VOLUME 40 NO. 2

BULLETIN

PsychotherapyOFFIC IAL PUBL ICAT ION OF D IV IS ION 29 OF THE

AMERICAN PSYCHOLOGICAL ASSOCIAT ION

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In This Issue

Ad Hoc Committee on Psychotherapy:Commitment to Scientist-Practitioner

Collaboration

Interview with Patricia Bricklin, Ph.D.,Past President of Division 29

Therapeutic Work and ProfessionalDevelopment: Main Findings and

Practical Implications of aLong-Term International Study

PresidentLeon VandeCreek, Ph.D.117 Health Sciences Bldg.School of Professional PsychologyWright State UniversityDayton, OH 45435Ofc: 937-775-3944 Fax: 937-775-5795E-Mail: Leon.Vandecreek@Wright.edu

President-electAbraham W. Wolf, Ph.D.Metro Health Medical Center2500 Metro Health DriveCleveland, OH 44109-1998Ofc: 216-778-4637 Fax: 216-778-8412E-Mail: axw7@po.cwru.edu

Secretary Armand Cerbone, Ph.D., 20053625 North PaulinaChicago IL 60613Ofc: 773-755-0833 Fax: 773-755-0834email: arcerbone@aol.com

TreasurerJan L. Culbertson, Ph.D., 2004-2006Child Study CenterUniversity of Oklahoma Hlth Sci Ctr 1100 NE 13th St Oklahoma City , OK 73117 Ofc: 405-271-6824, ext. 45129Fax: 405-271-8835 Email: jan-culbertson@ouhsc.edu

Past PresidentLinda F. Campbell, Ph.D.University of Georgia402 Aderhold HallAthens, GA 30602-7142Ofc: 706-542-8508 Fax: 770-594-9441E-Mail: lcampbel@uga.edu

Board of Directors Members-at-LargeNorman Abeles, Ph.D. , 2003-2005Michigan State Univ.Dept. of PsychologyE. Lansing, MI 48824-1117Ofc: 517-355-9564 Fax: 517-353-5437Email: Norman.Abeles@ssc.msu.edu

James Bray, Ph.D., 2005-2007Dept of Family & Community Med Baylor College of Medicine3701 Kirby Dr, 6th Fl Houston , TX 77098 Ofc: 713-798-7751 Fax: 713-798-7789 Email: jbray@bcm.tmc.edu

Charles Gelso, Ph.D., 2005-2006University of MarylandDept of PsychologyBiology-Psychology BuildingCollege Park, MD 20742-4411Ofc: 301-405-5909 Fax: 301-314-9566 Email: Gelso@psyc.umd.edu

Jon Perez, Ph.D., 2003-2005IHS Division of Behavioral Health12300 Twinbrook Parkway, Ste 605Rockville, MD 20852Ofc: 202-431-9952Email: jperez@hqe.ihs.gov

Alice Rubenstein, Ed.D., 2004-2006Monroe Psychotherapy Center20 Office Park WayPittsford, NY 14534Ofc: 585-586-0410 Fax: 585-586-2029Email: akr19@aol.com

Libby Nutt Williams, Ph.D., 2005-2007Department of PsychologySt. Mary’s College of Maryland18952 E. Fisher Rd.St. Mary’s City, MD 20686Ofc: 240-895-4467 Fax: 240-895-4436Email: enwilliams@smcm.edu

APA Council RepresentativesPatricia M. Bricklin, Ph.D., 2005-2007470 Gen. Washington Rd.Wayne, PA 19087Ofc: 610-499-1212 Fax: 610-499-4625Email: pmb0001@mail.widener.edu

Norine G. Johnson, Ph.D., 2005-200713 Ashfield St., Roslindale, MA 02131 Ofc: 617-471-2268 Fax: 617-325-0225Email: NorineJ@aol.com

John C. Norcross, Ph.D., 2005-2007Department of PsychologyUniversity of ScrantonScranton, PA 18510-4596Ofc: 570-941-7638 Fax: 570-941-7899E-mail: norcross@scranton.edu

COMMITTEES

FellowsChair: Lisa Porche-Burke, Ph.D.Phillips Graduate Institute 5445 Balboa Blvd. Encino, CA 91316-1509 Ofc: 818-386-5600 Fax: 818-386-5695 Email: lpburke@aol.com

MembershipChair: Rhonda S. Karg, Ph.D. Research Triangle Institute 3040 Cornwallis Road Research Triangle Park, NC 27709 Ofc: 919-316-3516 Fax: 919-485-5589

Student Development Chair: Adam Leventhal, 2005Department of PsychologyUniversity of HoustonHouston, Texas 77204-5022Ofc: 713-743-8600 Fax: 713-743-8588E-mail: aleventhal@uh.edu

Nominations and ElectionsChair: Abe Wolf, Ph.D.

Professional AwardsChair: Linda Campbell, Ph.D.

FinanceChair: Jan Culbertson, Ph.D.

Education & TrainingChair: Jeffrey A. Hayes, Ph.D.Counseling Psychology ProgramPennsylvania State University312 Cedar BuildingUniversity Park, PA 16802Ofc: 814-863-3799E-mail: jxh34@psu.edu

Continuing EducationChair: Steve Sobelman, Ph.D.Department of PsychologyLoyola College in MarylandBaltimore, MD 21210Ofc: 410-617-2461E-mail: sobelman@loyola.edu

Diversity Chair: Jennifer F. Kelly, Ph.D.Atlanta Center for Behavioral Medicine3280 Howell Mill Road Suite 100Atlanta, GA 30327Ofc: 404-351-6789 Fax: 404-351-2932 E-mail: jfkphd@aol.com

ProgramChair: Alex Siegel, Ph.D., J.D.915 Montgomery Ave. #300Narbeth, PA 19072Ofc: 610-668-4240 Fax: 610-667-9866E-mail: ams119@aol.com

Psychotherapy ResearchChair: William B. Stiles, Ph.D.Department of Psychology Miami University Oxford, OH 45056 Ofc: 513-529-2405 Fax: 513-529-2420 Email: stileswb@muohio.edu

The Ad Hoc Committee onPsychotherapyLinda Campbell, Ph.D. and

Leon VandeCreek, Ph.D., Co-ChairsJeffrey Hayes, Ph.D. and Craig Shealy,

Ph.D., Education and TrainingJean Carter, Ph.D. and Alice

Rubenstein, Ed.D., PracticeBill Stiles, Ph.D., ResearchJohn Norcross, Ph.D., Chair

Publications BoardNorine Johnson, Ph.D., Representative

Division of Psychotherapy � 2005 Governance Structure

ELECTED BOARD MEMBERS

COMMITTEES AND TASK FORCES

John C. Norcross, Ph.D., 2005-2007Department of PsychologyUniversity of ScrantonScranton, PA 18510-4596Ofc: 570-941-7638 Fax: 570-941-7899E-mail: norcross@scranton.edu

Jean Carter, Ph.D., 1999-20053 Washington Circle, #205Washington, D.C. 20032Ofc: 202-955-6182jeancarter5@comcast.net

Lillian Comas-Dias, Ph.D., 2001-2006Transcultural Mental Health Institute908 New Hampshire Ave. N.W., #700Washington, D.C. 20037cultura@erols.com

Raymond A. DiGiuseppe, Ph.D., 2003-2008Psychology DepartmentSt John’s University 8000 Utopia Pkwy Jamaica , NY 11439 Ofc: 718-990-1955 DiGiuser@STJOHNS.edu

Alice Rubenstein, Ed.D., 2000-2006Monroe Psychotherapy Center20 Office Park WayPittsford, NY 14534Ofc: 585-586-0410 Fax 585-586-2029akr19@aol.com

George Stricker, Ph.D., 2003-2008Institute for Advanced Psychol Studies Adelphi University Garden City, NY 11530 Ofc: 516-877-4803 Fax: 516-877-4805 stricker@adelphi.edu

Psychotherapy Journal EditorCharles Gelso, Ph.D., 2005-2010University of MarylandDept of PsychologyBiology-Psychology BuildingCollege Park, MD 20742-4411Ofc: 301-405-5909 Fax: 301-314-9566 Gelso@psyc.umd.edu

Psychotherapy Bulletin EditorCraig N. Shealy, Ph.D., 2004-2006Department of Graduate PsychologyJames Madison UniversityHarrisonburg, VA 22807-7401Ofc: 540-568-6835 Fax: 540-568-3322shealycn@jmu.edu

Internet EditorBryan S. K. Kim, Ph.D., 2005-2007Counseling, Clinical, and School Psychology ProgramDepartment of EducationUniversity of CaliforniaSanta Barbara, CA 93106-9490Ofc & Fax: 805-893-4018bkim@education.ucsb.edu

Student Website CoordinatorNisha NayakUniversity of HoustonDept of Psychology (MS 5022)126 Heyne BuildingHouston, TX 77204-5022Ofc: 713-743-8600 or -8611 Fax: 713-743-8633nnayak@uh.edu

PUBLICATIONS BOARD

DIVISION OF PSYCHOTHERAPY (29)

Central Office, 6557 E. Riverdale Street, Mesa, AZ 85215Ofc: (602) 363-9211 • Fax: (480) 854-8966 • E-mail: assnmgmt1@cox.net

www.divisionofpsychotherapy.org

PSYCHOTHERAPY BULLETIN

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

Contributors are invited to send articles (up to 4,000 words), interviews, commentaries, letters to the editor,and announcements to Craig N. Shealy, Ph.D., Editor, Psychotherapy Bulletin. Please note that PsychotherapyBulletin does not publish book reviews (these are published in Psychotherapy, the official journal of Division29). All submissions for Psychotherapy Bulletin should be sent electronically to shealycn@jmu.edu; please ensurethat articles conform to APA style. Deadlines for submission are as follows: February 1 (spring); May 1 (summer); August 1; November 1 (winter). Past issues of Psychotherapy Bulletin may be viewed at our website:www.divisionofpsychotherapy.org. Other inquiries regarding Psychotherapy Bulletin (e.g., advertising) orDivision 29 should be directed to Tracey Martin at the Division 29 Central Office (assnmgmt1@cox.net or 602-363-9211).

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Permit No. 83

PSYCHOTHERAPY BULLETIN

Published by theDIVISION OF

PSYCHOTHERAPYAmerican Psychological Association

6557 E. RiverdaleMesa, AZ 85215

602-363-9211e-mail: assnmgmt1@cox.net

EDITORCraig N. Shealy, Ph.D.

CONTRIBUTING EDITORS

Washington ScenePatrick DeLeon, Ph.D.

Practitioner ReportRonald F. Levant, Ed.D.

Education and TrainingJeffrey A. Hayes, Ph.D.

Psychotherapy ResearchWilliam Stiles, Ph.D.

Student FeatureAdam Leventhal

STAFF

Central Office AdministratorTracey Martin

Website

www.divisionofpsychotherapy.org

PSYCHOTHERAPY BULLETINOfficial Publication of Division 29 of the

American Psychological Association

Volume 40, Number 2

CONTENTS

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

Student Feature: Fostering Self-Awareness ........4

Ad Hoc Committee on Psychotherapy:Commitment to Scientist-Practitioner Collaboration ........................................................9

Interview with Patricia Bricklin, Ph.D.,Past President of Division 29............................12

Recent Trends in Internship Training ................13

Washington Scene: A Few DedicatedVisionaries ..........................................................21

2005 Rosalee G. Weiss Lecturer:Dr. Marvin R. Goldfield ....................................26

Therapeutic Work and Professional Development: Main Findings and Practical Implications of a Long-Term International Study ............................................27

2005 Recipient of the APA DistinguishedContributions to Education & Training ..........33

Membership Application......................................35

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One of the excitingand challengingaspects of servingas president ofDivision 29 is that I get to participatein many of the cut-ting edge issues ofthe committees ofthe Division. Youwould be pleasedto know that many

psychologists are actively working on ini-tiatives for psychotherapy. I will highlighta few of them here, and others havedescribed them elsewhere in this issue.

Linda Campbell, past-president, and I havecontinued to consult on a regular basisabout the initiatives that were begun lastyear. She and I have hosted conference callswith members of the Research Committee(Bill Stiles is the committee chair) and withmembers of the Professional PracticeCommittee (Jean Carter and AliceRubinstein are co-chairs). We have foundthese conference calls to be a very efficientand effective way to keep informed aboutcommittee work and to keep enthusiasmhigh. Some of these initiatives aredescribed by Linda Campbell in this issue.We expect to have similar calls in the nextmonth with both the MembershipCommittee and the Training Committee.

One of the exciting developments has beenthe continued expansion of the division’sweb page. Bryan Kim has added severalnew features. It will soon be possible toapply for membership online (includingpayment) without needing to download ormail the application form. Please encour-age your colleagues to join; it is easy andinexpensive. Another new feature of theweb page is the Research Clearinghousewhich provides an opportunity for

researchers to list their research projectsand to invite participation. All of us prob-ably receive periodic requests fromresearchers to serve as subjects or partici-pants, but we hope that our ResearchClearinghouse will encourage researchersto invite others in the division to partici-pate in projects in a variety of ways. Forexample, researchers could invite practi-tioners to participate by collecting clientdata, or researchers could invite practition-ers and trainers and other researchers toplay a role in the design of a project. Wehope the Clearinghouse will be attractiveto many members of the division.

One of APA President Ron Levant’s initia-tives is to gain some consensus on evi-dence-based practice in psychology (EBPP).He established a task force that developed adraft policy statement. The members of theAd Hoc Committee on Psychotherapy:Commitment to the Scientist-PractitionerCollaboration discussed this statement andmade recommendations that I submitted tothe task force. Our recommendation was toinclude the phrase “psychologically-basedpsychotherapy” in the definition of EBPPand we referenced a definition of psy-chotherapy that was adopted by the divi-sion in 2002. That definition reads as fol-lows: “Psychotherapy is the informed andintentional application of clinical methodsand interpersonal stances derived fromestablished psychological principles for thepurpose of assisting people to modify theirbehaviors, cognitions, emotions, and/orother personal characteristics in directionswhich the participants deem desirable.”Our recommendation to insert the phrase“psychologically-based psychotherapy”was consistent with our on-going effort toincrease the presence of the word “psy-chotherapy” in clinical literature and policystatements. As Linda Campbell noted lastyear in one of her presidential columns, this

PRESIDENT’S COLUMN

Leon VandeCreek, Ph.D.

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word has disappeared from many policydocuments and has been replaced by broad-er phrases, such as “methods of interven-tion” which includes procedures that arenot psychotherapy. The upshot of this shift-ing terminology is that training programsand accreditation bodies do not require thatstudents receive training in psychotherapy,but rather in methods of intervention. Wewant to keep the word psychotherapy frontand center for the profession.

Our discussion about the policy statementon evidence-based practice led to anotherexciting idea, namely that we are poorlyinformed about the role of clinical judg-ment and expertise of psychotherapists inproviding care to our clients. Someresearchers contend that practitionersshould only use empirically supportedtreatments which usually refers to thosetreatments that have found research sup-

port in rigidly controlled studies. The roleof the clinician’s judgment in tailoringtreatments to match the unique needs ofeach client is usually excluded from thisline of research. Yet, the experiences ofpractitioners tell us that few clients matchthe inclusion criteria of the research studiesand most of our clients are too complex forus to be bound by laboratory criteria. Wereally need to know more about the role ofclinical judgment in selecting and imple-menting treatment. In response to our dis-cussion, the Practice Committee has sug-gested to our journal editor that a specialsection of the journal be devoted to clinicaljudgment and he has enthusiasticallyagreed.

A lot is happening in the division and we arealways interested in hearing from you. I ameasy to contact at leon.vandecreek@wright.edu.

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

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STUDENT FEATURE

Fostering Self-Awareness: Moving in the Direction of Empirically-Based Training

Scott D. McDonaldVirginia Commonwealth University

AbstractSelf-awareness is regarded as an essentialcharacteristic of the competent, well-func-tioning therapist. However, it is unclearwhether general didactics and supervisionpractices are effective at fostering self-awareness. Recent findings suggest that anevidence-based training approach, usingself-reflection, improves self-awarenessand subsequently clinical skills. This articleasserts that self-reflection, particularlywhen paired with self-practice, is a tech-nique that can be used to enrich personalawareness, clarify the mechanisms ofchange, and deepen the understanding ofthe therapeutic process.

Fostering Self-Awareness: Moving in theDirection of Empirically-Based TrainingFellow therapist trainees: Let me begin byasking a few questions about your mostrecent intake session. In your best estima-tion: 1. How would the client rate the qual-ity of the therapeutic bond? 2. Did you andthe client have a common perception of hisor her goals for therapy? 3. Did you andthe client have a common perception ofwhat tasks would be important in therapy?And lastly, 4. Do you think the client willreturn for another session?

Now, let me ask two more questions. Howmuch confidence do you have in youranswers? Do you feel that your estimate ofquality of the therapeutic alliance and like-lihood of client return would correspond toyour client’s experience? If you are likemany trainees, you probably rationalizedthat, regardless of how good or bad, yourratings were fairly accurate. But accordingto a recent study described in ProfessionalPsychology: Research and Practice, the thera-pist trainee is a poor judge of the client’s

experience in the intake session. In fact,although client and observer quality rat-ings of the therapeutic working allianceand likelihood of return were comparable,therapist trainee ratings on analogous measures bore little resemblance to clientratings, even after a year of supervisedclinical practice.

For the abovementioned study, O’Donovan,Bain and Dyck (2005) recruited 61 therapisttrainees from clinical psychology programsand clinical apprenticeships (bothapproaches can lead to licensure inAustralia). At the beginning of therapisttraining and one year later, trainees con-ducted intake interviews with researcherconfederates who assumed standardizedpatient profiles. The researchers found thatalthough the client and observer were instrong concord on ratings of rapport,agreement on therapeutic goals and tasks,and ratings of likelihood of returning forfuture sessions, ratings by trainees did notmatch those of the clients.

What could account for the inaccuracy? O’Donovan and colleagues (2005) suggest-ed that although the trainees in their studymay have properly followed protocol andtechniques appropriate for conducting anintake session (i.e., building rapport, iden-tifying the problem, and setting goals),they had not yet developed a depth ofawareness that would allow them to dis-cern the experience from the client’s per-spective. However, lack of experiencealone may not have been to blame. In fact,therapists with substantially more experi-ence than O’Donovan’s trainees appear tosuffer the same inclination to misreadclients’ dispositions. An earlier study byHill and colleagues (1993) asked therapists

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with an average of ten years postgraduateclinical practice to anticipate whatthoughts or feelings their clients experi-enced but did not relay during therapy ses-sions. Results indicated that althoughclients reported hiding negative thoughtsand feelings during the session, the thera-pists were seldom aware of their clients’reactions.

In clinical psychology, a tenet of profes-sional competence is the possession of a self-awareness of biases, stereotypes,and self-schemas that can interfere withtreatment (American PsychologicalAssociation, 2002). Along those lines, sev-eral sources have emphasized that build-ing a student’s self-awareness is critical intraining (e.g., Sue et al., 1998). In fact, theCouncil of Chairs of Training Councils(CCTC)—the umbrella system of doctoral,internship, and postdoctoral training coun-cils in professional psychology—recentlydeveloped a document designed, in part,to notify students and trainees that theiracademic performance will be evaluatedacross a wide spectrum of competency areas,including but not limited to sufficient selfawareness (see http://gradpsych.apags.org/jun04/competence.cfm). Moreover, surveysof both practicing licensed psychologistsand heads of doctoral clinical, counseling,and school psychology programs agreedthat self-awareness was the leading con-tributor to whether a psychologist is able tofunction in an unimpaired manner(Schwebel & Goster, 1998). Furthermore, ina more recent study, interviews with high-ly-regarded therapists revealed that aware-ness of their own issues and the under-standing that personal issues had thepotential to impact the therapy session wasa primary ethical value (Jennings,Sovereign, Bottorff, Mussell, & Vye, 2005).

How can therapists improve their self-awareness? In light of their findings with trainees sum-marized above, O’Donovan and colleagues(2005) recommended that experientialaspects of therapist training programs, inaddition to didactic seminars, should

include the formal practice of self-reflection to improve the burgeoning professional’s ability to accurately judgetheir therapeutic work (see alsohttp://gradpsych.apags.org/jun04/com-petence.cfm). The recommendation thatself-reflection be included as part of clinicaltraining was not derived in a vacuum,however. A quick search of the literaturereveals several examples of how self-reflec-tion has been identified as a valuable com-ponent of professional training programsin medicine (Niemi, 1997), nursing (Marita,Leena, & Tarja, 1999), marriage and familytherapy (Naden, Johns, Ostman, & Mahan,2004), and music therapy (Camilleri, 2001).

Self-reflection, which refers to a “metacogni-tive skill that encompasses observation,interpretation and evaluation of one’s ownthoughts, emotions, feelings, and actions”(Bennet-Levy et al., 2001) is thought to be akey element in the learning of new skills(Schön, 1987). Practicing self-reflection canfoster a deeper understanding of technical-rational knowledge (i.e., textbook learningand lecture) and the mechanisms throughwhich particular techniques work. Althoughdidactics lay the foundation for professionaldevelopment, self-reflection helps the traineemature a sense of “professional artistry,” animportant component of professional com-petence that involves self-awareness andversatility in practice. In his seminal work,The Reflective Practitioner, Schön (1983)described the process of self-reflection:

When a practitioner reflects in and onhis practice, the possible objects of hisreflection are as varied as the kinds ofphenomena before him and the systemsof knowing-in-practice which he bringsto them. He may reflect on the tacitnorms and appreciations which under-lie a judgment, or on the strategies andtheories implicit in a pattern of behav-ior. He may reflect on the feeling for asituation which has led him to adopt aparticular course of action, on the wayin which he has framed the problem heis trying to solve, or on the role he hasconstructed for himself within a largerinstitutional context.

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Can clinical training improve self-awareness? Certainly, as this author ’s Director ofClinical Training recently pointed out, self-awareness takes the guise of various “gen-eral” factors in clinical competence such assupervisablity, maturity, and motivation toimprove. Unfortunately, it is unclear fromthe literature whether standard didacticsand supervised experience alone leads tothe trainee developing self-awareness. Infact, as the results of O’Donovan et al.(2005) indicate, a full year of supervisedclinical training did not improve trainee’sability to accurately judge their therapeuticwork.

On the other hand, there is some evidencethat programs implementing specific pro-tocols utilizing self-reflection have beensuccessful in improving clinical skills(Bennett-Levy, et al., 2001; Marita et al.,1999). For example, Bennett-Levy and col-leagues (2001) performed a qualitativestudy of a course in cognitive therapy thatincluded self-reflection paired with self-practice, such as completing thoughtsrecords, setting personal goals, and con-ducting behavioral experiments. At theend of the course, participants reported adeeper understanding of the therapeuticprocess which was useful as a therapist butalso in their personal lives. Specifically,they reported an enhanced understandingof the therapist role, cognitive theory, andthe mechanisms by which changeoccurred. As one participant conveyed,

Although I already knew that emotionsare a result of our interpretation ofevents, this situation gave me a goodexample of that from my own experi-ence. So rather than just “knowing”about this phenomenon I “realized” it –the difference between understandingthe concept at a head level and gainingan unquestionable, full-bodied experi-ence of understanding (p. 211).

Many participants also reported enrichedpersonal awareness:

The whole process has taught me thingsabout myself, the way I think, and the

way I unconsciously sabotage the posi-tive. I am now aware of Little MissNasty, who rears her ugly head whenev-er something positive happens (p. 213).

Results also suggested participants experi-enced an enrichment of therapist skills anddeveloped stronger self-concepts as thera-pists. In the words of one trainee,

What it has truly given me is a belief, abelief that cognitive therapy works, that Iam capable of doing cognitive therapyand that I can help clients do cognitivetherapy. Empirical and scientific ground-ing helped me to believe in the efficacy ofcognitive therapy. Practice and reflectiondemonstrated I could do it. Reflectionand my own experience of cognitive ther-apy techniques gave me confidence that Ihad what it took to help my clients usecognitive therapy (p. 214).

How does one practice self-reflection?There are several avenues to increasing self-awareness through the use of self-reflection.One approach is for the trainee to enter ther-apy as a client (Ramos-Sanchez et al., 2002).However, despite the requirement of analy-sis for the practitioner of psychoanalysis(Prochaska & Norcross, 1999) and limitedevidence that personal therapy improvesskills and attitudes used in practice (Macran,Stiles, & Smith, 1999), it is unclear whetherexperience as a client has an impact on atherapists clinical effectiveness (Macaskill,1988; Macran & Shapiro, 1998).

Perhaps a better option is for the trainee topractice self-reflection techniques duringsupervised practica, such as watching tapesof therapy sessions, keeping a “learninglog” of clinical experiences (Niemi, 1997),writing periodic reflection papers (Nadanet al., 2004), and role-playing from a client’sviewpoint with colleagues (Beck, Rush,Shaw, & Emery, 1979). In addition, there is agrowing emphasis, particularly in cognitivetherapy, for therapists to practice tech-niques on themselves and reflect on theexperience (Bennett-Levy et al., 2001). AsPadesky (1996) succinctly declared, “tofully understand the process of the therapy,

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there is no substitute for using cognitivetherapy methods on oneself.” (p. 288). TheBennett-Levy et al. (2001) study reviewedabove illustrated an exemplar of self-prac-tice and self-reflection, utilizing groupmeetings, weekly diaries, and Grenbergerand Padesky’s (1995) Mind over Mood whichincluded thought records and self-guidedbehavioral experiments. Furthermore,interested therapists may benefit from tak-ing advantage of other learning opportuni-ties such as workshops on schema identifi-cation (Padesky, 1996), practica experiencesin group therapy with an interpersonalfocus (Yalom, 1995), and becoming familiarwith the relevant literature (e.g., Schön,1983, 1987; Von Wright, 1992).

In summary, self-awareness is regarded asan essential characteristic of the competent,well-functioning therapist. Furthermore,therapists who are highly regarded by theirpeers report self-awareness as one of theircore ethical values. However, it is unclearwhether general didactics and supervisionpractices are effective at fostering self-awareness. Recently, the practice of self-reflection, particularly when paired withself-practice, has gained support as a tech-nique to enrich personal awareness, clarifythe mechanisms of change, and deepen theunderstanding of the therapeutic process(e.g., see http://www.apa.org/ed/gradu-ate/cctcevaluation.pdf). Despite the appar-ent agreement of the APA, clinical trainingdirectors, and practicing clinicians thatself-awareness is a critical attribute of thecompetent therapist, the paucity ofresearch that can inform training in thisarea is perplexing. Furthermore, a reviewof the four example student evaluationforms in the Manual for Directors of ClinicalTraining prepared by the Council ofUniversity Directors of Clinical Psychology(CUDCP, 2005) revealed that only two haditems that directly dealt with self-aware-ness (e.g., “shows a sensitivity to his/herown strengths and weaknesses”; “under-stands clients impact on self.”). Clearly, amore focused definition of “self-aware-ness” is needed if clinical researchers are towork towards developing a useful

research-based training agenda. Perhapsthe recent and above noted efforts by pro-fessional organizations such as the Councilof Chairs of Training Councils—combinedwith increased interest in empirically sup-ported therapeutic relationships (e.g.,Norcross, 2002)—will draw more eyestoward this issue.

ReferencesAmerican Psychological Association

(2002). Guidelines on multicultural educa-tion, training, research, practice, and organi-zational change for psychologists. RetrievedApril 25, 2005, from http://www.apa.org/pi/multiculturalguidelines/

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery,G. (1979). Cognitive therapy of depression.New York: The Guilford Press.

Bennett-Levy, J., Turner, F., Beatty, T.,Smith, M., Paterson, B., & Farmer, S.(2001). The value of self-practice of cog-nitive therapy techniques and self-reflec-tion in the training of cognitive thera-pists. Behavioural and CognitivePsychotherapy, 29, 203-220.

Camilleri, V. A. (2001). Therapist self-awareness: An essential tool in musictherapy. Arts in Psychotherapy, 28(1) 2001,79-85.

Council of University Directors of ClinicalPsychology (CUDCP; 2005) Manual fordirectors of clinical training. RetrievedApril 25, 2005, from http://www.am.org/cudcp/DCT%20manual_rev05.pdf

Greenberger, D., & Padesky, C. A. (1995).Mind over mood: A cognitive therapy treat-ment manual for clients. New York: TheGuilford Press.

Hill, C. E., Thompson, B. J., Cogar, M. C., &Denman, D. W. (1993). Beneath the sur-face of long-term therapy: Therapist andclient report of their own and eachother ’s covert processes. Journal ofCounseling Psychology, 40(3), 278-287.

Jennings, L., Sovereign, A., Bottorff, N.,Mussell, M. P., & Vye, C. (2005). Nineethical values of master therapists.Journal of Mental Health Counseling, 27(1),32-47.

Macaskill, N. D. (1988). Personal therapy inthe training of the psychotherapist: Is it

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effective? British Journal of Psychotherapy,4(3), 219-226.

Macran S, & Shapiro D. A. (1998). The roleof personal therapy for therapists: Areview. British Journal of MedicalPsychology, 71, 13-25.

Macran, S., Stiles, W. B., & Smith, J. A.(1999). How does personal therapy affecttherapists’ practice? Journal of CounselingPsychology, 46(4), 419-431.

Marita, P., Leena, L., & Tarja, K. (1999).Nurses’ self-reflection via videotaping toimprove communication skills in healthcounseling. Patient Education andCounseling, 36, 3-11.

Naden, M., Johns, K., Ostman, C., &Mahan, T. (2004). Student therapistsgrapple with modern and postmodernideas: One program’s approach to train-ing. Contemporary Family Therapy, 26(4),465-480.

Niemi, P. M. (1997). Medical student’ pro-fessional identity: Self-reflection duringthe preclinical years. Medical Education,31, 408-415.

Norcross, J. C. (2002). Psychotherapy rela-tionships that work: Therapist contributionsand responsiveness to patients. New York:Oxford University Press.

O’Donovan, A. Bain, J. D., & Dyck, M. J.(2005). Does clinical psychology educa-tion enhance the clinical competence ofpractitioners? Professional Psychology:Research and Practice, 36(1), 104-111.

Padesky, C. A. (1996). Developing cogni-tive therapist competency: Teaching andsupervision models. In P. M. Salkovskis(Ed.), Frontiers of cognitive therapy. (pp.226-292). New York: The Guilford Press.

Prochaska, J. O., & Norcross, J. C. (1999).Systems of psychotherapy: A transtheoreticalanalysis (4th ed.). Washington, D.C.:Brooks/Cole Publishing.

Ramos-Sanchez, L., Esnil, E., Goodwin, A.,Riggs, S., Touster, L. O., Wright, L. K., etal. (2002). Negative supervisory events:Effects on supervision satisfaction andsupervisory alliance. Professional Psych-ology: Research and Practice, 33, 197-202.

Schön, D. A. (1983). The Reflective practition-er: How professionals think in action. NewYork: Basic Books.

Schön, D. A. (1987). Educating the reflectivepractitioner: Toward a new design for teach-ing and learning in the professions. SanFrancisco: Jossey-Bass.

Schwebel, M., & Coster, J. (1998). Well-functioning in professional psycholo-gists: As program heads see it.Professional Psychology: Research andPractice, 29(3), 284-292.

Sue, D. W., Carter, R. T., Casas, J. M.,Fouad, N. A., Ivey, A. E., Jensen, M., et al.(1998). Multicultural counseling competen-cies: Individual and organizational develop-ment. Thousand Oaks, CA: Sage.

Von Wright, J. (1992). Reflections on reflec-tion. Learning and Instruction, 2, 59-68.

Yalom, I. D. (1995). The theory and practice ofgroup psychotherapy. (4th ed.). New York:Basic Books.

Author NoteCorrespondences concerning this articleshould be sent to Scott D. McDonald,Virginia Commonwealth University,Department of Psychology, ClinicalProgram, P.O. Box 842018, Richmond, VA23284-2018. E-mail: smcdonal@vcu.edu

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The Ad HocCommit tee onPsychotherapy wasd e v e l o p e d t oadvance the role ofpsychotherapy inpractice, training,and research. Thismission was thep r e s i d e n t i a l initiative of PatB r i c k l i n , L i n d a

Campbell, and the current president, LeonVandeCreek. This column in each issue ofthe Bulletin will inform the membership ofthe progress being made toward the fifteengoals set as priority actions by the board ofdirectors.

Several activities have occurred since thelast Bulletin briefing and several of theseare addressed in the President’s Column.Two major components of our priorityactions are continuing education opportu-nities and collaboration with federalgrantors on psychotherapy research.

In a conference call with the practice repre-sentatives on our committee, Jean Carterand Alice Rubenstein, the need for addi-tional vehicles for scientist-practitioner col-laboration was discussed. Our researchand our practice membership are veryinterested in working together to advanceclinically based psychotherapy researchand to be in the forefront of the evidencebased movement on clinical judgment andclinical expertise. The ideas that our focusgroups and our leadership offer as an ini-tial collaboration model include severalvariations.

Practitioners are very involved in appliedresearch that focuses on the psychothera-peutic process. Conventionally, when prac-

titioners participate with researchers, theresearchers benefit by advancing theirresearch project, but the practitioners may not be able to benefit other than altruistically (when we acknowledge it as an important motive). The practice and research focus groups suggest thatcontinuing education credit for types ofparticipation could be valuable. Further, aclearinghouse function for practitionersand scientists to match up for various levels of collaboration would also be valuable. These ideas take the form of thefollowing recommendations:

1. Practitioners who want to learn moreabout clinically relevant psychotherapyresearch could read articles in this specific focus area, answer questionsprovided by the author, and gain contin-uing education credit for the activity.This activity could also be expanded toinclude a time designated chat room ora web feature that allows practitionersto discuss the article with the author.This option allows participation at theCE learner level but does not requireactive participation in projects.

2. Practitioners may volunteer to partici-pate as subjects in clinically basedresearch. This option could includeresearch geared to therapist variables,client variables, relationship variables, oroutcome. The type and level of participa-tion would depend on the subject of theresearch. This option could be imple-mented by researchers presenting theirideas through a clearinghouse functionon our web site. Practitioners could selectthose that most appeal to them.

3. A type of actual collaboration was sug-gested in which researchers could present their research questions and

AD HOC COMMITTEE ON PSYCHOTHERAPY

Commitment to Scientist-Practitioner CollaborationLinda Campbell, Ph.D., Co-Chair

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proposed methodology to our practi-tioner participants in order to gain rec-ommendations for practicality, imple-mentation, pitfalls, and additional complicating factors not considered.Also, practitioners could identify thestrengths in the research questions andother factors that enhance the project.

4. The clearinghouse function would alsomake possible the equal collaborationfor practitioners and researchers towork on a project from the beginningtogether. There isn’t a mechanism cur-rently within our division, nor else-where as we know it, that promotes thematching of practitioners who have spe-cific clinically based research interestswith psychotherapy researchers of thesame interest areas. As these dialoguesbegin and our membership becomesmore accustomed to this activity withinthe division, a clearinghouse functionthrough the web would offer a vehiclefor practitioners and researchers tobegin their collaborations.

5. As Carol Goodheart and Jean Carter soeloquently put it, “clinicians arecanaries in the coal mines.” The coalminers carried canaries in cages withthem down those several miles into themines and knew when the canary couldnot breathe, that only a short time later,they too would not be able to breathethe deadly, but odorless, gases. OurDivision of Psychotherapy is proud tohave among our membership, manymaster psychotherapists who havemade and continue to make invaluablecontribution to the field and whoseinfluence has shaped the landscape ofclinical work immeasurably. These areclinical experts who identify previouslyunknown themes, patterns,patient/client reactions, relationshipvariables, client variables and their rela-tionship to other factors, and manyother perceptions that are unlikely to beknown by researchers before they arenoted by practitioners.

Jean Carter and Alice Rubenstein suggest-ed that practitioners could suggestresearch questions to be considered foradoption by psychotherapy researchers.These questions would emanate fromobservations made by practitioners butwhich are not pursued by researchers inthe field. This possibility opens up a veryexciting potential for collaboration and forearly detection of ideas that have not beenformulated heretofore.

These practitioner-researcher collabora-tion ideas are very exciting to those par-ticipating and we would very much appreciate hearing from you, our membership, on your ideas or simplyyour thoughts on these ideas.

Additionally, as reported in the lastBulletin issue, our research members havenoted that psychotherapy research thatfocuses on process variables, client or ther-apist variables, and other worthy variablesfor investigation are often not noted in thecriteria for federal funding of mentalhealth research. Our research members arediligently composing a document thatdescribed their issues and concerns regard-ing consideration for federal grant money.When the position paper is completed, theAd Hoc Committee representatives willwork within APA to determine how to pro-ceed with the initiative. The 2005Presidential Task Force on Evidence-BasedPractice has issued a draft for comment(see President’s Column). This positionpaper, if advanced through APA, furtherdocuments the importance of clinical evi-dence and expertise. The Ad HocCommittee is encouraged that the currentclimate supports inclusiveness of clinicalvariables in practice and therefore sets thestage for our pursuit of these variablesbeing extended into psychotherapyresearch criteria.

Please let us hear from you as you havecomments or ideas that contribute to ourmission of advancing psychotherapy. Thisis an important pursuit and we need you,

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the membership, to make this initiativesuccessful.

If any of our members are interested ininvolvement in any activities describedhere, please contact Linda Campbell(lcampbel@uga.edu) or Leon VandeCreek(Leon.VandeCreek@Wright.edu) and we can

steer you to the person conducting the activ-ity. We will be highlighting an area of the AdHoc Committee focus in each Bulletin. In thenext issue we will update you on the activi-ties going on in practice. Please stay tunedand stay connected to these important initia-tives for psychotherapy.

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Paukert: Dr. Bricklin,can you give me asummary of yourprofessional historystarting with whereyou went to gradu-ate school and end-ing with what youare doing today?

Dr. Bricklin: Actually, my profes-

sional career began a little bit before I wentto graduate school. I majored in Englishand journalism in college and I wanted tobe a writer. One summer while I was still incollege, I got a job at a small private resi-dential school for children. They were 3 to12 years old and they had moderate tosevere special needs. I fell in love with thechildren and I was intrigued by all of theissues surrounding them. I decided to go tograduate school mostly to learn a little bitabout these children and what contributedto their problems. I decided to apply tograduate school at Johns HopkinsUniversity because I had heard goodthings about their psychology program. Itwas there that I experienced discrimina-tion; they let me take courses, but when Iapplied for the doctoral program, I wasturned down, specifically because I was awoman. I will never forget the words of theprofessor who interviewed me: “If wethought that you were never going to getmarried and you were never going to havechildren, we would let you into the pro-gram. Your grades are great, everything isfine. But, you would take the place of aman.” So, I didn’t go to Johns Hopkins

University for graduate school. I went toTemple University in Philadelphia, andreceived my doctorate in clinical psycholo-gy with a focus on children with language,learning, and emotional disorders. In grad-uate school I met my husband, Barry, also aclinical psychologist-to-be. We marriedand along with completing our disserta-tions we had two sons. In addition to myrole as wife and mother I was on the facul-ty at Temple for a while and I worked withchildren and their families in two privateschools that were very much like the one inwhich I began my career.

To my surprise, I got a phone call one dayasking me to be a guest on a popular dailyradio show. Out of that guest appearance,I was invited to do a continuous dailyradio and later, a television show with myhusband. Although there were few psy-chologists in the media at that time, thetwo of us accepted the challenge andbegan what became a very important partof our professional career for fifteen years.One thing I observed about myself wasthat I never seemed to leave one job foranother, but just kept adding them.During the last twenty years I added doc-toral training at Hahnemann Universityand Widener University and developed aspecial interest in the Psy.D model.Additionally I focused on the legal, ethicaland regulatory aspects of psychology as aprofession through my work on and withlicensing boards.

Paukert: Wow, you’ve done a lot. I’m interested in how you have integrated yourprofessional and personal life through all of this.

INTERVIEW

INTERVIEW WITH PATRICIA BRICKLIN, PH.D.Past President of Division 29

Amber Paukert, B.S.University of Houston

Patricia Bricklin, Ph.D.

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Dr. Bricklin: Radio and television werethe first place, although it doesn’t seemlike a likely spot. It was during that timethat our family grew and we had four chil-dren, two boys and two girls. The part ofthe show that most interested our listenerswas not so much the psychology we talkedabout, but our own relationship with eachother and the children. On a day to daybasis I worked out my role as a profes-sional and a wife and a mother with anaudience of over a million people. Wetalked about most of the stresses and joysof daily life. My husband was a veryassertive person and I was very shy.People used to write letters telling him tonot talk so much and to let me talk more.We really worked out our relationship onthe radio and I also used our children asexamples of some of the things I wasstruggling with as a mother of young chil-dren. I used them to discuss issues like bedtime, adjusting to school, helping childrenwith homework and what you do in thesupermarket when your child is throwinga tantrum and everyone is looking at you.Over the years, some sad things happenedin our family and some happy things andall of them happened while we were onthe air and they became things we coulddevelop as examples and issues for problem solving.

In those days, if you wanted to be an ethicalpsychologist, you couldn’t give advice onthe air if somebody asked a question. Youweren’t ethically allowed to advise them.You could only talk about the issue andgive them examples in a very general way.We struggled with maintaining the integrityof psychology, the integrity of our family,and providing people with something thatkept them listening and that they couldlearn and profit from. It was truly a chal-lenge and very rewarding. We still meetboth fathers and mothers who say “I raisedmy children listening and watching you.”

Paukert: How do you think radio and tele-vision psychologists are different now, andwhat do you think of these differences?

Dr. Bricklin: I think the biggest differenceis that today is the day of the sound biteand people want a quick fix. Unless youcan say what you’re going to say quicklyand catch people immediately, they’re notgoing to stay with you. That makes it hard-er for the psychologist or the professional-ly trained person to do their job; there is noreal time to build a relationship with anaudience. Although I think there are somevery qualified people on the air right now,it is difficult for the consumer to know whois qualified and who is not. Almost anyonecan do a psychology type show and thereare fewer boundaries.

Paukert: Stemming from the ethical dilem-mas of television and radio psychologists,how do you think ethics have changedover the course of your career?

Dr. Bricklin: Oh, I think they’ve changedquite a bit. Psychology has become a regu-lated profession. Ethics are both guidingprinciples and regulatory codes of conduct.We’ve become a much more litigiousworld. Because ethics have become part ofthe regulatory world, I think there’s a lotmore concern and even fear. The psychol-ogist’s concern is about risk managementof their practice, and certain areas of psy-chology are more risky than others. Thishas affected the way people look at ethics.I think in one sense, people have becomemuch more conscious of what is ethicaland what is not. On the other hand, I thinkpeople used to think that ethics were inmany ways absolute and that is just not thecase. However, people want yes or noanswers and basically a lot of the answersare not yes or no answers. Students forsome reason, really want a yes or noanswer, they want to know what they needto do, to do things correctly, but a lot of theissues you confront in practice, in research,and in teaching, are not cut and dry and it’sa little hard to live in that kind of a world.I think most of us have come to understandthat besides some very basic ethical truths,a lot about ethics is dynamic and almost

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never absolute. Many of the problems thatpeople confront today are ethical dilemmaswhere there are really no absolute wrongor right answers. Ethical decision makingand critical thinking, problem solvingmodels are most useful.

Paukert: How has licensing changed overthe years?

Dr. Bricklin: Licensing has changed overthe years in the sense that the first activityof licensing boards was to get qualifiedpeople licensed. As time goes on, we arestill concerned with what should be thequalifications of somebody who islicensed, but the disciplinary part of licens-ing has increased and the focus of licensingboards now is not only to act as sort of a fil-ter to make sure only qualified people arelicensed, but also act to in a disciplinaryway to make sure consumers are protectedfrom psychologists who don’t pay atten-tion to what they’re supposed to do, and Ithink that’s a change. The practice of psy-chology is an evolving process and thelicensing process must keep pace. Issues ofinterdisciplinary practice, mobility,increased scope of practice (like prescrib-ing) are all issues that must be considered.

Paukert: Switching topics somewhat, youmentioned that you experienced someadversity entering the field as a woman; doyou think that women still experienceadversity entering the field?

Dr. Bricklin: Yes, I think that women expe-rience it differently depending on the partof psychology that they’re interested inpursuing. I don’t think that women experi-ence adversity particularly in getting intodoctoral programs. There are still, fromwhat I understand, in some academic programs, issues of promotion and tenurethat are sometimes problematic.Discrimination is more subtle today. I don’tthink the areas of discriminations are aseasy to identify as they were.

Paukert: Can you tell me a little bit aboutyour involvement in Division 29 and APAin general?

Dr. Bricklin: I had always been an advocatefor children and their families and did a lotof public relations kind of work and talkedand raised money and made sure laws gotpassed in my state that had to do with children and their families, but I never reallythought about being an advocate for pro-fessional issues in psychology until I gotinvolved in the state psychological associa-tion. I did a lot of work with them all theway up to being president of the associa-tion and of course the next step to that wasbecoming a council rep to APA from thestate. For the first ten years or so, most ofmy APA activity was done as a representa-tive of Pennsylvania to various parts ofAPA. Then, I served on a number of APAboards and committees. Most recently, Iwas chair of the APA Committee for theAdvancement of Professional Practice.

Division 29 was one of my favorite divi-sions. I went to their midwinter meetingsall the time. I read the journals. I was activeas a member and a fellow in the division’swork, but I had never held an office in thedivision. Bob Resnick, who was then presi-dent of division 29, called me and askedme if I would run for president of Division29. I said, “Look, I’ve been very active inthe division as a member and a fellow, butI have never held office, I don’t think I’mprepared” and he, along with several otherpeople, talked me into doing it and that gotme right smack in the middle of the gover-nance of Division 29. I loved and valued it.I find I like Division 29 particularlybecause of the integration that 29 has ofpractice, science, and academics. The activemembers of the division are a combinedgroup; they are either people who do a lit-tle bit of all of those things or else they’rescientists, researchers, academics, or practi-tioners. All of them coalesce around thearea of psychotherapy in its broadest senseand I find this a really powerful group andlove to be part of it.

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Paukert: What do you think were yourmost important contributions to Division29 during your presidency?

Dr. Bricklin: There are two things thatoccur to me. The year that I was president,Division 29 was in a temporary financialsituation, in which many divisions findthemselves, and I thought, “Well, this is notthe time for a presidential initiative or anycostly activities. I think one of the thingsthat would be most helpful to the divisionwould be to focus on an active year but notspend any more money than we need to,and not put us any further into debt.” Itturns out that that year happened to be a critical year for us getting back on keel.In addition, I had the opportunity to work with Linda Campbell and LeonVandeCreek, to plan a long term initiativethat would look at the field of psychother-apy from the standpoint of research, train-ing and, practice. The purpose would be toarticulate the state of the art in each ofthose three areas to determine what’sneeded and where some of the difficultiesmay be. That initiative has taken off and itseems the results may make a very big con-tribution to the field of psychotherapy. Itwas during my presidency that we had thetime to talk about such an initiative and

plan it carefully. I’m really delighted to seeLinda, Leon, along with others, moving itforward. I am currently pleased to be serv-ing Division 29 as Council representativeand hope to make a contribution there toboth Div. 29 and APA.

Paukert: My last question is, what advicewould you give students entering the fieldtoday?

Dr. Bricklin: Be optimistic and be fullyengaged in the field. I would suggest thatpeople look at the field very carefully, lookat the many parts of it, pick the programthat you want to go to carefully in terms ofits focus. Be aware that psychology is a con-stantly evolving field and that’s the mostexciting part about it. If you ask anybodythat is more than 20 years out of a doctoralprogram, the psychologists they are todayare not exactly what they were trained todo. The field of psychology that you’relearning about today is evolving and youhave to look at it as, “I’m learning this asthe information that will help me to devel-op the field.” Keep an open mind, recogniz-ing that what you’re learning, you’re notlearning as something that’s going to standstill. Love what you do, and be an activepart of the field as it moves forward.

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Joyce Illfelder-Kaye is the Associate Director ofTraining at the Center for Counseling andPsychological Services at the Pennsylvania StateUniversity. She is also the Vice Chair of theBoard of APPIC (The Association of Postdoctoraland Psychology Internship Centers).

The internship experience continues to beone of the capstone experiences in the train-ing of doctoral students in clinical, counsel-ing and school psychology. Depending onwhen the reader completed the internshipexperience, some of the changes in the expe-rience of seeking an internship and complet-ing an internship might be surprising.Technological changes have helped to sub-stantially improve the internship selectionprocess. At the same time some recent trendsin the field have intensified the anxiety stu-dents are experiencing about the internshipprocess. Since most clinical, counseling andschool psychologists in training are expectedto complete an internship as a final require-ment before receiving their degree, data col-lected at the internship juncture can alsoprovide a snapshot for trends and changesin the profession. This column is designed toprovide an update on the recent technologi-cal changes in the application and selectionprocess and to highlight some recent trendsin graduate training.

Technological ChangesIntern applicants of today have grown upin a technological era. Recent technologicalchanges in the internship application andselection process represent an effort tokeep pace with the technological develop-ments in society at large. These changes areoutlined below and include the APPICDirectory on Line, the APPIC Applicationfor Psychology Internships, and the APPIC

Computer Match.

APPIC Directory on Line: Intern applicantshave always needed to collect informationabout potential sites prior to submittingapplications for internship. The APPICDirectory has long been the initial resourcefor obtaining information about internshipsites. Applicants at a minimum would col-lect addresses from the directory and sendpost-cards to sites requesting theirbrochures. Any student seeking an intern-ship or post-doc can now access the APPICDirectory on Line (DoL) through theAPPIC website at www.appic.org, in addi-tion to the printed directory. This formathas provided APPIC member internshipand post-doc sites with an opportunity toinclude more information about their sites,in addition to electronic links to their owninstitutional program website, and the e-mail addresses of the training director.Students can search the DoL according tospecified criteria, including geographyrelated search options, time-related searchoption (application due dates), program-related search options (accreditation statusof internship or post-doc, agency type,type of program from which applicants areaccepted), position-related search options(full-time versus part-time, stipendamounts, and number of interns). Finallyapplicants can search on training opportu-nities provided (populations, treatmentmodalities, and specialty areas).

APPIC Application for Psychology InternshipsStudents applying for internships nowcomplete a universal application form,rather than different applications for each site. The APPIC Application forPsychology Internships, known in short asthe AAPI, has mostly replaced the individ-

FEATURE

Recent Trends in Internship Training

Joyce Illfelder-Kaye, Ph.D.Pennsylvania State University

17

ually designed applications used by eachtraining site. It is available on line on theAPPIC website as a word document, andstudents are asked to complete it and tosubmit it individually to each site in whichthey are interested. It is a long document,and it does take students a while to com-plete, however, it is no doubt a shorterprocess than in the past when studentscompleted 15 different applications for 15different sites. APPIC member programshave been strongly encouraged to use theAAPI, and when we last inquired all but 13sites were using the AAPI. Explorationcontinues into the possibility of a truly on-line AAPI that could be electronically sub-mitted via a website to a specified list ofprograms, but exploration into other pro-fessional fields that are using such modelshas not yet yielded a highly compellingoption. Our training sites still vary interms of their own technological resourcesand capabilities for receiving electronicapplications. It should be noted that thereis not a universal application for APPICpost-doctoral programs at this time.

APPIC Computer MatchThe APPIC Computer Match which is runin conjunction with National MatchingService (NMS) has replaced the old intern-ship call day. Applicants for psychologyinternship must now register with NMSduring the fall of the year that they areapplying for internships. Sites must alsoregister with NMS. Applicants submit theirapplications to individual sites, and inter-view with those who invite them to do so,as they always did. In early February by adate that is specified each year, applicantsand sites must submit their rank order listto NMS. There are also special provisionsfor applicants to submit their rank orderlist as couples if they are in a relationshipand want to seek internships in similarlocations. NMS takes approximately twoweeks to run the match. On the Fridaybefore Match Day applicants are informedwhether or not they matched; sites are notprovided with this information. This was arelatively recent change in order to provide

applicants who did not match with time toprepare for entering the Clearinghouse onMonday. On the Monday of Match Dayboth sites and applicants are informed oftheir match for the coming year. The com-puter match in combination with clearlystated Match guidelines has helped toeliminate much of the pre-internship court-ing rituals, as sites and applicants are notallowed to request or provide any rankrelated information. Those applicants andsites that do not fill through the match mayparticipate in the Clearinghouse thatbegins on Match Day. There is not currentlya match for APPIC member post-doctoralprograms.

Recent TrendsOur profession is facing a number of chal-lenges and opportunities at present. Someof the challenges that directly are impact-ing the internship process include intern-ship supply and demand issues and fund-ing issues. In addition the internship matchand follow-up survey allow us to makesome observations regarding changingdemographics in our field.

Internship Supply and Demand IssuesWhile the number of internship positionsavailable to applicants has shown a modestincrease in recent years, the number ofapplicants applying for internships hascontinued to grow at a faster rate. In themost recent match 617 sites participated inthe match, offering 2,757 internship posi-tions. This represented an increase of 25positions from the previous year. Thematch successfully matched 2,448 appli-cants, but 669 applicants were not matchedand 309 positions remained unfilled. If theclearinghouse successfully filled theunfilled positions, there were still 360 moreapplicants than positions in the match.This represents an increase of 131 moreapplicants in the match in 2005 than in2004. As a result of this ongoing andincreasing discrepancy, students areincreasingly anxious about the internshipmatch process.

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Financial Pressures on Internship SitesThe difference in the number of internshippositions and applicants would suggest thatmore internship positions could provide onesolution to the internship supply anddemand problem. At the same time, sites arefacing a number of concerns that make thecreation of more internship positions diffi-cult. Medical centers are all under financialpressure to produce revenue. Internshipsand training continue to be evaluated andreviewed regarding their contribution to thefinancial health of the medical center. If theinternship training is not contributing to theresearch mission by supporting the imple-mentation and success of external grantsand/or to the clinical revenue stream, they are most likely vulnerable to reductionor closure. Recently, government GPE(Graduate Psychology Education) funds andGME (Graduate Medical Education) fundsbecame available. However, there are too fewof these to have made much impact on thesupply and demand issues in psychology.

In addition recent changes in regulations inthe Fair Labor Standards Act (FLSA) haveincreased the minimum annual salary forfull-time employees in this country whoare not eligible for overtime pay to $23,660.Depending on the way that internshippositions are created at different sites, thelegislation may or may not apply to intern-ship positions. One of the determining fac-tors seems to be whether interns are con-sidered employees with benefits, orwhether the interns simply receive a train-ing stipend. Since the median internstipend across all settings in 2004-2005 was

$19,400 (APPIC Directory data) one can seethat the FLSA legislation creates issues formany sites. Some sites have needed to cutinternship positions, others are payingovertime pay, while others have been ableto increase their stipend.

Demographics of Internship Applicants: Thisyear for the first time, APPIC asked appli-cants who completed the post-match sur-vey to provide demographic information.This is information that has not beenrequested at the time of the match, due toconcerns about the potential appearance ofdiscrimination. Results of the survey con-ducted post-match suggest that at the pre-sent time approximately 78% of internshipapplicants are female, 22% of applicantswere male. Approximately 39 % are coming from Psy.D. programs, while 61%are coming from Ph.D. programs.Approximately 59% of intern applicantswere under the age of 30, 31% of applicantswere in their 30’s, while 10% of internshipapplicants were over age 40. Seventy eightpercent of intern applicants were white,while 22% represented other racial or eth-nic identifications.

ConclusionAs the demands and challenges of ourwork change over time, we strive to meetnew demands and take advantage of newtechnology. This is an ever changing land-scape, and yet at the core internship train-ing continues to provide a pivotal trainingexperience in the development of clinical,counseling and school psychologists, muchas it always has.

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(Clockwise) Armand Cerbone, Craig Shealy, Abe Wolf, Leon VandeCreek, Linda Campbell, Jan Culbertson, John Norcross, and Tracey Martin.

DIVISION 29 EXECUTIVE COMMITTEE MEETING

Miami, Florida • January 14, 2005

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This is the time of year for commencementactivities, and I was able to attend two thatwere particularly notable. At AmericanUniversity, U.S. Senator Daniel K. Inouyeprovided an historical perspective upon theissues underlying today’s intense Senatedebate on the filibuster and the so called“nuclear option” proposed by the MajorityLeader. “As I speak to you, a great debate israging in the United States Senate. Itinvolves a parliamentary action that is com-monly referred to as the ‘filibuster.’ On thefirst Tuesday of January 1963, I took myoath of office as a Senator from the State ofHawaii. Four weeks later I found myselfinvolved in what was later looked upon asa historic debate on civil rights. The mainissue was the filibuster. Many insisted thatthe filibuster was the stumbling block thatprevented passage of decent laws to protectthe rights and privileges of all citizens,regardless of race, color, or religion.

“On January 31, 1963, I said: ‘I have heardso often in the past few weeks, eloquentand good men plead for the chance to letthe majority rule. That is, they say, theessence of democracy. I disagree, for to meit is equally clear that democracy does notnecessarily result from majority rule, butrather from the forged compromise of themajority with the minority. The philosophyof the Constitution, and the Bill of Rights isnot simply to grant the majority the powerto rule, but is also to set out limitation afterlimitation upon that power. Freedom ofspeech, freedom of the press, freedom ofreligion; what are these but the recognitionthat at times when the majority of menwould willingly destroy him, a dissentingman may have no friend but the law. Thispower given to the minority is the mostsophisticated and the most vital powerbestowed by the Constitution....

“The majority leadership of the Senate hasinsisted that these matters [federal judicialconfirmations] should be resolved with asimple majority vote. To accomplish thisend, they would do away with the right ofthe minority to filibuster. To those whowould advocate this position, I say to themas I did 42 years ago: ‘You sow the wind,for minorities change and the time willsurely come when you will feel the hotbreath of a righteous majority at the back ofyour own neck. Only then perhaps willyou realize what you have destroyed.’”

The Senator made these remarks within thecontext of a very personal experience:“When I entered high school in 1939, I notedthat my parents, in filling out a school form,had provided information that was surpris-ing and stunning. I noted that my fatherhad indicated that he was not a UnitedStates citizen. That was understandablebecause he was born in Japan, and came toHawaii as a young child of three. I noted,however, that my mother had also notedthat she was not a citizen. I was certain shewas born in Hawaii, and, therefore, a citizenof the U.S. I took the form to her and said,‘I think you made a mistake in filling out theform,’ pointing to the citizenship question.She looked at me with sad eyes and told methat she had not made a mistake.‘According to the law,’ she said, ‘anAmerican who marries a Japanese loses hisor her U.S. citizenship, and, therefore, I real-ly don’t know what I am.’... I was horrifiedto learn of this law, but this horror was mag-nified when soon after December 7, 1941...an Executive Order authorized and estab-lished 10 concentration camps in desolateareas in our nation....

“In 1988, an official apology to those whowere placed in the internment camps was

WASHINGTON SCENE

A Few Dedicated Visionariesby Pat DeLeon, former APA President

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issued, and a token amount of redress pay-ment was provided to surviving internees.I cite this because it was a proud momentfor me to know that my country was strongenough to admit her past errors and apolo-gize. I cannot think of any other countrythat has come forth to make such an admis-sion of wrong and officially apologize....

“I could not help but conclude that historyis an ever-changing scenario, and that ourdemocracy was an ever-evolving concept.For example, the minority opinion in theSupreme Court may in later years becomethe majority view. Slavery and segregationare some of the numerous examples. Lawsmay be repealed or amended....Democracy is an imperfect concept slowlyseeking perfection.”

Personally, having attended an anti-warcandlelight service (at which Mary, ofPeter, Paul, and Mary heritage performed)the night before the bombing, I was deeplymoved by the Senator’s observation that:“However, I note that we Americans havebeen quite impatient with people of otherlands who have not embraced our democ-racy. In some cases, we have officially con-demned these nations in very harsh terms,and, in some, we have even used militaryforce. The question we Americans havedebated over the decades is simple butprofound: ‘Should we impose our willupon other lands? Or should we adopt amore peaceful path in convincing others ofthe goodness of our system and philoso-phy?’ I suppose this matter will be debatedfor as long as we exist.” As one mightimagine, these words elicited a veryengaged response from the audience—from both ends of the spectrum. On a per-sonal note, I suspect that those protestorswho stormed out, subsequently re-enteredvia the back door to see their loved onesgraduate later on in the program.

The second commencement exercise was at Simon’s Rock College of Bard, located in the hills of Great Barrington,Massachusetts, known to many of our col-

leagues, and particularly by those whoattended the APA Opening Ceremony dur-ing my Presidential year, as the home ofAlice’s Restaurant of Pete Seeger and ArloGuthrie fame. In the 1920s, when the landupon which the college now stands wasmostly pasture and cultivated fields, alocal landmark—Simon’s Rock—wasplainly visible. And from the rock therewere extended views of the surroundingBerkshire hills and the valley below.Today, the rock—now surrounded bytrees—still sits on the mountainsidebetween the main and upper campuses.When Elizabeth Blodgett Hall decided tofound an early college, she named it afterthe rock and explained its significance bydescribing what it meant to her when shewas an adolescent:

“Simon’s Rock is a glacial erratic on aBerkshire hillside. The small band ofneighborhood children who built a cabinthere in the early twenties did not knowthis until they grew up. At twelve and thir-teen, their interest centered on the rock forother reasons. It was a good place to getaway to. The adult world in the valleybelow could be viewed from on high.Grown men and women, teams of horses,and Model T Fords all dwindled to a sizewhere one could imagine oneself compe-tent to direct and control them. Yet the val-ley remained to return to when one wea-ried of freedom, wet feet, and raw baconburned at one end.

“And each time they returned they knew alittle more about a lot of things: that drywood and a proper draft make a big differ-ence in a fire; that much snow makes littlewater; that umbrellas opened at the top ofthe rock will not suffice as parachutes for aquick descent; that killing a squirrel with a.22 is not much of a victory; that adultsmay be more like oneself than onethought.” Today’s Simon’s Rock college,like its namesake, still offers a place foryoung people to learn and gain perspec-tive, a haven where they can explore,exchange confidences, grow and dreamlike the builders of that first cabin.

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This year’s commencement speaker wasEli Pariser, a Simon’s Rock alumnus. Asthe program said: “Known to millions ofAmericans through his political leadership,particularly through the Internet, the 24-year old Pariser is executive director ofMoveOn.org—a grassroots organizationdedicated to empowering ordinaryAmericans to be catalysts for politicalchange. Pariser became a groundbreaker inthe movement to use the Internet for polit-ical organizing when, 24 hours after theevents of September 11, 2001, he launcheda website calling for alternatives to a mili-tary response to the terrorist attacks.... (He)has directed MoveOn’s campaign againstthe Iraq war – in the process tripling theorganization’s member base, which nowstands at 2.9 million. He also raised morethan $30 million from over 350,000 smalldonors to support the efforts of MoveOn.”Eli Pariser matriculated at Simon’s Rock atthe age of 15, graduating in 2000, summacum laude. An impressive resume.

The underlying, take-home message ofEli’s address was: “There ain’t nobody herebut us chickens.” Or, stated another way,“It is up to us as individuals and concernedcitizens to accept responsibility for ourown future.” There are no grand plans forthe future or infallible leaders. Living in ademocracy means there is only us.

Eli got me thinking about our profession ofpsychology. Who are our visionary lead-ers? Who is making a difference in ourdaily lives? The individuals who quicklycame to mind during that rainy, and yetsunny, afternoon were APA President RonLevant and Practice Directorate executivedirector Russ Newman. Both have longappreciated (as did former APA PresidentNorine Johnson) the importance of psy-chology becoming one of the healthcare pro-fessions and obtaining prescriptive author-ity (RxP). For, the prescriptive authorityagenda has always been about revolution-izing society’s definition of “quality” careand ensuring that the all important psy-chosocial-economic-cultural gradient of

care is granted appropriate priority bysociety and our nation’s healthcare policyexperts. RxP is all about bringing psychol-ogy into the 21st century. Nothing more;nothing less.

In New Mexico, Elaine LeVine and MarioMarquez have clearly made a difference,as has Guam’s Mamie Balajadia andIndiana’s Mike Murphy. Each of thesevisionaries has been instrumental in hav-ing RxP legislation enacted by their legisla-tures. Elaine recently reported: “I havebeen prescribing for about a month now. Ihave had a number of positive experiencesalready. Given the grueling efforts neededto pass a prescribing psychologist law, myshort life as a prescribing psychologisthighlights why it is worth psychologistspursing this path.... Now that I have alicense/certificate to prescribe, the physi-cians have been quite willing to defer tomy judgment regarding the specific med-ication. Their input regarding the medicalmanagement of the patient has been veryhelpful. There are new issues every day inthis new territory. For example: Whoshould take my call when I am unavail-able?—The best person would be a pre-scribing psychologist because no one elseis prepared to deal with both the psycho-logical and the medication issues, but sofar there are only two of us in the State!There are issues regarding getting a DEAlicense; the government has not figured outthere are prescribing psychologists yet.Pharmacists wonder how to code us.Pharmaceutical companies wonder if theycan sample us. All this commotion is actu-ally kind of fun. It doesn’t have the samevicious underpinnings as our legislativebattles. Out here in the primary care,everyone seems to have the same goal ofgetting care to the patients, in an under-served and overburdened medical arena.The question is how to get through andover all the hurdles.”

In response to Elaine’s queries APAPresidential citation recipient John Bolternoted: “I got my DEA number about a

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month ago. I think I was the first psychol-ogist to get a DEA number. I don’t thinkany of the [DoD] PDP people have actuallyobtained a DEA number. Anyway, justthought I would let you know the DEA hasresolved the issue of providing a DEAnumber for medical psychologists (pre-scribing psychologists).” Earlier this year,Glenn Ally reported: “On February 18,2005, the first prescription was written by acivilian ‘medical psychologist’ in BatonRouge, Louisiana under the new RxP lawsigned by Governor Blanco. Dr. John Bolterwrote the first prescription—a prescriptionfor Remeron (for the trivia folks). This wasan historic moment for the LouisianaAcademy of Medical Psychology, for thecitizens of Louisiana, and for psychologyas a profession.” Our special thanks toJohn and Jim Quillin—Louisiana is trulyon the cutting edge of change.

Recently, under Mike Sullivan’s tutorage,Lance Laurence and his Tennessee col-leagues have taken on the good fight.Keith Hulse: “Well, we have some goodnews and some bad news to report. Thebad news is that we were unable to passour prescriptive authority bill out of theSenate General Welfare committee today.We have concluded that it will not be pos-sible to do so during this legislative ses-sion. While we are disappointed, we arenot discouraged, and we are determined toprevail in the long run. Passing this pieceof legislation is the hardest thing that TPAhas ever tried to do. In Louisiana, it took 10years of work to pass a similar bill. This isour second year. We have made remark-able progress compared to where we start-ed just two years ago in advancing our‘case’ for the bill. In fact, the ‘case’ itselfwas not disputed this year to any signifi-cant degree, even by our opposition. If notfor ‘larger’ political forces outside our con-trol, we might well have been writing youa very different letter today. A year ago, wewere unable to move the bill out of anycommittee. This year, we successfullymoved the bill out of the House

Professional Occupations subcommitteedespite there being an MD on the commit-tee, and we also passed the bill untouchedout of the House GovernmentalOccupations subcommittee. Unfortunatelyfor our efforts, the majority in the legisla-ture shifted towards Republican, on thecoat-tails of the last Presidential election,and the legislature this year has beendivided along party lines to an unusualand unfortunate degree. Our bill becamecaught up in that partisan battle. As aresult of this shift in the composition of thelegislature, in the Senate General Welfarecommittee this year, we had two definite‘yes’ votes unexpectedly thrown off thecommittee and replaced with Republicans,one of which was yet another RepublicanMD. The vote today would have beenalong straight party lines (had we allowedit to go forward). We needed five of ninevotes to pass out of committee, but all fiveRepublican members of the committee, inthe end, signaled that they intended to voteagainst our bill.

“The good news: there is much good thathas come out of this legislative effort,despite our not passing the bill this year.TPA’s ‘status’ in the legislature has neverbeen higher. We have earned an unprece-dented overall presence and level ofrespect. This status will outlast the out-come of any given bill, RxP or otherwise.Not a single bill adversarial to TPA wasdropped this year, which is unusual.Increasingly, TPA is being looked to by thelegislature as THE expert in the area ofmental health. In the process of pursuingthe RxP effort, we have continued to buildstrong relationships with many membersof the legislature, and those will alsoendure far beyond this one bill. The size ofTCPA (TPA’s PAC), thanks to you all, hasincreased over 400 percent in the past twoyears(!). APA has given TPA substantialgrant support in the past two years, andhas also included Tennessee in its pilot pro-ject utilizing their CAP Wizard website,which has allowed literally thousands of e-

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mails to be sent to the state legislators dur-ing this session. And you all, our grass-roots network, have responded unbeliev-ably well to our calls. APA tells us thatTennessee’s use of the CAP Wizard websiteis an order of magnitude greater than anyother state’s. Your utilization of their web-site has been greater than that of everyother state combined! That is totally to thecredit of you, the TPA membership. TPA’sgrassroots network has been phenomenaland is the envy of every other state. OurPowerPoint presentation and ‘white paper’supporting the RxP agenda are both beingutilized nationwide to advance the case forRxP. And rest assured, we have alreadystarted today laying the groundwork forpassing our RxP bill next year.

“To quote Jim Quillin: ‘If we don’t quit, wewin.’ And to quote Margaret Meade:‘Never doubt that a small group ofthoughtful committed people can changethe world; indeed it’s the only thing thatever has.’ We hope that all of you will allcontinue to be members of our now-not-so-small group of thoughtful committedpeople. Thank you for all your hard workthis year. Please seriously consider signingup for RxP training. We are going to be ask-ing for your help very shortly in the ‘offseason’ to begin to prepare for next year’slegislative session.”

And finally in Hawaii, one can feel the flowtide for psychology where two colleagueswho work within our state’s community

health centers, Jill Oliveira-Berry and RobinMiyamoto, have taken the lead on behalf ofHPA’s RxP legislative efforts. Jill is a NativeHawaiian and member of the APACommittee on Rural Health. After extensivepublic hearings focusing upon the criticalissue of access—and with the enthusiasticsupport of the Hawaii’s Primary CareAssociation and its centers’ medical direc-tors—two Senate Committees recommend-ed the enactment of legislation allowingappropriately trained psychologists to pre-scribe within federally qualified health cen-ters. HPA was one vote short on the Senatefloor. However, subsequently HouseConcurrent Resolution #255 passed bothbodies, “Establishing An Interim Task ForceOn The Accessibility Of Mental Health CareTo Consider The Feasibility Of The StateAuthorizing Trained And SupervisedPsychologists To Safely PrescribePsychotropic Medications For TheTreatment Of Mental Illness.” Jill: “The reso-lution basically seeks to form a task forcethat will consist of the chairs from the Houseand Senate Health Committees, along withtwo appointees from HPA and the HawaiiPsychiatric Medical Association.” These twolegislators know the issues well and it isanticipated that implementing legislationwill be introduced next session.

Aloha,

Pat DeLeon, former APA PresidentDivision 29 – May, 2005

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The American PsychologicalFoundation (APF) and APADivision 29 (Psychotherapy)are pleased to announceMarvin R. Goldfried, Ph.D.,Distinguished Professor ofPsychology at Stony BrookUniversity, as the speaker forthe 2005 Rosalee G. WeissLecture. The Rosalee G. WeissLecture was established in1994 by Raymond A. Weiss,Ph.D., in honor of his wife,Rosalee Greenfield Weiss,Ph.D. The lecturer, who is anoutstanding leader in psychology, or aleader in the arts or sciences whose workand activities has had an effect on psychol-ogy, presents at the annual APAConvention.

Goldfried is a diplomate in clinical psy-chology and is the recipient of numerousawards including the APA DistinguishedPsychologist Award for Contributions toKnowledge, Distinguished Psychologist

awards from the clinical psy-chology; general psycholo-gy; psychotherapy; and gay,lesbian, and bisexual divi-sions of APA, and the Awardfor Clinical Contributionsfrom the Association for theAdvancement of BehaviorTherapy. He is PastPresident of the Society forPsychotherapy Research,founder of the journal InSession: Psychotherapy inPractice and author of sever-al books. Dr. Goldfried is

cofounder of the Society for theExploration of Psychotherapy Integration(SEPI), and founder of AFFIRM:Psychologist Affirming Their Gay, Lesbian,and Bisexual Family. Dr. Goldfried willpresent The role of relationship and techniquein therapeutic change on Saturday, August20, 2005 from 3:00 p.m. – 3:50 p.m. in theWashington Convention Center, MeetingRoom 143C.

2005 ROSALEE G. WEISS LECTURER

Dr. Marvin R. Goldfried

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RESEARCH

Therapeutic Work and Professional Development:Main Findings and Practical Implications of a Long-Term International Study

Michael Helge Rønnestad & David E. Orlinsky

How do psychotherapists experience theirwork with patients? What impacts do ther-apists’ work experiences have on their pro-fessional development? How does thetherapist’s level and state of development,in turn, influence their therapeutic work?These are the central questions explored,empirically and theoretically, in a newbook titled How Psychotherapists Develop(Orlinsky & Rønnestad, 2005) that wesummarize selectively and briefly here,emphasizing the main findings and someof their practical implications.

BackgroundIn 1989, a group of international colleaguesin Society for Psychotherapy Research(SPR) began a cooperative, self-supportingstudy of psychotherapists’ experiences oftherapeutic work and professional devel-opment. This group, the SPR CollaborativeResearch Network,1 consisted of clinicalresearchers who also were well-experi-enced practicing therapists. We conceivedof our project as a study of, by, and for psy-chotherapists, aiming to study the process-es of therapeutic work and professionaldevelopment from the psychotherapist’sown perspective.

Toward this end, we designed theDevelopment of Psychotherapists CommonCore Questionnaire (DPCCQ) to survey var-ious professional and personal experiencesin the spirit of a wide-ranging interviewamong colleagues. To date, our group hasgathered extensive information from morethan 7,000 therapists of diverse profes-sions, theoretical orientations, and careerlevels. These therapists represent twodozen countries, with the largest groups

thus far from the United States (many ofwhom were Division 29 members),Norway, Germany, the United Kingdom,and South Korea. The results reported inour book are based on approximately 5,000of these therapists, analysts, and coun-selors, who were engaged in various formsof individual, couple, family and grouppsychotherapy.

Therapeutic Work and Practice PatternsTwo broad dimensions of therapeuticwork experience were identified induc-tively by factor analyses of many specificfacets of work, such as therapists’ clinicalskills, difficulties in practice, coping strate-gies, modes of relating to patients, and in-session feelings. One broad dimensionclearly described an experience of HealingInvolvement. This consisted of current skill-fulness, minimal difficulties, constructivecoping strategies, genuine personal invest-ment in affirmative, receptive relation-ships with patients, in-session experienceof flow (Csikszentmihalyi, 1990), and anoverall sense of therapeutic efficacy. Theother broad dimension clearly reflected aparallel but contrasting experience ofStressful Involvement. Therapists in thiscase frequently reported multiple difficul-ties in practice accompanied by defensive,therapeutically unconstructive copingstrategies as well as in-session feelings ofanxiety and boredom.

These two dimensions are statisticallyindependent, and both are descriptive, invarying degrees, of all our therapists’experiences with their patients. The vari-ables that most strongly predicted experi-ences of Healing Involvement with

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patients were the therapist’s theoreticalbreadth, work setting support and satisfac-tion, and the breadth and depth of caseexperience across different treatmentmodalities—as well as their positive workmorale (about which more later). Relativelyfew therapist characteristics predictedStressful Involvement, suggesting that thisaspect of experience is more responsive tocurrent caseload and practice characteris-tics, but work stress was greater for thera-pists who felt little support or satisfaction intheir main work setting, who had no pri-vate practice—and who were caught in aprocess of demoralization.

Since Healing Involvement and StressfulInvolvement were statistically independent,we were able to characterize therapists’overall practice experience by distinguish-ing between those who reported much (ornot much) Healing Involvement and little(or more than a little) Stressful Involvement.These distinctions allowed us to see fourbroad patterns of current therapeutic workexperience, as follows. Approximately 50%of our therapists experienced an EffectivePractice, featuring much HealingInvolvement and little StressfulInvolvement. Another 23% were in whatmight be called a Challenging Practice, inwhich there was much Healing Involvementbut also more than a little StressfulInvolvement. The “good news” is that near-ly three-fourths of those we surveyed wereactually experiencing much HealingInvolvement in their therapeutic work.

By contrast, 17% of our therapists reporteda personally neutral but apparently unpro-ductive pattern of Disengaged Practice, fea-turing little Stressful Involvement but notmuch Healing Involvement. Even worse,about 10% of our therapists were involvedin a basically Distressing Practice, wherethey experienced not much HealingInvolvement and more than a littleStressful Involvement.

The incidence of Effective Practiceincreased markedly in successively more

experienced therapist cohorts, from 40%among novices to 60% among seniors,with a total reporting of all those havingmuch Healing Involvement rising from60% among novices to 80% among seniors.A parallel decline was noted in the inci-dence of Distressing Practice, which typi-fied 20% of the novices but only 6-7% ofestablished, seasoned, and senior thera-pists. Some of these differences may bedue to departure from clinical work by themost distressed therapists, but much isalso likely due to therapists’ improvementover time. What these figures demonstratedramatically is the relative vulnerability ofnovice therapists, and their need for effec-tive supervisory guidance and support.

Professional DevelopmentDevelopment was defined and assessed inthree ways. First, comparisons were madeamong cohorts of therapists at differentcareer levels, as mentioned above. Six lev-els were distinguished based on clinicaland statistical considerations: novices (lessthan 1.5 years of work with patients);apprentices (1.5 to 3.5 years); graduates (3.5to 7 years); established therapists (7 to 15years); seasoned therapists (15 to 25 years);and senior therapists (with 25 to 50 years ofclinical practice). These cross-sectionalanalyses were supplemented by measuresof the therapists’ experiences of their cur-rent or ongoing development, and by vari-ous measures of their cumulative careerdevelopment.

Analyses of ongoing development yieldedtwo independent dimensions, CurrentlyExperienced Growth and CurrentlyExperienced Depletion. CurrentlyExperienced Growth included a sense ofactive change and improvement, a deepen-ing understanding of therapeutic process,enhanced skillfulness, enthusiasm forpractice, and a sense of overcoming pastlimitations as a therapist. A major portionof this can be interpreted as a continuingrenewal of the therapists’ work morale(Orlinsky, Rønnestad, Ambühl et al., 1999),which derives in large part from their

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experience of Healing Involvement, andenables them to continue engaging pro-ductively with patients despite the stressesof professional practice.

By contrast, Currently ExperiencedDepletion included a sense of deteriorat-ing skills, loss of empathic responsivenessto patients, routinization of practice, andgrowing doubt concerning the effective-ness of therapy. This can be interpreted asa process of demoralization resulting inlarge part from the experience of therapeu-tic work as a Stressful Involvement, whichtends to further undermine the therapist’sability to engage positively with patients,producing a spiral of negative effects thatcan lead to therapist burnout and potentialharm to patients.

Growth and depletion both are experi-enced by therapists in response to theirpractice experience, although in varyingdegrees. Where Currently ExperiencedGrowth predominates, the therapist’soverall sense is one of Progress. By contrast,where Currently Experienced Depletion ispredominant, the therapist’s overall senseis one of Regress. Where both are clearlypresent, the overall experience is a confus-ing one of Flux, with improvement felt insome areas and deterioration in others.Therapists who experience little depletionbut not much growth can be described asin Stasis, of which the positive side is sta-bility but the negative is stagnation.

Therapists’ experiences of CumulativeCareer Development were reflected in a sin-gle second-order dimension that includedseparate factor-analytically defineddimensions of retrospective perceiveddevelopment, change from initial to cur-rent levels of clinical skill, and level ofattained therapeutic mastery. CumulativeCareer Development was only modestlycorrelated with years in clinical practice,and in fact was more strongly related tothe breadth and depth of the therapist’scase experience across diverse treatmentmodalities—indicating that what one does

and learns has more to do with careerdevelopment than mere length of service.

Higher levels of Cumulative CareerDevelopment were positively related toCurrently Experienced Growth, as expect-ed, and were inversely related to CurrentlyExperienced Depletion. This means that theharmful effect of experiencing clinical workas a Stressful Involvement is attenuated orbuffered by advanced development, butthat, by the same token, relatively inexperi-enced therapists are most vulnerable.

Our book presents a detailed, empirically-grounded theoretical model of the recipro-cal impacts of professional developmentand therapeutic work experience, as wellas many other relevant findings, which wehope interested readers will want to exam-ine there. Here, in this brief article, we con-clude by summarizing some of the practi-cal implications explored in the bookbased on our findings. These include rec-ommendations with respect to profession-al training, clinical supervision, and thera-peutic practice.

Professional TrainingThe most important recommendation fortraining is to ensure, as far as possible, thatnovice and apprentice therapists experi-ence Healing Involvement in their initialwork with patients, and that StressfulInvolvements be kept to a minimum.Beginners are especially vulnerable to thedemoralizing impact of a DistressingPractice, and may sustain personal harmas well as fail to help their patients.

These recommendations require carefulcase selection to match the skill level ofbeginning therapists, as well as practicaleducation to provide them with relevantskills and ample supervisory and peersupport. Given appropriate training andsupervision, early exposure to clinicalwork is also recommended as therapists ofall orientations and career levels consis-tently focus on practice as their majorsource of learning. Moreover, we further

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recommend that this early practice includemeaningful participation in diverse treat-ment modalities—that is, in couple andfamily and group psychotherapy withmore experienced co-therapists, in addi-tion to standard one-on-one individualtherapy.

Clinical SupervisionThe significance of supervision for thera-pists is reflected in its consistent rankingby practitioners at all career levels as thesecond or third most important positiveinfluence on their development, followinglearning from work with patient—and wasranked as the most important influence bynovice therapists. The value of supervisionis expressed by the simple but convincingfact that 56% of established therapists (7-15years in practice) and 42% of seasonedtherapists (15-25 years in practice) report-ed they were currently in supervision forsome of their cases. Thus many therapistsseek supervision well beyond what is for-mally required to attain licensure.

Despite its positive importance, our studyalso highlights a negative potential ofsupervision, particularly when it involvesevaluation of the student or candidate.This circumstance exaggerates the powerdifferential between participants and com-promises the supportive part of the rela-tionship. Recent empirical contributionson non-optimal supervision have focusedon conflicts in supervision (Moskowitz &Rupert, 1983), distorted and restrictedcommunication (Yourman & Farber, 1996);supervisee non-disclosure (Ladany, Hill,Corbett & Nutt, 1996) counter-productiveevents (Gray, Ladany, Walker & Ancis,2001), impasses (Nigam, Cameron &Leverette (1997), and factors that con-tribute adversely to supervision (Reichelt& Skjerve, 2002). These negative aspects ofsupervision erode the trainees’ self-confi-dence, engender self-doubt about theirability to become effective therapists,evoke self-criticism as well as negativepersonal reactions to the supervisor andnegative countertransference reactions to

patients. Reactions such as these in super-vision when combined with the experienceof therapy as a Stressful Involvement canbe very detrimental to the development ofinexperienced therapists. The concept ofdouble traumatization introduced in ourbook refers to the process in which the can-didate is simultaneously stressfullyinvolved in work and also experiencingconflict with a supervisor—a circumstancein which Stressful Involvement is exacer-bated by negative supervision, and a neg-ative supervisory process is augmented byStressful Involvement. Supervisors shouldbe particularly aware of the potential fordouble traumatization when superviseesare experiencing Stressful Involvementwith clients, and be sensitive not only tothe quality of the supervisory alliance butalso the need to supportively confront andrepair alliance ruptures.

Therapeutic PracticeProbably the most important finding ofour study for practicing therapists, at allcareer levels, is the reciprocal influencebetween the clinician’s work morale andtheir experience of therapeutic work.Positive morale (in the guise of CurrentlyExperienced Growth) appears both as aconsequence and a major contributor toHealing Involvement. Incipient demoral-ization (in the guise of CurrentlyExperienced Depletion) similarly is atten-dant upon and a forerunner to StressfulInvolvement. Although therapist self-awareness is deeply embedded in the psy-chotherapy culture, it is all too easy to dis-count one’s sense of improvement ordepletion as a purely personal reaction,rather than as an indicator of the freshness,vitality, and optimism—or else the possi-bly “technically correct” but unenthusias-tic and indifferent manner—that onebrings to work with patients. The cyclicalrelationship between currently experi-enced development and therapeutic prac-tice is an argument for all therapists to con-tinually monitor their own sense of devel-opment as well as quality of their workinvolvement. To assist therapists in this,

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we selected the most relevant items fromthe DPCCQ to construct two brief self-rat-ing forms for monitoring work involve-ment (the Therapeutic Work InvolvementScale) and professional growth and deple-tion (the Current and Career DevelopmentScale). These are included as appendices inour book, along with data enabling practi-tioners to match themselves with compa-rable therapists.

Other recommendations to practitioners areaddressed specifically to the small but sig-nificant minorities who are experiencingStasis (not much growth and little depletion)or Regress (not much growth and more thana little depletion). To the one-in-five we esti-mate are in Stasis, we propose that they takesteps to diversify their therapeutic work(e.g., by doing couple, family, or group ther-apy as well as individual therapy), and weencourage them to explore diverse theoreti-cal approaches. The key to both recommen-dations is breadth: breadth and depth ofcase experience across modalities, as a stim-ulus to cumulative career development; andtheoretical breadth, as a facilitator ofHealing Involvement. This empiricallybased advice converges with the recommen-dation of Norcross (2000) to “Diversify,diversify, diversify” as a principle of thera-pist self-care. Another source of stimulationthat therapists in Stasis should consider isvoluntary, non-evaluative supervision,either in an individual or peer group for-mat—with the latter of particular value fortherapists who practice independently.

To the one-in-ten therapists who may becaught in a state of professional Regress,we strongly urge that they take steps toprotect themselves as well as their patientsfrom potential harm. Over 60% of novicesand nearly 60% of apprentices in Regressare also in a Distressing Practice, wherethey are experiencing more than a littleStressful Involvement and not muchHealing Involvement. For them especially(but also for all except the most seniortherapists) we recommend a change incomposition of caseload, where that is pos-

sible, to obtain a better match betweentheir current skills and the challenges pre-sented by patients. Attempting to treat toomany difficult patients at the same timemay result in treating some not very well,in addition to possible adverse effects forthe therapist.

A disproportionate number of those whopractice only in institutional settings (espe-cially inpatient institutions) were alsofound prone to professional Regress. Thesource of this negative influence accordingto our therapists appears to be the institu-tional conditions of practice rather thanthe challenge presented by treating severe-ly disturbed patients, and therapistsshould not be reluctant to treat suchclients. The addition of some private prac-tice to the therapist’s work pattern seemsto insulate the clinician from professionalRegress, but in extreme circumstanceschange in employment and work role arealternatives to consider.

Finally, our study indicates that two leadingsources of professional growth for all thera-pists are supervision (Orlinsky, Botermans& Rønnestad, 2001) and personal psy-chotherapy (Geller, Norcross & Orlinsky,2005). These are important as sources ofmotivational support and stimulation toprofessional and personal growth. Theyalso support the process of continuous pro-fessional reflection that Rønnestad andSkovholt (2003) found to be an essential fac-tor in therapist development. To facilitatethis, therapists can help themselves byusing aids such as the self-monitoring mea-sures assessing therapeutic work involve-ment and professional development includ-ed in How Psychotherapists Develop.

Authors’ noteMichael Helge Rønnestad is professor of clinicalpsychology at the University of Oslo(helge.ronnestad@psykologi.uio.no). DavidOrlinsky is professor of comparative humandevelopment and social sciences at the Universityof Chicago (d-orlinsky@uchicago.edu).Communications about this article may beaddressed to either author.

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Notes1This article is a highly condensed summa-ry of the major findings reported in HowPsychotherapists Develop, published by theAmerican Psychological Association in2005

2David Orlinsky has served as the group’scoordinator for North America and else-where in collaboration, successively, withPaul Gerin, Hansreudi Ambühl, andMichael Helge Rønnestad, who served asEuropean coordinators for the project. Thegroup initially included (in alphabeticalorder): Nicoletta Aapro (Switzerland),Hansruedi Ambühl (Switzerland), WouterBackx (Netherlands), Jean-FrançoisBotermans (Belgium), Christine Davidson(USA), John Davis (England), Marcia Davis(England), Alice Dazord (France), PaulGerin (France), Jean-François Iahns(France), David Orlinsky (USA), ThomasSchröder (England), Ulrike Willutzki(Germany). They were soon joined by PeterBuchheim (Germany), Manfred Cierpka(Germany), Michael Helge Rønnestad(Norway), and Hadas Wiseman (Israel),while some also left (e.g., Backx, Davidson,Iahns). The present international steeringcommittee consists of Botermans, Orlinsky,Rønnestad, Schröder, Willutzki, andWiseman.

ReferencesGeller, J. D., Norcross, J. C., & Orlinsky, D.

E. (Eds.), The psychotherapist’s own psy-chotherapy: Patient and clinician perspec-tives. New York: Oxford UniversityPress.

Gray, L. A., Ladany, N., Walker, J. A., &Ancis, J. R. (2001). Psychotherapytrainees’ experience of counterproduc-tive events in supervision. Journal ofCounseling Psychology, 48, 371-383.

Ladany, N., Hill, C. E., Corbett, M. M., &Nutt, E. A. (1996). Nature, extent, andimportance of what psychotherapy

trainees do not disclose to their supervi-sors. Journal of Counseling Psychology, 43,10-24.

Moskowitz, S. A., & Rupert, P. A. (1983).Conflict resolution within the superviso-ry relationship. Professional Psychology:Research and Practice, 14, 632-641.

Nigam, T., Cameron, P. M., & Leverette, J.S. (1997). Impasses in the supervisoryprocess: A resident’s perspective.American Journal of Psychotherapy, 51,252-272.

Norcross, J. C. (2000). Authoritative guide toself-help resources in mental health. NewYork, Guilford.

Orlinsky, D. E., Botermans, J.-F., &Rønnestad, M. H. (2001). Towards anempirically grounded model of psy-chotherapy training: Four thousandtherapists rate influences on their devel-opment. Australian Psychologist, 36, 139-148.

Orlinsky, D. E. & Rønnestad, M. H. (2005).How psychotherapist develop: A study oftherapeutic work and professional develop-ment. Washington, DC: AmericanPsychological Association.

Orlinsky, D. E., Rønnestad, M. H., Ambühl,H., et al. (1999). Psychotherapists’assessments of their development at dif-ferent career levels. Psychotherapy, 36,203-215.

Reichelt, S., & Skjerve, J. (2002).Correspondence between supervisorsand trainees in their perception of super-vision events. Journal of ClinicalPsychology, 58, 759-772.

Rønnestad, M. H., & Skovholt, T. M. (2003).The journey of the counselor and thera-pist: Research findings and perspectiveson professional development. Journal ofCareer Development 30, 5-44.

Yourman, D. B., & Farber, B. A. (1996).Nondisclosure and distortions in psy-chotherapy supervision. Psychotherapy,33: 567-575.

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The APA Division ofPsychotherapy is pleased torecognize that Dr. John C.Norcross has been selected asa 2005 recipient of theAPA/APF DistinguishedContributions to Educationand Training Award. Dr.Norcross is a CouncilRepresentative from theDivision of Psychotherapyand is also a Past-President ofthe Division.

Dr. Norcross is beingacknowledged for the continuing impact ofhis work on education and training in psy-chology. The award criteria include posi-tive influence in the teaching of students,engagement in educational and trainingresearch, development of instructionalmaterials that influence the direction of

training, professional gover-nance, and promotion of con-tinuing education.

Dr. Norcross’s scholarly pro-ductivity and his educationalimpact are of the highestquality. His ongoing work inchronicling the course of psy-chotherapy in psychologyhas been invaluable to thework of the Division ofPsychotherapy. His gover-nance and policy contribu-tions are singular in their

value to the profession.

Dr. Norcross will be delivering his awardaddress at the APA convention inWashington, DC. We look forward to yourjoining us to celebrate this distinguishedrecognition.

2005 RECIPIENT OF THE APA DISTINGUISHED CONTRIBUTIONS TO

EDUCATION AND TRAINING

John C. Norcross, Ph.D., ABPP

Invited AddressThe Psychotherapist’s Own Psychotherapy: Educating and Developing Psychologists

Friday, August 19, 2005 10:00-10:50

Meeting Room 204CWashington Convention Center

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