organization.

FORENSIC REPORTSIf your purpose in coming to my practice is to obtain a forensic evaluation and report, there are some very important differences you

must be aware of. THIS IS NOT THERAPY. YOU ARE NOT MY PATIENT. I have been hired to perform an evaluation and report my

findings to a court of law. At a minimum, this means THE USUAL RULES OF CONFIDENTIALITY DO NOT APPLY. BY THE VERY

NATURE OF OUR RELATIONSHIP, I WILL BREACH ANY CONFIDENCE WE MAY HAVE. This must be clearly understood. By

signing this agreement, you acknowledge your understanding and agreement.

PAYMENTI expect to be paid in full prior to the provision of the final report. Before the first session, I require a retainer of $________. This is

estimated to be equal to ___% of the total cost of the evaluation and report. Prior to the final evaluation session, an additional $_____ is

expected to be paid. The final report will not be released unless the entire cost of the process is paid in full. By your signing of this contract

you agree to be bound by this. _______ (Initials)

RELEASE OF INFORMATION(General)

I, (name of patient), hereby request (name of therapist) to provide a complete copy of my Therapeutic Contract to (Name, and address

of the party to get the records) for the purposes of (reason). I am aware that this information will contain personal and private disclosures

made during the course of my therapy. The content of the file has been explained to me by (Therapist). I WISH TO AUTHORIZE ITS

RELEASE.

_________________________ (NAME OF PATIENT)

__________________________ (WITNESS OR NOTARY PUBLIC)

________ (DATE)

RELEASE OF INFORMATION (Forensic evaluation)

I, ______________, hereby acknowledge that the purpose of my coming to see ____________________ is to provide an evaluation

and report to the referring organization. This is not therapy. I have no reasonable expectation of confidentiality. The information I provide

during the evaluation process will be shared with other parties. I understand that the records generated by this process will only be released

with the permission of and through the referring organization. I agree to this situation.

I am aware that I have certain federal guarantees to confidentiality dealing with any incidence of substance abuse on my part. I hereby

specifically waive those rights as they pertain to this evaluation and report. _____ (Initials)

I am also aware that there are further federal rights to confidentiality dealing with a status of HIV positive or suffering from AIDS

(Acquired Immune Deficiency Syndrome). I freely waive those rights to confidentiality as they pertain to this evaluation and report.

________ (Initials)

Texas Psychologist 23SUMMER 2004

I, ______________________, HAVE READ THE ABOVE STATEMENT ON THE RELEASE OF CONFIDENTIAL

INFORMATION. I UNDERSTAND THE INFORMATION CONTAINED AND HEREBY AGREE TO THE CONDITIONS

CONTAINED.

_______________________________________ Signature

______________________________________ Print name

_________________________ Date

_______________________________________ Witness

CONTROVERSIAL OR EXPERIMENTAL MODALITY OR PROCEDUREI, (name of patient)_, have had the modality of _(type of therapy)_ proposed as a possible course of therapy. (name of therapist)_, my

therapist, has explained the process to me. The explanation included reference to all current information on this modality. I have asked and

received answers to all my questions. I acknowledge that there is not complete agreement within the therapeutic community on the

effectiveness of this form of treatment. It has been explained that there still is data being gathered by the scientific community on the results

of this type of treatment.

I have given all this information due consideration and have opted to proceed with the proposed course of treatment outlined by (name

of therapist) .

_________________________________ (Print name)

Name of patient

__________________________________ (Signature)

__________________________________

Witness

TERMINATION OF TREATMENTThe length of time required for therapy will be determined by your personal situation. I will do my best to fulfill your therapeutic needs

and provide you with my best professional care. For your part, you agree to participate in the process to the best of your ability. It is intended

that when your needs are met, to the extent that they can be, we will terminate our relationship. There is no guarantee of a cure.

For your part, you may terminate my services at any time. This may be done in any one of several ways. These include, but are not

limited to, putting it in writing, informing me verbally, failing to maintain your appointment schedule without proper notification or your

failure to follow treatment recommendations that I may make. I will respect your wishes.

If you do terminate therapy with me, it will be my decision as to whether we can re-establish our therapeutic relationship. Keep in mind

that your decision to terminate therapy and the method chosen to accomplish the termination will impact any decision to resume a

therapeutic relationship.

About the Author

American Professional Agency, Inc. is the largest provider of mental health Professional Liability insurance in the United States. With over 30

years of experience and well over 100,000 policy holders in all endeavors in the mental health field, the agency provides some of the most

comprehensive and cost effective insurance available.

Eric C. Marine is the Vice President for claims of the American Professional Agency, Inc. With almost 30 years experience in the claims industry,

he has written on and presented Risk Management seminars all over the country.

24 Texas Psychologist SUMMER 2004

1. The purpose of a written contract can be:a. To spell out the rights and duties of

all parties.b. To memorialize the financial

arrangementsc. To explain the limitations of the

therapist, as they pertain to the law.d. None of the above.e. All of the above

2. The purpose of a professional license is:a. To protect against the use of the

professional title by unauthorized parties.

b. Allow people to have something to aspire to.

c. Allow the operation of heavy equipment.

d. None of the above.e. All of the above.

3. Informed Consent:a. Is necessary for the release of any

records.b. Should be obtained before any

treatment begins.c. Is nice to have but is not ever required.d. Is a term that has no applicability in

mental health care.

4. The concept of confidentiality:a. Helps people feel good about

themselves.b. May be effective in all attempts to

obtain private information.c. Allows Insurance Companies to

obtain patient records.d. Is a basic principle of good therapy.

5. Your professional license:a. Allows you to practice anywhere in

the U.S.A.b. Never has to be renewed.c. Allows only people so licensed to

practice in your state.d. Guarantees a profitable practice.

6. Records are:a. Highly over rated.b. Confusing and, of necessity, illegible.c. The single most important element

that will evidence the appropriateness of your approach.

d. Not needed.

7. Historically, complaints against therapisthave:a. Been few.b. Been frequent.c. Been Frivolous.d. Hardly made any difference.

8. State Licensing Boards :a. Are there to collegially to review

complaints.b. Protect licensees from frivolous

complaints.c. Protect the consumers of your state

from bad licensees.d. Made up of bad therapists.

9. Terminating therapy with a patient is:a. A very important event.b. A good way to draw a complaint to a

licensing board.c. Easier if instituted by the patient,d. None of the above.e. All of the above.

10.When using a controversial or new treatment modality:

a. Sometimes, it is not good to tell the patient.

b. Tell the patient only about the positive aspects and outcomes that may occur.

c. Obtain an informed consent agreement from the patient, in writing.

d. Avoid anything that even suggests new or controversial.

11. If I obtain all the release and informed consent documents necessary:

a. I will never have a claim or complaint lodged against me.

b. If a frivolous complaint or claim is made, I will probably be exonerated.

c. The patient will be happy and stay until the therapy is concluded.

d. No patient will stay beyond the initial visit.

The Therapeutic Contract CE Exam

First Name: Last Name: Degree:

Mailing Address:

City/State/Zip:

Email: Phone:

Visa/MC/Amex/Discover: Exp. Date:

Check #:

Signature: Date:

TEST QUESTIONS

Texas Psychologist 25SUMMER 2004

Iwas recently invited to participate in the

California Psychological Association’s

Annual Convention, Change: The

Power of Psychology. As always, CPA was

inspirational and once again reminded me

that we really are all one family, dedicated to

improving the quality of life for our nation’s

citizens. Friday’s “PAC Monte Carlo Night at

the Races” was definitely fun, although I did

miss seeing the Texas Blues Brothers who

would have undoubtedly done quite well “at

the tables.” As was evident at the Practice

Directorate State Leadership Conference

(SLC) earlier in the month, the prescriptive

authority (RxP) agenda is nicely maturing.

CPA President Sallie Hildebrandt instituted a

very popular programmatic psychopharm-

acology track, including RxP didactic content

by John Preston, a graduate of Baylor

University and in depth discussions of

practice and public policy issues. I was

especially intrigued with the extent to which

the graduates of Alliant University’s

psychopharmacology program found their

advanced training has already significantly

enhanced their clinical practices, although

California has yet to pass RxP legislation.

CPAGS, which represents our profession’s

future, was visually present with Zara

Ashikyan as chair.

For those who attended this year’s SLC

event hosted by Russ Newman and Mike

Sullivan, the panel, “How Prescribing Has

Changed Our Clinical Practice: Experiences

Of The [DoD] Prescribing Psychologists,”

clearly demonstrated that RxP is the future.

John Sexton, for example, noted that at both

events RxP has been a prominent part of SLC

since 1995. According to the 2003

Presidential Commission, there is a “mental

health crisis” in the US “due to lack of

accessibility,” and 75 percent of all visits to

primary care managers can be attributed to a

psychological problem. Psychologists are

primary health care providers. Why should

we continue to passively accept reports that

general physicians (with minimal mental

health training) provide 75 percent of the

psychotropic medications or that the Food

and Drug Administration felt it was necessary

to issue a public health advisory urging

doctors to be especially careful in prescribing

antidepressants to children and adolescents

due to a possible association between the

drugs and suicide? Psychology must provide

proactive leadership in this area—it is our

societal responsibility. For those (e.g., our

colleagues in Florida) who are particularly

concerned about the quality of care for

women, one should seriously reflect upon

John Preston’s report that they receive only 58

percent of all psychiatric services but 73

percent of psychotropic prescriptions. Is this

really what we believe our daughters or loved

ones deserve?

Sally’s focus on change fits very nicely

with the realities of the health care

environment of the 21st Century and SLC’s

Strategic Resilience For The Profession:

Getting A Jump On Change. In his keynote

address, Russ Newman was enthusiastic

about the future of RxP and professional

psychology:

“It seems rather clear that psychiatrists

have a financial incentive to keep

psychologists from serving as attending

clinicians in [California’s] state hospitals. In

fact, this was something I discussed with

the Federal Trade Commission and

Department of Justice Antitrust Division in

June when we had the opportunity to

testify at the Joint Hearing on Health Care

and Competition Law and Policy. In

addition to detailing a number of instances

of what we believe are organized

psychiatry’s efforts to restrain trade in

hospitals, we also alerted the FTC to what

we expect will happen as more states come

on line with prescriptive authority statutes.

After all, who better than psychologists to

explain to the FTC that the best predictor

of future behavior is past behavior?

Attempts to undermine regulatory

implementation of prescriptive authority

laws and potential boycott activity by

psychiatrists against pharmaceutical

Never Stand In Front of Flowing Lava:RxP On the Move

Pat DeLeon, PhD, Former APA President

26 Texas Psychologist SUMMER 2004

Should I Warn My Patients

of the Possible SideEffects of

Medications They Are Taking?

Sam A. Houston

As you have probably read, the

Food and Drug Administration

recently released a statement

warning of a possible link between

antidepressants and suicide. It is likely that

many of your clients take antidepressants.

Although such medications are probably

prescribed by psychiatrists (to whom you

may have referred your patients) or other

medical doctors, you should still be aware

of possible litigation arising from some of

these recent reports.

Litigation against major pharmaceutical

companies is common. Many times the

prescribing physician or treating doctor is

sued along with the manufacturer. In some

cases, suit is brought against only the

physician. However in other cases, the

litigation net is cast wide to bring in more

distant defendants. Because of this potential

for inclusion, you should be aware of the

questions concerning the duties and roles of

psychologists in cases involving patient

suicide or harm while taking antidepressants.

The general rule is that a psychologist

is not included in the legal definition of a

“health care provider.” Texas statutory law

indicates that duty to warn and provide

“informed consent” falls on the health care

provider prescribing the drug. Since the

psychologist is typically not the prescribing

physician, the duty to provide informed

consent or warn would probably fall on the

psychiatrist or other prescribing doctor.

However, I looked and could not find any

cases specifically involving whether or not a

psychologist had to warn a patient of the

companies who support psychologists are a

couple of the future behaviors we thought

the FTC could expect from organized

psychiatry based on its past behavior.

“Speaking of prescription privileges for

psychologists, the past year witnessed

considerable continuing activity on this

front. Nine states introduced RxP

legislation in 2003—Florida, Georgia,

Hawaii, Illinois, New Hampshire, Oregon,

Tennessee, [the Great State of ] Texas and

Wyoming. Six of these states had committee

hearings on their bills, the largest number

ever in one year. And Wyoming had its first-

time bill not only pass out of a senate

committee but also go to a floor vote. Bills

in 2004 so far include Georgia, Hawaii,

Illinois, Louisiana, Maine, New Hampshire,

Oklahoma and Tennessee. And Guam

continues to work to implement its law.

“Importantly, the New Mexico

Psychological Association remains hard at

work implementing their prescriptive

LAWauthority law. Although the process has been

slow going for sure, recent developments

have provided reason to smile. At the end of

February, the state’s Board of Medicine voted

unanimously to accept the draft regulations.

The Board of Psychology recently approved

the regulations as well...The regulations face

their next major hurdle during a 30-day

public comment period followed by a public

hearing where organized psychiatry will

undoubtedly try, once again, to derail the

process. Thank you, New Mexico

psychologists, for staying the course.”

Finally, I would like to take this

opportunity to personally commend TPA’s

Past-President Dee Yates on her service to our

nation as a member of the President’s New

Freedom Commission on Mental Health.

Because of Dee, psychology’s voice was heard

at the highest levels. Too many colleagues

simply do not appreciate the importance of

being personally involved in the public policy

process. Aloha.

Texas Psychologist 27SUMMER 2004

PSY-PAC ContributorsJanuary 1 - March 31

$1000-1999Paul Burney, PhD

$100-499Laurence Abrams, PhD

Barbara Abrams, EdD

Barbara Alford, PhD

Judith Norwood, Andrews,

PhD

Elizabeth Barry, PhD

Patricia Barth, PhD

Connie Benfield, PhD, ABPP

Joan Berger, PhD

Malcolm Bonnheim, PhD

Peggy Bradley, PhD

Tim Branaman. PhD

Glenn Bricken, PsyD

Stacy Broun, PhD

Ray H. Brown, PhD

Timothy Brown, PhD

Joan Bruchas, PhD

King Buchanan, PhD

Barry Bullard, PsyD

Erica Burden, PhD

Linda Calvert, PhD

Kay Ransom Carey, PhD

Betty Cartmell, PhD

Gloria Chriss, PhD

Ron Cohorn, PhD

Donna Copeland, PhD

Walter Cubberly, PhD

Caryl Dalton, PhD

Philip Davis, PhD

Michael Duffy, PhD, ABPP

James Duncan, PhD

Patrick Ellis, PhD

Richard Ermalinski, PhD

Raymond Finn, PhD

Alan Fisher, PhD

Lynn Fisher-Kittay, PhD

Alan Frol, PhD

Richard Fulbright, PhD

Ray Gilbert, PhD

Jerry Grammer, PhD

Charles Haskovec, PhD

JoBeth Hawkins, PhD

Annette Helmcamp, PhD

William Helton, PhD

David Hensley, PhD

Ethel Hetrick, PhD

Robert Hochschild, PhD

Alan Hopewell, PhD

David Hopkinson, PhD

Robert Hughes, PhD

Jerry Hutton, PhD

Sheila Jenkins, PhD

Johnny Johnson, PhD

Morton Katz, PhD

Gilda Kessner, PsyD

Charlotte Kimmel, PhD

Burton Kittay, PhD

Amelia Kornfeld, PhD

Richard Kownacki, PhD

Tom Kubiszyn, PhD

Angela Ladogana, PhD

John Largen, PhD

Nancy Leslie, PhD

Rochelle Levit, PhD

Franklin Lewis, PhD

David Litton, PhD

Alaire Lowry, PhD

Marilyn Maas, PhD

Jerry Mabli, PhD

Ann Matt Maddrey, PhD

Perry Marchioni, PhD

Raul Martinez, PhD

Denise McCallon, PhD

Donald McCann, PhD

Richard McGraw, PhD

Sherry McKinney, PhD

Robert McLaughlin, PhD

Robert McPherson, PhD

Donald McRee, PhD

F. Gary Mears, PhD, PsyD

Brenda Meeks, PhD

Robert Mehl, PhD

Robert Mims, PhD

Lee Morrison, PhD

alleged dangers associated with a particular

drug. Thus, while it is fairly clear that the

psychologist has no statutory obligation to

warn the patient of the risk associated with

the drug, it is not clear that a psychologist

is completely immune from liability.

Texas law places a duty on a psychologist

to act as a reasonably prudent person under

the same or similar circumstances with regard

to the treatment of a patient. This would

include a heightened awareness and

knowledge of the potential side effects of

medications and the tell-tale signs exhibited

by patients with suicidal behavior. An

argument could be made that you would have

a duty to warn a patient or, at minimum,

recognize and take action to prevent suicide of

patients who are taking such medications

even if you did not have a statutory duty to

warn them of the potential side effects.

In light of the fact that the law is

unclear, I recommend that you take the

following steps on all of your patients who

are taking antidepressant medications:

Familiarize yourself with all potential side

effects and go over them with your client. I

think this is particularly important in cases

where you have referred a patient to a

psychiatrist for drug treatment medication in

addition to your therapy. Many times an

arrangement is made where psychiatrists will

see a patient on a fairly infrequent basis and

the patient will see the psychologist even while

taking such medication. In such a situation, it

is especially important to warn and keep watch

for telltale signs. Document that you warned

the patient, and discuss with him or her any

possible new feelings on each visit.

Pay special attention to your referral

sources and make certain they are reputable

physicians who will fully discuss the side

effects of the medications with their patients.

While treating patients who began

antidepressant medications prior to seeing

you, make sure you document that you

have discussed possible side effects with

them and that you have advised them to

follow up with their physician if they are

feeling any untoward effects.

Careful documentation and practice

will help keep you out of any litigation.

FDA warnings have prompted mass tort

litigation in the past. Breasts implants,

Phen-Fen, Baycol and other medications

have fallen under close scrutiny. It is

unlikely that you would be included in the

event such litigation proceeds against the

antidepressant manufacturers; however, it is

better to be safe than sorry, and these

simple steps will help keep you away from

the lawyers and the courtroom.

I continue to receive numerous

telephone requests for the telephone

consultation program established through

my office and the Texas Psychological

Association several years ago. If you have

any questions about the program, please

call me at 713-650-6600.

28 Texas Psychologist SUMMER 2004

Texas Psychological Foundation ContributorsJanuary 1 - March 31, 2004

$500 +

Manuel Ramirez, PhD

$100-499

Gloria Chriss, PhD

Jerry Grammer, PhD

Ronald Jereb, PhD

Burton Kittay, PhD

Kimberly McClanahan, PhD

Robert McLaughlin, PhD

Robbie Sharp, PhD

Under $100

Connie Benfield, PhD, ABPP

Tim Branaman, PhD

Stacy Broun, PhD

Alan Frol, PhD

Ray Gilbert, PhD

M.P. Hewitt, EdD

Arthur Linskey, PhD

Marilyn Maas, PhD

Laurie Robinson, PsyD

Donald Trahan, PhD

Thomas Van Hoose, PhD

Richard Wheatley, PhD

Dean Paret, PhD

Randy Phelps, PhD

Barry Rath, PhD

Lynn Rehm, PhD

John Reid, PhD

Laurie Robinson, PsyD

Gordon Sauer, Jr, PhD

Verlis Setne, PhD

Robbie Sharp, PhD

Joyce Sichel, PhD

Jill Squyres, PhD

David Steinman, PhD

Thomas Tully, EdD

Thomas Van Hoose, PhD

Nancy Van Morkhoven, PhD

Beverly Walsh, PhD

David Welsh, PhD

Mark Wernick, PhD

Richard Wheatley, PhD

M. Wright Williams, PhD

Connie Wilson, PhD

Constance Wood, PhD

Kathryn Wortz, PhD

Robert Zachary, PhD

Under $100Mary Alvarez-del-Pino, PhD

Paul Andrews, PhD

Juana Antokoletz, PhD

Charles Cleland, PhD

John Elwood, PsyD

Jeanne Field, MS

Sylvia Gearing, PhD

Carol Grothues, PhD

M.P. Hewitt, EdD

Pamela Horton, PhD

Ronald Jereb, PhD

Arthur Linskey, PhD

Dwayne Marrott, PhD

Muriel Meicler, PhD

Kavita Murthy, PhD

Carole Pentony, PhD

Dorothy Pettigrew, PsyD

Manuel Ramirez, PhD

Anna Satterfield, PhD

Laura Spiller, PhD

Jessica Varnado, PhD

Patricia Weger, PhD

Anthony Arden, PhD

Joan Berger, PhD

Robin Binnig, MS

Timothy Daheim, PhD

Mary De Ferreire, PhD

El Paso County Psychological Society

Cynthia Fincher, PhD

Cynthia Galt, PhD

Alan Griffin, PhD

Terence Hannigan, PhD

Richard Holt

Alan Hopewell, PhD

Thomas Johnson, PhD

Morton Katz, PhD

Amelia Kornfeld, PhD

James Gary Marsh, PhD

Robert McLaughlin, PhD

Randy Phelps, PhD

Nell Schwartz, PhD

Richard Wheatley, PhD

Sunrise Fund ContributorsJanuary 1 - March 31, 2004

Doctoral Members

Rhonda Akkerman, PhD

Marilu Berry, PhD

Nicole Bodor, PhD

Denise Boyd, EdD

Kevin Correi, PhD

Paul Damin, PhD

Michael Hand, PhD

Lisa Lewis, PhD

Ramona Noland, PhD

Evelyn Parker-Gaspard, PhD

T. Kevin Roberts, PhD

Bridget Sonnier-Hillis, PhD

Student Members

Diane Antonvich, BA

Miriam Arnold, MA

Deborah Horn, MS

Jodie Lane, MS

Barbara McGowan

Jamie McNichol, PsyD

Michael Morris, MSSW

Alexia Tran, BA

New MembersTPA welcomes all of our new members.

Employment OpportunityDallas County, the second most populated county in Texas,is currently seeking:

PSYCHOLOGIST(Salary Commensurate w/ experience)

Psy.D. or Ph.D. in clinical or counseling psychology. One year supervised clinical experience in psychology

service. Must be licensed by Texas Board of Examiners.Must be willing to relocate to Dallas County.

Visit www.dallascounty.org or call our office at (214) 653-7638. Equal Opportunity Employer

Austin group looking for a colleague!Come join an existing group of solo practitioners each witha minimum of 10 years in private practice. Very nice officein central Austin with support staff. Pleasant atmospherewith well-established professionals. This is a wonderfulopportunity to establish or expand a practice in Austin withthe possibility for immediate referrals. (512) 454-3685.

Licensed Psychologist Needed. Expanding interdisciplinaryprivate group practice seeks a Texas licensed psychologist.Must have experience in working with children school age toadolescents. Located in a prominent part of Houston, theoffice has a very attractive setting. Very little managedcare/emergency work. Excellent benefits. E-mail resumes toJohn@tarnowcenter.com or fax to 713-621-7015.

STAFF PSYCHOLOGIST NEEDED. The Callier Center forCommunication Disorders is a nationally recognizedresearch, diagnostic and treatment facility that has beenpart of the University of Texas at Dallas since 1975. We seeka full-time PhD level clinical psychologist to join themultidisciplinary clinical staff serving individuals withcommunication impairments. The psychologist will work withspeech-language pathologists, audiologists and educatorsserving individuals with mental health concerns and co-existing communication disorders related to developmentaldelay, hearing impairment, language disorder, autisticspectrum disorder and/or brain injury. Patients range in agefrom 6 months - elderly.Minimum Professional Qualifications include a PhD or PsyDin Clinical Psychology from an APA approved training programand a Texas Psychology License. Necessary experienceincludes: administration of nonverbal IQ tests, diagnosis ofPDD, mood/anxiety disorders, etc in early childhood, skill inuse of parent guidance and coaching, crisis managementwith suicide and child abuse. Prefer ABPP inNeuropsychology, Texas LSSP, Fluency in Spanish and/orSign Language may be eligible for a one-time hiring bonus.Contact Dr. Teresa Nezworski, Search Committee Chair at214-905-3040 or nezworsk@utdallas.edu.

CLASSIFIEDS

American Professional Services Inside Front Cover

CE-credit.com 26

Center for Anger Resolution 5

Hazelden 10

Remuda Ranch 10

Rockport Insurance Associates 3

Senior Connections, Inc. 14

Nova Southeastern University 17

UT MD Anderson Cancer Center 29

ADVERTISERS INDEX

Texas Psychologist 29SUMMER 2004

M. D. Anderson Cancer Center is an EOE employer and does not discriminate on the basis ofrace, color, national origin, gender, sexual orientation, age, religion, disability or veteran status,except where such distinction is required by law. All positions at M. D. Anderson are considered

security sensitive; drug screening and thorough background checks will be conducted. TheUniversity of Texas M. D. Anderson Cancer Center values diversity in its broadest sense.

Diversity works at M. D. Anderson. Smoke-free environment.

ASSISTANT PROFESSORThe University of Texas M. D. Anderson Cancer Center, Department ofBehavioral Science, is accepting applications for a nontenure trackclinical faculty position. The individual filling this position will have acentral programmatic and educational role in the institutional facultyhealth program, and may hold a joint appointment in the Department ofNeuro-Oncology in the Division of Cancer Medicine. Candidates musthave a minimum of 5 years’ experience in mental health, strong back-ground in organizational health programs, counseling and programdevelopment. Previous experience in an academic setting and with afaculty health or professional assistance program is very desirable.Qualifications include a doctoral degree from an accredited college oruniversity in clinical psychology, counseling psychology, organiza-tional psychology, educational psychology or related field or a medicaldegree in related field. Both salary and benefits are very competitive,and salary is commensurate with experience.

The University of Texas M. D. Anderson is located within the TexasMedical Center, the largest medical center in the world. Houston is adynamic, multicultural city with a very affordable cost of living.Applications will be accepted and reviewed until the position is filled.

Application procedures: Mail cover letter, curriculum vitae and profes-sional reference list to: Ellen R. Gritz, Ph.D., Professor and Chair,The University of Texas M. D. Anderson Cancer Center, Department ofBehavioral Science - 243, 1515 Holcombe Blvd., Houston, Texas 77030-4009, or by courier, Department of Behavioral Science - HMB 7.100,1100 Holcombe Blvd., Houston, Texas 77030.

Following September 11, the American Psychological Association asked each of the 50 states’

psychological associations to create a network of psychologists who are trained in disaster or

crisis response. Drs. Rita Justice and Judith Andrews were asked by TPA to chair the Texas

Psychological Association Disaster Response Network. Since then, the TPA Disaster Response Network

chairs and committee have attempted to educate psychologists regarding specialty training and to

identify those licensed psychologists in the state of Texas who have had crisis response training or would

like to have such training.

As a group of crisis response trained psychologists, the TPA DRN does not act as an

independent team but may respond through various venues such as Red Cross, NOVA, or CISM

teams. Our purpose includes encouraging psychologists to become trained in crisis response and

to obtain local practice before being asked to respond to a statewide or nationwide disaster.

The purpose of this notice is to reach TPA members who are crisis trained and are not part of our

database. If you would like to become a part of our TPA DRN, please e-mail Judith Andrews at

judithphdjudith@yahoo.com. We will then e-mail you a database form and current information about

the business of the Disaster Response Network here in Texas.

Sincerely,

Judith Andrews, PhD

Rita Justice, PhD

TPA DRN Coordinators

Calling TPA Psychologists to Disaster Response: