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Summer 2004 Texas Psychologist
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PRSRT STDU.S. Postage
PAIDPermit No. 1467Ft. Worth, Texas
Summer 2004Volume 55, Issue 2
HappeningsAcross TexasHappeningsAcross Texas
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Texas Psychologist 1SUMMER 2004
Features
7 Evidence-Based Practice and the Endeavor of PsychotherapyCarol D. Goodheart, EdD
11 How Will Texas Implement Atkins?Ollie J. Seay, PhD
12 Sunset Committee ReportMelba Vasquez, PhD
13 Local Area Society UpdatesDallas, Houston, El Paso and Southeast Texas
16 “Lab Work” at McKenna HospitalAllison R. Williams, BS
Ollie J. Seay, PhD
18 CE Credit Home Study - The Therapeutic ContractEric Marine, American Professional Agency
25 Never Stand in Front of Flowing Lava—RxP on the MovePat DeLeon, PhD
Departments
2 From the EditorElizabeth L. Richeson, PhD
4 From the PresidentC. Alan Hopewell, PhD
6 From TPA HeadquartersDavid White, CAE, Executive Director
26 LAW
27 2004 PSY-PAC Contributors
28 2004 Texas Psychological Fund Contributors
28 2003 Sunrise Fund Contributors
28 New Members
29 Classified Advertising
30 Disaster Response Network
Elizabeth Richeson, PhDEditor
David White, CAEExecutive Director
Lynda KeenExecutive Assistant
Sherry ReismanDirector of Convention & Non-Dues
TPA BOARD OF TRUSTEES
C. Alan Hopewell, PhDPresident
Paul Burney, PhDPresident-Elect
Melba J. T. Vasquez, PhDPresident-Elect Designate
Deanna F. Yates, PhDPast-President
Board MembersRon Cohorn, PhD
Donna Davenport, PhDRichard Fulbright, PhDCharlotte Kimmel, PhD
Kimberly McClanahan, PhDRobert McPherson, PhD
Suzanne Mouton-Odum, PhDRoberta L. Nutt, PhD
Dean Paret, PhDM. David Rudd, PhD
Ollie Seay, PhD
EX-OFFICIO BOARD MEMBERS
Randy Noblitt, PhDFederal Advocacy Coordinator
Melba J. T. VasquezCAPP Representative
Lane Ogden, PhDTexas Psychological Foundation President
Richard M. McGraw, PhDBusiness of Practice Network Representative
LaDonna SaxonStudent Division Director
PUBLISHERRector-Duncan & Associates
P.O. Box 14667Austin, TX 78761
512-454-5262
Stephanie ShawManaging Editor
Lance LawhonAdvertising Manager
Megan MollerProduction Coordinator
The Texas Psychological Association islocated at 1011 Meredith Drive, Suite 4,Austin, Texas 78748. TexasPsychologist (ISSN 0749-3185) is theofficial publication of TPA and ispublished quarterly.
www.texaspsyc.org
SUMMER 2004 VOLUME 55, ISSUE 2
This issue of the Texas Psychologistaffords us a perfect opportunity to
share some of the many exciting
things that are happening with psychologyaround Texas. There was a good response
from some of our Local Area Societies
(LAS) updating us as to what their specific
accomplishments and foci are at present as
well as their plans for the future. In thisissue you’ll read about the LAS of Dallas, El
Paso, Houston, and Southeast Texas. It is
my hope that these articles will inspire us allwith ideas that we can incorporate into our
own cities and towns as we continue to
make psychology a household word and
proceed with our grassroots agenda forSunset review.
After reading Ms. Allison Williams and
Dr. Seay’s article introducing us to Annie,
the therapy dog, I gave Winnie our Springer
Spaniel an extra hug for her therapeutic
value in our household. There is no
question the therapeutic value of our pets,
and Williams and Seay share the story of a
very successful program using a therapy dog
in Texas. Attorney Sam Houston has
provided us with a very timely article
regarding duty to discuss adverse effects of
psychotropic medications with our patients.
This is an especially well-timed article giventhe recent press regarding suicide and
antidepressant medications. Additional
timely and pertinent information can befound in Dr. Melba Vasquez’s article that
provides a report from the March 23rd
formal testimony to the Sunset Committee
in which she participated.
Also in this issue is an opportunity forinterested psychologists to become a part of
the Disaster Response Network (DRN) in
Texas. Please see the “Call for TPAPsychologists to Disaster Response” by the
two Texas DRN Coordinators, Drs. Judith
Andrews and Rita Justice.
The Texas Implementation of the
Supreme Court Decision in Atkins v.Virginia (Mental Retardation & Death
Penalty) is given a final review by Dr. Ollie
Seay, the TPA Public Policy Chair,
bringing us up to date on this critically
important issue.
In addition to reading what is going on
around Texas, Dr. Pat DeLeon, Past
President of APA, gives us an updated
global picture about prescriptive authority
in his article “Never Stand in Front of
Flowing Lava—RxP on the Move.” Dr.
Carol D. Goodheart of New Jersey, a
Member of the Board of Directors at APA,
provides a thought-provoking article,
“Evidence-based Practice and the Endeavor
of Psychotherapy,” which addresses an area
of national significant interest today.
As always, reading our regular columns“From the President” (Dr. Alan Hopewell)
and “From TPA Headquarters” (David
White, CAE, Executive Director) allows usto stay on top of the developments in
psychology in Texas. I want to reiterateDavid White’s recommendation to go tothe Web site at www.sunset.state.tx.us toreview the information on the SunsetCommission and further recommend youfamiliarize yourself with this site in orderto follow the developments of SunsetLegislation as they unfold.
Please send articles for consideration to
elricheson@earthlik.net or Dr. Elizabeth L.
Richeson, 600 Sunland Park Drive, 6-400,
El Paso, TX 79912. I look forward tohearing from you. ✯
2 Texas Psychologist SUMMER 2004
FROM THE EDITOR
Elizabeth L. Richeson, PhD, MS PsyPharm
Our next issue of the Texas Psychologist is the fall pre-convention issue and will feature information on
the convention. The format of the journal will change to an online newsletter beginning with the fall
pre-convention issue. As we make this leap into the 21st century, we hope to reach even more
psychologists, students and others across Texas or anywhere in the world. Additionally, this will give
us the opportunity to include more timely articles because our production time is greatly decreased. If
you are not receiving email from TPA and want to receive the new version of our newsletter, please
email newsletter@texaspsyc.org. There is no need to email us if you are already receiving informational
emails from TPA. We are excited to offer this service to psychologists in the state of Texas!
Texas Psychologist 3SUMMER 2004
4 Texas Psychologist SUMMER 2004
Following a Board retreat and a busy
Board meeting in Fort Worth
during January, several members
attended the State Leadership Conference
in Washington, D.C. This proved to be one
of the busiest conferences ever as there was
much to do and the Texas delegation was
actively involved in more presentations and
meetings than ever before. For the first
time, central office staff member Sherry
Reisman presented at one of the programs.
David White helped network with groups
like the Pennsylvania delegation, which
sparked a number of helpful ideas we can
use in Texas. Bob McPherson, Rick
McGraw, Dee Yates, and Paul Burney had
special assignments. Lane Ogden and
Randy Noblitt accepted appointments as
Federal Advocacy Coordinators and have
been hard at work on my “Legislative 181
Project,” in which we are coordinating our
psychologist/legislator liaison network
throughout the state as we build our
legislative relationships. Working with
them on this is Walt Cubberly, who is
serving as State Advocacy Coordinator for
the Houston area. We were also pleased to
have Celia Servin-Lopez as our diversity
delegate. Many of us braved freezing rain
and even light snow on our “Hill Day,”
when we visited our representatives and
urged them to vote for mental health parity
against insurance plans, which could opt-
out of state laws and mental health
coverage, and for an extension of mental
illness court demonstration projects.
Our March Board meeting was held in
the Woodlands in conjunction with a very
well-attended Spring Professional
Education Conference, sponsored by the
Houston LAS. The conference focused on
practice, legal, and ethical issues, and also
highlighted the quality of work which
continues throughout the year by our local
area societies. Other LASs have also been
busy with Fort Worth preparing an
invitation for many of the Tarrant County
representatives to address legislative issues.
Don Wolff of Collin County LAS
sponsored a TPA update made by me, but
his wife was posted to Germany, so Bob
Weiner carried on into 2004 as Past-
President.
Also, with our large military
population, the War on Terror continues to
present challenges to us here in Texas.
Nationwide, we have had some of our
Reserve colleagues report for active service,
including some of our TPA members for
both stateside and overseas duty
assignments. Especially at Ft. Hood, we
have had a year with large numbers of
military families with spouses overseas,
many of them just now returning with the
inevitable stress-related and adjustment
issues. The war is not yet over, but we
already owe our military and our first
FROM THE PRESIDENT
C. Alan Hopewell, PhD, MS, Psypharm, ABPP
The Texas Psychological Association, Board of Trustees, and the Central Office met a flurry of activity
in the beginning of 2004. Of paramount importance, our Sunset Committee worked steadily and then
responded to the initial round of formal inquiries made by the Legislative Sunset Commission. In
March, the Committee, along with the Board of Examiners, represented the views of TPA when they
gave formal testimony at the public hearing of the Commission. The Sunset Committee, with the help
of our legislative consultant Chris Shields and co-chairs Melba Vasquez, PhD, and David Rudd, PhD,
worked extremely hard and did a very good job. Thanks to the work of the Committee and the support
we have received from TPA members, we believe we are well positioned as we enter the Sunset
process. As expected, anything can happen during this time. We need to remain vigilant and work
together to ensure that our licensing law is renewed as we wish to define it and not as those untrained
in psychology would wish it to be defined.
Texas Psychologist 5SUMMER 2004
responders more than we can ever really repay. We as psychologists
can also do much to help avoid some of the problems that we had
when veterans previously returned from Vietnam. Even in doing
routine rehabilitation work, I am surprised at how often a patient has
a relative in the service (often it is a grandparent who brings their
picture to the hospital room). Additional stressors can often interact
with depression, pain, and other syndromes. Interested TPA
members may also want to work with the APA Resilience Program
or coordinate with our Disaster Response Network. If you see a first
responder or military member while at the store or gas station,
simply telling them that you appreciate their service goes a long way.
And finally, congratulations to all students who are graduating this
spring and to those who are also receiving military commissions and
entering service to the country. ✯
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6 Texas Psychologist SUMMER 2004
SUNSET LEGISLATION
In the Summer 2003 issue of the Texas
Psychologist, I shared with you the
process that the Texas State Board of
Examiners of Psychology must undergo to
determine if the state will continue to
license psychologists. Since that time we
have met with the Sunset Commission staff
and developed position papers on behalf of
the profession, outlining what our concerns
and desires are for psychology and, in
particular, TSBEP. As the state of Texas
continues to deal with budget issues, one
strategy under consideration, and in some
cases implementation, is state agency
consolidation in which several boards will
be collapsed into one. Many types of
consolidation have been discussed ranging
from internal functions to actual policy and
rulemaking consolidation. The Sunset
Advisory Commission staff has completed
their recommendations, which they have
presented to the 10-member panel of the
Sunset Commission. I would STRONGLY
encourage you to look at these
recommendations at www.sunset.state.tx.us.
Their recommendations were presented
to the Commission on March 23, 2004 at
which time our TPA leaders had the
opportunity to testify about these
recommendations. You can view the actual
testimony by going to www.senate.
state.tx.us/75r/Senate/AVarch.htm and
selecting the “March 23 – Sunset Advisory
Committee.” (TSBEP was the first agency to
testify so it will be the beginning of this tape.)
As you know, the licensed psychological
associates have been working on gaining the
status of independent practitioners, and as we
learned at this testimony, they will try again
next session. If you are not engaged in this
process by either contacting your legislator,
joining and participating in your LAS, or
joining TPA, you are risking a change in your
current right to practice psychology. I cannot
impress upon you the need to ACT and
ACT NOW. Your profession is at stake.
MEDICARE/MEDICAIDAs many of you know, during the last
legislative session a bill passed that took
away Medicaid “optional services.” Well,
we are getting hit again. In the next
couple of weeks, the Medicare Advisory
Committee will be discussing yet another
cut in reimbursement which would
significantly lower by 20 to 30 percent
the reimbursement for physicians,
psychologists, and nursing facilities and
other providers of health care services to
dually eligible Medicare-Medicaid
beneficiaries. The majority of nursing
home residents are dually eligible
beneficiaries, and health care providers
might drop services to this group if the fee
cut is severe. Those receiving mental
health services are especially affected
because Medicare pays only 50 percent
(not the standard 80 percent) for mental
health; thus the fee cut for these services
will be even worse. We need
psychologists to speak out against these
cuts. We need to stand up as a profession
and let the bureaucrats understand the
impact these cuts will have on citizens of
this state. Please monitor the TPA Web
site and look for legislative alerts for
the action you can take regarding these
issues. ✯
Capital Update
In the past, I have taken the opportunity to share with you the importance of getting involved in the
legislative process by encouraging you to get to know your legislator and make contact with him/her
on behalf of TPA to share the critical issues that are facing the profession. Well, let me give you an
update on where we are on some legislative issues and what we need from you.
FROM TPA HEADQUARTERS
David White, CAE ,TPA Executive Director
Texas Psychologist 7SUMMER 2004
Many of us who are clinicians
want to broaden the
discussion of evidence-based
psychotherapy. We want to move beyond
the basics of the easy to measure efficacy
studies and into a more complex realm. In
today’s climate, it is a challenge for practicing
psychologists to balance the needs to develop
and maintain a personally effective
therapeutic voice, translate multiple streams
of evidence into meaningful interventions,
offer safe and confidential therapeutic
relationships, and practice in the real world.
Disparate voices carry conflicting messages
about the need for psychotherapy and its
costs, worth, components, allowable
interventions, and effectiveness. These forces,
both within the discipline of psychology and
outside in the health care system, compete for
supremacy and the attention of clinicians.
It is important for clinicians to join in
the discussion and to share information on
practices that contribute to good results for
patients. Our discipline needs a
bidirectional conversation between clinical
scientists and clinical practitioners. Our
academic colleagues are giving us
information daily about specific treatments
and elements of the therapeutic relationship
that work. We need to give them
information about the problems we identify
in our communities, the ways we approach
those problems, and the outcomes.
This article gives an overview of our
knowledge about psychotherapy: the
endeavor of psychotherapy, the evidence we
use for its underpinnings, and the resources
we turn to for guidance in the absence of
hard research findings.
EvidenceWhat do we mean when we talk about
evidence? The foundation for psychology is
science, of course. The practice of
psychology is built upon that base,
although clinicians are faced also with
problems that go beyond what the research
has yet been able to describe, measure, or
ameliorate.
The Institute of Medicine defines
Evidence-Based Practice as: “the integration
of the best research evidence with clinical
expertise and patient values” (Sackett et al.,
2000). The APA document, Criteria for
evaluating treatment guidelines, integrates the
same three components: empirical research,
clinical judgment and expertise, and
acceptability to the patient (American
Psychological Association, 2002).
Most knowledgeable psychologists
support this kind of broad scientific
Evidence-Based Practice and the Endeavor of Psychotherapy
Carol D. Goodheart, EdDIndependent PracticePrinceton, New Jersey
Member Board of Directors, APA
8 Texas Psychologist SUMMER 2004
definition for psychotherapy. There are,
however, some who would like to minimize
or eliminate the roles of clinical observation,
and judgment and patient values. That is a
mistake, if one considers the nature of
psychotherapy and the resources available
that contribute to its success.
EndeavorPsychotherapy is first and foremost a
human endeavor. It is messy. It is not solely a
scientific endeavor, nor can it be reduced to a
technical mechanistic enterprise. The
triumvirate of factors that contribute to
psychotherapy outcome is: the patient’s
personal factors (e.g. motivation), the
therapist’s personal factors (e.g., capacity for
empathy), and the interventions offered.
Keep in mind that specific techniques
contribute only 5 percent to 15 percent to the
outcome (Norcross, 2002). Therapist effects
are greater than treatment effects (Wampold,
2001). People get a substantial benefit from
psychotherapy and no one modality is shown
to be better than all the others (Seligman,
1995). We know that suffering is a part of
the human experience, and we know that
psychotherapy is effective in easing that
suffering, no matter how you define it.
Psychotherapy is a rich process. It is an
attempt to reach understanding, ease pain,
solve problems, and find meaning within the
context of a trusting relationship. Our
patients want to be heard and understood.
They want respectful help in obtaining
relief, making sense out of their experiences
and improving their lives. Each wants to be
treated as a whole person, not a diagnosis or
a case. Real world psychotherapy involves
working in the face of a few variables one
can control and with the knowledge that
there are many one cannot control. This is
where clinical experience, judgment, and
the ability to use creative combinations and
adaptations of interventions come into play.
Psychotherapy draws on many theories,
including behavioral, cognitive behavioral,
family systems, feminist, humanistic,
psychodynamic, and cultural competency
orientations. Perhaps not surprisingly,
different patients make different theories
look good, depending on the “fit” in
language and world view between the person
seeking help and the person providing it. In
practices across the country, underlying
theories may differ but experienced clinicians
look quite similar. They offer proven
interventions, a solid therapeutic
relationship, and a shared expectation with
the patient for a positive outcome. Good
clinicians borrow what works from each
other. There are few differences among bona
fide therapies, widely practiced over time,
that have a coherent theoretical structure and
a research underpinning (Wampold, 2001;
Messer, 1995).
Psychotherapy is an art as well as a
science. It is a fluid, mutual, and interactive
process. Each participant shapes and is
shaped by the other. Good clinicians
respond to the nuances of language, both
verbal and bodily expressions. They are
masters of tact and timing, of when to push
and when to be patient. They are creative in
finding paths to understanding, in
matching an intervention to a need.
Psychotherapy is complex. Our patients’
biological predispositions, personalities,
preferences, developmental level, and
psychological functioning intertwine with
their life circumstances and stressors. The
great preponderance of psychotherapy
patients have cross diagnostic issues and
comorbid conditions. Dual diagnosis is
common. We know that individually
tailored interventions can be as much as
100 percent more effective than
standardized ones (Azur, 1999).
ResourcesWhere do clinicians turn for guidance
to make decisions and treatment choices for
psychotherapy? Psychologists use a
combination of tools to do meaningful and
effective psychotherapy. We use research
evidence where it exists, modify it where
necessary, and create new interventions in
the field on a case by case basis, often by
combining accepted techniques from
different areas in novel ways. We seek
feedback and guidance from multiple
sources on how it is working and how it can
be improved. Where the research evidence
is spotty, we draw upon evidence from our
clinical experience and expertise.
Here is a brief list of some of the
sources of guidance valuable to clinicians:
1. Doctoral Training Program and Internship
It is humbling to learn publicly in front
of one-way mirrors with supervisors and
fellow students how to do an intake; build an
alliance; develop working hypotheses about a
patient; make a diagnosis; offer trial
interventions appropriate to the person and
the situation; appraise the response; continue
or change course; and come to a mutual
agreement on a treatment plan, goals, and
termination. The training period is also the
initiation into a practitioner work ethic that
values openness about one’s work and builds
in an ongoing expectation of feedback.
2. Observation
Observation, both in session and over
time, is a powerful tool. It includes four
types of observational skills: objective (from
the outside), participant (including
awareness of the reciprocal effects on
observer and observed), subjective
(empathic and intuitive), and self (self-
examination) (Shakow, 1976). A therapist
functions as a finely tuned instrument and
thinking person, not as a technician
following a script.
3. Experience
Clinicians turn frequently to their own
experience for guidance. Faced with a
difficult or murky psychotherapy situation,
clinicians sort through their own
experiences and expertise for a way to move
the treatment forward. Often this process is
associative, rather than linear. Clinical
judgment is necessary. Sometimes we make
mistakes, but then we learn from them and
add to our expertise.
Texas Psychologist 9SUMMER 2004
4. Patient Report
Patients are a primary source of
information about how psychotherapy is
progressing. An attuned clinician gains
valuable feedback about improvements or
setbacks that are taking place outside the
treatment room in the patient’s everyday life.
5. Third Party Report
It is not only the patient who gives
feedback to the clinician, but it may be a
spouse or parent who contributes
observations about changes in the patient. In
some particular circumstances, it may be the
patient’s physician, attorney, or employer.
6. Consultations and Peer Discussion
Regular consultations and case
discussions shed light on our thinking and
broaden our perspective. They push us to talk
about cases that are puzzling, or not going
well, or that may have one aspect that is
bothersome or unique. Group consensus may
not always be correct, but it is a valuable tool.
7. Continuing Education
Some programs are skill based, such as
a workshop that teaches specific techniques
for use with pain. Some programs might
better be characterized as focused on
attitude and growth, such as the “Difficult
Dialog” workshops held at the APA
Multicultural Conference last year.
8. Professional Literature
Often clinicians do not read journal
articles that address research directly
applicable to clinical problems. They do read
books of clinical relevance to their practices,
and they value the journals that are most
helpful to clinicians, such as Professional
Psychology: Research and Practice and the
Clinicians Research Digest.
9. Internet
Clinicians have benefited greatly from
internet access, which did not exist when
some of us started practice. From our
offices we can gain needed information
quickly, without taking time away from
practice to go to the nearest university or
medical school library.
10. The Patient’s Impact
This variable in the therapeutic
relationship was described first in
psychoanalytic theory as countertransference.
It is an important psychotherapy
phenomenon and is now recognized across
other theoretical orientations, based on a
somewhat limited but growing body of
empirical research that shows its effects on
treatment (Gelso & Hayes, 2002). It helps us
all to recognize the impact of working in
psychotherapy with people who are distressed
and may be quite disturbing.
11. Outcome Assessment
This may be a formal or informal
process used for guidance. More clinicians
seem to use informal evaluations rather than
formal methods at the end of psychotherapy,
although this is changing. It is quite
straightforward to ascertain information
about global improvement and symptom
reduction. It can be harder to tease out the
multiple variables that have contributed to
the result. Outcome measures are an
excellent source of guidance for clinicians
and a wonderful reinforcement for work well
done. We can also use our outcomes to show
the world psychotherapy works.
ConclusionsClinicians need and prize evidence. We
learn over time to use evidence and
guidance without subscribing to artificially
constructed hierarchies about which
evidence is most important because
usefulness varies widely. Our “best
practices” are built on a foundation of
empirical research; comprehensible and
reasoned theories; clinical observation
and expertise; and our patient’s values,
contributions, and responses. ✯
ReferencesAmerican Psychological Association. (2002).
Criteria for evaluating treatment guidelines.
American Psychologist, 57 (12), 1052-1059.
Azur, B. (1999). Tailored interventions prove
more effective. APA Monitor, 30 (6), 38-9.
Gelso, C. J., & Hayes, J. A. (2002). The
management of countertransference, In:
Norcross, J.C. (ed). Psychotherapy relationships
that work. New York: Oxford University Press.
Messer, S.B. (2002). Empirically supported
treatments: Cautionary notes. Medscape
General Medicine 4(4). http://www.
medscape.com/viewarticle/445082
Norcross, J.C. (2002). Empirically supported
relationships. In: Norcross, J.C. (ed).
Psychotherapy relationships that work. New
York: Oxford University Press.
Sackett, D. L., Strauss S. E., Richardson, W.
S., Rosenberg, W., & Haynes, R.B. (2000).
Evidence based medicine: How to practice and
teach EBM. Second Edition. London,
England: Churchill, Livingston.
Seligman, M. E.P. (1995). The effectiveness
of psychotherapy: The Consumer Reports
Study. American Psychologist, 50, (12),
965-974.
Shakow, D. (1976). What is clinical
psychology? American Psychologist, 31,
553-560.
Wampold, B.E. (2001). The great
psychotherapy debate: Models, methods, and
findings. Mahwah, NJ: Erlbaum.
10 Texas Psychologist SUMMER 2004
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Announcing the Children’s Intensive Program at Remuda Ranch.
Bring up the Death Penalty in any
large group and you can be assured of
finding a difference of opinion.
Bring up the Death Penalty in the Texas
Legislature and you’d better hang on to your
hat! For at least the last three sessions, at least
one bill has been introduced to address a ban
on the execution of criminals who have
mental retardation. Yet as of today, Texas is no
closer to implementing a law in this area
despite the Supreme Court ruling in Atkins v.
Virginia in June 2002.
There are two points of view in the
legislature as reflected in the bills presented
by Sen. Rodney Ellis (D-Houston) and Rep.
Terry Keel (R-Austin) during the last session.
The biggest difference in the bills has to do
with the timing of the determination of
mental retardation and who will hear the case
for this phase. In Sen. Ellis’ bill, the issue of
mental retardation would be
decided before a capital trial was
pursued and would allow the
jury to be waived by the
defendant such that a judge
could make the determination
after hearing testimony from
experts. In Rep. Keel’s bill, the
same jury that heard the capital
case would make the decision on
mental retardation after a
defendant had been found
guilty.
In March of this year,
Capacity for Justice, a non-
profit organization that
addresses competency issues for
respondents and defendants
with mental illness, mental
retardation or concurrent
mental and substance use
disorders, held the first of what should be
several meetings on implementing the
Atkins decision in Texas. They invited TPA
and representatives of other professional
organizations, attorneys, service
organizations and advocates to help make
recommendations to the Legislature. One
approach is to find areas in which we can
agree first, then see what we can negotiate on
the timing issue. The other issues to be
discussed include the definition of mental
retardation, who should conduct the
assessment of mental retardation, and what
factors should be considered in the
evaluation and included in the report.
An update will be included in the next
issue of the Texas Psychologist. The adjacent
Position Statement was adopted by the TPA
Board of Trustees at their March 26, 2004
meeting:
How Will Texas Implement Atkins?
Ollie J. Seay, PhDTPA Public Policy Chair
Texas Psychologist 11SUMMER 2004
TPA Position Statement
Texas Implementation of the Supreme
Court Decision in Atkins v. Virginia
(Mental Retardation & Death Penalty)
March 26, 2004
In issues relating to the Death Penalty,
the Texas Psychological Association supports
legislation that provides a clear definition of
mental retardation that is consistent with
nationally accepted professional standards.
Such a definition of mental retardation
requires three elements: significantly
subaverage general intellectual functioning,
limitations in adaptive behavior, and
origination during the developmental period.
Significantly subaverage general
intellectual functioning in this definition
refers to measured intelligence on a
standardized psychometric instrument of two
or more standard deviations below the age
group mean for the test used. Adaptive
behavior means the effectiveness or degree to
which a person meets the generally
recognized standards of personal
independence and social responsibility.
Developmental period refers to the period
from birth to age eighteen. Any further
qualification of the definition should be
clearly articulated so that the result is
measurable and necessary.
Licensed psychologists, particularly
those with appropriate training and
experience in diagnosing mental retardation,
are the most qualified professionals to
determine mental retardation through use of
psychometric instruments and assessment
techniques. There are already precedents for
the use of licensed psychologists in other laws
relating to forensic assessment of competence
to stand trial and juvenile fitness. In addition,
other state statutes on determination of
mental retardation specify the use of licensed
psychologists. While collaboration with
experts from other professions may assist in
such areas as historical data collection, the
resulting diagnostic determination must be
made by the licensed psychologist.✯
12 Texas Psychologist SUMMER 2004
On Tuesday, March 23, 2004, the Texas Psychological Association provided testimony to the Legislative Sunset Review
Commission. The Texas State Board of Examiners of Psychologists was the first of the scheduled groups to provide testimony
during a two-day hearing. Drs. David Rudd and Melba Vasquez, who have served as co-chairs of the TPA Sunset Review
Committee, provided testimony that focused on the critical points to address in the Sunset Advisory Commission Staff Report during their
allotted five minutes of presentation. Dr. Robert McPherson, TPA’s Director of Professional Affairs, provided response to testimony from
Psychological Associates who made a request for the independent practice of psychology. Dr. Paul Burney, TPA President-Elect, was available
as a resource. Chris Shields, TPA lobbyist, and David White, TPA Executive Director, were also in attendance. The Sunset Review
Commission will provide its recommendations to the legislature on May 18 and 19.
TPA will continue to monitor information, and continue to provide input as appropriate. A draft summary of the commentary is
included below.
Sunset Committee Report
Melba Vasquez, PhD
TPA would like to thank the members of the Sunset
Commission for the opportunity to offer public testimony here
today. We would also like to acknowledge and thank the staff for
their exceptional efforts and gracious assistance during this process.
The staff has responded in courteous and timely fashion to our
requests, allowing us ample time to review and respond to issues
raised.
1. TPA supports continuing the Psychology Board as an independent
state agency and regulatory body.
• For over 30 years the Psychology Board has served and
protected the people of Texas as an independent state agency
and regulatory body.
• Given the complexity of professional psychology, an
independent board provides critical public and professional
representation, which is essential to the public.
• A board provides protection in terms of both licensing
qualified psychologists and enforcing rules of practice.
• If reorganization is pursued at some point or the possibility of
consolidation is discussed, TPA respectfully requests the
opportunity to provide additional input and offer further
testimony as the need arises.
2. TPA supports continuation of the Board’s oral examination for
psychologist licensure candidates, for three main reasons:
• It ensures that all candidates meet minimal competency
standards for practice. Most importantly, it protects the public
from those few that do not possess the basic skills necessary for
entry-level independent practice, including those skills that
cannot be assessed by traditional paper and pencil exams.
• It is a cost neutral activity for the Texas State Board of Examiners
of Psychologists.
• The oral examination is the national standard in licensure of
psychologists. Continuing the oral examination allows Texas to
participate in the national reciprocity agreement, as well as
future options for reciprocity; it ensures Texas can continue in
the multi-state agreement to ease the licensure process for
psychologists moving from one state to another.
3. Texas Psychological Association strongly concurs with the
recommendation of the Commission staff to dissolve the
Psychological Associate Advisory Committee (PAAC):
• Funding for the PAAC has been eliminated and the Committee
has achieved its mission as originally conceptualized.
• Current regulatory language regarding the roles of psychologists
and psychological associates is clear and unambiguous. ✯
TPA Testimony
Texas Psychologist 13SUMMER 2004
Dallas Psychological AssociationGetting to Know Us
Michael McLane, PsyD
Through its active and dedicated membership, the Dallas
Psychological Association (DPA) has for almost 50 years played an
integral role in serving the mental health needs of residents in North
Texas and in providing psychologists with opportunities for ongoing
professional development.
Early in 1956, Dr. Joseph Siegel invited a small group of Dallas
psychologists to form a local professional psychological association.
From those humble beginnings, DPA’s membership has grown to
approximately 200 psychologists of diverse backgrounds.
There are many benefits to being a member of DPA.
Professional membership in the DPA affords a variety of learning
opportunities. For instance, special interest groups have been
established in diverse areas, such as geropsychology, forensics, or
child and adolescent issues, so members can collaborate with local
experts. Members can also request to be contacted in their area of
expertise when local media contact DPA for referrals. Each year,
DPA sponsors multiple workshops on a range of topics, such as
ethics, health psychology, geropsychology, cultural issues, and
borderline personality disorder. DPA members pay a reduced
registration fee for these workshops.
Like the boards of most non-profit organizations, DPA’s
Executive Committee has worked hard to keep costs low without
sacrificing quality of services. For instance, thanks to the generosity
of the Texas Scottish Rite Hospital for Children, a local non-profit
hospital that allows DPA to use their facilities at no charge, overhead
for workshops is reduced. In return, DPA strongly encourages
Scottish Rite employees to attend workshops for free. This ongoing
partnership with Scottish Rite presents a “win-win” situation for all
involved. Other creative methods to curtail expenses include
replacing our local physical administrative office with a virtual one
through our association with DKW Associates. Through the
leadership of David White, DKW Associates has assisted DPA by
providing secretarial support to answer general phone queries and by
developing a highly functional Web site that allows online renewal
of membership, workshop registration, and viewing of monthly
DPA newsletters. Those who visit DPA’s official Web site,
http://dallaspsychologists.org, can also obtain information about
the professional services of its members. Through these and other
cost saving measures, there has been dramatic improvement in
DPA’s balance sheet over the past few years without sacrificing the
high quality of services provided to members and the community.
Three times each year, DPA welcomes current and new
members to gather informally at social events for networking,
eating, drinking, and being merry. Supporting excellence in
psychology is a high priority of DPA; therefore, the organization
offers three awards each year: the Distinguished Psychologist award
to honor the accomplishments of an outstanding psychologist, the
Pam Blumenthal Community Service award to recognize a
psychologist devoted to under served minorities, and the
Dissertation award to acknowledge excellence in research.
Learn more about the exciting opportunities for ongoing
professional development that membership brings by visiting our
Web site http://dallaspsychologists.org or by calling DPA at 800-
306-8886.
El Paso County Psychological Society
From the Ashes
Elizabeth L. Richeson, PhD, MS PsyPharm
It was difficult to decide what or even whether to write about
this LAS. Having concluded there are always lessons to learn, I felt
I would be remiss in not sharing this story.
The El Paso County Psychological Society (EPCPS) once
existed as the El Paso Psychological Association (EPPA)—a much
easier acronym. Due to events too tedious and ancient to revisit,
suffice it to say, it was reborn. Since that time it has struggled to
maintain its membership. El Paso has a relatively small number of
psychologists—21 clinical practitioners listed in the phone book
and 25 academicians at the University of Texas at El Paso—with
little growth in our professional community. However, there is a
small core of psychologists that remain dedicated, and it is about
them that I wish to write.
Perhaps it is the greater distance from Austin that contributes
to the limited insight for some psychologists in El Paso about the
importance of legislative issues and their impact on psychology.
However, the EPCPS works hard to ensure its support is felt even in
Austin. It is this small but dedicated group that contributes
financially as a group to the TPA PAC every single year. While the
$500 contribution (there have been years in which it has been a
$1000) may not seem like much to a large LAS, it is significant
given the size of EPCPS. Additionally, the El Paso LAS historically
held monthly brown bag lunch meetings that offered didactic
LOCAL AREA SOCIETY UPDATES
14 Texas Psychologist SUMMER 2004
presentations in conjunction with the UTEP Psychology
Department. In some years, there were also some very well attended
area conventions that offered CEUs of interest to a wide variety of
mental health practitioners.
Most recently it has been difficult to maintain the organization
at all. There was not an election last year, since those dedicated to
the LAS have served as officers in the organization multiple times
and now refuse to do so. At our last social meeting, there were a few
that agreed to run (most likely unopposed) as board members if
three members were willing to run for board officers. I have been
working behind the scenes to identify those psychologists who do
not want this most important organization to simply slip away.
When I first moved to El Paso in 1982, it was the EPPA that
welcomed me and encouraged me to get involved with the LAS
and TPA. With their support I held the office of Secretary, Vice-
President and President before I moved on to my work with TPA.
I worked on the Health Services Committee for six years as Chair
of the Hospital Admitting Privileges Committee and three years as
a member of the Prescriptive Privileges Committee. Supported by
the LAS, I went on to become President of the PAC, Chair of the
Special Interest Group in Psychopharmacology, Member of the
Board of Trustees of TPA, and now Editor of the Texas Psychologist.
I continue to maintain my position of Liaison Officer with the
LAS keeping them informed of the developments within TPA.
None of this would have been possible without the support of the
El Paso LAS.
Our fundraisers have not always been well attended but they
have, nonetheless, made a political statement and served us well.
Even our psychology socials have worked to keep us in touch with
each other and updated on the most pressing issues of our
profession. However, in order to be heard, we must reestablish
ourselves as a professional organization.
Whether it’s to support individuals in our professional
community or to protect our licenses as we MUST do in Sunset, I
cannot impress upon you the importance of a strong LAS in each
and every community in Texas. This is the way we can make our
voices heard. Over the years, there have been other LASs that have
ceased their existence, most often in small communities. I encourage
each and every one of you in communities that do not have
an LAS to revisit the opportunity to create or reestablish
your LAS for all the benefits listed here and those that are
simply in our imaginations.
I am pleased to announce that the EPCPS will be active
again. We have the numbers needed for the much overdue
election and will be up and running in the near future.
Making psychology a household word can only be
accomplished with efforts in each and every community in
this state and across the country. It is the grassroots effort
that ultimately makes the difference.
Houston PsychologicalAssociation
Educational Opportunities Abound
Julie Landis, PhD
If you are a psychologist in Houston, there is no lack of
things to do! We are a very busy professional organization
offering a wealth of activities for psychologists to attend.
During February, members attended a film series,
“Mental Health and the Law,” with the Museum of Fine
Arts. This series presented four films selected for their
interpretations of the legal consequences surrounding
sociopolitical issues and mental illness. Panel discussions
led by local area psychologists followed each screening.
Texas Psychologist 15SUMMER 2004
HPA was also lucky to benefit from some local area expertise. J.
Ray Hays, PhD, JD, presented an ethics workshop on February
20, titled “Privacy for Couples, Families, and Groups: Split
Alliances, Dual Duties, and Trust,” that resulted in a record
turnout of psychologists meeting their three hours of continuing
education in ethics requirement for license renewal. After the early
morning workshop, we held our regular monthly luncheon
meeting with featured speaker, Patrick Brady, PhD, who spoke on
“Appropriate Interventions and Referrals for Addressing
Addictions in Private Practice.” In March, instead of our usual
monthly luncheon, we encouraged our members to attend TPA’s
Professional Education Conference in the nearby Woodlands.
Those who attended benefited from the practice tips and
information offered.
Members of our executive committee were very busy in
preparation for HPA’s Annual Spring Conference held May 14 and
15. As we are all aware “about 1.5 million children experience the
divorce of their parents each year—ultimately 40 percent of all
children” (National Center for Health Statistics, 1995). While most
adapt well, 20-25 percent suffer significant adjustment problems as
children and teenagers. The negative impact often persists into
adulthood, resulting in nearly twice the normal prevalence of
mental health problems and impaired educational attainment,
socioeconomic and family well being (NIH news release, 2002).
Much more needs to be done at the community and practice level
to strengthen the family unit so that they can adequately care for
their children.
For the previous two years, HPA presented very successful
conferences, titled “Violence: Prevention, Intervention, Activism”
in 2002 and “Violence 2: Prevention-Resilience” in 2003. These
conferences were designed to provide the community with the
knowledge and ability to confront and respond to the increasing
level of violence in our society. This year, HPA has shifted the
focus to individual practice and education to develop and
enhance our therapeutic skills so that we may better address the
needs of our clients. To this end, we brought Michele Weiner-
Davis, MSW, to Houston to present workshops for mental health
professionals and the public. Michele was in Houston May 14,
2004 at the Derek Hotel to present a seminar, “Putting ‘Marriage’
Back into Marriage Therapy: Divorce Busting.” In this seminar,
mental health professionals learned a new model of working with
couples with very challenging problems so that they will be better
able to help couples “resolve their differences rather than dissolve
their marriages.”
Also included in the conference was a day intended for the
benefit of the Houston community at large. On Saturday, May 15,
Ms. Weiner-Davis offered her seminar, “Keeping Love Alive,” to
couples and individuals. This workshop is designed to teach
relationship skills to improve a couple’s ability to communicate,
parent, and negotiate differences. This event was held at the Christ
Church Cathedral downtown. Childcare was available. For more
details and registration information about future workshops, check
out our Web site at www.hpaonline.org.
Finally, I wanted to let you know that I have represented
HPA at meetings of the newly formed Houston Area Suicide
Prevention Coalition. It is composed of many area agencies
providing services to prevent and respond to people in crisis.
They have asked us to put together a list of professionals
specializing in suicide response and trauma who would like to be
identified as providing services in this area.
Southeast Texas Psychological Association
Reorganized and Going Strong
Charlotte M. Kimmel, PhD
The Southeast Texas Psychological Association has been
meeting every month since last year. This group of approximately
20 members includes psychologists from the Golden Triangle area
of Beaumont, Port Arthur, and Orange, Texas. This chapter had
been inactive for several years until approximately one year ago.
Bob Meier, PhD, was integral in contacting all the local
psychologists and arranging a lunch meeting. Since that time,
the association members have continued to meet at a local
restaurant during the lunch hour to network and share ideas.
Current officers are President Bob Meier, PhD; Vice President/
Secretary Charlotte M. Kimmel, PhD; Treasurer Cristina
Serrano, PhD; and Past President Andrew W. Griffin, PhD.
Members have agreed to have a monthly program and speaker.
Programs during the current year have included information on
the following topics: Psychology Services in the Federal Prison by
Jim Mann, PhD; Diagnosis and Treatment of Substance Abuse in
Older Adults by Andrew Griffin, PhD; Differential Diagnosis
and Treatment of Children: ADHD or Bipolar Disorder; and
Ethics Issues by Bob Meier, PhD.
The group also keeps current with legislative issues through
legislative alerts posted to the group members via e-mail by
Charlotte M. Kimmel, PhD, who is a Texas Psychological
Association Board Member at Large and receives frequent updates
of issues relevant to the practice of psychology in Texas. Several
local members have been active in contacting their legislators
about these issues to ensure that local representatives are informed
about these concerns. ✯
16 Texas Psychologist SUMMER 2004
“Lab Work” at McKenna Hospital
Allison R. Williams, BSOllie J. Seay, PhD
Three years ago, Annie and Tim
went through six weeks of
obedience training with the Delta
Society in Portland, Oregon. Delta Society’s
mission is “to improve human health
through service and therapy animals.” The
society has three main goals: “to expand
awareness of the positive effect animals can
have on human health and development, to
remove barriers that prevent involvement of
animals in everyday life, and to expand the
therapeutic and service role of animals in
human health, service, and education.” The
Delta Society helped establish the Standards
of Practice in Animal-Assisted Activities and
Animal-Assisted Therapy and provides
guidance on the administrative structure
of AAA/AAT programs, including such areas
as the selection of animals, personnel
training, treatment plan development,
documentation, and more. Annie would fall
into the Animal-Assisted Activities category
since there are no specific treatment goals
planned that include her—the handlers are
not required to take detailed notes—and
Annie’s visits are spontaneous and last for as
long or as little as is needed for each patient.
Annie spent an additional six weeks
with the trainer who would be guiding her
as she made her rounds in the rehabilitation
ward. This allowed her to become
acquainted with her supervisors at the
hospital and helped her learn what duties
and behavior would be expected of her.
Annie is well trained to follow hand
motions, and staff had to learn these, as well
as to not to leave food lying around for her
to eat. In her three years on staff at
McKenna Hospital, Annie has primarily
worked with patients in rehabilitation who
are in the hospital for an extended period,
usually after a complicated surgery or
stroke. Annie assists these patients in
reacclimating into the world.
One of the tasks that Annie helps
patients cope with is being reintroduced to
basic functions. If these patients need to
learn how to do simple things such as
brushing their hair again, they can brush
Annie’s hair for practice. Tim Brierty said
that some people have a better connection
with the animal than with people, and if
they do not react well to a therapist, then
Annie can assist them in getting the help
they need.
Another job that Annie performs is
being a friend who comforts patients by
spending time with them. “Some people
can’t get out of bed, so we are trying to
What qualities or characteristics are necessary to create and offer a healthy workplace? Granted, there are
numerous ways to do this, but Tim Brierty, CEO of McKenna Memorial Hospital, enlightened us on a key element that
helped establish a healthy environment for both workers and patients. McKenna Health Systems, with its strong
anchor, McKenna Hospital of New Braunfels, Texas, received the Healthy Workplace Award from the Texas
Psychological Association (TPA) in 2003. The development of the environment for both patients and employees is
partially accredited to a four-legged Labrador Retriever named Annie.
Texas Psychologist 17SUMMER 2004
patient who was recovering from surgery on
his knees was particularly happy to see
Annie and grabbed her with both arms to
give her a great big hug. He did not want
her to leave with us, so as we said goodbye,
Annie stayed in his group rehabilitation
session to keep him company.
After making the rounds with Annie,
we could see that she was indeed an
essential worker and that she gave her heart
to each patient she saw helping them feel a
little better in what could have been just
another hospital stay. Given the benefits
observed for everyone at McKenna
Hospital, it is surprising that more hospitals
do not follow their example. It is easy to see
why TPA chose them for the Healthy
Workplace award. Theirs is definitely a
healthy workplace, for people and for a dog
named Annie. ✯
Annie—and that was not just the patients.
Staff members’ demeanors changed when
Annie walked in the room. Everyone
seemed glad to see her. Mr. Brierty took us
to the different rehabilitation rooms to
show us Annie in action. He made sure to
ask permission to bring Annie into each
patient’s room. While there was no
requirement to see her, most patients said,
“Sure, bring her in.” We saw how the
patients’ faces lit when Annie entered their
rooms. We encountered one woman who
was using a walker to go down the hall, and
she became very animated and excited when
she saw this big black dog enter the door.
Annie went up to a man who did not have
much control of his arm, but he used that
arm to pet her and was surprised that such
an ordinary response to an animal could
help him learn to reuse the limb. Another
break down their depression, and Annie
will hop up in the bed, always with
permission, and most of the time you can
find Annie lying perfectly still in someone’s
bed because they have fallen asleep with
her,” says Brierty. For some patients, Annie
is a replacement dog for the one they had to
leave behind while they are staying in the
hospital. She becomes their new
companion. In addition, some patients
must relearn how to take care of their
animals, and Annie becomes their
“training” dog. Annie works with a variety
of patients and is adaptable to meet the
patients’ different needs.
Annie is basically an alternative
therapy, providing emotional support in
ways that other forms of therapy cannot.
“Sometimes the patients actually heal
faster because their hearts and spirits are
getting better,” says Brierty. Although no
research has been conducted concerning
Annie’s role at the hospital, it is evident in
the response from past and present
patients that she has helped improve
patient care. Many former patients return
to McKenna Hospital just to see Annie,
and sometimes she even receives Christmas
presents. Brierty said that his research is
based on the reactions people have and the
fact that so many of them come back to see
her once they have been rehabilitated.
Some return patients come just to see
Annie because they say she “saved their
lives.” In addition, staff members have told
him that patients who were either
depressed or unwilling to cooperate in
therapy changed once they met Annie.
Despite the lack of formal research, Tim
Brierty’s intuition tells him that Annie
works. During our visit, we could tell by
the way that he talked that he knew having
Annie at McKenna Hospital had increased
the morale of patients and staff members
alike.
As we were walking Annie to the
rehabilitation floor, the people we met
seemed much happier when they saw
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18 Texas Psychologist SUMMER 2004
CE Credit Home StudyThe Therapeutic ContractEric Marine, American Professional Agency
One of the fundamental elements
of the therapeutic process is the
contract for services between the
patient and therapist. This is generally
referred to as the therapeutic contract. In the
past, this document was very rarely written
down. While verbal, it still contained the
basic provisions for the services the therapist
would provide to the patient. It was an
evolving agreement. As the therapy
progressed, the therapist would explain what
was going on and what would happen next.
Since it was assumed that the treatment
would always be delivered in good faith, it
was infrequently written down.
Yesterday was a different world than
today. In the past, therapists would hardly
ever encounter the legal system. The
relationship with the patient was intimate
and private. The patient would never want
their therapy made public and that was the
end of that.
The world we now live in is quite
different. In the past 20 years, therapy has
been recognized as mainstream health care.
The client base has expanded and changed.
It has become multi-cultural and quite
diverse. The mental health profession has
acquired the court system as a client and
referral source. While the historic principles
that make up the therapeutic process have
been altered and adjusted, the underlying
concepts have remained constant.
One of the most profound changes to
the therapeutic process is the advent of the
consumer revolution. In all other forms of
commerce, consumerism has met with
some resistance by the manufacturers and
purveyors of goods and services. In the
therapy community, it has been met with
outrage and misunderstanding. Also, the
consumer protection apparatus has little
understanding of the services they have the
responsibility to regulate. This confluence
of events has led us to where we are today.
A place where most therapists try and carry
on with limited understanding of the forces
that operate around and inside the practice
of therapy.
As we go through some of the elements
that have changed or become preeminent in
the modern practice of psychotherapy,
certain areas will be highlighted and
discussed in detail. It is from these areas that
the elements of a new treatment contract
will be crafted. The scope of practice and
client base for psychotherapy has changed
dramatically in the past 100 years. The rules
for the provision of the services have also
radically been altered. We will attempt to
create a framework to remove the anxiety
from practice in the future.
LICENCED OR CERTIFIEDThe first step in the societal
recognition process for therapy was the
requirement for the licensure or
certification of the professional. This was
completed in the past 10 years in all states.
It is important to note the license or
certification does not make the professional
a therapist, which is done with education
and experience. The license or certification
allows only those individuals duly approved
by the various states to use protected terms,
such as psychologist, social worker,
counselor or marriage and family therapist.
The laws protect the terms and allow only
those individuals to call themselves what
the license or certificate refers to them as. It
also defines the type and extent of the
services that can be performed by the duly
licensed or certified practitioner. This
protects the public from unqualified
individuals using the protected titles and
thereby deceiving the public into receiving
sub-standard or unqualified care.
Directions: To receive one hour of ethics continuing education credit for psychologists, licensed
psychological associates, licensed professional counselors and licensed social workers, for this TPA
sponsored home study assignment, you must:
1.) Read the article in its entirety;
2.) Take the test at the end of the article;
Mail the test along with $25 (TPA Members) or $50 (Non-TPA Members) to the TPA Central Office at 1011
Meredith Drive, Ste. 4, Austin, TX 78748 or you can fax back to 512-280-4334.
Texas Psychologist 19SUMMER 2004
The prior paragraph not withstanding,
the license or certificate is a permission to
conduct a business in the state. It defines
what services may be provided and by
whom. It is intended to inform the
consumers of the state what they might
expect should they see the therapist. It also
gives the state the right to regulate the
practice in order to protect the consumer.
Therefore, there is a presumption that the
consumer is always right. It is this
presumption that the therapist encounters
when a complaint is made to the state
regulatory board. It is the same operative
presumption that the therapist would have
going for them should they make a
consumer complaint against another
provider of state regulated services, such as
an automobile dealership.
Historically, there were few complaints
made against therapists to the various state
regulatory agencies. This was probably
because the patient did not wish to have the
fact that they were in therapy known to any
one. This self-limiting factor stopped many
clients from even considering bringing a
complaint. This is not the world in which
we live today. States advertise the services of
the various consumer protection boards.
Some even require the therapist to inform
the patient directly about the existence and
procedures of the boards. Other states
require the therapist to post in their lobby a
copy of the approved “Patient’s Bill of
Rights.” These are examples of the
consumer protection mandate of the state.
The basic nature of psychotherapy
works against the therapist when a
complaint is made. Because the services are
delivered in private, there is little evidence
of the actual quality of the service provided.
Generally, the word of the patient is given at
least equal value as that of the therapist as to
what occurred during the therapeutic
process. From this premise the state will
begin an investigatory process. The reason is
to find out why a consumer is unhappy
with the services received. The United
States Constitution provides for a
presumption of innocence in criminal
investigations and prosecutions. The state
regulatory law does not contain that same
presumption. Additionally, the state may
use the services of the Attorney General’s
office to act as the primary investigatory
and prosecution personnel. These
individuals are used to protecting the
citizens of the state from criminal activity.
They bring the same mindset and zeal to
the regulatory process. While on the surface
this energy may be laudable, it fails to take
into consideration the special circumstances
of mental health care.
When the mental health professional
achieves either licensure or certification, the
state will provide a copy of the regulations
that govern the license. Each time that
license or certificate is renewed, the therapist
signs a statement that they are familiar with
all the regulations and are in compliance
with them. If an investigation is begun, the
state is empowered to not only investigate
the complaint, but any compliance issue
they choose to look into. This means a
therapist may be exonerated from the
original complaint, but found in violation of
something discovered during the initial
investigation. This may have nothing to do
with the reason for the complaint, but the
state can apply penalties nonetheless.
An example of this is record keeping.
Contained within the state mental health or
public health law or the actual licensure or
certification statute is a specific requirement
for record keeping. Each time the therapist
renews the license or certificate, they
warrant that they are keeping records in
accordance with the requirement. If the
investigation turns up a deficiency in this
area, the therapist will face disciplinary
action even though the complaint made by
the consumer is dismissed. This may not
seem fair, but the therapist had agreed that
he/she was complying with all the rules, but
the investigation showed a lack of
compliance. Further, compliance with a
national organization’s requirements may
not provide sufficient protection from the
regulatory process. Where the organization’s
rules and state law come into conflict, the
state has primacy.
A further example of the rise of
consumerism is the varying state
requirements for disclosure and informed
consent. The mental health community has,
for years, been less than forthcoming about
the therapeutic process. The education and
experience required to become conversant
with the process is formidable. For years,
the only information given out about the
process was the admonition to “trust me.”
In today’s world, the full disclosure of all
information generated by the therapist is
almost a universal mandate. If a patient,
former patient or a guardian of either of the
previous two groups requests treatment
information, it must be given.
This has not always been the practice
of the therapy profession. Treatment notes
and information were guarded to protect
the patient’s confidentiality. If the
information was released, it was generally
done in the form of a treatment summary or
report. For a long time, this was acceptable.
Today, it is not.
While the state laws that govern the
practice of therapy still require the therapist
to maintain the patient’s confidentiality,
they recognize it is the patient that controls
the record. Confidentiality is the duty owed
to the patient. Privilege is the right of the
patient to keep confidential those
communications made with the therapist. It
is similar to the privilege provided between
an attorney and a client. The patient
controls this aspect. If the patient does not
wish to waive privilege, the therapist cannot
breach the patient’s confidentiality. There
are, of course, exceptions to this rule—
abuse, suicide and dangerousness being the
most notable.
There are many other aspects of any state
licensure or certification law. They deal with
who may sit for the state examination and the
20 Texas Psychologist SUMMER 2004
general principles of what makes up an ethical
and moral practice. Some are more spelled
out, while others are less defined and open to
interpretation. Keep in mind that the
consumer may use a different interpretation
of the state law to instigate a complaint. The
state will attempt to see the situation from the
point of view of the consumer.
INFORMED CONSENTThe concept of informed consent has a
long history in the medical profession. It is
intended to allow the patient to participate
in the treatment decisions that most directly
affect the patient. The physician has to
explain what is going to be done and why.
The patient must consent to the course of
treatment outlined. The patient always has
the right to refuse the treatment. This
refusal would be based upon all relevant
information being provided about the
treatment and the possible negative
outcomes if the treatment is not performed.
Therapy has no such history of the
application of informed consent. For the
most part, the therapist has worked with the
patient in a one-way relationship. The
patient participated in the therapy but was
not completely informed of the modalities
to be used, the time frame expected for the
problem, or, in some cases, the actual
diagnosis. With the advent of consumerism
and regulation of the therapy profession,
the changes have already begun.
Informed consent means that the
patient has been fully informed of the
problem being worked upon, the modality of
treatment being used, the known positive
and negative aspects of the modality,
alternative treatments and the prospects of
success. If a certain modality is the subject of
controversy, such as hypnotherapy, the
controversy must be explained. If there are
alternatives to the method used by the
therapist, these must also be explored and
explained. The expected time frame of the
treatment must be outlined and agreed
upon.
While this may seem an unwarranted
step in the therapeutic process, it is gaining
support with the various states’ licensing
authorities. Since this step would allow the
consumer (patient) to participate in the
treatment process and exhibit control over
treatment, some states have mandated the use
of informed consent documents. Managed
care facilities have long required the provider
of services to use a form of informed consent
documentation in the intake process. It can be
expected by state mandate or best practice
recommendation that some type of informed
consent documentation will be required from
all patients before the therapeutic process
can begin.
While the clinical area of therapy can
be enhanced by the use of informed consent
documentation, it is extremely helpful in
forensic practice. When a client visits a
therapist, there are certain preconceived
notions at work. Foremost is the notion of
therapist-client confidentiality. A client can
reasonably expect the information
developed in therapy will remain sacrosanct.
The client must specifically release the
therapist to allow for dissemination of the
client’s information.
In a forensic setting, the information is
being developed for release. Usually, the
client is there as a result of some order from
an authority figure. That figure has been
asked to settle a dispute for the client. This
is the premise of a court action. The court
has been asked to rule on a question
brought to court at least partially by the
client. The court has determined that in
order to provide the best answer some help
is needed. Therefore, the court will refer the
person to a forensic expert. The most
common reason for forensic evaluation is in
the area of child custody.
In a typical child custody situation, the
parents or guardians cannot or will not
agree on the best location for children of the
marriage to live. Additionally, they may not
agree on what degree of access one of the
parents is to have to the children. In order
to make the best decision for the children;
the court will often order a custody
evaluation by a mental health professional.
By this order, the fundamental relationship
of the client and the therapist is set. It is not
the traditional one that any client might
expect.
While the change dictated by a
forensic examination would appear to be
obvious, it may not be. In order to make
sure all parties know exactly what will
happen and what to expect, using an
informed consent document can be of
immense help. It removes areas of
confusion and specifically covers any
problematic features, such as
confidentiality.
In the January 1997 issue of the
California Board of Psychology Update,
Bruce W. Ebert, PhD, JD, wrote, “Every
psychologist has a duty to obtain informed
consent from each patient or client to whom
he or she provides services in the
professional capacity.” While this quote is
from a psychologist, it is instructional for all
mental health professionals. It should be
noted that Dr. Ebert is the chairman of the
California Board of Psychological
Examiners. His comments are quite
instructional regarding the view of a state
licensure board with regard to informed
consent.
Dr. Ebert goes further, in the same
article, “The most important question is
what information the client should receive
in order to obtain thorough informed
consent. It is recommended that the client
be informed of:
1. Limits of confidentiality;
2. Nature and extent of your record
keeping system;
3. Your title, training, experience and
areas of special expertise or any areas
in which you are not adequately
trained to provide services to
clients;
4. Probable length of services;
Texas Psychologist 21SUMMER 2004
5. Risks involved with the services you
are providing;
6. Alternatives to the services you are
scheduled to provide;
7. Your fee, as well as relevant billing
practices;
8. The rights of the person receiving
services;
9. The rights of not proceeding with
anticipated services;
10. Emergency access to you or
someone who can respond to a
psychological crisis, if applicable.”
The previous recommendations should
be looked at as the absolute minimum
requirements of any informed consent
document. As previously pointed out, if the
services are forensic in nature, special care
should be taken to point this fact out. It is
the true informed consent of the patient
and the empowerment that comes with
consent that are powerful deterrents to
allegations of professional negligence.
SAMPLE CONTRACTSThe following are examples of types of
disclosure statements that my be combined
in a contract. These are neither the
definitive nor the only possible wordings
that may be used. They should be modified
to meet the needs of your individual
situation.
The use of these examples is no
guarantee that legal action will be neither
taken or successful. They are given merely
to assist in the preparation of a treatment
contract. An attorney, to ensure their
conformity to the laws of your locality,
should review all legal documents.
SAMPLE OF AN INFORMED CONSENT DISCLOSURE AND TREATMENT CONTRACT
Welcome to the therapy practice of _______________. I am a (Licensed/Certified) ___(profession)_______________. I have been
licensed in this state since ______. While I would like to be an expert in all things, I try and limit my practice to ______________. This is
because I have a great deal of training and experience in this area. If you would like, I will provide you with a copy of my Cirriculum Vitae.
CONFIDENTIALITYIt is axiomatic that all communications made during any therapy visit are to be kept confidential. I will endeavor to follow your wishes
on this subject, as you are the one who generally controls this information. However, I must make you aware of those few circumstances
where I am compelled to breach this important promise.
In the event that our therapy session reveals any information concerning the abuse of either children or senior citizens, I am mandated
by law to make a report to the proper authorities. By the signing of this document, you acknowledge your awareness of these facts.
Additionally, if the course of therapy reveals any intent to harm either yourself or others, you acknowledge my legal and moral duty to
prevent you from bringing this harm about. I specifically have your irrevocable permission to warn those parties that I feel may be harmed.
If you reveal an intent to harm yourself, I have your permission, also irrevocable, to prevent you from accomplishing your intent.
As an attachment to this document, there is a release to be signed by you that will allow me to discuss your case with your other health
care providers. This will include your psychiatrist, if you have one, and any prior treating therapist. I may also request a copy of the treatment
records from these individuals. I will inform you if I feel the need to get this information.
If you have been referred to this practice by a managed care or insurance company, you should be aware of this arrangement. As a
requirement of the referring organization, I may be required to provide them with a complete copy of the records generated by your therapy.
Once these records are in the possession of the referring organization, I cannot guaranty their continued confidentiality.
RECORDSIt is a state law that I maintain a record of the treatment given to you. This record will contain the information that will allow me to
chart the course of your therapy. I will use it only for that purpose. It is my intent that no one will ever see what is contained in the file. You
may get a copy of the file only by providing me with a signed and notarized release of information request. I may provide you with a synopsis
of the course of treatment and outcome in lieu of the actual record. You agree you will pay, in advance, for either the copying cost of the
actual record or the time required for the preparation of a treatment summary. This includes providing copies or reports to any court or legal
representative or designate. In the event of your death, these requirements will be binding on any heirs, successors or executor(s).
If the therapy sessions contain more than one patient, you agree that no one person may get the complete treatment file. I will attempt
to maintain a separate record on each patient. However, only that individual is entitled to his/her own record. You agree I may synopsize the
22 Texas Psychologist SUMMER 2004
course of each individual’s treatment as opposed to providing a copy of what notes may have been made during any therapy session.
The laws of this state require that your record be maintained for a period of ____ years. I will maintain them for that period of time.
At the end of that period, they will be destroyed.
If you have been referred by an insurance plan, company or managed care organization; you must be aware that you may have waived
your right to confidentiality as it pertains to the referring organization. If I am an approved provider for this organization, I may have to
share all the information you provide with this organization. I will do so as required to get you all the treatment that is appropriate. You
should be aware that the organization is not bound by my ethical and legal requirements on maintaining the confidentiality your treatment
may require. By providing the required reports, you understand that I have no control over the use of the information made by the referring
organization.
FORENSIC REPORTSIf your purpose in coming to my practice is to obtain a forensic evaluation and report, there are some very important differences you
must be aware of. THIS IS NOT THERAPY. YOU ARE NOT MY PATIENT. I have been hired to perform an evaluation and report my
findings to a court of law. At a minimum, this means THE USUAL RULES OF CONFIDENTIALITY DO NOT APPLY. BY THE VERY
NATURE OF OUR RELATIONSHIP, I WILL BREACH ANY CONFIDENCE WE MAY HAVE. This must be clearly understood. By
signing this agreement, you acknowledge your understanding and agreement.
PAYMENTI expect to be paid in full prior to the provision of the final report. Before the first session, I require a retainer of $________. This is
estimated to be equal to ___% of the total cost of the evaluation and report. Prior to the final evaluation session, an additional $_____ is
expected to be paid. The final report will not be released unless the entire cost of the process is paid in full. By your signing of this contract
you agree to be bound by this. _______ (Initials)
RELEASE OF INFORMATION(General)
I, (name of patient), hereby request (name of therapist) to provide a complete copy of my Therapeutic Contract to (Name, and address
of the party to get the records) for the purposes of (reason). I am aware that this information will contain personal and private disclosures
made during the course of my therapy. The content of the file has been explained to me by (Therapist). I WISH TO AUTHORIZE ITS
RELEASE.
_________________________ (NAME OF PATIENT)
__________________________ (WITNESS OR NOTARY PUBLIC)
________ (DATE)
RELEASE OF INFORMATION (Forensic evaluation)
I, ______________, hereby acknowledge that the purpose of my coming to see ____________________ is to provide an evaluation
and report to the referring organization. This is not therapy. I have no reasonable expectation of confidentiality. The information I provide
during the evaluation process will be shared with other parties. I understand that the records generated by this process will only be released
with the permission of and through the referring organization. I agree to this situation.
I am aware that I have certain federal guarantees to confidentiality dealing with any incidence of substance abuse on my part. I hereby
specifically waive those rights as they pertain to this evaluation and report. _____ (Initials)
I am also aware that there are further federal rights to confidentiality dealing with a status of HIV positive or suffering from AIDS
(Acquired Immune Deficiency Syndrome). I freely waive those rights to confidentiality as they pertain to this evaluation and report.
________ (Initials)
Texas Psychologist 23SUMMER 2004
I, ______________________, HAVE READ THE ABOVE STATEMENT ON THE RELEASE OF CONFIDENTIAL
INFORMATION. I UNDERSTAND THE INFORMATION CONTAINED AND HEREBY AGREE TO THE CONDITIONS
CONTAINED.
_______________________________________ Signature
______________________________________ Print name
_________________________ Date
_______________________________________ Witness
CONTROVERSIAL OR EXPERIMENTAL MODALITY OR PROCEDUREI, (name of patient)_, have had the modality of _(type of therapy)_ proposed as a possible course of therapy. (name of therapist)_, my
therapist, has explained the process to me. The explanation included reference to all current information on this modality. I have asked and
received answers to all my questions. I acknowledge that there is not complete agreement within the therapeutic community on the
effectiveness of this form of treatment. It has been explained that there still is data being gathered by the scientific community on the results
of this type of treatment.
I have given all this information due consideration and have opted to proceed with the proposed course of treatment outlined by (name
of therapist) .
_________________________________ (Print name)
Name of patient
__________________________________ (Signature)
__________________________________
Witness
TERMINATION OF TREATMENTThe length of time required for therapy will be determined by your personal situation. I will do my best to fulfill your therapeutic needs
and provide you with my best professional care. For your part, you agree to participate in the process to the best of your ability. It is intended
that when your needs are met, to the extent that they can be, we will terminate our relationship. There is no guarantee of a cure.
For your part, you may terminate my services at any time. This may be done in any one of several ways. These include, but are not
limited to, putting it in writing, informing me verbally, failing to maintain your appointment schedule without proper notification or your
failure to follow treatment recommendations that I may make. I will respect your wishes.
If you do terminate therapy with me, it will be my decision as to whether we can re-establish our therapeutic relationship. Keep in mind
that your decision to terminate therapy and the method chosen to accomplish the termination will impact any decision to resume a
therapeutic relationship.
About the Author
American Professional Agency, Inc. is the largest provider of mental health Professional Liability insurance in the United States. With over 30
years of experience and well over 100,000 policy holders in all endeavors in the mental health field, the agency provides some of the most
comprehensive and cost effective insurance available.
Eric C. Marine is the Vice President for claims of the American Professional Agency, Inc. With almost 30 years experience in the claims industry,
he has written on and presented Risk Management seminars all over the country.
24 Texas Psychologist SUMMER 2004
1. The purpose of a written contract can be:a. To spell out the rights and duties of
all parties.b. To memorialize the financial
arrangementsc. To explain the limitations of the
therapist, as they pertain to the law.d. None of the above.e. All of the above
2. The purpose of a professional license is:a. To protect against the use of the
professional title by unauthorized parties.
b. Allow people to have something to aspire to.
c. Allow the operation of heavy equipment.
d. None of the above.e. All of the above.
3. Informed Consent:a. Is necessary for the release of any
records.b. Should be obtained before any
treatment begins.c. Is nice to have but is not ever required.d. Is a term that has no applicability in
mental health care.
4. The concept of confidentiality:a. Helps people feel good about
themselves.b. May be effective in all attempts to
obtain private information.c. Allows Insurance Companies to
obtain patient records.d. Is a basic principle of good therapy.
5. Your professional license:a. Allows you to practice anywhere in
the U.S.A.b. Never has to be renewed.c. Allows only people so licensed to
practice in your state.d. Guarantees a profitable practice.
6. Records are:a. Highly over rated.b. Confusing and, of necessity, illegible.c. The single most important element
that will evidence the appropriateness of your approach.
d. Not needed.
7. Historically, complaints against therapisthave:a. Been few.b. Been frequent.c. Been Frivolous.d. Hardly made any difference.
8. State Licensing Boards :a. Are there to collegially to review
complaints.b. Protect licensees from frivolous
complaints.c. Protect the consumers of your state
from bad licensees.d. Made up of bad therapists.
9. Terminating therapy with a patient is:a. A very important event.b. A good way to draw a complaint to a
licensing board.c. Easier if instituted by the patient,d. None of the above.e. All of the above.
10.When using a controversial or new treatment modality:
a. Sometimes, it is not good to tell the patient.
b. Tell the patient only about the positive aspects and outcomes that may occur.
c. Obtain an informed consent agreement from the patient, in writing.
d. Avoid anything that even suggests new or controversial.
11. If I obtain all the release and informed consent documents necessary:
a. I will never have a claim or complaint lodged against me.
b. If a frivolous complaint or claim is made, I will probably be exonerated.
c. The patient will be happy and stay until the therapy is concluded.
d. No patient will stay beyond the initial visit.
The Therapeutic Contract CE Exam
First Name: Last Name: Degree:
Mailing Address:
City/State/Zip:
Email: Phone:
Visa/MC/Amex/Discover: Exp. Date:
Check #:
Signature: Date:
TEST QUESTIONS
Texas Psychologist 25SUMMER 2004
Iwas recently invited to participate in the
California Psychological Association’s
Annual Convention, Change: The
Power of Psychology. As always, CPA was
inspirational and once again reminded me
that we really are all one family, dedicated to
improving the quality of life for our nation’s
citizens. Friday’s “PAC Monte Carlo Night at
the Races” was definitely fun, although I did
miss seeing the Texas Blues Brothers who
would have undoubtedly done quite well “at
the tables.” As was evident at the Practice
Directorate State Leadership Conference
(SLC) earlier in the month, the prescriptive
authority (RxP) agenda is nicely maturing.
CPA President Sallie Hildebrandt instituted a
very popular programmatic psychopharm-
acology track, including RxP didactic content
by John Preston, a graduate of Baylor
University and in depth discussions of
practice and public policy issues. I was
especially intrigued with the extent to which
the graduates of Alliant University’s
psychopharmacology program found their
advanced training has already significantly
enhanced their clinical practices, although
California has yet to pass RxP legislation.
CPAGS, which represents our profession’s
future, was visually present with Zara
Ashikyan as chair.
For those who attended this year’s SLC
event hosted by Russ Newman and Mike
Sullivan, the panel, “How Prescribing Has
Changed Our Clinical Practice: Experiences
Of The [DoD] Prescribing Psychologists,”
clearly demonstrated that RxP is the future.
John Sexton, for example, noted that at both
events RxP has been a prominent part of SLC
since 1995. According to the 2003
Presidential Commission, there is a “mental
health crisis” in the US “due to lack of
accessibility,” and 75 percent of all visits to
primary care managers can be attributed to a
psychological problem. Psychologists are
primary health care providers. Why should
we continue to passively accept reports that
general physicians (with minimal mental
health training) provide 75 percent of the
psychotropic medications or that the Food
and Drug Administration felt it was necessary
to issue a public health advisory urging
doctors to be especially careful in prescribing
antidepressants to children and adolescents
due to a possible association between the
drugs and suicide? Psychology must provide
proactive leadership in this area—it is our
societal responsibility. For those (e.g., our
colleagues in Florida) who are particularly
concerned about the quality of care for
women, one should seriously reflect upon
John Preston’s report that they receive only 58
percent of all psychiatric services but 73
percent of psychotropic prescriptions. Is this
really what we believe our daughters or loved
ones deserve?
Sally’s focus on change fits very nicely
with the realities of the health care
environment of the 21st Century and SLC’s
Strategic Resilience For The Profession:
Getting A Jump On Change. In his keynote
address, Russ Newman was enthusiastic
about the future of RxP and professional
psychology:
“It seems rather clear that psychiatrists
have a financial incentive to keep
psychologists from serving as attending
clinicians in [California’s] state hospitals. In
fact, this was something I discussed with
the Federal Trade Commission and
Department of Justice Antitrust Division in
June when we had the opportunity to
testify at the Joint Hearing on Health Care
and Competition Law and Policy. In
addition to detailing a number of instances
of what we believe are organized
psychiatry’s efforts to restrain trade in
hospitals, we also alerted the FTC to what
we expect will happen as more states come
on line with prescriptive authority statutes.
After all, who better than psychologists to
explain to the FTC that the best predictor
of future behavior is past behavior?
Attempts to undermine regulatory
implementation of prescriptive authority
laws and potential boycott activity by
psychiatrists against pharmaceutical
Never Stand In Front of Flowing Lava:RxP On the Move
Pat DeLeon, PhD, Former APA President
26 Texas Psychologist SUMMER 2004
Should I Warn My Patients
of the Possible SideEffects of
Medications They Are Taking?
Sam A. Houston
As you have probably read, the
Food and Drug Administration
recently released a statement
warning of a possible link between
antidepressants and suicide. It is likely that
many of your clients take antidepressants.
Although such medications are probably
prescribed by psychiatrists (to whom you
may have referred your patients) or other
medical doctors, you should still be aware
of possible litigation arising from some of
these recent reports.
Litigation against major pharmaceutical
companies is common. Many times the
prescribing physician or treating doctor is
sued along with the manufacturer. In some
cases, suit is brought against only the
physician. However in other cases, the
litigation net is cast wide to bring in more
distant defendants. Because of this potential
for inclusion, you should be aware of the
questions concerning the duties and roles of
psychologists in cases involving patient
suicide or harm while taking antidepressants.
The general rule is that a psychologist
is not included in the legal definition of a
“health care provider.” Texas statutory law
indicates that duty to warn and provide
“informed consent” falls on the health care
provider prescribing the drug. Since the
psychologist is typically not the prescribing
physician, the duty to provide informed
consent or warn would probably fall on the
psychiatrist or other prescribing doctor.
However, I looked and could not find any
cases specifically involving whether or not a
psychologist had to warn a patient of the
companies who support psychologists are a
couple of the future behaviors we thought
the FTC could expect from organized
psychiatry based on its past behavior.
“Speaking of prescription privileges for
psychologists, the past year witnessed
considerable continuing activity on this
front. Nine states introduced RxP
legislation in 2003—Florida, Georgia,
Hawaii, Illinois, New Hampshire, Oregon,
Tennessee, [the Great State of ] Texas and
Wyoming. Six of these states had committee
hearings on their bills, the largest number
ever in one year. And Wyoming had its first-
time bill not only pass out of a senate
committee but also go to a floor vote. Bills
in 2004 so far include Georgia, Hawaii,
Illinois, Louisiana, Maine, New Hampshire,
Oklahoma and Tennessee. And Guam
continues to work to implement its law.
“Importantly, the New Mexico
Psychological Association remains hard at
work implementing their prescriptive
LAWauthority law. Although the process has been
slow going for sure, recent developments
have provided reason to smile. At the end of
February, the state’s Board of Medicine voted
unanimously to accept the draft regulations.
The Board of Psychology recently approved
the regulations as well...The regulations face
their next major hurdle during a 30-day
public comment period followed by a public
hearing where organized psychiatry will
undoubtedly try, once again, to derail the
process. Thank you, New Mexico
psychologists, for staying the course.”
Finally, I would like to take this
opportunity to personally commend TPA’s
Past-President Dee Yates on her service to our
nation as a member of the President’s New
Freedom Commission on Mental Health.
Because of Dee, psychology’s voice was heard
at the highest levels. Too many colleagues
simply do not appreciate the importance of
being personally involved in the public policy
process. Aloha.
Texas Psychologist 27SUMMER 2004
PSY-PAC ContributorsJanuary 1 - March 31
$1000-1999Paul Burney, PhD
$100-499Laurence Abrams, PhD
Barbara Abrams, EdD
Barbara Alford, PhD
Judith Norwood, Andrews,
PhD
Elizabeth Barry, PhD
Patricia Barth, PhD
Connie Benfield, PhD, ABPP
Joan Berger, PhD
Malcolm Bonnheim, PhD
Peggy Bradley, PhD
Tim Branaman. PhD
Glenn Bricken, PsyD
Stacy Broun, PhD
Ray H. Brown, PhD
Timothy Brown, PhD
Joan Bruchas, PhD
King Buchanan, PhD
Barry Bullard, PsyD
Erica Burden, PhD
Linda Calvert, PhD
Kay Ransom Carey, PhD
Betty Cartmell, PhD
Gloria Chriss, PhD
Ron Cohorn, PhD
Donna Copeland, PhD
Walter Cubberly, PhD
Caryl Dalton, PhD
Philip Davis, PhD
Michael Duffy, PhD, ABPP
James Duncan, PhD
Patrick Ellis, PhD
Richard Ermalinski, PhD
Raymond Finn, PhD
Alan Fisher, PhD
Lynn Fisher-Kittay, PhD
Alan Frol, PhD
Richard Fulbright, PhD
Ray Gilbert, PhD
Jerry Grammer, PhD
Charles Haskovec, PhD
JoBeth Hawkins, PhD
Annette Helmcamp, PhD
William Helton, PhD
David Hensley, PhD
Ethel Hetrick, PhD
Robert Hochschild, PhD
Alan Hopewell, PhD
David Hopkinson, PhD
Robert Hughes, PhD
Jerry Hutton, PhD
Sheila Jenkins, PhD
Johnny Johnson, PhD
Morton Katz, PhD
Gilda Kessner, PsyD
Charlotte Kimmel, PhD
Burton Kittay, PhD
Amelia Kornfeld, PhD
Richard Kownacki, PhD
Tom Kubiszyn, PhD
Angela Ladogana, PhD
John Largen, PhD
Nancy Leslie, PhD
Rochelle Levit, PhD
Franklin Lewis, PhD
David Litton, PhD
Alaire Lowry, PhD
Marilyn Maas, PhD
Jerry Mabli, PhD
Ann Matt Maddrey, PhD
Perry Marchioni, PhD
Raul Martinez, PhD
Denise McCallon, PhD
Donald McCann, PhD
Richard McGraw, PhD
Sherry McKinney, PhD
Robert McLaughlin, PhD
Robert McPherson, PhD
Donald McRee, PhD
F. Gary Mears, PhD, PsyD
Brenda Meeks, PhD
Robert Mehl, PhD
Robert Mims, PhD
Lee Morrison, PhD
alleged dangers associated with a particular
drug. Thus, while it is fairly clear that the
psychologist has no statutory obligation to
warn the patient of the risk associated with
the drug, it is not clear that a psychologist
is completely immune from liability.
Texas law places a duty on a psychologist
to act as a reasonably prudent person under
the same or similar circumstances with regard
to the treatment of a patient. This would
include a heightened awareness and
knowledge of the potential side effects of
medications and the tell-tale signs exhibited
by patients with suicidal behavior. An
argument could be made that you would have
a duty to warn a patient or, at minimum,
recognize and take action to prevent suicide of
patients who are taking such medications
even if you did not have a statutory duty to
warn them of the potential side effects.
In light of the fact that the law is
unclear, I recommend that you take the
following steps on all of your patients who
are taking antidepressant medications:
Familiarize yourself with all potential side
effects and go over them with your client. I
think this is particularly important in cases
where you have referred a patient to a
psychiatrist for drug treatment medication in
addition to your therapy. Many times an
arrangement is made where psychiatrists will
see a patient on a fairly infrequent basis and
the patient will see the psychologist even while
taking such medication. In such a situation, it
is especially important to warn and keep watch
for telltale signs. Document that you warned
the patient, and discuss with him or her any
possible new feelings on each visit.
Pay special attention to your referral
sources and make certain they are reputable
physicians who will fully discuss the side
effects of the medications with their patients.
While treating patients who began
antidepressant medications prior to seeing
you, make sure you document that you
have discussed possible side effects with
them and that you have advised them to
follow up with their physician if they are
feeling any untoward effects.
Careful documentation and practice
will help keep you out of any litigation.
FDA warnings have prompted mass tort
litigation in the past. Breasts implants,
Phen-Fen, Baycol and other medications
have fallen under close scrutiny. It is
unlikely that you would be included in the
event such litigation proceeds against the
antidepressant manufacturers; however, it is
better to be safe than sorry, and these
simple steps will help keep you away from
the lawyers and the courtroom.
I continue to receive numerous
telephone requests for the telephone
consultation program established through
my office and the Texas Psychological
Association several years ago. If you have
any questions about the program, please
call me at 713-650-6600.
28 Texas Psychologist SUMMER 2004
Texas Psychological Foundation ContributorsJanuary 1 - March 31, 2004
$500 +
Manuel Ramirez, PhD
$100-499
Gloria Chriss, PhD
Jerry Grammer, PhD
Ronald Jereb, PhD
Burton Kittay, PhD
Kimberly McClanahan, PhD
Robert McLaughlin, PhD
Robbie Sharp, PhD
Under $100
Connie Benfield, PhD, ABPP
Tim Branaman, PhD
Stacy Broun, PhD
Alan Frol, PhD
Ray Gilbert, PhD
M.P. Hewitt, EdD
Arthur Linskey, PhD
Marilyn Maas, PhD
Laurie Robinson, PsyD
Donald Trahan, PhD
Thomas Van Hoose, PhD
Richard Wheatley, PhD
Dean Paret, PhD
Randy Phelps, PhD
Barry Rath, PhD
Lynn Rehm, PhD
John Reid, PhD
Laurie Robinson, PsyD
Gordon Sauer, Jr, PhD
Verlis Setne, PhD
Robbie Sharp, PhD
Joyce Sichel, PhD
Jill Squyres, PhD
David Steinman, PhD
Thomas Tully, EdD
Thomas Van Hoose, PhD
Nancy Van Morkhoven, PhD
Beverly Walsh, PhD
David Welsh, PhD
Mark Wernick, PhD
Richard Wheatley, PhD
M. Wright Williams, PhD
Connie Wilson, PhD
Constance Wood, PhD
Kathryn Wortz, PhD
Robert Zachary, PhD
Under $100Mary Alvarez-del-Pino, PhD
Paul Andrews, PhD
Juana Antokoletz, PhD
Charles Cleland, PhD
John Elwood, PsyD
Jeanne Field, MS
Sylvia Gearing, PhD
Carol Grothues, PhD
M.P. Hewitt, EdD
Pamela Horton, PhD
Ronald Jereb, PhD
Arthur Linskey, PhD
Dwayne Marrott, PhD
Muriel Meicler, PhD
Kavita Murthy, PhD
Carole Pentony, PhD
Dorothy Pettigrew, PsyD
Manuel Ramirez, PhD
Anna Satterfield, PhD
Laura Spiller, PhD
Jessica Varnado, PhD
Patricia Weger, PhD
Anthony Arden, PhD
Joan Berger, PhD
Robin Binnig, MS
Timothy Daheim, PhD
Mary De Ferreire, PhD
El Paso County Psychological Society
Cynthia Fincher, PhD
Cynthia Galt, PhD
Alan Griffin, PhD
Terence Hannigan, PhD
Richard Holt
Alan Hopewell, PhD
Thomas Johnson, PhD
Morton Katz, PhD
Amelia Kornfeld, PhD
James Gary Marsh, PhD
Robert McLaughlin, PhD
Randy Phelps, PhD
Nell Schwartz, PhD
Richard Wheatley, PhD
Sunrise Fund ContributorsJanuary 1 - March 31, 2004
Doctoral Members
Rhonda Akkerman, PhD
Marilu Berry, PhD
Nicole Bodor, PhD
Denise Boyd, EdD
Kevin Correi, PhD
Paul Damin, PhD
Michael Hand, PhD
Lisa Lewis, PhD
Ramona Noland, PhD
Evelyn Parker-Gaspard, PhD
T. Kevin Roberts, PhD
Bridget Sonnier-Hillis, PhD
Student Members
Diane Antonvich, BA
Miriam Arnold, MA
Deborah Horn, MS
Jodie Lane, MS
Barbara McGowan
Jamie McNichol, PsyD
Michael Morris, MSSW
Alexia Tran, BA
New MembersTPA welcomes all of our new members.
Employment OpportunityDallas County, the second most populated county in Texas,is currently seeking:
PSYCHOLOGIST(Salary Commensurate w/ experience)
Psy.D. or Ph.D. in clinical or counseling psychology. One year supervised clinical experience in psychology
service. Must be licensed by Texas Board of Examiners.Must be willing to relocate to Dallas County.
Visit www.dallascounty.org or call our office at (214) 653-7638. Equal Opportunity Employer
Austin group looking for a colleague!Come join an existing group of solo practitioners each witha minimum of 10 years in private practice. Very nice officein central Austin with support staff. Pleasant atmospherewith well-established professionals. This is a wonderfulopportunity to establish or expand a practice in Austin withthe possibility for immediate referrals. (512) 454-3685.
Licensed Psychologist Needed. Expanding interdisciplinaryprivate group practice seeks a Texas licensed psychologist.Must have experience in working with children school age toadolescents. Located in a prominent part of Houston, theoffice has a very attractive setting. Very little managedcare/emergency work. Excellent benefits. E-mail resumes toJohn@tarnowcenter.com or fax to 713-621-7015.
STAFF PSYCHOLOGIST NEEDED. The Callier Center forCommunication Disorders is a nationally recognizedresearch, diagnostic and treatment facility that has beenpart of the University of Texas at Dallas since 1975. We seeka full-time PhD level clinical psychologist to join themultidisciplinary clinical staff serving individuals withcommunication impairments. The psychologist will work withspeech-language pathologists, audiologists and educatorsserving individuals with mental health concerns and co-existing communication disorders related to developmentaldelay, hearing impairment, language disorder, autisticspectrum disorder and/or brain injury. Patients range in agefrom 6 months - elderly.Minimum Professional Qualifications include a PhD or PsyDin Clinical Psychology from an APA approved training programand a Texas Psychology License. Necessary experienceincludes: administration of nonverbal IQ tests, diagnosis ofPDD, mood/anxiety disorders, etc in early childhood, skill inuse of parent guidance and coaching, crisis managementwith suicide and child abuse. Prefer ABPP inNeuropsychology, Texas LSSP, Fluency in Spanish and/orSign Language may be eligible for a one-time hiring bonus.Contact Dr. Teresa Nezworski, Search Committee Chair at214-905-3040 or nezworsk@utdallas.edu.
CLASSIFIEDS
American Professional Services Inside Front Cover
CE-credit.com 26
Center for Anger Resolution 5
Hazelden 10
Remuda Ranch 10
Rockport Insurance Associates 3
Senior Connections, Inc. 14
Nova Southeastern University 17
UT MD Anderson Cancer Center 29
ADVERTISERS INDEX
Texas Psychologist 29SUMMER 2004
M. D. Anderson Cancer Center is an EOE employer and does not discriminate on the basis ofrace, color, national origin, gender, sexual orientation, age, religion, disability or veteran status,except where such distinction is required by law. All positions at M. D. Anderson are considered
security sensitive; drug screening and thorough background checks will be conducted. TheUniversity of Texas M. D. Anderson Cancer Center values diversity in its broadest sense.
Diversity works at M. D. Anderson. Smoke-free environment.
ASSISTANT PROFESSORThe University of Texas M. D. Anderson Cancer Center, Department ofBehavioral Science, is accepting applications for a nontenure trackclinical faculty position. The individual filling this position will have acentral programmatic and educational role in the institutional facultyhealth program, and may hold a joint appointment in the Department ofNeuro-Oncology in the Division of Cancer Medicine. Candidates musthave a minimum of 5 years’ experience in mental health, strong back-ground in organizational health programs, counseling and programdevelopment. Previous experience in an academic setting and with afaculty health or professional assistance program is very desirable.Qualifications include a doctoral degree from an accredited college oruniversity in clinical psychology, counseling psychology, organiza-tional psychology, educational psychology or related field or a medicaldegree in related field. Both salary and benefits are very competitive,and salary is commensurate with experience.
The University of Texas M. D. Anderson is located within the TexasMedical Center, the largest medical center in the world. Houston is adynamic, multicultural city with a very affordable cost of living.Applications will be accepted and reviewed until the position is filled.
Application procedures: Mail cover letter, curriculum vitae and profes-sional reference list to: Ellen R. Gritz, Ph.D., Professor and Chair,The University of Texas M. D. Anderson Cancer Center, Department ofBehavioral Science - 243, 1515 Holcombe Blvd., Houston, Texas 77030-4009, or by courier, Department of Behavioral Science - HMB 7.100,1100 Holcombe Blvd., Houston, Texas 77030.
Following September 11, the American Psychological Association asked each of the 50 states’
psychological associations to create a network of psychologists who are trained in disaster or
crisis response. Drs. Rita Justice and Judith Andrews were asked by TPA to chair the Texas
Psychological Association Disaster Response Network. Since then, the TPA Disaster Response Network
chairs and committee have attempted to educate psychologists regarding specialty training and to
identify those licensed psychologists in the state of Texas who have had crisis response training or would
like to have such training.
As a group of crisis response trained psychologists, the TPA DRN does not act as an
independent team but may respond through various venues such as Red Cross, NOVA, or CISM
teams. Our purpose includes encouraging psychologists to become trained in crisis response and
to obtain local practice before being asked to respond to a statewide or nationwide disaster.
The purpose of this notice is to reach TPA members who are crisis trained and are not part of our
database. If you would like to become a part of our TPA DRN, please e-mail Judith Andrews at
judithphdjudith@yahoo.com. We will then e-mail you a database form and current information about
the business of the Disaster Response Network here in Texas.
Sincerely,
Judith Andrews, PhD
Rita Justice, PhD
TPA DRN Coordinators
Calling TPA Psychologists to Disaster Response:
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