VOLUME 56, ISSUE 3

New Frontiers inPsychology

FALL 2005

FALL 2005 3

Donna S. Davenport, PhDBrian Stagner, PhD

Co-Editors

David White, CAEExecutive Director

Sherry ReismanDirector of Convention & Non-Dues

Bob McPherson, PhDDirector of Professional Affairs

Lynda KeenExecutive AssistantCandy D. Graves

Communications SpecialistLindell Brown

Membership Director

TPA BOARD OF TRUSTEESPaul Burney, PhD

PresidentCAPP Representative

Melba J.T. Vasquez, PhDPresident-Elect

M. David Rudd, PhDPresident-Elect DesignateC. Alan Hopewell, PhD

Past PresidentBoard Members

Tim F. Branaman, PhDMary Alice Conroy, PhDDonna Davenport, PhD

Alan T. Fisher, PhDRichard Fulbright, PhDRobert McPherson, PhD

Randy Noblitt, PhDRoberta L. Nutt, PhD

Lane Ogden, PhDDean Paret, PhD

Alison Wilson, PhD

EX-OFFICIO BOARD MEMBERSCatherine Matthews, PhD

Texas Psychological Foundation PresidentPatrick J. Ellis, PhD

PSY-PAC PresidentBonnie Gardner, PhD; Andrew Griffin PhD

Aging Division Co-ChairsLane Ogden, PhD

Psychopharmacology Division ChairRobbie Sharp, PhD, Selia Servin-Lopez, PsyD

Psychology of Women Division Co-Chairs Lane Ogden, PhD, Sherry Reisman

Federal Advocacy CoordinatorsAmy O’Neill, BS

Student Division ChairRichard M. McGraw, PhD

Business of Practice Network Representative

The Texas Psychological Association is located at 1005 Congress Avenue, Suite 410,

Austin, Texas 78701. Texas Psychologist (ISSN0749-3185) is the official publication

of TPA and is published quarterly.www.texaspsyc.org

FALL 2005 VOLUME 56, ISSUE 3

Features

8 Meeting People Where They Are: The Promise ofTelephone TherapyRobert J. Reese, PhD

12 The Great State of Texas: a PsychopharmacologyUpdatePat DeLeon, PhD

16 Reaching Out to Rural Adolescents: OnlineCounselingDonna S. Davenport, PhD

20 Innovative Behavior Medicine at UTTom Marrs, PhD

24 PSYCHOLOGY IN THE PUBLIC INTEREST: The Proposed Constitutional AmendmentBanning Same-Sex Marriage in Texasand How Psychology can Contribute to theDialogueNathan Grant Smith, PhD

Departments4 FROM THE EDITOR

Donna S. Davenport, PhD5 FROM THE PRESIDENT

Paul Burney, PhD6 FROM TPA HEADQUARTERS

David White, CAE23 IT’S THE LAW:

New Technology — Same Legal IssuesSam Houston, JD

28 New Members and Contributors30 Inside TPA30 Classified Advertising

TEXAS PSYCHOLOGIST

4 FALL 2005

FROM THE EDITOR Donna S. Davenport, PhD

W hen I was at the APA con-ference several weeks ago, Iheard a term tossed about

on several different occasions: CultureShift. Some psychologists were wonderingif the field was changing so much that itcould lose its identity. Have we allowedourselves to be defined too much by oth-ers, they asked in one way or another, aswe struggle with sometimes quite discour-

aging political and academic and econom-ic realities? I heard professors bemoan theemphasis on grant-writing, therapistsupset about both the progress and lack ofprogress in obtaining prescription privi-leges, students worried that the programsthey had entered were being redefinedunder their feet.

At a personal level, I am less fond ofchange than I used to be. I tell my stu-dents about the Human PotentialMovement (really, now, exactly how is thecurrent emphasis on Positive Psychologyall that different?) and feel nostalgic aboutthe T-groups I used to go to at ElliotAronson’s house. Accordingly, I had mixed

feelings at the notion of editing an issuefeaturing treatment innovations.

Happily, these articles about tele-phone counseling, online counseling, anda new Behavior Health focus at the UT-Austin Counseling Center are about inno-vations solidly within my identity bound-aries! As the profession struggles to findways to serve individuals in rural areas, aswell as to be more generally cost-effective,these three articles reflect ways to remaintrue to our ethics and roots, while at thesame time making use of technology andcollaboration with other disciplines in newexciting ways.

Additionally, we were happy to takeformer APA President Pat DeLeon up onhis offer to describe where Texas is regard-ing the prescription privilege issue. Please see on page 22 a call for papers onspecific themes we have planned.Contribute if you are interested, or feelfree to suggest a theme of your own if youfeel especially strongly about some aspectof psychology. We look forward to hearingfrom you! Donna

The Editors

DDDDoooonnnnnnnnaaaa SSSS.... DDDDaaaavvvveeeennnnppppoooorrrrtttt,,,, PPPPhhhhDDDD is anAssociate Professor in the CounselingPsychology program at Texas A&M, whereher research areas include ethics and mul-ticultural issues. In addition to her teach-ing and independent practice, she is thefounding director of the Lifelong LearningInstitute at Texas A&M. Contact her atddavenport@coe.tamu.edu.

BBBBrrrriiiiaaaannnn SSSSttttaaaaggggnnnneeeerrrr,,,, PPPPhhhhDDDD is a ClinicalAssociate Professor in the PsychologyDepartment at Texas A&M and is thefounder and co-director of Associates forApplied Psychology, a multispecialtygroup practice in Bryan/College Station.He is a former member and chair of theTSBEP and former Ethics Chair for TPA.His email address isbhs@psyc.tamu.edu.

Brian Stagner, PhDCo-Editor

Donna S. Davenport, PhDCo-Editor

FALL 2005 5

TEXAS PSYCHOLOGIST

6 FALL 2005

FROM THE PRESIDENT Paul Burney, PhD

I thank co-editors Drs. Donna S.Davenport and Brian Stagner for theexcellent first 2005 Spring-Summer

issue of Texas Psychologist. Texas Psychologistis an important publication providinginformation to all TPA members and psy-chologists in Texas.

A special thanks to the State of Texasand Texas psychologists for their extraordi-nary and continuing efforts during theaftermath of Hurricane Katrina. AmericanPsychological Association partners withthe American Red Cross through ourDRN (Disaster Response Network) toprovide psychological services to those inneed, and we were onsite immediatelyproviding our services. Our state and ourpsychologists achieved national recogni-tion for their efforts and I am proud to bea Texan, a psychologist, a member of APA,and especially a member of TPA. JudithAndrews, PhD and Rita Justice, PhD,TPA’s DRN Coordinators, have done anoutstanding job and deserve special recog-nition. A special thanks also goes to DavidWhite, TPA’s Executive Director, and toSherry Reisman, TPA’s Director ofConventions, for coordinating the massivenumber of calls and emails, directinginquiries to the proper resources, and for

providing timely and informative updatesand links on TPA’s website.

Glenn Ally, PhD, presented “RxPLouisiana Style” at the Sam Houston AreaPsychological Association’s (SHAPA)September 6, 2005 monthly meeting atSam Houston State University. Approx-imately 100 psychology students and mem-bers of the faculty attended the presenta-tion. The presentation was very wellreceived and there were excellent questions.This is a must-see presentation for all whoare interested in RxP. The presentationdetails the exceptional committed effort ofLAMP (Louisiana Association of MedicalPsychologists) in time, legislation, andmoney to accomplish their RxP law. Thispresentation is relevant to any state inter-ested in passing RxP legislation. Dr. Ally isa Louisiana RxP trained psychologists, afounding member of LAMP, a member ofLouisiana’s legislative team instrumental inpassing Louisiana’s RxP law, the LouisianaAPA Council of Representative member,and a member of APA’s Committee for theAdvancement of Professional Practice(CAPP). Dr. Ally deserves a special thanksfor presenting during the aftermath ofHurricane Katrina as it took precious timeaway from his family and his psychologicalresponsibilities.

You are receiving this issue of theTexas Psychologist prior to TPA’s AnnualConvention to be held in Houston, Texas(November 3-5). I urge you to make a spe-cial effort to attend this year’s convention.It is especially relevant that the conventionwill be held in Houston which, like manyother cities in Texas, has done a magnifi-cent job of reaching out to our neighborsso drastically affected by HurricaneKatrina. Make this convention a specialcelebration of psychology at work. The2005 Convention Program Committee,chaired by Dr. Pat Ellis, has worked dili-

gently to present an absolutely superb listof continuing education opportunitiesand poster sessions. This year’s theme is“New Horizons for Texas Psychology.” Dr.Joseph Parent will serve as our KeynoteSpeaker. A dynamic and engaging publicspeaker, Dr. Parent’s keynote address forthe 58th annual TPA convention is enti-tled “Stealth Psychology-Under theRadar” and will serve to underscore theconference theme of “New Horizons forTexas Psychology.” In addition to hiskeynote presentation, Dr. Parent will alsoserve as a special speaker at the TexasPsychological Association fundraisingdinner to be held at Houston City Club.Finally, he will offer a special two day post-convention seminar to be held at the inthe Woodlands. He is dynamic, enlighten-ing, and entertaining.

I thank everyone who has been soinstrumental for TPA’s accomplishmentsduring this presidential year. Every TPApresident who has preceded me and thosewho will follow know this is a team effort.

The Board of Trustees, ExecutiveCommittee, Ex-officio Officers, the com-mittee members, and especially DavidWhite, TPA’s Executive Director and hissuperb staff are to be commended for theirexceptional commitment, work, andaccomplishments. I send a special thanksto APA’s Practice Directorate and CAPPfor the tremendous support and encour-

agement they provide to state associations,practitioners, and advocacy. Their StateLeadership Conference is the premiertraining vehicle for leadership and advoca-cy. CAPP, through its grant program, hasprovided TPA with $94,000 the past yearsto help our legislative advocacy for Texaspsychologists.

TEXAS PSYCHOLOGIST

FALL 2005 7

FROM TPA HEADQUARTERS David White, CAE

96155 – the intervention service providedto a family without the patient present. Anexample would be working with parents andsiblings to shape the diabetic child’s behavior,such as praising successful diabetes manage-ment behaviors and ignoring disruptive tactics.

Until recently all intervention codes usedby psychologists required a mental healthdiagnosis under the DSM-IV. These codesfocus on patients whose primary diagnoses arephysical in nature and therefore must have aphysician’s ICD-9-CM diagnosis. As a result,psychologists are prohibited from diagnosing aphysical health problem, but must use thephysicians ICD-9-CM code when reportingtheir services captured under these codes.

As far as we know, all Texas Medicare providers are reimbursing for these codes. Theassigned value for these codes are listed in the physician fee schedule issued by theCenters for Medicare and Medicaid Services (CMS). The chart below illustrates the esti-mated Medicare reimbursement amount for the six health and behavior codes:

CCCCPPPPTTTT CCCCooooddddeeee SSSSeeeerrrrvvvviiiicccceeee ((((AAAApppppppprrrrooooxxxx.... PPPPaaaayyyymmmmeeeennnntttt((((11115555 mmmmiiiinnnn:::: 1111 uuuunnnniiiitttt 1111 hhhhrrrr:::: 4444 uuuunnnniiiittttssss))))

96150 Assessment: initial $26 * $106 *96151 Re-assessment $26 * $103 *96152 Intervention: individual $25 $9896153 Intervention: group (per person) $5 ** $22 **96154 Intervention: family w/ patient $24 $9696155 Intervention: family w/o patient $23 $93

NOTE: Although Medicare has assigned a payment rate, the program is notpresently covering services billed under 96155.

* Multiple-unit differences compared to one-unit amounts are due to rounding.** Total group fee equals amount times number of persons in the group.From 2002 to 2003 the number of Health and Behavior claims submitted by psy-

chologists increased almost 400%. The following chart depicts the increase of claims sub-mitted by psychologists from 2002 to 2003.

CCCCOOOODDDDEEEE 2222000000002222 2222000000003333 IIIInnnnccccrrrreeeeaaaasssseeee

96150 - Assessment 12,952 49,944 386%96151 - Re-Assess 21,089 52,058 247%96152 - Individual 24,833 134,468 541%91653 – Group 3,073 9,209 300%96154 – Family* 2,070 6,043 292%

Convert these claims to dollars reimbursed by Medicare to psychologists and you get:

CCCCOOOODDDDEEEE 2222000000002222 2222000000003333 IIIInnnnccccrrrreeeeaaaasssseeee

96150 - Assess $342, 321 $1,324,015 $981,69496151 - Re-assess $541,987 $1,321,752 $779,76596152 - Individual $611,388 $3,263,538 $2,652,15096153 - Group $16,686 $51,570 $34,68496154 - Family (w pt) $49,452 $144,427 $94,975TOTALS $1,561,834 $6,105,302 $4,543,468

M any of you might be aware ofthe recent CPT codes that areavailable to psychologists, but

I think it is worth reminding you of them.As of January, 2003, psychologists are nowable to use the six reimbursement codesunder the Current ProceduralTerminology (CPT) coding system. Thesecodes address behavioral, social, and psy-chophysiological conditions in the treat-ment or management of patients diag-nosed with physical health problems. These codes are:

96150 – the initial assessment of thepatient to determine the biological, psy-chological, and social factors affecting thepatient’s physical health and any treat-ment problems.

96151 – a re-assessment of thepatient to evaluate the patient’s conditionand determine the need for further treat-ment. A re-assessment may be performedby a clinician other than the one who con-ducted the patient’s initial assessment.

96152 – the intervention service pro-vided to an individual to modify the psy-chological, behavioral, cognitive, and socialfactors affecting the patient’s physicalhealth and well being. Examples includeincreasing the patient’s awareness about hisor her disease and using cognitive andbehavioral approaches to initiate physicianprescribed diet and exercise regimens.

96153 – the intervention service pro-vided to a group. An example is a smokingcessation program that includes educa-tional information, cognitive-behavioraltreatment and social support. Group ses-sions typically last for 90 minutes andinvolve eight to ten patients.

96154 – the intervention service pro-vided to a family with the patient present.For example, a psychologist could userelaxation techniques with both a diabeticchild and his or her parents to reduce thechild’s fear of receiving injections and theparents’ tension when administering theinjections.

Continued on page 23

TEXAS PSYCHOLOGIST

8 FALL 2005

Using the telephone to providemental health assistance is nota new idea. The 1950s saw the

genesis of crisis lines in London(Hornblow, 1986). These types of serv-ices are very much alive and well today.In the 1970s it was suggested that thetelephone might serve as an adjunct toface-to-face therapy (Miller, 1973). Inthe last couple of decades, there hasbeen support for using the telephone asthe primary medium for providing psy-chotherapy (Shepard, 1987). Since thistime telephone psychotherapy hasbegun to receive more attention withthe proliferation of telephone-basedproviders and emphasis on time-limited,less expensive treatment.

Meeting People Where They Are: The Promise of Telephone Therapy

by Robert J. Reese, PhDAbilene Christian University

The Use and Perceptions ofTelephone-Based Psychotherapy

TEXAS PSYCHOLOGIST

FALL 2005 9

Advances in communication technol-ogy have changed how we interact withthe world, from how we connect with oth-ers to how we seek information. Thesechanges have been extended to look athow psychological services can be provid-ed using these exciting technologies.While newer technologies such as theInternet or real-time videoconferencingare decidedly sexier and may ultimatelyhold more promise, the telephone shouldnot be overlooked for providing psycho-logical services. Given the ubiquity andrelative low-cost in comparison to othercommunication technologies, the popular-ity of the telephone is unlikely to diminishanytime soon. Among psychologists, the telephone is still the most popular tele-health medium for providing services(VandenBos & Williams, 2000).

Telephone-based services can be asimple referral or providing consultation.However, the use of the telephone to ren-der psychotherapy has been touted to holdmuch promise for increasing the accessi-bility of services for underserved popula-tions, individuals in rural areas, thoseunable to physically go to an office (e.g.,physically disabled persons, house-boundagoraphobics), or for those whose jobrequires frequent travel. With all of itspromise, however, the profession of psy-chology has not rushed to publiclyembrace the use of the telephone as anacceptable alternative for rendering clini-cal services. This reluctance is likely rootedin the lack of a solid empirical basedemonstrating its effectiveness (althoughthis is changing) and the debate over legaland ethical concerns. Also, perhaps, con-ducting psychotherapy over the phonemay be perceived as inferior to face-to-facetherapy because of its historical connec-tions with crisis lines managed by layper-sons or that the current training of thera-pists emphasizes visual cues. Nevertheless,the use of the telephone for providing psy-

chological services is increasing in certainsettings. Many large corporations (includ-ing the largest private employer in theU.S.) as well as the federal governmentnow offer telephone-based counselingprograms for their employees (Stephensonet al., 2003).

The purpose of this article is three-fold: to provide an overview of the currentempirical literature on telephone psy-chotherapy, the legal and ethical concernsfor providing such services, and the prom-ise that the telephone medium has in pro-liferating the delivery of psychologicalservices.

DDDDooooeeeessss TTTTeeeelllleeeepppphhhhoooonnnneeee TTTThhhheeeerrrraaaappppyyyy WWWWoooorrrrkkkk????

Some have opined that telephonepsychotherapy is, at best, an inferior alter-native to face-to-face therapy and, atworst, an unethical form of practice(Haas, Benedict, & Kobos, 1996).However, such reactions are not empirical-ly based but rather on supposition andintuition. To address the question ofwhether telephone therapy is an effectivealternative, one needs to back up and askwhy psychotherapy works. Psychotherapyoutcome researchers have found that thetherapeutic relationship is a consistentpredictor in outcome (Wampold, 2001)and, as a whole; other variables rangingfrom type of treatment to client and ther-apist variables have yielded equivocalresults. Another pattern identified by out-come researchers is that more therapytends to be better, although there is animpact of “diminished return” with muchof the improvement occurring early in thetherapy process. If psychotherapy can beeffective with different treatments, withdifferent clients, and different therapists,is it possible that it can be effective whenit is provided in a different medium?

Studies that measure outcome fortelephone therapy have tended to be prob-lem or population focused. Examples ofthese include: smoking cessation (Zhu,

Tedeschi, Anderson, & Pierce, 1996),combined treatment with antidepressantmedication for depressed persons (Simonet al., 2004), group counseling for the dis-abled elderly (Evans, Smith, Werkhoven,Fox, & Pritz, 1986), and treatment forhousebound agoraphobics (McNamee,O’Sullivan, Lelliott, & Marks, 1989).These studies have tended to report favor-able results. Of these, smoking cessation isone area that has numerous studies (e.g.,Mermelstein, Hedecker, & Wong, 2003;Zhu et al., 2002) documenting favorableresults with the reduction or cessation ofsmoking being found superior for tele-phone counseling compared to othertreatments.

Evidence that mirrors what is morelikely found in a general therapy practice isstill limited. However, a study by Reese,Conoley, & Brossart (2002) found evi-dence for the effectiveness of telephonepsychotherapy for a variety of presentingissues. They replicated the ConsumerReports (1995) study that measured out-come as function of satisfaction, generalwell-being, and improvement for the spe-cific problem that led to seeking help. Theresults of a telephone sample were com-pared to the Consumer Reports sampleand the outcome scores were similarlyfavorable. Also, the processes underlyingthe effectiveness of psychotherapy ap-peared to be similar for the telephone ther-apy sample. The dose-effect response wassimilar to what is typically found in theoutcome literature, more therapy resultedin better outcomes along with moreimprovement occurring early in theprocess. A measure of the working alliancefound scores that were just as strong asthose found in the literature. While thiswas not a controlled study, it provides evi-dence that telephone therapy appears to begenerally effective and appears to parallelsome of the processes of traditional, face-to-face psychotherapy.

TEXAS PSYCHOLOGIST

10 FALL 2005

LLLLeeeeggggaaaallll aaaannnndddd EEEEtttthhhhiiiiccccaaaallll CCCCoooonnnncccceeeerrrrnnnnssss ooooffff

TTTTeeeelllleeeepppphhhhoooonnnneeee TTTThhhheeeerrrraaaappppyyyy

Much of the discussion concerningthe use of the telephone, as well as othercommunication technologies, has centeredon legal and ethical concerns of their use.The Ethics Committee of the AmericanPsychological Association (1997) weighedin on this issuing a statement that the“Ethical Principles of Psychologists andCode of Conduct” is not specific to suchservices and thus has no rules prohibitingthe use of telehealth media. However, theyadd that psychologists should stay withinthe bounds of their competence in suchnew areas. While not definitive, this state-ment is not exactly supportive of suchmediums as a stand-alone service.

The research literature, albeit limited,is supportive of using the telephone for

psychotherapy. If psychotherapy by tele-phone is demonstrated to be helpful, how can it be unethical to provide suchservices? On a broader level this is true,but the issues surrounding the logisticsand scope of providing telephone-basedservices are far from resolved. Logisticalissues range from legal issues (e.g., licen-sure, providing services across state lines,liability insurance, getting reimbursed bythird-party insurers) to the mechanics of

providing such services in a competent andethical manner (e.g., establishing clearinformed consent, addressing the limits ofprivacy when using cellular or cordlessphones, and simply establishing an envi-ronment with the client that is conduciveto talk therapy). Scope issues include iden-tifying the limits of telephone therapy andestablishing the parameters for renderingservices.

Logistical Issues. Most states,including Texas, have not caught up withtechnology from a legal standpoint. WhileTexas law provides some clarification forphysicians, referred to as “telemedicine,”there is little direction provided for psy-

chologists. Koocher & Morray (2000) sur-veyed state attorneys general regardinglegal and regulatory issues and found thatstates were far from consistent. Texas hadno statutes specific to psychotherapy ormental health service provided by tele-phone or other telecommunication medi-ums. However, Texas was also listed as astate that “claimed regulatory authorityover mental health practitioners residingoutside of the state who offer psychothera-py and counseling to residents of that statevia the telephone…” (p. 505). Over half(55%) of the other states polled said theydid not. Texas psychologists conductingphone therapy with a client in a differentstate may be subject to the other state’slaws. While a practitioner might rational-ize that a client is coming to them for serv-ices, therefore, the client is receiving serv-ices in the practitioner’s state, many statessee it as just the opposite. This brings intoplay licensure issues as well as having anunderstanding of state laws. For example,is the duty to warn and protect for NewJersey different from Texas?

Nickelson (1998) pointed out themalpractice issues that need to be consid-ered. He recommended that psychologistscheck with their liability insurance carrierabout providing telehealth services sincesuch services may not be covered. Inter-estingly, Nickelson also pointed out thatpsychologists are eligible for Medicarereimbursement for telehealth services,including the telephone, across all states inareas listed as a “Health Provider ShortageArea.” This demonstrates support for tele-health services at the federal level. Lesliereported (as cited in Bischoff, 2002), how-ever, that California law states that tele-phone counseling is not acceptable forproviding services. Needless to say, legaland regulatory issues are not resolved.

Even if a practitioner successfully nav-igates the legal issues, she must make surethat the services being provided meet ethi-cal and professional standards. One diffi-

culty is assuring privacy and confidentiali-ty on the telephone given the popularity ofwireless technology. Creating a behavioralsetting conducive to having a session viathe phone can also be challenging. Aninformed consent that covers these areasand others by specifying the nature of therelationship, fees, the scope, and the possi-ble benefits and limits of therapy via thetelephone is necessary and consistent withthe standards for practice whether it is onthe phone or in person.

Scope of Treatment Issues. Issuesinvolving the scope of practice includeidentifying presenting issues or diagnosesthat may not be feasible to treat over thetelephone, severity of an issue where phys-ical proximity might be more importantfor assessment or referral purposes (e.g.,intent to harm self or others, other crisissituations), and identifying treatments andprocesses that are conducive to treatment

via the telephone. For example, Reese etal. (2002) found that those who reportedmore severe problems reported lessimprovement on the telephone. Simplybeing intuitive about the issues involvingscope of treatment are not enough.Research has contradicted statements thattelephone therapy is not effective. Forexample, not being able to identify visualcues may be considered an integral part oftraining, but perhaps visual cues can alsobe a distraction and doing therapy on thetelephone may remove biases and actuallypromote better listening. After all, thereare no restrictions for sight impaired indi-viduals becoming licensed psychologists.

WWWWhhhhyyyy BBBBooootttthhhheeeerrrr WWWWiiiitttthhhh TTTTeeeelllleeeepppphhhhoooonnnneeee

TTTThhhheeeerrrraaaappppyyyy????

Given the lack of clarity on legal andethical issues, why go to all the trouble?For one, telephone therapy holds thepromise of providing services to under-served populations. Seligman (1995) stat-ed that the majority of psychotherapyclients are educated and from the middle

TEXAS PSYCHOLOGIST

FALL 2005 11

class. Traditional psychological servicessimply are not available to everyone; indi-viduals of low socioeconomic status havebeen underserved (Mays & Albee, 1992).The proliferation of telephone-based serv-ices is mainly due to its lower cost (i.e.,excluding pay-per-call services). Communitymental health services funding continuesto shrink with services only available forthe more severe psychiatric disorders. Amodel that follows employee assistanceprograms that contract with privateemployers or those associated with federalservices could be adapted to work withexisting state agencies and communitymental health centers. Such a modelwould be more cost effective and increaseaccess to both rural and urban under-served areas and help realize the promiseof providing services at a lower cost.

In addition to the promise of reach-

ing underserved populations, clients sim-ply appear to value the service. Reese,Conoley, and Brossart (in press) foundthat convenience, accessibility and feelingmore in control over the process were thecharacteristics most valued by clients. Notbeing able to see the therapist was per-ceived as increasing the client’s perceptionof control and helped decrease their fear ofreceiving counseling. It seems clients are

more comfortable than we are with notseeing the other party.

Psychotherapy is typically effectivewith a variety of clients, provided by a vari-ety of therapists who use a variety of treat-ments. We know that a strong workingalliance is central to good outcome as is theability to instill hope in our clients. Thereis evidence that psychotherapy via the tele-phone can do the same. Practi-tioners seemto understand this, given the increase insuch services provided. Clients seem tounderstand this as well, evidenced by theirpositive outcomes in the literature.

Successfully navigating the issues sur-rounding telephone therapy as well as

other telecommunication technologieswill require different solutions, but thesolutions are interrelated. Whether alegal or scope of practice issue, havingempirically-based literature thataddresses both outcome and process forsuch technologies is imperative to mak-ing decisions buttressed by evidence(Nickelson, 1998). Research fundingopportunities in this area do exist. TheNIMH in January 2005 announcedthat it was encouraging research pro-posals specifically in this area andencouraging researchers and practition-ers of telehealth to collaborate(Kersting, 2005). High-quality researchin this area may serve to promote socialjustice and enhance the likelihood oftelehealth programs being funded toprovide assistance to those who wouldnot otherwise receive it. Psychologistshave long been taught to meet peoplewhere they are. The telephone is apotentially powerful way to do this.

RRRReeeeffffeeeerrrreeeennnncccceeeessss

American Psychological Association EthicsCommittee (1997). Services by telephone,teleconferencing, and Internet. Washington,DC: Author. Retrieved July 26, 2005 fromthe World Wide Web: http://www.apa.org/ethics/stmnt01.html.

Bischoff, R.J. (2004). Consideration in theuse of telecommunications as a primarytreatment medium: The application ofbehavioral telehealth to marriage and familytherapy. The American Journal of FamilyTherapy, 32, 173-187.

Consumer Reports (1995, November).Mental health: Does therapy help? 734-739.

Evans, R.L., Smith, K.M., Werhoven, W.S.,Fox, H.R., & Pritzl, D.O. (1986).Cognitive telephone group therapy withphysically disabled person. TheGerontologist, 26, 8-11.

Haas, L.J., Benedict, J.G., & Kobos, J.C.(1996). Psychotherapy by telephone: Risksand benefits for psychologists and con-sumers. Professional Psychology: Researchand Practice, 27, 154-160.

Hornblow, A.R. (1986). The evolution andeffectiveness of telephone counseling servic-

es. Hospital and Community Psychiatry, 37,731-733.

Kersting, K. (2005). NIMH seeks telehealthresearch proposals. APA Monitor, 36(1), 18.

Koocher, G.P., & Morray, E.M. (2000).Regulation of telepsychology: A survey of StateAttorneys General. Professional Psychology:Research and Practice, 31, 503-508.

Mays, V.M., & Albee, G.W. (1992).Psychotherapy and ethnic minorities. InDonald K. Freedheim (Ed.), History of psy-chotherapy: A century of change (pp. 552-570).

McNamee, G., O’Sullivan, G., Lelliott, P., &Marks, I. (1989). Telephone-guided treatmentfor housebound agoraphobics with panic disor-der: Exposure vs. relaxation. Behavior Therapy,20, 491-497.

Mermelstein, R., Hedecker, D., & Wong, S.C.(2003). Extended telephone counseling forsmoking cessation: Does content matter?Journal of Consulting and Clinical Psychology,71, 565-574.

Miller, W.B. (1973). The telephone in outpa-tient psychotherapy. American Journal ofPsychotherapy, 27, 15-26.

Nickelson, D.W. (1998). Telehealth and theevolving health care system: Strategic opportu-nities for professional psychology. ProfessionalPsychology: Research and Practice, 527-535.

Reese, R.J., Conoley, C.W., & Brossart, D.F.(2002). Effectiveness of telephone counseling:A field-based investigation. Journal ofCounseling Psychology, 49, 233-242.

Reese, R.J.., Conoley, C.W., & Brossart, D.F.(in press). The appeal of telephone counseling:An empirical investigation of client percep-tions. Journal of Counseling and Development.

Shepard, P. (1987). Telephone therapy: Analternative to isolation. Clinical Social WorkJournal, 15, 56-65.

Simon, G.E., Ludman, E.J., & Tutty, S.(2004). Telephone psychotherapy and tele-phone care management for primary carepatients starting antidepressant treatment: Arandomized controlled trial. JAMA: Journal ofthe American Medical Association, 292, 935-942.

Stephenson, D., Bingaman, D., Plaza, C.,Selvik, R., Sudgen, B., & Ross, C. (2003).

Implementation and evaluation of a formaltelephone counseling protocol in an employeeassistance program. Employee AssistanceQuarterly, 19, 19-33.

Continued on page 19

TEXAS PSYCHOLOGIST

12 FALL 2005

H aving been intimately in-volved in psychology’sprescriptive authority

(RxP) quest since its inception,when U.S. Senator Daniel K.Inouye addressed the HawaiiPsycho-logical Associationannual convention onNovember 30, 1984, I havebeen extremely gratified byour profession’s efforts overthe years and particularly, bythe growing enthusiasm evidentat the Practice Organization’sState Leadership conferences andour annual conventions.

Over two decades ago, the Senator proffered: “Finally, Iwould like to suggest an entirely new legislative agenda which I thinkfits very nicely into the theme of your convention: ‘Psychology in the 80’s: Transcending Traditional Boundaries.’ As a United

States Senator, I have also been working closely during the past decade with a number of your ‘natural allies.’ I am particularlythinking of our nation’s nurse practitioners, nurse midwives, and optometrists. The members of these professions have been suc-cessful to differing degrees in amending their state practice acts to allow them to independently utilize drugs where appropri-ate.... “In my judgment, when you have obtained this statutory authority, you will have really made the big time. Then, youtruly will be an autonomous profession and your clients will be well-served.” At the August, 1995 APA convention in New YorkCity, the Council of Representatives formally endorsed prescriptive privileges for appropriately trained psychologists and calledfor the development of model legislation and a model training curriculum. RxP became APA policy and, we would suggest, isinfinitely consistent with your theme — “Innovations In Treatment.”

This spring, at the Practice Organization’s 22nd annual State Leadership conference, Russ Newman informed a highly

enthusiastic audience: “The prescription privileges agenda continues to see great strides accomplished. Everyone, I hope, knows

by now that last May, Louisiana became the second state joining New Mexico and the territory of Guam to enact a prescriptive

authority law. What everyone may not know is that just this past January, both Louisiana and New Mexico successfully com-

pleted implementation of these laws, with final rules and regulations becoming effective. Psychologists in these states are now

becoming certified to prescribe, and just recently, Louisiana medical psychologist Dr. John Bolter was caught on film being the

first to write a prescription under the new law. Congratulations to all in New Mexico and Louisiana who participated in these

The Great State of Texas: a Psychoparmacology Update

by Pat DeLeon, PhD

TEXAS PSYCHOLOGIST

FALL 2005 13

hard fought victories. Of course, our work

is far from over....” Texas’s Randy Phelps

serves as Russ’ Deputy Executive Director.

When one becomes personally

involved in the public policy (i.e., politi-

cal) process, certain seemingly fundamen-

tal “rules,” reflecting its unique culture,

soon become evident. Perhaps foremost in

my mind is the importance of the “learned

professions” (i.e., psychology) becoming

involved in addressing society’s most press-

ing needs. Without question, psychology

and the behavioral sciences have much to

offer to our nation’s elected officials at

both the state and federal level. Yet, in the

last Session of Congress (2003-2004) the

dominant profession of the elected offi-

cials was law, followed by business. Fifty-

nine members of the U.S. Senate were

lawyers. Members of these professions

think differently about health or education

than do clinicians, educators, or

researchers. They are not knowledgeable

about the nuances of our profession or of

our potential contributions. They, of

necessity, rely heavily upon the popular

media for information and new ideas, and

within the legislative arena, they particu-

larly rely upon the public hearing process,

during which witnesses of various persua-

sions effectively “make their best case.”

Simply stated, if we are not present, we

will not be heard no matter how meritori-

ous our case may be.

Over the years, we have come to

appreciate that to be ultimately successful

in public policy deliberations, it is extraor-

dinarily important to possess long-term

vision for where one wants to channel one’s

energy. Change is always unsettling, far

more than one might initially appreciate.

And change is often slow and incremental.

One must expect individual and institu-

tional resistance, especially from one’s own

colleagues. And, for truly meaningful

change to evolve, one’s efforts must be fun-

damentally consistent with trends occur-

ring within the broader context of society-

at-large. Waiting on an invitation to pres-

ent professional needs to legislators is not

an option, all health care professionals (and

we are healthcare professionals) have an

inherent responsibility to drive changes

that will demand improved patient safety

and access to care. My sincerest apprecia-

tion to your Past President Dee Yates for

ensuring that psychology’s voice was effec-

tively “heard” during the deliberations of

the President’s New Freedom Commission

on Mental Health. In reflecting, I realized

that I have had the opportunity of person-

ally addressing Texas audiences approxi-

mately 15 times, undoubtedly the most

memorable being during my APA

Presidency at your joint Texas-Oklahoma

annual meeting. Change takes time. Yet, it

is evident we are being heard.

APA President Ron Levant noted at

our recent Washington, DC convention,

that Institute of Medicine (IOM) reports

have concluded that: “The American

health care system is confronting a crisis....

The health care delivery system is inca-

pable of meeting the present, let alone the

future needs of the American public.”

And, “Substantial investments have been

made in clinical research and development

over the last 30 years, resulting in an enor-

mous increase in the medical knowledge

base and the availability of many more

drugs and devices. Unfortunately,

Americans are not reaping the full benefit

of these investments. The lag between the

discovery of more efficacious forms of

treatment and their incorporation into

routine patient care is unnecessarily long,

in the range of about 15 to 20 years. Even

then, adherence of clinical practice to the

evidence is highly uneven.”

In his Presidential address, Ron pas-

sionately proclaimed: “A broken health

care system is bankrupting families across

the country. These problems are clearly so

serious that they demand a complete re-

examination of the U.S. health care sys-

tem. One core assumption that requires

re-thinking is the idea of the separation of

mind from body, the notion pervading our

concepts of health and illness that there

are some illnesses that are physical and

others that are mental... As we all know,

mind and body are not separate, but rather

they are inseparable. By assuming that

mind and body are separate, and further,

assuming that the only role that the mind

plays in health and illness is in mental

health and illness, we have maintained a

healthcare system that is unable to deal

with the many varied roles that mind and

behavior play in so-called physical illness.

This system, further, does not even deal

with mental health and illness, per se,

effectively. Descarte’s 17th century meta-

physical philosophy, which separated

mind from body, has had an enormous

negative impact on our health care sys-

tem.... The current system virtually

ignores the psychosocial pathways that

lead to unnecessary utilization of medical

and surgical services, as well as poorer

health .... Mind-Body dualism, is, in a

word, bankrupt.” Thus, the extreme

importance of Ron’s Presidential Initiative:

“Health Care For The Whole Person.” I

enjoyed the realization that throughout the

impressive RxP presentations, new faces

and new voices were being heard no longer

solely those like Betty Richeson’s who was

there from the beginning. Bruce Bennett,

CEO of the APA Insurance Trust, once

again made it clear that prescribing

psychologists would be covered, given that

TEXAS PSYCHOLOGIST

14 FALL 2005

RxP was APA policy.

This year the IOM released its report

Quality Through Collaboration: The

Future Of Rural Health which essentially

places psychology’s RxP agenda in a larger

public policy context, and should be par-

ticularly poignant for Texas. “Rural com-

munities are a vital, diverse component of

the United States, representing nearly 20

percent of the nation’s population.... Rural

America reflects the multiethnicity of the

nation as a whole.... Rural communities

are heterogeneous, differing in population

density, remoteness from urban areas, and

the cultural norms of the regions of which

they are part. As a result, they vary in their

demographic, environmental, economic,

and social characteristics. These differences

influence the magnitude and types of

health problems communities face....

Many rural communities continue to

struggle to sustain viable health care deliv-

ery systems. In recent years, it has also

become apparent that rural communities

confront serious quality of care challenges

as well....”

“Quality of care is the degree to which

health services for individuals and popula-

tions increase the likelihood of desired

health outcomes and are consistent with

current professional knowledge.... This

strategy is based on the use of states or

‘market areas’ as laboratories for the

design, implementation, and testing of

alternative strategies, leading ultimately to

the creation of a set of model 21st -centu-

ry community health systems over the

coming years....” “Patients likely have dif-

ferent preferences for settings and

providers, and there may well be differ-

ences in the quality, accessibility, and cost

of services by type of setting and

provider....”

The RxP agenda is fundamentally

about ensuring that all Americans have

access to the highest possible quality of care

no more, no less. Texas is extraordinarily for-

tunate that former USAF Prescribing

Psychologist Jim Meredith has left Hawaii

to reside in your state. As Jim and each of his

DoD colleagues have reported, psychology

has much to offer to those patients who are

on (or perhaps need) psychotropic medica-

tions. Psychology views the judicious use of

medication dramatically differently than

those trained in the traditional medical

model. Rural America provides the oppor-

tunity to demonstrate the cost-effectiveness

and efficacy of psychology prescribing.

A personal view: Jim Quillin,

President of the Louisiana Psychological

Association:

“Louisiana’s Medical Psychology

statute was signed into law on May 6,

2004, and the rules governing this land-

mark statute were finalized on January

20th of this year clearing the way for the

certification of medical psychologists

(MPs) under state law. This represented

the culmination of a decade of hard work

by a small group of extremely dedicated

psychologists who believed in themselves

and in their ability to effect progressive

health care change through the political

process. With the unfailing support of the

APA Practice Directorate and CAPP, LPA

and its sister organization, the Louisiana

Academy of Medical Psychologists

(LAMP), forged a partnership that

brought to fruition, after four legislative

sessions, the country’s second statute. In

all, it was an exhilarating ride and one

which all of us will forever remember not

only for its outcome but also for the

process.

“We are now embarked upon the

implementation of this historical statute.

A total of 23 medical psychologists are

now authorized to prescribe here in

Louisiana, and by Summer’s end, no less

than 25 MPs will likely be practicing in

Louisiana, and it is my hope that by the

end of the year the remainder of those

who have completed their training thus far

will be doing so as well. A new class of psy-

chologists is underway and being trained,

and the next wave of MPs, will follow in

due time. I also hope to be able to report

to you in the near future another ground-

breaking first, the credentialing of an MP

to prescribe as part of the medical staff of

a hospital. We have also been working

with the insurance industry and I believe

that I will soon have the pleasure of

announcing an important breakthrough

in the reimbursement of services provided

by MPs, one that may well extend to other

states for qualifying psychologists.

“To date, we are successfully feeling

our way through the logistics required to

fully realize the potential of our law.

Louisiana is one of a number of states that

require a state Controlled and Dangerous

Substance Permit before application can

be made for a DEA number. This process

has gone very smoothly and, with our

DEA numbers in hand, we are now

authorized to prescribe any drug, Schedule

II through V, that has a recognized use

(including off-label) in the management

of any psychiatric disorder listed under

either DSM or ICD.

“To a person, all current MPs have

enjoyed excellent relationships with phar-

macists, all of whom, across the state,

received a memo from the Pharmacy

Board earlier this year advising them of

MPs as a new class of prescribers in

Louisiana. Taking a tip from the Executive

Director of that Board, I contacted many

of the pharmacies in my area and provide

them all the information necessary for

TEXAS PSYCHOLOGIST

FALL 2005 15

them to put me into their systems. Several

of them now fax or call my clinic to

remind me of expiring prescriptions so

that I can discontinue, change or refill as

needed. It has also been gratifying to see

that nonpsychiatric physicians appear to

accept and even welcome MPs as partners

in the delivery of health care. Whereas

organized medicine has been obliged to

oppose psychology in this movement,

partly in deference to their psychiatric col-

leagues and partly out of a sense that med-

icine’s monopoly on health care is waning,

rank and file MDs, in my experience, are

concerned not with turf issues but rather

with providing quality care to their

patients. We are not a threat; we are their

allies and are being increasingly accepted

as such. Patients appear absolutely thrilled

with the ability of MPs to prescribe their

psychotropic medications. It has freed

them of the onerous requirement of seeing

two doctors each time a prescription is

needed while the close coordination of

care between their MP and MD helps

ensure optimized outcomes. As of this

writing, MPs here in Louisiana have writ-

ten over 2,000 prescriptions representing

nearly 50,000 treatment days, all without

incident. We are prescribing all classes of

psychotropic medications.

“As for myself, this implementation

period has been interesting. I find that I

am conservative in my prescribing habits,

adhering to the age old admonition to

‘start low and go slow’ when treating

patients psychopharmacologically. I have

prescribed for all classes of psychotropic

medications across all relevant schedules.

Still, all in all, patients have a better than

50-60% chance of leaving my clinic with-

out a prescription so far, as psychothera-

peutic/behavioral management was indi-

cated and sufficed. Those for whom med-

ication is necessary report that they find it

refreshing that the doctor who prescribes

for them also takes the time to listen to

them and to approach their care in a more

holistic manner. I understand that this is

similar to the experience of the DoD grad-

uates. It will be interesting to track this

over the longer term.

“As I’ve started prescribing, I’ve found

myself pondering afresh the concern of

some that we are ‘medicalizing’ psychol-

ogy. To be brief, such concerns, while cer-

tainly understandable, appear to be

unnecessary. While some of our new pro-

fessional activities are unmistakably med-

ical in character (i.e., vital signs, evalua-

tion of drug-drug and disease-drug inter-

actions, etc.), the ‘medical’ in medical psy-

chology is an adjective that modifies

rather than defines who and what we are

psychologists. The opportunity to provide

a broader range of therapeutic options to

my patients certainly has not seemed to

diminish my sense of professional identity.

It is clearer to me now more than ever that

the core of the healing arts, the therapeu-

tic ‘g-factor’ if you would, is still to be

found in that somewhat mysterious, elu-

sive bond of the doctor-patient relation-

ship. I don’t find that I am abandoning my

psychological roots I think I’m discovering

them anew.”

A final thought: as I requested during

my Presidential address, please join me in

urging Melba Vasquez to seek the APA

Presidency. All of us will truly be well

served by her vision and compassion.

Aloha,

Pat DeLeon, PhD

Former APA President

It’s not too early to plan for the 2006 AnnualConvention

November 16 - 18, 2006

WestinGalleriaDallas, TX

Coming in 2006

Join us in

Scotland

TPA invites you and your family to a Family Getawayin Scotland in late Spring

2006! Watch for more information in the Winter2006 Texas Psychologist.

TEXAS PSYCHOLOGIST

16 FALL 2005

Reaching Out to Rural Adolescents:Online Counseling

by Donna S. Davenport, PhDTexas A&M University

TTTThe following information was obtained froman interview with Linda Castillo, assistantprofessor in Counseling Psychology at Texas

A&M University, supplemented by professional papersshe authored for publication and presentation.

TEXAS PSYCHOLOGIST

FALL 2005 17

Tell me about your online counsel-ing project.

We have a couple of projects going, allunder the umbrella of GEAR UP—whichstand for Gaining Early Awareness andReadiness for Undergraduate Pro-grams.The gist of it is that we’re following agroup of students from their 7th throughthe 12th year in school, trying to preparethem for college. My projects are focusingon helping them with psychologicalaspects, specifically a support group forLatinas and career counseling.

Why go online? Why not just pro-vide direct intervention?

For several reasons, really. These stu-dents are located in three small ruraltowns—Sinton, Odem, and Aransas Pass.Typically, most students are Latino andmany are from families who know littleabout college or how to get into college.Although their school counselors try, theyare often in primarily administrative rolesand don’t have the time to connect witheach student as much as they would like.We wanted to reach out to these students,but it was too far to drive! Besides, I’ve hada good deal of experience providing onlinecounseling and I’ve seen first-hand howsome people open up quickly that way, so

we were eager to try a couple of approach-es that haven’t been tried before.

This is through a grant, right?

Yes, through the US Department ofEducation. The whole project reachesabout 400 students, and we want to com-pare how students who received variousinterventions compare to students whodon’t receive them.

Okay. So talk to me about whatyou’ve found exciting about theseprojects?

The one closest to my heart is proba-bly the online 10-week support group forLatinas. We knew from other research that

success for Latino students is often relatedto experiencing expressions of warmth,caring, and personal regards from teachersand counselors. We hoped that we couldbe part of that team of supporters.

How did you manage to gainaccess to them? Did you gothrough the school counselors?

Oh, yes, that was a very importantpart of the plan. We absolutely neededtheir collaboration. They identified for usLatina students who were having prob-lems with school performance, and theyobtained the parental consent for studentsto participate in the online support group.They also gave the students the screen-names and passwords we provided.

So this was through InstantMessaging?

Yes. American On-line (AOL) InstantMessaging is free, so we created an accountthrough them. We knew it could be madeeasily accessible to the schools.

You did the facilitation of thegroups yourself?

No, I trained and supervised six grad-uate counseling students. We called themAggie Partners and each of them created aprivate chat room that was available onlyby invitation. Each Aggie Partner workedwith a group of five Latina students. To

enter the chat room, you had to be invit-

ed, and that invitation went out to theassigned students, the school counselor,

and me.

You mentioned training the AggiePartners. What kind of trainingdid you provide?

Primarily they were taught not to writelike graduate students! They needed to bevery informal, very supportive, to self-dis-close when appropriate, and to facilitate thediscussion if too many ideas were thrownout at once by the group members.

Sometimes the Aggie Partner introduced atopic for discussion, but often studentsbrought up their own concerns.

A lot of it, discussed almost every ses-sion, was about relationships with peersand boys. The group members came totrust each other and talked a lot aboutpressure to have sex at a young age. Manyof them had older boyfriends. Same-sexrelationships were also very important tothem. They wanted help dealing with peerpressure and sometimes raised issues likeneeding to figure out how to handle a sit-uation in which a friend betrayed them orstarted giving them the cold shoulder.Family conflicts was also another verycommon topic.

So was it all support? No con-frontation?

Confrontation from Aggie Partnerswas challenging their group members’ per-spectives of a problem. Their main role,however, was to offer that warmth andacceptance we talked about earlier. It wasinteresting, though, that although thegroup members tended to share openlyand be encouraging of each other, they didsometimes critique other members orshow them another way to see something.

How do you think this helped pre-pare them for college?

Well, although a lot of the discussionswere about their present circumstances, inalmost every session concerns about col-

lege were brought up. This was where the

Aggie Partners could really be helpful.

For example. . .?

One group was talking about theirfears of going to college and being aloneand away from family and friends. Theyworried about how they could supportthemselves and still keep up with theirstudies. One student asked her AggiePartner, Debra, directly if she had beenscared to go to college. Debra wrote back,

TEXAS PSYCHOLOGIST

18 FALL 2005

“OH YES! I still remember what I feltwhen I drove away from home. I musthave called my mom at least twice a dayevery day at first!” She asked if the groupmember was worried about things likethat, and was told yes, that was it. At thatpoint Debra responded, “The good thingto remember is that most of the peoplearound you will be feeling the same way.”

So the Aggie Partners reallybecame role models and mentors,right?

Yes, exactly.

What advice would you have forothers trying to set up such anonline support group? What haveyou learned the hard way?

First, it’s crucial to get support fromthe school administration. For us, this wassimpler, because our grant provided fund-ing for computer equipment and technol-ogy support. Without support from theadministrative body and the school coun-selors, this wouldn’t have worked.

Anything else?

One of the problems we encounteredwas that the Aggie Partners sometimes hada little difficulty managing the groupbecause the students were sitting next toeach other in the computer lab, so sideconversations occurred that were not partof the group discussion. If the studentshad been from different schools, or if therehad been a monitor in the lab, it wouldhave worked better.

The other thing I want to say is that Iknow how crowded a school counselor’sschedule is; they often just don’t have timeto facilitate such groups. That’s why wethink letting graduate students in trainingget practicum credit for something like thisas they work to become counselors or psy-chologists is such a win/win proposition.

Let’s switch gears for a min-ute. Tell me about the career

counseling component you’veintroduced. Is that with the samestudents?

Yes and no. It was from the sameschool districts, but none of the studentsin the Latina support groups were in thecareer counseling program. I set this oneup through the Career Counseling courseI teach. I trained them, and then they hadtwo or three Latino students to work with.

This was set up the same way,through instant messaging?

We used the WebCT software pro-gram that allowed us to use password pro-tected email and discussion boards. Likethe other group, each middle school stu-dent was given a personal login accountand password; that way we could maintainconfidentiality. The school counselor and Iwere the only ones with access to students’accounts.

Was this just open-ended counsel-ing, or did you use a specificmodel?

We used the Career Zone. Once a stu-dent was logged into WebCT, a discussionboard with the student’s name and a linkto the Career Zone was visible. It’s a freeonline career guidance program for middleand high school students and has a lot ofcareer activities to help explore students’talents, skills, and interests. One greatthing about this program is that schoolcounselors can keep track of a student’scareer development by using the onlineportfolio feature.

What training did you offer yourgraduate students?

To begin with, they learned how tointroduce themselves – informally again –and how to explain confidentiality. I gavethem specific Career Zone activities towork on with their students and was ableto provide individual supervision by read-ing each counseling student’s postings.

Give me an example. How mightthe first interaction go?

I told them ahead of time the trickwould be to establish a working alliance,to create a presence, without actuallybeing physically present. I gave themexamples of the kind of messages thatworked—informal, enthusiastic, someself-disclosure—as well as a very formalexample of what wouldn’t work. So in

their first message they would give theirnames and say how excited they were to bethe student’s career counselors for the nextseveral weeks. It was very informal—usingexclamation points, contractions, ellipses,incomplete sentences.

The goal was just to establish rapportwith the middle school student. Theymodeled self-disclosure by talking abouttheir own interest, for example windsurf-ing, shopping for bargains, things likethat. Then they asked the student to tellthem what the student wanted them toknow. There was a P.S. at the end of thatfirst communication, explaining again,very informally, the limits of confidential-ity, but explaining that before it was bro-ken, the career counselor would definitelytalk to them about it first so they couldmake a plan on how to deal with it.

In addition to going through theCareer Zone activities, were stu-dents trained to offer other kindsof comments?

Oh, yes. In each posting, they

reflected back on the middle school stu-

dents’ previous message, praising them

for their good work and participation

and offering encouragement to continuethe process. They also incorporated someof their own personal thoughts and expe-riences in order to cultivate a personalcommunication. Then at the end of eachmessage, they would summarize the top-ics that they hoped the students wouldrespond to next.

TEXAS PSYCHOLOGIST

FALL 2005 19

How did you supervise your gradu-ate students?

Well, as I said before, I read each stu-dent’s postings. My career counseling stu-dents also had to keep case notes, usingthe SOAP format, for every two e-com-munications. These were kept on disk andturned in at the end of the semester. Whenthey finished the process, they wrote atreatment summary.

Were there special ethical issuesyou had to deal with in either ofthese projects?

The main one was figuring out howto make online counseling confidential.We did that by creating private chat roomsand students had to be invited in order toparticipate. Parental consent had alreadybeen obtained through GEAR UP, but wemade sure they had their own informedconsent. We needed to feel that, in anemergency, we could contact their schoolcounselors. Students knew the counselorshad access to their messages. These schoolcounselors served as our safety net, andthat made the whole process less anxietyprovoking for me. In online counselingwith adolescents, it can be worrisome if astudent suddenly quit dialoguing. Thisway, we didn’t have to worry; someone wason site who could check up on them.

I imagine you’re collecting data onthis?

Yes, I’m collecting some process data.GEAR UP will be doing the analyses ofthese 400 students. But that won’t be avail-able for two more years—we’re now in the4th year of the project.

Thanks so much, Linda! This is areally great example of collabora-tion between a graduate programand a public school. Everyonewins!

Telephone Counseling - cont. from page 11

VandenBos, G.R., & Williams, S. (2000). Theinternet versus the telephone: What is tele-health anyway? Professional Psychology:Research and Practice, 31, 490-492.

Wampold, B.E. (2001). The great psychother-apy debate: Methods, models, and findings.Mahwah, NJ: Lawrence Erlbaum Associates.

Zhu, S.-H., Tedeschi, G.J., Anderson, C.M., &Pierce, J.P. (1996). Telephone counseling forsmoking cessation: What’s in a call? Journal ofCounseling and Development, 75, 93-102.

Zhu, S.-H., Tedeschi, G.J., Anderson, C.M.,Rosbrook, G., Byrd, M., Johnson, C.E., et al.(2002). Telephone counseling as adjuvant treat-ment for nicotine replacement therapy in a“real-world” setting. Preventing Medicine: AnInternal Journal Devoted to Practice andTheory, 31, 357-363.

Corre spondence concerning thi s ar t i -c l e should be addre s s ed to Rober t J .Ree s e , Box 28180, Abi l ene Chri s t ianUniver s i t y, Abi l ene , TX 79699-8180

TEXAS PSYCHOLOGIST

20 FALL 2005

U niversity counseling centers arebeing forced to take a difficult lookat how and to whom they provide

service. As a member of the 2004 intern cohort,I had the opportunity to attend the annualCounseling Center Internship Conference heldat the University of Houston. Outside the for-mal presentations, one of the most discussedtopics among training directors and counselingcenter staff seemed to be the unanimousagreement that college and university counsel-ing centers are experiencing across-the-boardincreases in service requests and in the severi-ty of presenting issues. Although there is someempirical support for the increase in severity, itseems that speculated factors that might becontributing to the felt increase are as numer-ous as the people experiencing it.

University counseling centers constantly strive toward providing ever-higher quality services to students within the everydayrealities in which their counseling centers exist. One way to accomplish the goal of providing better service to students is toincrease availability and awareness, including the integration of different student services offered within the institution. A pro-gram that can integrate multiple resources so that more students can be served more efficiently and effectively would certainlymesh exceptionally well with the goals of a counseling center. The best of these ideas are sure to rise to the top and become thebenchmark in services that student mental health can provide, and in fact, one of the more progressive ideas about student serv-ices and mental health care came about in 2002.

At that time, David Drum, PhD, ABPP, Director of the Counseling and Mental Health Center and Associate Vice Presidentof Student Health at the University of Texas at Austin, set into motion a long-time vision he has had about student health. Withthe creation of what has come to be called the Integrated Healthcare Program, Dr. Drum sought to create a system of service deliv-ery that treated the whole person, both mind and body, with a particular emphasis on the interplay between the two.

In fact, while mind-body approaches to health have certainly been around for a very long time, both the AmericanPsychological Association and the American Medical Association recognize the validity in development of programs that focus onit. In 2002, as the UT program was getting started, the Journal of the American Medical Association covered an APA meeting onwhat they called “Mind-Body Medicine,” stating “Every day, primary care clinicians face patients whose primary disease is psy-chiatric or is complicated by psychiatric issues. Recent findings, including brain imaging studies, deepen appreciation that mindand body are one.” (Lamburg, 2002). In fact, 3 years later, the APA Practice Directorate’s public education initiative namedSeptember of 2005 “Mind/Body Health Month”, and includes “more materials than any previous public education campaigneffort,” according to Helen Mitternight, Assistant Executive Director of Public Relations in APA’s Practice Directorate (Karen

Integrated Health Care at UT Austinby Tom Marrs, PhD

Texas A&M University

TEXAS PSYCHOLOGIST

FALL 2005 21

Kersting, 2005). It appears that both sidesof health care begun making moves toincorporate treatment from an overallmind-body approach.

In UT’s integrated healthcare pro-gram, psychologists and social workerspractice collaboratively with medicalproviders in the University Health Servicesclinic and offer a wide range of psycholog-ical services to students referred by med-ical providers. According to ChrisBrownson, PhD, Assistant Director of

Integrated Healthcare and Research andleader of the University of Texas program,“Integrated healthcare at its core is seam-less, integrated, and collaborative. It isseamless in that mental health services andbehavioral or other psychological interven-tions occur within the primary care clinic.Medical providers and behavioral healthproviders give treatment that reinforcesthe fact that the mind and body are notseparate from one another.” Clinicians inthe integrated care program present holis-tic care to patients initially seeking treat-ment from medical providers. They referto the work as primary care psychology,with a particular emphasis on the mind-body interventions and mindfulness. Inthe three years since the start of the pro-gram, medical providers have respondedpositively and the program has flourished.

The integrated approach to health-care provides effective treatment reachingpatients at the primary care level. Dr.Brownson cites that lifestyle factors, emotional and cognitive issues, and per-sonal and interpersonal factors are oftenignored or de-emphasized during treat-ment because medical providers oftendon’t have the time or the expertise toaddress such issues. However, if these

issues are addressed in the context of phys-

ical health, patients learn about the waystheir mind and body influence one anoth-er.

Dr. Brownson went on to say “A sig-

nificant portion of mental health issuessurface in primary care, so providing theseservices where the patients present isimportant.” As a result of this immediacyeffect, the program has experienced a sig-nificant increase in patient follow throughand compliance, as well as reaching seg-ments of the student population who pres-ent less frequently at counseling, particu-larly men and international students.

Through the integrated program, thebehavioral health providers see studentswith more typical counseling center con-cerns such as depression, anxiety, eating dis-orders, and relationship issues. Ad-ditional-ly, however, they see students for morephysical health concerns, such as irritablebowel syndrome, chronic pain, GI prob-lems, insomnia, and chronic illnesses.Services are provided for any medical con-dition in which stress, lifestyle, or personalor interpersonal issues have an impact onthe cause, course, severity, or duration ofphysical complaints. Dr. Brownson saysthat they respond to all mental health criseswithin University Health Services as well,especially the urgent care clinic – includingrecent suicide attempts, suicidal ideation,panic attacks, or psychotic symptoms. Inthis way, when a student is in crisis andcomes to see a doctor, she or he can be seenby someone with training in mental healthimmediately, without the need for a referralor a possible delay in getting the student tothe counseling center.

In addition to the synergistic affectsof this level of integration of mental healthservices into primary care, Dr. Drum sanc-tioned the Integrated Health-care Programto construct a Mind-Body Lab that wouldmake Jon Kabat-Zinn very happy. In thelab, put in place in early 2005, studentscan learn relaxation skills with the aid ofbiofeedback. Students can go to the labwithout the usual appointment needed incounseling services or health services, andchoose one of three stations containing a

recliner, a wall mounted LCD monitor,headphones, and simple biofeedbackequipment. The student can then selectand listen to various audio tracks whichteach how to use the equipment.Relaxation and mindfulness exercises arealso offered with multiple tracks onbreathing, progressive muscle relaxation,mindfulness meditation, guided imagery,and self-hypnosis; additionally, individualGalvanic Skin Response units are providedfor each station that the student can use inconjunction with the audio tracks. Boththe counseling service and the health serv-ice can refer students to the Mind-BodyLab, with the counseling center staff oftenintegrating it into treatment plans. Thisencourages students to take a more proac-tive role in their own treatment, thusallowing staff to use their direct servicedelivery hours with students that requireother approaches.

Dr. Brownson suggested that provid-ing some open counseling slots in thehealth center and offering ready consulta-tion helps to improve referral followthrough as well as relationships with

health center colleagues. He stated that,

“Throughout the 3 years that this programhas been in existence, we have done satis-faction surveys of the medical providersand recently completed a program evalua-tion of our services. Our feedback hasbeen overwhelmingly positive and this isbest seen by the growth of the program.After our pilot project in 2002, we provid-ed services to the patients of only four ofour 25 medical providers. We only hadone full time behavioral health counselor.In the past three years the demand for ourservices has grown to where there are nowfour full-time counselors providing servic-es to the patients of all 25 of our medicalproviders.”

The integrated healthcare programhas helped students in more ways than justproviding services. In 2004, the program,

TEXAS PSYCHOLOGIST

22 FALL 2005

which within the UT system is known asthe “Behavioral Health Program,” re-ceived funding for two psychology internsfrom the national APPIC match. Internsreceived training in the integrated system,and had the advantage of participating inactivities and training in both the counsel-ing center as well as the University HealthServices department. Like the IntegratedHealthcare Program staff, this internshipappointment also included offices in bothdepartments and provided the ability tolead groups that were accessible to clientsat the Counseling and Mental HealthCenter as well as to patients at UniversityHealth Services.

For most psychologists or centerdirectors reading this right now, the nextthought might be “This sounds like a greatprogram, but how might I be able to startmaking changes toward more integratedhealthcare service delivery within the prac-tical constraints of our system?” Dr.Brownson stated. “There are many ways tobegin to develop more integrated health-care initiatives. We do a lot of consultationwith our medical providers, and have beenproviding some joint continuing educa-tion for providers from our health centersand counseling centers. These types ofactivities tend to improve relationshipswith very little expense. Simply providingsome open counseling slots in the healthcenter can help to improve referral follow-through as well as collaboration withhealth center colleagues, resulting in morestudents getting the help they need.”

Another way in which integrated caremight be feasible through existing budgetand staff constraints is through group serv-ices programming. Dr. Brownson reportedthat one of the most successful integratedinterventions has been through a groupled by interns and Integrated HealthcareProgram staff members Mary Vance, PhDand Cary Tucker, LCSW, RN, that is as

avant-guard as the program itself.

Optimizing Your Potential: The Mind-Body Connection “is a time-limited inten-sive intervention for students with physicalor psychological symptoms which theysuspect are exacerbated by stress or lifestylefactors. At the core of the group is mind-fulness meditation, but facilitators workcollaboratively with other healthcare pro-fessionals to teach yoga, mindful eating,the benefits of physical activity for health,emotional expression, and a cadre of relax-ation skills.” The program also offers amindfulness meditation group whichmeets weekly and is open to students andUniversity employees as well, which hasproven to be a great way to generate enthu-siasm and referrals from faculty and staff.

The integrated program piloted at theUniversity of Texas since 2002 has a posi-tive track record and appears to havebridged the gap in university mental andphysical healthcare. The program has beenwell received by all segments of the univer-sity population thus far. Counselors reportthat their jobs are professionally rewardingbecause they feel the students being seen inhealth services are often young and new tomental health treatment, and are prone to

be less entrenched in their symptoms, thusmaking rapid change possible. The cross-training that occurs between the twoworlds also appears to be bringing themtogether for the common goal of helpingstudents in the most complete and effi-cient manner, insuring valuation of mentalhealth services by the university system,and giving medical providers on campusgreater options and resources. The pro-gram also insures adequate usage of servic-es to secure a future for mental health serv-ices through retention of funding andmaintaining a training ground for thefuture of mental health.

RRRReeeeffffeeeerrrreeeennnncccceeeessssKirsting, K. (2005) A showcase for the mind-body connection. Monitor on Psychology,36(8), 42.

Lamburg, L (2002). Mind-body medicineexplored at APA meeting. Journal of TheAmerican Medical Association, 288(4), 435-439.

CALL FOR ARTICLES! SPECIAL UPCOMING THEMES!

EEEEtttthhhhiiiiccccaaaallll DDDDiiiilllleeeemmmmmmmmaaaassss aaaannnndddd RRRReeeessssoooolllluuuuttttiiiioooonnnnssss –––– dddduuuueeee 11112222////1111////00005555

This issue will address dilemmas that occur in both standard and non-traditionalsituations. The articles should include a description of the dilemma, a review ofrelevant literature, a discussion of the issues involved, and suggested ethical guide-lines or procedures. An example might be: Confidentiality Issues for MilitaryPsychologists.

TTTThhhheeeeoooorrrreeeettttiiiiccccaaaallll AAAApppppppprrrrooooaaaacccchhhheeeessss iiiinnnn MMMMuuuullllttttiiiiccccuuuullllttttuuuurrrraaaallll CCCCoooouuuunnnnsssseeeelllliiiinnnngggg ––––dddduuuueeee 3333////1111////00006666

This issue will address the use of specific theories of counseling and psychotherapywith clientele representing various diverse groups. Articles explaining the adapta-tions of a theory, or the integration of two theories, are also acceptable. An exam-ple might be: The Use of Cognitive/Behavioral Approaches with Chinese-American Clients.

New technology is changingthe practice of psychology.The Internet and improved

voice and telecommunications makelong-distance counseling a muchmore viable solution to the practiceof psychology. However, the samerequirements regarding Confiden-tiality, Consent and Recordkeepingbind you both legally and ethically.Therefore, if you are embarking ona new “tech” counseling career,keep in mind the following legalpoints:1. Informed Consent. 465.11 of the

Texas Administrative Code requiresthat all licensees obtain and docu-ment in writing in formed consentconcerning all services they intend toprovide to the patient. To the extentyou are providing new or differentservices, you should prepare a detailedconsent page to inform the client thatcounseling will be provided via eitherthe telephone or the Internet. Be sureto address the limitations of the tech-nology, as well as the possibility ofany potential security or confidential-ity leaks. You should have the clientsign the consent forms in your office,even if the services are offered online.If not, make certain there is some-

TEXAS PSYCHOLOGIST

FALL 2005 23

The American PsychologicalAssociation Practice Organization andseveral of APA’s Divisions have workedtirelessly not only to get these codesapproved for psychologists but also toeducate psychologists on the proper use ofthese codes for billing. TPA will be hold-ing workshops in early 2006 to educateand train our members on how to getreimbursed from Medicare and privateinsurance for these codes.

For more information on these codes,visit the Texas Psychological Association’swebsite at www.texaspsyc.org.

CPT Codes - cont. from page 7

New Technology – Same Legal Issues

thing mailed to the client, at leastidentifying that informed consent wasgiven.

2. Recordkeeping. Even if the client isnot personally seen, recordkeepingis important. Be sure and keep suchrecords in a legible form. Rememberto document voicemail and print allE-mails.

If you are shifting your practiceto keep all records electronically, thesame rules apply with regard to main-tenance. Under 465.22 of the TexasAdministrative Code, you are re-quired to keep and maintain accurateand current records of all psychologi-cal services. The records and datashould be maintained and stored in away that permits review and duplica-tion. Also, remember that pursuant toboth the state law and theAdministrative Code, clients are enti-tled to access to their records regard-less of whether the records are keptelectronically or in paper form, orwhether or not the client is seen inperson.

3. Confidentiality. The duties of conf i -dent ia l i t y apply when there is a psy-chological patient relationship –whether the patient is seen in theoffice or in some other way. If you are

giving psychological advice or treat-ment, there is such a duty. Be surethat the system you design to com-municate with your patients is secure

and trustworthy. If the sessions arerecorded in some form, make certainthat the recordings are kept in a prop-er fashion.

4. Billing. It would be a good idea tocheck with all insurance carriers andto check on the requirements forMedicare and/or Medicaid bi l l ing tomake certain that the format and pro-cedures that you utilize for therapymeet the billing requirements.

These are only a very few of the legalquestions that you need to consider whenadapting your practice to available tech-nology. You should consult an attorneywith regard to all of the ethical prohibi-tions and reviews.

At a minimum, I would review theethical rules that you either have in youroffice or that can be found online on theThe Texas State Board of Examiners ofPsychologists web page which iswww.t sbep . s ta te . tx .u s / .

If you have any detailed questionsabout such issues, you can also join thetelephone consultation service by callingme at my office at 713-650-6600.

IT’S THE LAW Sam Houston, JD

TEXAS PSYCHOLOGIST

24 FALL 2005

This is the first of various articles entitled, “Psychology in

the Public Interest.” This column has been developed in order

to communicate psychological research and knowledge that

informs us about issues relevant to marginalized groups in soci-

ety. Doing so allows for us to convey key information to the

membership as a means of promoting human welfare, an

important part of TPA’s mission. Because this, as well as other

of the topics may be controversial in nature, it is important to

note the following disclaimer:

The information in the following article is provided by the author, with

consensus of the Social Justice Task Force, to facilitate analysis and discussion

of the issues presented. It is not intended to represent official policy of the Texas

Psychological Association or the opinions of its membership. The Texas

Psychological Association has not taken a position for or against the proposed

constitutional amendment on marriage. It is recognized that there are many

differences among our perspectives, and comments are invited.

Richard M. McGraw, PhD, TPA Social Justice TF Chair, and

Melba J.T. Vasquez, PhD, TPA President Elect

IIII n recent years, the issue of same-sex marriage has come under

increasing scrutiny by the courts, legislative bodies, the media, and

the general public. In June of 2003, the United States Supreme

Court struck down sodomy laws as unconstitutional in their Lawrence v.

Texas decision. In May of 2004, after the Commonwealth of

Massachusetts Supreme Judicial Court ruled that the ban on same-sex

marriage was unconstitutional, that state began issuing marriage licenses

to partners of the same sex. In the 2004 elections, measures banning

same-sex marriage passed in all 11 states that had them on the ballot. This

year, the Texas legislature passed a proposed constitutional amendment

banning same-sex marriage, which will go to voters in November.

On April 25, 2005 the Texas House of Representatives passed House

Joint Resolution 6 (HJR6) by a vote of 101 to 29, with eight members

voting “present.” Subsequently, on May 25, 2005, the Texas Senate passed

the resolution by a vote of 21 to 8. HJR6 would amend the Texas consti-

tution to define marriage as the union of one man and one woman (see

Table 1 for the full text of the resolution). On November 8,

2005, the proposed constitutional amendment will be sub-

mitted to voters to determine whether the amendment will

become part of the state constitution.

WWWWhhhhaaaatttt eeeeffffffffeeeecccctttt wwwwiiiillllllll tttthhhhiiiissss aaaammmmeeeennnnddddmmmmeeeennnntttt,,,, iiiiffff ppppaaaasssssssseeeedddd,,,, hhhhaaaavvvveeee

oooonnnn tttthhhheeee lllliiiivvvveeeessss ooooffff lllleeeessssbbbbiiiiaaaannnn,,,, ggggaaaayyyy,,,, aaaannnndddd bbbbiiiisssseeeexxxxuuuuaaaallll TTTTeeeexxxxaaaannnnssss

aaaannnndddd tttthhhheeeeiiiirrrr ffffaaaammmmiiiilllliiiieeeessss????

Many Texas families will be affected. According to

2000 US Census data, Texas has 21,740 cohabitating same-sex couples,

ranking fourth in number behind California, New York, and Florida

(Simmons & O’Connell, 2003). Texas also has a high number of same-

sex couples who are raising children. Indeed, according to 2000 Census

data, Harris and Dallas counties are in the top ten in the nation in terms

of number of same-sex couples raising children. Bexar, Tarrant, Travis,

and Hidalgo counties are also in the top 50 counties in the US in num-

ber of same-sex couples raising children (Bennett & Gates, 2004). It is

important to note that these figures are likely underestimates, as the data

were compiled only for individuals who indicated that they lived with a

“husband /wife” or “unmarried partner.” Some same-sex couples may not

identify as such on Census surveys.

The Government Accounting Office (2004) has identified 1,138

federal protections afforded by marriage. Opposite-sex married couples

are granted hospital visitation, social security benefits, family medical

leave, and tax benefits, to name a few. Though some of the protections

of marriage can be obtained through legal contracts, not all can be guar-

anteed. Moreover, resources are needed in order to attempt to put these

protections in place. This inequity puts an unfair burden on same-sex

couples and their families and many may not have access to the needed

resources.

Lesbian, gay, and bisexual individuals and their families are nega-

tively affected by legislation such as constitutional amendments. Not only

are they denied equal rights, but anti-gay politics have a negative effect on

the well-being of lesbian, gay, and bisexual individuals (Russell, 2004a).

The dialogue concerning same-sex marriage often calls into question the

mental stability of lesbian, gay, and bisexual persons, their effectiveness as

parents, and the validity of their identities. The debate around same-sex

The Proposed Constitutional AmendmentBanning Same-Sex Marriage in Texas

and How Psychology can Contribute to the DialogueBy Nathan Grant Smith, PhD

Texas Woman’s University

PSYCHOLOGY IN THE PUBLIC INTEREST

TEXAS PSYCHOLOGIST

FALL 2005 25

marriage and the often hostile rhetoric involved opens old wounds and

contributes to divisions within communities (Bullis & Bach, 1996).

WWWWhhhhaaaatttt ddddooooeeeessss tttthhhheeee ppppssssyyyycccchhhhoooollllooooggggiiiiccccaaaallll rrrreeeesssseeeeaaaarrrrcccchhhh hhhhaaaavvvveeee ttttoooo ssssaaaayyyy aaaabbbboooouuuutttt tttthhhheeee

iiiissssssssuuuueeee ooooffff ssssaaaammmmeeee----sssseeeexxxx mmmmaaaarrrrrrrriiiiaaaaggggeeee????

Research on same-sex relationships shows many similarities between

heterosexual and same-sex relationships. Many gay men and lesbians are

currently in committed relationships and a substantial number have been

in relationships over 10 years (e.g., Kurdek, 2003; Peplau & Spalding,

2000). Lesbian and gay couples report levels of relationship satisfaction

and commitment that are similar to those of heterosexual couples (e.g.,

Peplau & Beals, 2004). Likewise many of the challenges facing hetero-

sexual couples (such as intimacy, stability, etc.) are the same

challenges facing same-sex couples (e.g., Kurdek, 2004).

Similarly, research on the children of lesbian, gay, and

bisexual parents indicates comparable levels of adjustment

between children raised in opposite-sex and same-sex fami-

lies. Research has demonstrated no differences between the

effectiveness of lesbian, gay, and bisexual parents and their

heterosexual counterparts (e.g., Armesto, 2002; Patterson,

2000; Perrin, 2002; Tasker & Golombok, 1997). Claims

that the optimal environment for raising children is a heterosexual house-

hold have not been supported by empirical research. Moreover, research

on development of factors such as gender identity, sexual orientation,

personality, and self-concept reveals that children raised by lesbian, gay,

and bisexual parents are similar to children raised by heterosexual parents

(though most research is focused on lesbian mothers; Patterson, 2004;

Perrin, 2002; Stacey & Biblarz, 2001; Tasker, 1999). Given the large

numbers of children who are being raised in same-sex households (some

estimates are that there are over 1 million children in the nation being

raised by same-sex parents; Patterson & Friel, 2000; Perrin, 2002), deny-

ing legal rights to their parents will put many children at a disadvantage.

Despite the many similarities between same-sex and opposite-sex

couples and their children, there is growing consensus that discrimination

against lesbian, gay, and bisexual individuals is linked to negative behav-

ioral and mental health outcomes. The term “minority stress” has been

used to describe the stigmatizing and hostile environment lesbian, gay, and

bisexual individuals encounter on a daily basis (e.g., DiPlacido, 1998;

Meyer, 1995). Because of the stressful societal context of widespread dis-

crimination at the interpersonal, institutional, and socio-cultural levels,

lesbian, gay, and bisexual individuals are at increased risk for stress-related

psychological disorder. A recent meta-analysis found that lesbian, gay, and

bisexual individuals report higher levels of psychological disorder than do

their heterosexual counterparts (Meyer, 2003). However, there is wide-

spread agreement that these differences in psychological adjustment are

not attributable to homosexuality, per se (note that homosexuality was

removed from the Diagnostic and Statistical Manual of Mental Disorders

in 1973; American Psychiatric Association, 1973). These differences can

be explained by the stress of living in a stigmatizing environment.

Moreover, studies that have examined the direct effects of anti-gay dis-

crimination have found positive correlations between discrimination and

a number of negative psychological outcomes. For example, experiences of

anti-gay discrimination have been linked to depression, anxiety, psycho-

logical distress, suicidal ideation and behavior, and somatic symptom (e.g.,

Diaz, Ayala, Bein, Henne, & Marin, 2001; Meyer, 1995; Ross, 1990;

Smith & Ingram, 2004; Waldo, 1999). The experience of anti-gay dis-

crimination is common among lesbian, gay, and bisexual individuals.

National surveys have revealed that the majority of lesbian, gay, and bisex-

ual individuals have been the victim of sexual-orientation-related verbal

and physical attacks, stalking, and/or vandalism (Kaiser

Family Foundation, 2001; National Gay and Lesbian Task

Force, 1984).

To summarize, research on lesbian, gay, and bisexual

individuals and their families indicates that this group tends

to be as healthy and well-adjusted as their heterosexual

counterparts. However, discrimination can lead to psycho-

logical problems; and lack of legal recognition can put fam-

ilies at risk. Moreover, discriminatory laws contribute to the

stigmatizing environment faced by lesbian, gay, and bisexual individuals,

and perpetuate the societal status quo of oppression.

Psychology as a field can contribute significantly to the dialogue on

same-sex marriage and the civil rights of lesbian, gay, and bisexual indi-

viduals. Our expertise in mental health and our ethical commitments to

justice and respect for people’s rights (American Psychological

Association, 2002) equip us with the tools to effect pro-social change.

Concrete ways to effect change have been discussed by several writers

(see, for example, Russell, 2004b and Stevenson & Cogan, 2003). By

using our skills as psychologists and working together to share our expert-

ise, we can help to ensure the health of all Texans and their families.

TEXAS PSYCHOLOGIST

26 FALL 2005

RRRReeeeffffeeeerrrreeeennnncccceeeessss

American Psychiatric Association (1973). Diagnostic and statistical manualof mental disorders (2nd ed.). Washington, DC: Author. American Psychological Association (2002). Ethical principles of psycholo-gists and code of conduct. American Psychologist, 57, 1060-1073.Armesto, J. C. (2002). Developmental and contextual factors that influencegay fathers’ parental competence: A review of the literature. Psychology ofMen and Masculinity, 3, 67-78. Bennett, L., & Gates, G. J. (2004). The cost of marriage inequality to chil-dren and their same-sex parents. Washington, DC: Human RightsCampaign.Bullis, C., & Bach, B. W. (1996). Feminism and the disenfranchised:Listening beyond the “other.” In E. B. Ray (Ed.), Communication and dis-enfranchisement: Social health issues and implications (pp. 3-28). Mahwah,NJ: Lawrence Erlbaum.Diaz, R. M., Ayala, G., Bein, E., Henne, J., & Marin, B. V. (2001). Theimpact on homophobia, poverty, and racism on the mental health of gay andbisexual Latino men: Findings from 3 US cities. American Journal of PublicHealth, 91, 927–932.DiPlacido, J. (1998). Minority stress among lesbians, gay men, and bisexu-als: A consequence of heterosexism, homophobia, and stigmatization. In G.M. Herek (Ed.), Stigma and sexual orientation (pp. 138-159). ThousandOaks, CA: Sage.Government Accounting Office (2004). Defense of marriage act: An updateto prior report. Washington, DC: Author. Kaiser Family Foundation. (2001). Inside-OUT: A report on the experiencesof lesbians, gays, and bisexuals in America and the public’s views on issuesand policies related to sexual orientation. Menlo Park, CA: Author.Kurdek, L. A. (2004). Are gay and lesbian cohabitating couples really differ-ent from heterosexual married couples? Journal of Marriage & Family, 66,880-900.Kurdek, L. A. (2003). Differences between gay and lesbian cohabitating cou-ples. Journal of Social Personal Relationships, 20, 411-436.Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay,and bisexual populations: Conceptual issues and research evidence.Psychological Bulletin, 129, 674-697.Meyer, I. H. (1995). Minority stress and mental health in gay men. Journalof Health Sciences and Social Behavior, 36, 38–56.National Gay Task Force. (1984). Anti-gay/lesbian: A study by the NationalGay Task Force in cooperation with lesbian organizations in eight U. S. cities.Washington, DC: Author.Patterson, C. J. (2000). Family relationships of lesbians and gay men. Journalof Marriage and Family, 62, 1052-1069. Patterson, C. J. (2004). Gay fathers. In M. E. Lamb (Ed.), The role of thefather in child development (4th Ed.). New York: John Wiley. Patterson, C. J., & Friel, L. V. (2000). Sexual orientation and fertility. In G.Bentley & N. Mascie-Taylor (Eds.), Infertility in the modern world:Biosocial perspectives (pp. 238 - 260). Cambridge: Cambridge UniversityPress.Peplau, L. A., & Beals, K. P. (2004). The family lives of lesbians and gay men.In A. L. Vangelisti (Ed.), Handbook of family communication (pp. 233-248). Mahway, NJ: Erlbaum.Peplau, L. A., & Spalding, L. R. (2000). The close relationships of lesbians,gay men, and bisexuals. In C. Hendrick & S. S. Hendrick (Eds.), Close rela-tionships: A sourcebook (pp. 111-123). Thousand Oaks: Sage.Perrin, E. C., & the Committee on Psychosocial Aspects of Child and FamilyHealth (2002). Technical Report: Coparent or second-parent adoption bysame-sex parents. Pediatrics, 109, 341-344. Ross, M. W. (1990). The relationship between life events and mental health

TTTTaaaabbbblllleeee 1111:::: TTTTeeeexxxxtttt ooooffff TTTTeeeexxxxaaaassss HHHHoooouuuusssseeee JJJJooooiiiinnnntttt RRRReeeessssoooolllluuuuttttiiiioooonnnn 6666

(Retrieved August 15, 2005 from http://www.capitol.state.tx.us)

A JOINT RESOLUTION proposing a constitutional amend-ment providing that marriage in this state consists only of theunion of one man and one woman.

BE IT RESOLVED BY THE LEGISLATURE OF THESTATE OF TEXAS:

SECTION 1. Article I, Texas Constitution, is amended byadding Section 32 to read as follows:

Sec. 32. (a) Marriage in this state shall consist only of theunion of one man and one woman.

(b) This state or a political subdivision of this state may notcreate or recognize any legal status identical or similar to marriage.

SECTION 2. This state recognizes that through the designa-tion of guardians, the appointment of agents, and the use of privatecontracts, persons may adequately and properly appoint guardiansand arrange rights relating to hospital visitation, property, and theentitlement to proceeds of life insurance policies without the exis-tence of any legal status identical or similar to marriage.

SECTION 3. This proposed constitutional amendmentshall be submitted to the voters at an election to be heldNovember 8, 2005. The ballot shall be printed to permit votingfor or against the proposition: “The constitutional amendmentproviding that marriage in this state consists only of the union ofone man and one woman and prohibiting this state or a politicalsubdivision of this state from creating or recognizing any legal sta-tus identical or similar to marriage.”

in homosexual men. Journal of Clinical Psychology, 46, 402–411.Russell, G. M. (2004a). The dangers of a same-sex marriage referendum forcommunity and individual well-being: A summary of research findings.Angles: The Policy Journal of the Institute for Gay and Lesbian StrategicStudies, 7 (1), 1-4.Russell, G. M. (2004b). Surviving and thriving in the midst of anti-gay pol-itics. Angles: The Policy Journal of the Institute for Gay and Lesbian StrategicStudies, 7 (2), 1-7.Simmons, T., & O’Connell, M. (2003). Married-couple and unmarried part-ner households: 2000. Retrieved August 15, 2005, from US Census BureauWeb site: census.gov/prod/2003pubs /censr-5.pdf.Smith, N. G., & Ingram, K. M. (2004). Workplace heterosexism and adjust-ment among lesbian, gay, and bisexual individuals: The role of unsupportivesocial interactions. Journal of Counseling Psychology, 51, 57-67. Stacey, J., & Biblarz, T. J. (2001). (How) does sexual orientation of parentsmatter? American Sociological Review, 65, 159-183.Stevenson, M. R., & Cogan, J. C. (Eds.) (2003). Everyday activism: A hand-book for lesbian, gay, and bisexual people, and their allies. New York:Routledge. Tasker, F. (1999). Children in lesbian-led families: A review. Clinical ChildPsychology and Psychiatry, 4, 153-166.Tasker, F., & Golombok, S. (1997). Growing up in a lesbian family. NewYork: Guilford Press. Waldo, C. R. (1999). Working in a majority context: A structural model ofheterosexism as minority stress in the workplace. Journal of CounselingPsychology, 46, 218–232.

MEMBERSHIP APPLICATIONPlease fill this out and send it immediately! Send to: Texas Psychological AssociationFax # 512-476-7297 1005 Congress Ave., Ste 410 Austin, TX 78701

First Name: ________________________________________ Last Name: ______________________________________________ Degree: ______________________

TPA Membership (Select one)______ Member (PhD earned more than two years ago) $275.00 ______ Associate (Earned Master’s more than two years ago) $125.00______ New Member (no previous TPA membership; must have PhD) $137.50 ______ Associate Out-of-State (Master’s, resides outside of Texas) $ 62.50______ Member Out-of-State (PhD, resides outside of Texas) $137.50 ______ Recent Graduate Associate (Master’s within past two years) $ 62.50______ Recent Graduate Member (PhD within past two years) $137.50 ______ Student (Must provide signature below) $ 30.00

Texas Psychological Foundation - Tax Deductible (Optional) Texas Psychological Association Political Action Committee (Optional)___Centennial Member $1000.00 ______ Platinum Member $1000.00___Member $ 500.00 ______ Gold Member $500.00___Contributor $100.00 ______ Silver Member $250.00___Contributor $ 50.00 ______ Member $100.00

______ Other $_____

Total $________ Method of Payment: ___Check ___M/C ___Visa ___American Express ___DiscoverCredit Card # ________________________________________________________________ Security Code __________ Expires____________________________Signature__________________________________________________________________________________________________________________________________

Answers to the following questions are required for membership. Please attach a detailed explanation for any affirmative answers.1. Has your license/certification been suspended, revoked, or limited in the last 12 months by a state licensing board? ___Yes ___No2. Have you been convicted of a felony during the past year? ___Yes ___No3. Have you been found guilty of unethical or unprofessional conduct by a local, state or national ethics committee, professional organization or licensing board during the pastyear? ___Yes ___No4. Have you been found guilty of malpractice during the past year? ___Yes ___NoHome Address, City, State, Zip_____________________________________________________________Phone#_________________Business Address, City, State, Zip__________________________________________________________Phone#__________________Fax_______________________ Email Address________________________________________________________

Divisions/Special Interest Groups (Check all that apply) NO ADDITIONAL CHARGE______ Psychopharmacology Division ____ Psychology of Diversity SIG ______ Psychologists in Schools SIG______ Psychology of Women Division ____ Gay-Lesbian-Bisexual-Transgender Issues SIG ______ Mental Retardation/Developmental Disabilities SIG______ Forensic Practice Division ____ Child/Adolescent Issues SIG ______ Binational SIG______ Aging Division

Ethnicity__ American Indian or Alaskan Native__ Asian-American or Pacific Islander__ Black/African American__ Chicano/Mexican American__ Puerto Rican__ Other Hispanic/Latino__ White/Caucasian__ Other (Specify)

Primary Employment Setting__ Public School (K-12)__ Private School (K-12)__ Medical/Surgical Hospital__ Psychiatric Hospital__ Private Practice__ State-Funded Institution__ Federally-Funded Institution__ College/University__ Other

Primary Position__ School Psychologist – LSSP (Doctoral)__ Associate School Psychologist – LSSP (masters)__ Psychological Associate__ Clinical Psychologist__ College/University Trainer__ Consultant__ Counseling Psychologist__ Sports Psychologist__ Other

Primary Areas of Interest__ Private Practice__ School__ Industrial/Organizational__ Academia/Research__ Public Service__ Families__ Prevention__ Neuropsychology__ Geriatrics__ Other

If you are a student applicant, you must provide evidence that you continue to be enrolled in a graduateor undergraduate program in Psychology by having a faculty member sign below. Alternatively, you maysubmit a copy of your most recent paid tuition receipt:Faculty Signature ______________________________________________ Date__________________University __________________________________________________________________________

Gender__ Male __ Female

Doctoral MembersMike Brooks, PhDVera Gill, PhDArthur Joyce, PhDGinger Kinsey, PhDRose McDonald, PsyDJames McLaughlin, PhDMary Powell, PhDRobyn Reed, PhDRussel Thompson, PhD

Associate MembersLeah Getz, MACharlotte Jensen, MA

Student MembersRuben Aguirre James Bolton Michelle Cearley Sonya Cornwell Grace Dean, BATamara DeHay, BAJared Dempsey, MANeetha Devdas Clare Duffy Steven Gonzalez, ABDDebbie Gram, MAElisabeth Hyland Charlotte Johnson, MS

Lisa Kan

Joanna Malach

Ryon McDermott, BA

Jennifer McGinty

Elizabeth Otenaike

Kim Roaten, MS

Kelly Robinson

Robert Seals

Richard Sechrest

Anna Thomison, BAChristina Torti, MA

TEXAS PSYCHOLOGIST

28 FALL 2005

2005 PSY-PAC CONTRIBUTORS

$1000 or morePaul Burney, PhD

$300-999Richard Fulbright, PhDDean Paret, PhDMichael C. Pelfrey, PhD

$100-299Barbara Alford, PhDMary Alvarez-del-Pino, PhDJudith Norwood Andrews, PhDLarry Aniol, PhDHoward Atkins, PhDKyle Babick, PhDMargaret Berton, PhDNicole Bodor, PhDMalcolm Bonnheim, PhDBonnie Brookshire, PhDKing Buchanan, PhDSam Buser, PhDJavier Carrillo, PhDBetty Cartmell, PhDFrankie Clark, PhDP. Andrew Clifford, PhDRon Cohorn, PhDJim Cox, PhDMary Cox, PhDWalter Cubberly, PhDCaryl Dalton, PhDMary De Ferreire, PhDMichael Duffy, PhD, ABPPAnette T. Edens, PhDWayne Ehrisman, PhDPatrick J. Ellis, PhDJohn V. Elwood, PsyDRichard Ermalinski, PhDRonald Garber, PhDAdrienne (Ann) Gardner, PhDBonny Gardner, PhDUri Gonik, PhDCheryl L. Hall, PhDT. Walter Harrell, PhDJames Ray Harrison, PhDDavid B. Hensley, PhDRobert M. Hochschild, PhDJerry Hutton, PhDSheila Jenkins, PhDRonald J. Jereb, PhDMorton L. Katz, PhDMartha J. Kennedy, PhDBurton A. Kittay, PhDChristopher L. Klaas, PhDKenneth Kopel, PhD

Franklin D. Lewis, PhDMarcia Lindsey, PsyDArthur Linskey, PhDStephen Loughhead, PhDAnn Matt Maddrey, PhDDwayne D. Marrott, PhDRebecca Marsh, PsyDRaul Martinez, PhDSam Marullo, PhDCatherine Matthews, PhDElizabeth Maynard, PhDStephen P. McCary, PhD, JDRichard M. McGraw, PhDSherry McKinney, PhDBrenda S. Meeks, PhDRobert W. Mims, PhDLee L. Morrison, PhDLane Ogden, PhDSherry L. Payne, PhDFrancisco I. Perez, PhDRandy E. Phelps, PhDRobin Reamer, PhDElizabeth L. Richeson, PhDDavid M. Sabine, PhDKatie D. Salas, PhDLeigh S. Scott, PhDOllie Seay, PhDRobbie Sharp, PhDBrian Stagner, PhDConstance J Turner, PhDMelba Vasquez, PhDDavid Wachtel, PhDColleen A. Walter, PhDDavid J. Welsh, PhDM. Wright Williams, PhDConnie S. Wilson, PhDJohn W. Worsham, PhDMimi Wright, PhD

Less than $100Brian Carr, PhDPeter Cousins, PhDSylvia Gearing, PhDGuillermo E. Gonzalez, Jr., PhDB. Thomas Gray, PhDCharles Kluge, PhDCharles McDonald, PhDKermit Parker, PhDVerlis L. Setne, PhDLaura Spiller, PhDDavid R. Steinman, PhDPatricia D. Weger, PhD

2005 NEW MEMBERSMay 31 through September 1, 2005

TEXAS PSYCHOLOGIST

FALL 2005 29

2005 TPF CONTRIBUTORS

$100 or moreCaryl Dalton, PhDPatrick J. Ellis, PhDRonald Garber, PhDJerry Hutton, PhDCatherine Matthews, PhDElizabeth D. Richardson, PhDRobbie Sharp, PhDDavid Wachtel, PhDManuel Ramirez, PhDSam Buser, PhD

Less than $100Peter Cousins, PhD, ABPPWayne Ehrisman, PhDB. Thomas Gray, PhDRonald J. Jereb, PhDLaura Spiller, PhD

Less than $100Dorothy C. Pettigrew, PsyDWilliam Randy Frazier, PhDRichard Fulbright, PhDLaura Spiller, PhDWilliam M. Erwin, PhDCarol Grothues, PhDDwayne D. Marrott, PhDLeigh S. Scott, PhDNeil B. Holliman, PhDMichelle Lurie, PsyDRobin Binnig, PhDSam Buser, PhDDaniel Corley, PhDRichard E. Eckert, PhDRobert M. Hochschild, PhDRonald J. Jereb, PhDMorton L. Katz, PhDBurton A. Kittay, PhDRichard M. McGraw, PhDLee L. Morrison, PhDGary Neal, PhDDeborah Rabeck, PhDRobbie Sharp, PhDJeffrey C. Siegel, PhDEdward Silverman, PhDJules Weiss, EdDBurton J. Zung, PhDThomas Johnson, PhDMary Burnside, PhDMarcia Lindsey, PsyDPatricia Perrin, PhD

2005 SUNRISE CONTRIBUTORS

GOut TPA’s Member Benefits!* Are you in the market for pppprrrrooooffffeeeessssssssiiiioooonnnnaaaallll lllliiiiaaaabbbbiiiilllliiiittttyyyy iiiinnnnssssuuuurrrraaaannnncccceeee? Call TPA's preferred vendor, American Professional

Agency, 800-421-6694. Renewal reduction when you attend one of Eric Marine's workshops at the Annual Convention!* DDDDiiiissssccccoooouuuunnnntttteeeedddd CCCCrrrreeeeddddiiiitttt CCCCaaaarrrrdddd PPPPrrrroooocccceeeessssssssiiiinnnngggg: Affiniscape Merchant Solutions 800-644-9060, ext. 225.* DDDDiiiissssccccoooouuuunnnntttteeeedddd LLLLeeeeggggaaaallll CCCCoooonnnnssssuuuullllttttaaaattttiiiioooonnnn SSSSeeeerrrrvvvviiiicccceeee: Sam A. Houston 713-650-6600.* FFFFeeeeeeee CCCCoooolllllllleeeeccccttttiiiioooonnnn SSSSeeeerrrrvvvviiiicccceeee: I.C. System 800-325-6884.* PPPPssssyyyycccchhhhoooollllooooggggiiiisssstttt oooonnnn ssssttttaaaaffffffff:::: Director of Professional Affairs (Robert McPherson, PhD) is available part-time to answer

member questions and requests for information concerning professional affairs, including, but not limited to, ethics,insurance/managed care, practice management 512-280-4099.

* SSSSuuuubbbbssssccccrrrriiiippppttttiiiioooonnnn ttttoooo tttthhhheeee Texas Psychologist: Your quarterly journal is designed to provide with the most current informa-tion about professional news and practice changes in the state.

* CCCCoooonnnnttttiiiinnnnuuuuiiiinnnngggg EEEEdddduuuuccccaaaattttiiiioooonnnn: We offer both live and home study at substantially discounted member rates.* LLLLiiiisssstttt sssseeeerrrrvvvveeee ssssuuuubbbbssssccccrrrriiiippppttttiiiioooonnnn for timely updates. (Be sure TPA has your current email address!)

$100 or moreJudith Norwood Andrews, PhDAnthony Arden, PhDJana Assenheimer, PhDJames Berkshire, Ed.D.Corwin Boake, III, PhDPaul Burney, PhDGloria Chriss, PhDAlexandria H. Doyle, PhDWayne Ehrisman, PhDDavid B. Hensley, PhDCarola Hundrich-Souris, PhDStephen P. McCary, PhD, JDManuel Ramirez, PhDElizabeth L. Richeson, PhDBrian Stagner, PhDRichard Wheatley, PhDKenneth F. Wise, PsyDJohn W. Worsham, PhDSean Connolly, PhD

TEXAS PSYCHOLOGIST

30 FALL 2005

TPA

Inside

The APA recognized JJJJaaaammmmeeeessss HHHH.... BBBBrrrraaaayyyy,,,, PPPPhhhhDDDD with severalawards at their Annual Convention: Fellow of the Division ofState Psychological Association Affairs for his outstanding contri-butions to psychology, Presidential Citation from the Division ofMedia Psychology for invaluable service and dedication to thegrowth and success of the division, and Certificate ofAppreciation from the Division of Family Psychology for contri-butions as Council representative 2000-2005. In addition, hereceived the Faculty Teaching Award for 2004-2005 from theDepartment of Family and Community Medicine, Baylor Collegeof Medicine, in Houston.

JJJJeeeennnnnnnniiiiffffeeeerrrr IIIImmmmmmmmiiiinnnngggg,,,, PPPPhhhhDDDD is excited to announce the open-ing of her private practice! You may find her new contact infor-mation at www.drjenniferimming.com.

CCCChhhhaaaarrrrllllooootttttttteeee MMMM.... KKKKiiiimmmmmmmmeeeellll,,,, PPPPhhhhDDDD is being promoted to FellowStatus with the American Association on Mental Retardation(AAMR) at their annual conference in Washington DC onSeptember 21. AAMR Fellows must have made a meritoriouscontribution to the field of mental retardation through theiremployment, research, or years of service to persons with mentalretardation. Dr. Kimmel has worked in the field of mental retar-dation for 30 years and has made numerous presentations at local,regional, state, national, and international conferences. In addi-tion, she has several research papers that have been published inrelated journals. Dr. Kimmel currently is the Director of

Classified AdvertisingAustin group looking for a colleague! Come join an existing group of solo practitioners with a minimum of 10 yearseach in private practice. Very nice office in central Austin available October 2005, complete with support staff.Pleasant atmosphere with well-established professionals. This is a wonderful opportunity to establish or expand apractice in Austin with the possibility for referrals. 512-454-3685 ext 21.

North Texas State Hospital is recruiting highly skilled and motivated Doctoral Psychologists for its GeneralPsychiatric programs, Wichita Falls campus, and Forensic programs, Vernon campus. Responsibilities: assessment,treatment and consultation services. Competitive salary and great benefits. Proximity to DFW; cutting-edge psy-chiatric hospital practice. An Equal Opportunity/Drug Free Workplace. For additional information, contact MichaelJumes, PhD 940-552-4140 or michael.jumes@dshs.state.tx.us or visit http://jobs.hhsc.state.tx.us.

Expanding interdisciplinary private group practice seeks a Texas licensed Psychologist, must have experience inworking with children school age to adolescents. Located in a prominent part of Houston, the office has a veryattractive setting. Very little managed care/emergency work. Forward resumes by fax: 713-621-7015 or email:john@tarnowcenter.com.

Psychology Services at Mexia State School which serves juvenileand adult offenders with mental retardation who have been deter-mined incompetent to proceed to trial.

TPA member SSSStttteeeepppphhhheeeennnn LLLLoooouuuugggghhhhhhhheeeeaaaadddd,,,, PPPPhhhhDDDD co-producedwith Christina McGhee, MSW a video for children of divorce.Released in January 2005, Lemons 2 Lemonade has already gainedthe respect of parents and divorce professionals everywhere.Lemons 2 Lemonade was recently honored with both a BronzeTelly Award in the 26th Annual Telly Awards competition and aniParenting Media Award in their 2005 Outstanding ProductsCall.

SSSSccccooootttttttt PPPPoooollllaaaannnndddd,,,, PPPPhhhhDDDD has retired from many years as theDirector of Psychological Services for Cy-Fair ISD and has movedto Florida. Scott accepted a position as the School PsychologyProgram Administrator at NOVA Southeastern University inFort Lauderdale.

KKKKiiiimmmmbbbbeeeerrrrllllyyyy LLLL.... vvvvaaaannnn WWWWaaaallllssssuuuummmm,,,, PPPPhhhhDDDD (Texas A&M - CollegeStation, 2005) has taken the position of Educational Director ofClinical Simulation at Scott & White Memorial Hospital/TexasA&M University System Health Science Center/College ofMedicine in Temple, Texas. She will be involved in designingmedical education and research using high fidelity human simu-lators and standardized patients, in collaboration with physicianand other health professional colleagues.

Imagine getting all of your CE Credits in one place in just a few days! Withthe many choices available to you, you can catch up on the latest researchin your field, find out what regulations and laws will change the wayyou do business, and receive the Continuing Education you need foryour professional excellence, including many options for Ethics CE cred-

its. In addition, you will enjoy stimulating exchanges with your peers, make newcontacts and renew your commitment to your profession. The TPA Convention is theonly way to accomplish all this at one time, in one place, right here in Texas.

Take a look at www.texaspsyc.org for all the workshop listings. Then register forthe convention right online and make your hotel reservation at the same time. The

2005 TPA Annual Convention will be hosted by the elegant Hyatt Regency Hotel inHouston. Just click the hotel link on our website to receive the convention rate of$139, or call 713-654-1234 and mention that you will be attending the TPAConvention.

With more than 140 workshops, research papers, posters and more, this is anevent you can’t afford to miss.

New HorizonsNew Horizonsfor Texas Psychologyfor Texas Psychology2005 TPA Annual Convention

November 3-5, 2005Hyatt Regency Hotel

Houston, Texas

See you in Houston!See you in Houston!

PRESORTEDSTANDARD

U.S. POSTAGE PAIDAUSTIN, TEXAS

PERMIT NO. 1149