Vol. 59, No. 4
The North Carolina
Psychologist
North Carolina Psychological Association
Fall Conference a CE Blockbuster
The lineup for the NCPF/NCPA Fall Continuing Education Conference provides a
blockbuster educational opportunity for
psychologists and other mental health professionals in North Carolina. The conference will
be held Friday and Saturday, October 5 and 6
at the Friday Center in Chapel Hill.
Prolonged Exposure Therapy for PTSD
On Friday, Elizabeth A. Hembree, Ph.D.,
assistant professor of psychology in psychiatry, University of Pennsylvania, will present
on Facilitating the Emotional Processing
of Traumatic Experiences: Prolonged Exposure Therapy for Posttraumatic Stress
Disorder.
Chronic posttraumatic stress disorder
(PTSD) is an often complex and challenging
disorder for clinicians to treat. But with a
lifetime prevalence of 8% of the population,
many clinicians see a sizable number of
clients with PTSD and other trauma-related
pathology.
The workshop will begin with a presentation of the background theoretical
and empirical work underlying prolonged
exposure (PE). Studies investigating the
efficacy of PE and other forms of cognitive
behavioral treatments will be described.
Dr. Hembree will then present an overview
of the PE treatment program, followed by
a more in-depth description of the core
components of the treatment: imaginal and
in-vivo exposure. These procedures will be
In This Issue
ACT Therapy . . . . . . . . . . . . . . . . . . . . . page 3
Profile: Tad Clodfelter. . . . . . . . . . . page 5
Resiliency at Virginia Tech . . . . . .page 6
Authority Training. . . . . . . . . . . . . .page 8
Integrated Primary Care . . . . . . . page 13
illustrated with excerpts from videotapes
of PE treatment sessions with clients who
have authorized the use of their treatment
tapes in professional trainings. The workshop will provide guidelines for assessment
strategies and decision-making regarding
when to consider using PE with a trauma
survivor.
Dr. Hembree is the director of training
and the director of the rape and crime
victims program at the Center for the Treatment and Study of Anxiety. Dr. Hembree’s
primary interest and area of specialization is
the investigation and dissemination of cognitive behavioral treatments for PTSD. She
is the principal investigator of an on-going
NIMH-funded study that aims to examine
the effectiveness of cognitive behavioral
treatments for women with assault-related
PTSD at two local community agencies.
Dr. Hembree has provided treatment to
many individuals with PTSD and other anxiety disorders over the years and has trained
numerous clinicians in the use of manualized treatment for anxiety disorders.
Neurofeedback and Applied Neuroscience
The second Friday presenter is NCPA
member Ed Hamlin, Ph.D. who will present
on the topic Tune Your Brain: An Introduction to Neurofeedback and Applied
Neuroscience.
The last two decades have produced an
explosion of knowledge about the brain and
its functioning. We are beginning to understand the brain mechanisms and dynamics
underlying many cognitive and emotional
disorders, and this increased understanding
is leading to new and exciting treatments
for many problems confronting people.
EEG biofeedback, or neurofeedback as it is
more commonly called, has been shown to
be effective in treating a number of diagnostic conditions. Neurofeedback meets
clinical guideline criteria established by the
American Academy of Child and Adolescent
continued on page 4
Members of the NCPA Task Force on Education
and Training Leading to Licensure pose at
their first meeting in May, 2007. Back row
left to right are Dr. Elizabeth Huddleston,
Dr. Susan Keane, Ms. Lauren Reba-Harrelson,
Dr. David Hattem, Dr. Ken Whitt. Front row
left to right are Dr. Mitch Prinstein, Co-Chair
Dr. Erica Wise, Co-Chair Dr. John Curry, and
Dr. John Esse. The Task Force is exploring
implementation of the APA Resolution on
Training Leading to Licensure.
MH Parity Passes in NC!!!
It was an historic moment in the North
Carolina General Assembly in July when
House Bill 973 - Equitable Coverage for
Mental Illness passed both the House and
Senate. As of this writing, the bill is awaiting signature by the Governor. Rep. Martha
Alexander (D-Mecklenburg) sponsored the
bill and has been a champion of mental
health and substance abuse parity for all of
her eight terms in the legislature. While this
bill does not include coverage for substance
abuse, it is a huge step forward for persons
needing treatment for mental illness.
The bill provides full parity for nine diagnoses - bipolar disorder, major depressive
disorder, obsessive compulsive disorder,
paranoid and other psychotic disorder,
schizoaffective disorder,schizophrenia,posttraumatic stress disorder, anorexia nervosa
and bulimia. All other diagnoses are covered
at financial parity–meaning that deductibles,
coinsurance factors,co-payments,maximum
out-of-pocket as well as annual and lifetime
continued on page 12
JULY–AUGUST
2007
1
July–August 2007
The North Carolina Psychologist
from the
president
Dave Wiesner, Ph.D.
As I write my first column as President
of NCPA, I am consumed with gratitude towards members who voted to support me
in this journey. I feel honored to represent
and head the Association.
As your new association President, I feel
a need to tell you more about my leadership
style and experience. Many may evaluate
my leadership by examining outcomes
throughout the next year, but it is important
that you know my leadership style from the
start to get the most benefit and have the
most fruitful outcome.
Leadership Style
My experiences as a leader go back to my
first job during high school. After six months
working at a McDonald’s restaurant at the
age of 16, I was promoted to swing manager. This position, with authority to hire
and fire, proved to be a challenge. At that
point, I did not know what type of leader I
would be and questioned whether anyone
would listen to what I told them to do. I
soon found myself functioning as a type of
“player-coach”, working as part of the team
while structuring experiences to facilitate
the sharing of ideas, problem solving, and
settling of disputes. This leadership style
followed me into my professional life in two
administrative roles.
In my roles as area manager of the community mental health centers in Little Rock,
AR and as administrator of one of the largest DD service providers in North Carolina,
I continued to function as a leader while
learning more about management styles and
leadership. Over the years those skills have
been refined. Today I hope those skills will
prove helpful to NCPA members and the
practice of psychology in North Carolina.
Collective Enterprise
As a leader I have tried to empower others, believing that knowledge and wisdom
is not isolated to a few, but results from
The North Carolina Psychologist
2
July–August 2007
the collective. To minimize the power differential between “members” and “leaders”
in real or perceived ways allows all to be
heard, involved, utilized, and valued. I will
be working to allow your voice to be heard,
to respect your ideas, to value your efforts,
and to recognize your contributions.
To increase communication we will
continue the great tradition of Executive
Committee outreach meetings. During the
next year, I am pleased to announce that
there will be four meetings: in Wilmington,
Charlotte, Boone, and Asheville. I encourage
you to voice your needs, ideas, praise, and
criticism at the meetings. Another way to
let your ideas be known is to communicate
with your regional representative, who will
share your thoughts with the Board. Of
course, you can always share your ideas
with me as well.
Other efforts to meet the needs of our
members will take place. I will call 10
members each month to share information
and solicit feedback. In continuation of
support of newer members, an Early Career
Psychologist Task Force will be formed to
address the needs of psychologists who
are newly licensed. New developments in
the Colleague Assistance Program embrace
a preventative model that makes the work
of this new committee applicable to all
members. The task of helping psychologists to be more resilient and more aware
of factors that can negatively affect their
judgment is needed and beneficial to all. As
your new president of NCPA, I look forward
to your involvement in these efforts and
other work.
NCPA’s 60th Year
We have an association that has made
significant changes in areas that affect psychologists and consumers of psychological
services. We have an effective and wellrespected staff and we are highly regarded
within the state and outside our borders. I
appreciate your membership in this association. You have chosen NCPA, supported it
financially with your dues, invested your
time, and committed yourselves to its mission. I will do what I can to remove barriers
and enhance your contributions to this great
organization.
Let’s make the 60th year of NCPA in 2008
the best yet! 왕
The North Carolina Psychological Association
The North Carolina Psychologist is published six times per year.
Items for the newsletter may be sent to: NCPA, 1004 Dresser Court,
Suite 106, Raleigh, NC 27609, Fax 919/872-0805. Phone 919/872-1005.
E-mail [email protected].
EDITOR Jennifer L. Strauss, Ph.D., HSRD (152), Durham VAMC,
508 Fulton St., Durham, NC 27705. 919/286-0411, ext. 5275.
E-mail [email protected].
PRODUCTION EDITORS Sally R. Cameron, Executive Director,
N.C. Psychological Association; and Jane Moseley, Administrative Assistant.
ASSOCIATE EDITORS
Neil Barry, Ph.D., 1024 West South St., Raleigh, NC 27603. 919/847-6699.
Angela Enlow, M.A., 2102 Walnut Creek Road, Marshall, NC 28753. 803-318-2133.
Betsy Kimrey, Ph.D., 629 Oberlin Road, Raleigh, NC 27605. 919/828-7217.
Suzanne G. Martin, Psy.D., 155 Page Road, Pinehurst, NC 28374. 910-603-8666.
Richard L. Ogle, Ph.D., 465 Baytree Road, Wilmington, NC 28409. 910-962-7753.
Jennifer A. Snyder, Ph.D., 615 Nantahala Dr., Durham, NC 27713. 919/575-2445.
The North Carolina Psychologist
is sent free of charge to NCPA
members. The charge for a nonmember (not eligible for NCPA
membership) subscription is $15
per year. Change of address notices should be sent to the NCPA
office. Classified and display advertisements are published subject to approval. Rates for display
ads (submitted in camera-ready
form) are $350 for full-page,
$175 for half-page, and $125 for
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charged at the rate of $8 per line.
Acceptance for advertising does
not imply endorsement by NCPA.
Opinions expressed in The North
Carolina Psychologist should not
be considered as being endorsed
by the NCPA.
Acceptance and Commitment Therapy: Old Wine
in a New Bottle?
to the spoken word. Suppose the child gets bitten by a dog, cries
and runs away. Days later the child hears his mother say,“Oh look,
a dog,” and the child emits the same response even though that
child was never bitten in the presence of the words “Oh look, a
s an academic and a private practitioner, I find studying
dog.” Throughout life, events (internal and external) become related
new psychotherapies an interesting experience. When
through derivation, not experience, and these relations are applied
wearing an academic’s hat, I am excited and enthralled by
to new contexts. This allows people to talk and think about things
sifting through the relevant literature and critiquing the theory
that aren’t present, to compare possible outcomes, and then have
and techniques with a perspective only maintained by the view
these verbal relationships alter how analyzed events function.
from an ivory tower. When wearing the hat of a practitioner, I find
Through this process, language and cognition develop, not only
myself sitting through CE seminars hoping against another case
allowing individuals to successfully adapt, but also to suffer.
of old wine in new bottles so I can be of more help to my clients.
ACT: Theory of Psychopathology
About two years ago, I was reading about Acceptance and CommitPsychopathology is a result of psychological inflexibility. Three
ment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999). At one point,
factors lead to inflexibility: (1) the
the authors described the differences
ubiquity of pain; (2) cognitive fusion;
between ACT and CBT and I thought,“I
and (3) experiential avoidance.
don’t actually do CBT, this is what I do.”
Pain is unavoidable. Humans are
Since then I have been trying to figure
Change
occurs
through
innaturally
attuned to aversive stimulaout if I have learned something new, or
tion. Relational framing increases the
if I am merely blinded by the sparkling
creased psychological flexibility,
reach of experienced aversive events.
glare of a fancy new bottle.
not through changing the content
These events can be reconstructed in
ACT is a behavior therapy that emany context, even those contradictory
braces tenets of traditional behavioral
or form of one’s thoughts or bein form. A dog that is kicked by a large
and cognitive therapies, and integrates
haviors. ACT describes a number
man may later whimper at the sight of
“new” elements as well. ACT has three
of different processes by which
him, or those resembling him. A hugoals: (1) acceptance of unwanted
man experiencing the same event may
thoughts and feelings (as opposed to
change occurs, but each can be
respond similarly, but may, at the sight
changing thoughts and feelings); (2)
combined
into
three
processes:
of a happy couple or a special occasion,
commitment toward a valued life; and
think,“I used to be happy before I was
(3) taking action toward that life while
acceptance, mindfulness, and
abused.” This thought then alters the
knowing that suffering is unavoidable.
committed valued behavior.
function of these events leading to pain
Literature supporting the theory and
and suffering.
efficacy of ACT for different populations
“That is a thought, not a fact,” cap(e.g., mood, anxiety, and substance use
tures the problem of cognitive fusion.
disorders) is growing (Hayes & Strosahl,
Fusion takes place when verbal rules (thoughts) dominate other
2004; Hayes, Strosahl, & Wilson, 1999). With a novel basic theory of
forms of behavioral regulation, making the individual less in contact
behavior, common-sense theory of psychopathology, and integrative
with the here-and-now. Thus, behaviors, feelings, and additional
theory of change and clinical techniques,ACT proponents assert it
thoughts are governed by the verbal evaluative rules,not the context.
as the third wave of behavioral therapy.
The uniqueness of the context is lost and rigidity results.
ACT: Basic Theory
Experiential avoidance occurs when there is unwillingness to
The theory of behavior (including language and cognition) unremain in contact with private experiences (e.g., thoughts, feelings,
derlying ACT is called Relational Frame Theory (RFT; Hayes, Barnessensations,memories) with steps taken to alter the form or frequency
Holmes, & Roche, 2001). RFT posits that humans learn direct and
of these events and the contexts that elicit them. An individual who
derived stimulus relationships that interrelate through relational
fears flying and experiences anxiety when both thinking about
frames, which are combinations of relationships between stimuli
and while flying receives an invitation to a close friend’s wedding.
learned in particular contexts. Relational frames are extended into
This individual engages in experiential avoidance by declining the
novel contexts to drive responding. Relational frames develop
invitation because it involves a plane flight. To avoid anxiety over
through stimulus equivalence, the process by which relationships
the thought and experience of a flight, the person avoids situations
between stimuli are learned without direct experience/training
that may otherwise be fulfilling and valued. The goal is control of
(derived relations). For example, once a child is “trained” that a
anxiety, not engagement in a valued life. Behavioral repertoires are
printed word (dog) refers to a particular object (a dog), and that
reduced leading to inflexible responding.
the spoken word (“dog”) means the printed word (dog), that child
Psychological inflexibility results from these processes because
can now derive four new relationships without training: the object
people come to believe that pain is to be avoided at all costs.
refers to the printed word; the spoken word refers to the printed
continued on page 10
word; the spoken word refers to the object; and the object refers
By Richard L. Ogle, Ph.D.
A
July–August 2007
3
The North Carolina Psychologist
Fall Conference a CE Blockbuster
continued from page 1
Psychiatry for treatment of ADHD, seizure
disorders, anxiety, depression, reading
disabilities, and addictive disorders. This
procedure is being applied in a variety of
clinical settings and research is accumulating to validate its impact on a broad array of
functions mediated by the central nervous
system.
Neurofeedback involves the application of operant conditioning techniques to
training brain functioning as reflected in the
brainwave activity. In this workshop, the
history of this approach will be reviewed.
The essential anatomy and physiology of the
brain regions impacted will be discussed.
Many of the techniques utilized in neurofeedback training will be demonstrated,
and the application to various common
mental health and physical illnesses will be
presented. It is becoming progressively clear
that by challenging the brain, much as you
challenge your body in physical exercise,the
brain can learn to function more optimally. A
better functioning brain can make a person
both more flexible and more resilient when
facing stressors.
Dr. Ed Hamlin is a native son of North
Carolina and received his B.A. from the University of North Carolina at Asheville and his
Ph.D. from the University of North Carolina
at Chapel Hill. He has worked in a variety of
settings including community mental health
centers, general medical hospitals, psychiatric hospitals, and private practice. Currently
he is the clinical director of the Pisgah Institute’s Center for the Advancement of Human
Potential and holds academic appointments
at Western Carolina University and the East
Tennessee State University Medical Center.
The present emphasis of his work is in utilizing, teaching, researching, and developing
approaches of applied neuroscience.
Bullying – Evidence-Based Practice
Understanding School Bullying: An
Ecological Approach to Evidence-Based
Practice is the topic to be presented by
Samuel Y. Song, Ph.D., assistant professor of
school psychology,human development and
psychological studies, UNC-Chapel Hill, as
one of the two Saturday offerings.
School bullying is a pervasive problem
in American schools and around the world.
To effectively intervene in schools, bullying
must be understood comprehensively from
an ecological perspective. The purpose of
The North Carolina Psychologist
4
July–August 2007
this workshop is to disseminate the current
empirical knowledge regarding bullying,and
its prevention and intervention in schools.
This workshop will use a variety of teaching
tools and techniques that include interactive mini-lectures, small group discussions,
electronic presentations, case vignettes, and
appropriate handouts.
Dr. Samuel Song’s research focuses on
promoting the healthy development of all
children and youth in schools and communities. Dr. Song’s current research program,
the Protective Peer Ecology Program, seeks
to develop a school bullying prevention
model and intervention program, which has
received funding by the American Education
Research Association/Spencer Foundation,
the Wood’s Charitable Fund, and the Frank
Porter Graham Institute of UNC. Dr. Song is
also an investigator on two federally-funded
national,whole-school prevention and intervention studies designed to promote school
success and prevent delinquent behaviors,
conducted by the National Rural Center
on Rural Education Support and the Social
Development and Intervention Research
Program of the Center for Developmental
Science.
Therapy for Generalized Anxiety
Disorder
The duo of Lizabeth Roemer, Ph.D., associate professor of psychology, University
of Massachusetts and Susan M.Orsillo,Ph.D.,
associate professor of psychology, Suffolk
University will present Acceptance-Based
Behavioral Therapy for Generalized Anxiety Disorder on Saturday.
Generalized anxiety disorder (GAD) is
one of the least successfully treated of the
anxiety disorders. In addition to being a
chronic disorder associated with reductions
in quality of life, GAD is highly comorbid,
leaving clinicians with the challenge of treating complex clinical presentations.
This workshop will introduce participants to a new, integrative treatment
for GAD that specifically targets the experiential/emotional avoidance thought to
underlie GAD and comorbid diagnoses, and
assists clients in leading meaningful lives.
This acceptance-based behavioral therapy
uses both traditional cognitive behavioral
interventions and newer acceptance-based
behavioral techniques (drawn from acceptance and commitment therapy, mindfulness-based cognitive therapy, and dialectical
behavior therapy) and has been found to
successfully reduce symptoms of GAD and
other comorbid disorders,as well as improve
reports of quality of life.
Numerous case examples and exercises
will illustrate the central elements of the
treatment as well as considerations and challenges in successfully implementing them
with clients. Participants will learn psychoeducational aspects of the treatment, how
to develop and implement mindfulness and
other acceptance-based exercises, and how
to identify individualized valued directions
and increase action in these domains. While
clients with a principal diagnosis of GAD will
be the focus of the workshop, applications
to other clinical presentations will also be
discussed. Outcome and process data from
the presenters,recently completed treatment
development grant will also be presented.
Dr. Lizabeth Roemer received her Ph.D.
from Pennsylvania State University. She then
completed her internship and a postdoctoral
fellowship at the National Center for Posttraumatic Stress Disorders in the Boston VA
Healthcare System. Dr.Roemer has published
over 50 journal articles and book chapters
and co-edited two books.
Dr. Susan M. Orsillo received her Ph.D.
from the University ofAlbany-SUNY. She then
completed her internship and a postdoctoral
fellowship at the National Center for Posttraumatic Stress Disorders in the Boston VA
Healthcare System. Dr. Orsillo has published
over 60 journal articles and book chapters
and co-authored two books.
Drs. Roemer and Orsillo are currently
funded by the National Institute of Mental
Health to examine the efficacy of acceptance-based behavioral therapy for GAD in
a randomized control trial comparing the
treatment to applied relaxation. They are
the co-editors of Acceptance and mindfulness-based approaches to anxiety: Conceptualization and treatment and they are
currently completing a clinician’s guide to
acceptance-based therapy titled Mindfulness
and acceptance-based behavioral therapies
in practice.
Registration Information
Each of the workshops is offered for six
hours of Category A continuing education.
NCPA is approved by the American Psychological Association to offer continuing education for psychologists. 왕
The brochure and registration information
can be found at www.ncpsychologist.org.
PROFILE
Reynolds (Tad) Craig Clodfelter, Jr.,
Psy.D.: Directing Substance Abuse
Treatment in NC Through Expertise,
Leadership, and Vision
By Betsy Kimrey, Ph.D.
R
eynolds (Tad) Craig Clodfelter, Jr., Psy.D. is, simply put, an
amazing person. Since he arrived in Raleigh in June 2003,
he has taken Southlight by storm. Southlight is a nonprofit
institution established in the 1970s to treat drug abuse and cooccurring mental health disorders. Southlight provides a variety
of services, mostly outpatient, through seven different programs,
including counseling, intensive outpatient treatment, court services,
and methadone treatment. In June 2003, one year after completion of his postdoctoral fellowship at Columbia University, Tad
was hired as director of clinical research at Southlight.Three and
one-half years later, he was promoted to CEO. Southlight treats
over 7,800 clients per year, has over 100 employees, and a budget
in excess of $6,000,000.
Strong Academic Foundation
It’s no accident that Southlight found Tad to be so capable. Since
high school, he has spent 13 years in college and postgraduate work
to prepare him for just such a challenge. Tad grew up in Henderson,
NC,where his parents still reside. He attended Wake Forest University,
majoring in psychology with a minor in religion. Like many of us
he was an avid fan of ACC basketball. A year after graduating from
Wake Forest,Tad moved to Atlanta to attend Emory University, where
he earned a master’s of theological studies with a concentration in
counseling. It was during his clinical pastoral internship that he had
his first experience in behavioral medicine, at Northside Hospital
where he worked with dually diagnosed patients. Immediately after
completing that internship, Tad enrolled in the Georgia School of
Professional Psychology.
Tad completed his Psy.D. in five years. During that time he returned to Northside Hospital where he was able to conduct both
group and individual psychotherapy with dually diagnosed patients.
In addition to a concentration in substance abuse, he also completed
a concentration in neuropsychology. He did his doctoral internship
in an inpatient substance abuse treatment program at Tewksbury
Hospital in Tewksbury, MA. There he worked with nationally known
researchers in the area of treatment of dually diagnosed substance
abusers while continuing to develop expertise in neuropsychological assessment and research.
Tad’s postdoctoral fellowship at Columbia focused primarily on
research, but was followed by additional clinical experience with
dually diagnosed, opioid-dependent clients. It was in New York
that Tad met his wife, Susan Ford, a Wisconsin native who studied
law at NYU.
Fast Track at Southlight
Tad returned to North Carolina in June 2003 to begin work at
Southlight as director of clinical research. In May 2005, he became
the operations director for the Pathways adolescent program, one
of Southway’s treatment divisions. In March 2006, he became the
operations director for all seven of Pathways’ divisions. Shortly
therafter, in November 2006, he was asked by the board of directors to become Southlight’s CEO. Tad accepted this role while
also maintaining his responsibilities as Southlight’s director of
clinical research and Pathway’s operations director. Tad notes that
he has consciously taken on cumulative responsibilities rather
than letting go of earlier ones. His creativity is now challenged
with how to build a system that promotes a “culture of work” in
which both staff and productivity will thrive, resulting in a strong,
healthy agency able to serve a broad base of clients.
In addition to his job, Tad maintains a private practice in association with Grew, Morter, and Harty, P.A. He is active in St Mark’s
Episcopal Church and a member of the advisory board of the NC
Drug Treatment Court. He is also a member of NCPA and serves on
both the Public Sector and the Legislative Committees. He worked
closely with Sally Cameron, NCPA’s Executive Director, in the last
session of the General Assembly to promote parity for mental health
and substance abuse treatment. She says of him,”I am so glad Tad
is part of the legislative team at the General Assembly. He is able
to combine his clinical skills with an excellent ability to talk with
legislators at a level that is persuasive.”
Good People
For all his accomplishments, Tad presents as a calm, unassuming person who thoroughly enjoys what he does and may
possibly be somewhat surprised by what he has been able to
do. He keeps in shape by running and exercising at the gym
and he speaks with pride of his wife, an attorney specializing in
employment and immigration law, and their new baby daughter,
Madeleine. When asked what he would want people to know
about him he answered,“I would want to say about myself... that
I view service to/availability to others, especially those in need,
as a hallmark of my journey and focus. This motivation is realized
through my work as well as in personal relationships.” In short,
Tad Clodfelter is not only extremely well trained and capable, he
is “good people”. We are very lucky to have him here. 왕
July–August 2007
5
The North Carolina Psychologist
DISASTER RESPONSE COMMITTEE
NCPF The Virginia Tech Community:
North Carolina
Psychological
Foundation
Resilience in Action
By Sandra Wartski, Psy.D., DRN Coordinator
During a recent summer weekend, I had the opportunity to visit
Virginia Tech with my family to participate in an organized cycling
race. I had never been to this university or to the community of
Blacksburg,VA. This quiet town is situated on a plateau between the
Blue Ridge and Alleghany Mountains. Virginia Tech is in the heart of
Blacksburg, situated on 2,600 acres of sprawling, green land with elegant stone buildings. The beauty of the campus and the friendliness
of the town were immediately evident,but it was the strong presence
of solidarity evident throughout which was most impressive.
It is clear that the April 16, 2007 tragedy on Virginia Tech campus is still very fresh in the minds of most. Twenty-three year old
Cho Seung-Hui’s killing of 32 fellow students and faculty members
shocked the nation but, most poignantly, shocked the small community of Blacksburg. Nonetheless, this close-knit and connected
community seems to be a living role model of resilience in action.
Spirit of Recovery
Most of the students had already gone home for the summer
during the weekend I visited, although some students and faculty
lingered for summer classes, work, and recreation. Although the departure of the students apparently decreases the town’s usual population of 40,000 down to 14,000 every summer, it is clear that even
the permanent residents of Blacksburg carry the memories and the
spirit of recovery.
Banners and signs
adorn most business
and restaurant windows, with messages such as “Hokies
Unite” or “We will
prevail” providing an
overpowering visual
image. T-shirts with
similar slogans were
Would you like to be part of
worn by people of
the NCPF Disaster Response
all ages, the Virginia
Network? It’s easy. Just complete
Tech turkey mascot
an application and sent it to the
appearing strong and
NCPF/NCPA office. You can get a
unwavering. The mecopy on line at www.ncpsychology.
morial on campus
org or contact Elizabeth Cloud at
is a quiet, respectful
[email protected]
display of flowers
or through the NCPA office at
and personal items
919/872-1005.
representing each of
the individuals killed.
The DRN welcomes volunteers
A steady stream of
from throughout the state. Please
visitors stopped to
consider joining!
pay tribute, some
with handkerchiefs
Want to Join the
Disaster Response
Network?
The North Carolina Psychologist
6
July–August 2007
in hand and others with smiles of memories. Yellow and red ribbons are tied on trees around campus, serving as subtle but simple
reminders of the recent tragedy. And near the center of town, a line
of 32 flagpoles has been erected to represent each of the deceased,
with a flag to represent each of their
nationalities.
We are Virginia
Resilience
Tech.
The field of disaster mental health
We are strong
has become more interested in recent
years in not just how to cope after
enough to stand
disaster but also with the notion of
tall tearlessly,
resiliency. APA launched The Road to
we are brave
Resiliency campaign after the Septemenough to bend
ber 11th terrorist attacks. According to
to cry, and we
APA, resilience is defined as “the process of adapting well in the face of adare sad enough
versity, trauma, tragedy, threats, or even
to know that
significant sources of stress.” Research
we must laugh
has shown that resilience is actually
again.
quite usual and that people commonly
demonstrate resilience. As described in
We are Virginia
APA’s literature,being resilient does not
Tech.
mean that a person doesn’t experience
difficulty or distress;in fact,considerable emotional distress can occur
along the road to resilience. While coping is believed to be more
about what we do in reaction to disaster, resilience is more about
how we perceive the after-effects of disaster.
APA created the notion of “bounce back” skills to represent the
finding that resilience is not a trait that people either have or do
not have but rather involves behaviors, thoughts, and actions that
can be learned and developed in anyone. Many factors contribute
to resilience but studies show that the primary factor in resilience
is having caring and supportive relationships within and outside
the family. In this small community of Blacksburg, student and
non-student alike, there is a sense that the relationships are strong,
supportive, and showing signs of resilience in full swing.
At this year’s graduation ceremony at VATech,one of the speeches
was given was by Nikki Giovanni, a long-time native of Blacksburg
and a renowned poet. Her convocation address was printed in the
town’s New River Free Press. An excerpt from her speech provides
even more words which seem so clearly reflective of the spirit of
resilience:
We are Virginia Tech.
We are sad today, and we will be sad for quite a while.
We are not moving on, we are embracing our mourning.
We are Virginia Tech.
We are strong enough to stand tall tearlessly, we are brave
enough to bend to cry, and we are sad enough to know that
we must laugh again.
We are Virginia Tech. 왕
Reach out - The Academic Outreach Program Needs You!
By Carrie Dittner, Ph.D.
Co-Chair, Scientific, Academic, and Student Affairs Committee
The Scientific, Academic, and Student Affairs Committee has
had a very busy six months! After holding the Undergraduate
Conference in November at NCCU, we recently organized the research poster session at the NCPA/NCPF Spring Conference at the
Friday Center in Chapel Hill. Both events continue to grow and are
extremely successful in terms of connecting students and professionals. Truth be told, neither event would be possible without the
time and commitment provided by NCPA members year after year.
The benefit that students receive is unquestionable. In addition to
these annual events, the SASA Committee would like to take a moment to provide information on perhaps a lesser known endeavor:
the Academic Outreach Program (AOP). We are hopeful that through
AOP,the relationship between NCPA members and student initiatives
will continue to strengthen.
What is Academic Outreach?
Several years ago, the Scientific, Academic, and Student Affairs
Committee began an innovated program designed to link NCPA
members with psychology departments and internship sites. The
purpose of the AOP is for NCPA members to volunteer their time
to teach students or interns on various topics as part of a class or
seminar series at their training sites. Graduate departments and
internship sites receive a list of available topics and the SASA Committee works to pair up members with interested departments.
Interest in this program among NCPA’s membership has been
strong, with over 80 members offering to volunteer their time. In
the first few years of operation, this program has had a number
of speaking requests and has received very positive feedback for
serving as a vehicle to educate students and interns as well as to
promote collaboration among graduate programs, internship sites,
and professionals.
It’s The Perfect Time of Year!
To get signed up! In your future NCPA mailings, please look for
an opportunity to sign up as a volunteer for the AOP. The academic
and internship year will be starting this summer and programs will
be preparing course materials, lectures, and workshops.The SASA
Volunteers Needed
14TH Undergraduate
Psychology Conference
Saturday, November 10, 2007
Committee would like to revive and refresh their current list of
volunteers and topics.
How Do I Get Involved?
If you are an NCPA member, the mailing will specifically ask for
topic areas that members would be willing to present. It is suggested that members select topics within their areas of expertise.
The list of topics, not names, will be available to institutions and
NCPA/SASA Committee will contact the member when a request
has been made. I am certain that most members lead very busy, active lives and perhaps wonder about the time commitment for this
program. The member can always work directly with the graduate
department or internship site to determine the best time for the
presentation or workshop. And hopefully, given that it is suggested
that members select topic areas within their expertise, preparation
time will be minimal as well. This program is not intended to be a
burden for members, but rather to provide an opportunity for giving back to psychology in a unique and meaningful way – through
teaching the psychology leaders of tomorrow.
If you are an academic institution or internship site, check
out the list! We hope to have the list available online in the near
continued on page 10
NCPF President Dr. Andy Short presents the 2007 NCPF President’s
Award to Dr. Barbara Vosk for her past work as chair of the foundation’s
Development Committee. (see page 12 of May/June issue)
The committee is looking for psychologists interested in facilitating
small groups on various areas of psychology, such as private practice
(adult and child), teaching, community, corrections, forensics,
developmental disabilities, health/rehab, I/O, military, psychiatric
hospitals, neuropsychology, school, social/personality, sport, substance
abuse or any area that you might specialize in and could be helpful to
students considering psychology as their career.
UNC Wilmington
Stay an extra day and enjoy Wilmington and the beaches.
Sponsored by the Scientific, Academic,
and Student Affairs Committee
If you would like to participate please contact Carol Kulwicki in the
NCPA office at [email protected] or phone 919/872-1005.
July–August 2007
7
The North Carolina Psychologist
APA Reviews Requirements for Prescription
Authority Training Programs
By Mary Evers-Szostak, Ph.D.,
Division of Independent Professional Practice, Board Member
I
n February 2006 the APA Council of Representatives authorized a joint Board of Educational Affairs/Committee
for the Advance of Professional Practice (BEA/CAPP) Task
Force to review the current requirements for prescriptive
authority training programs. This was necessary to meet the
APA’s requirement that standards and guidelines be reviewed
at least every 10 years. The original document, APA Recommended Postdoctoral Training in Psychopharmacology for
Prescription Privileges, was approved in 1996. There have
been several important advances in prescriptive authority
education, training, and legislation since then, most notably
the passage and enactment of legislation in New Mexico,
Louisiana, and Guam and the passage of legislation currently
awaiting the governor’s signature in Hawaii. A number of
training programs have also been established during this period of time. The BEA/CAPP task force recently completed
the initial draft of the revised training guidelines, which were
offered for comments. NCPA submitted comments as did other
state and provincial psychological associations, APA divisions,
state licensing boards, APA members, and other organizations.
These comments are now being reviewed and it is hoped that
the guidelines will be available for action by the APA Council
of Representatives at its August meeting during the APA Convention in San Francisco.
Program Prerequisites, Content Areas Remain Unchanged
Several aspects of the guidelines remain unchanged. First, the
prerequisites for admission to a training program continue to be: a
doctoral degree in psychology; current licensure as a psychologist;
and practice as a health services provider. The content areas to be
covered continue to include: anatomy and physiology;biochemistry;
neuroanatomy; neurophysiology; neurochemistry; physical assessment; laboratory and radiological assessment; medical terminology
INSURANCE UPDATES
ABOUT ONCE A MONTH OR SO, DIPP members receive
Insurance Updates by email from the NCPA Office. Insurance
Updates are sent throughout the year on a regular basis, whenever
there is new information. The feedback from DIPP members is that
Insurance Updates is a valuable tool in their practice.
This is a member benefit of your DIPP dues – please don’t share
them with non-DIPP or NCPA members who are not “paying their
fair share.”
Insurance Updates would like to hear from you – are there issues
you would like to have covered? Are there ideas for information?
Are there tips you would like to share?
E-mail [email protected]. 왕
The North Carolina Psychologist
8
July–August 2007
and documentation; pathophysiology; clinical medicine; differential
diagnosis; clinical correlations; chemical dependency; chronic pain
management; pharmacology; clinical pharmacology; pharmacogenetics; psychopharmacology; developmental psychopharmacology;
professional issues; combined therapies; computer-based aids; pharmacoepidemiology; methodology and design of psychopharmacological research; interpretation and evaluation of pharmacological
research; and FDA drug development and regulatory processes.
Competency Model Adopted
A major change in the proposed guidelines is the adoption of
a competency model in keeping with the movement toward this
model in other health professions. The guidelines continue to
specify a minimum number of contact hours of instruction (400),
but these hours are not broken into specific contact hours for each
content area. The adoption of the competency model allows for a
shift from a focus on documenting what has been taught to demonstrating what students have learned and how they are integrating
this into practice. To do this effectively, the new guidelines integrate
supervised clinical experiences with coursework so that students
can begin to apply concepts as they are addressed in the curriculum. The guidelines also require programs to develop a capstone
competency evaluation that is summative and distinct from the
mastery of information that is assessed by the Psychopharmacology
Examination for Psychologists. The capstone competency evaluation provides for the integration of knowledge, skills, and abilities
psychologists are expected to master in these training programs.
These programs are also expected to prepare psychologists to take
on the lifelong learning that will be necessary to maintain their skills
in psychopharmacological practice.
The requirements of the supervised clinical experience have
been revised to better match the competency model. It is expected
that this intensive experience will cover a range of populations and
diagnostic categories that are representative of the trainee’s current
and anticipated practice. For example, psychologists interested in
working primarily with geriatric patients could focus their supervised experience in this area. As part of this experience, psychologists should gain exposure to acute, short-term, and maintenance
medication strategies. The guidelines specify a list of competencies
that are to be targeted in this experience which include: physical
exam and mental status;review of systems;medical history interview
and documentation; assessment; differential diagnosis; integrated
treatment planning; consultation and collaboration; and treatment
management.
Finally, the proposed guidelines recommend that APA establish
a formal designation process for identifying training programs that
meet APA guidelines. This will help assure that psychologists completing a training program have received the necessary education and
training for safe and effective psychopharmacological practice. 왕
Division of Independent
Professional Practice
Division of
Independent
Professional
Practice
A Trend of
Practice
James L. Hilke, Ph.D., President
First, do no harm. This admonition is
applicable to psychologists as easily and as
well as to physicians. We assume this is a
given in the work that we do. After all, we
have spent many hours, not to say years,
preparing ourselves to do that work, not to
mention the many hours after our formal
preparation: the post-docs, the conferences,
the lectures, the committees, etc. To say that
our goal is merely not to harm is almost an
insult to our life’s work.
While our view may be that not doing
any harm is a minimal goal, this idea is not
so obvious to many others. Within and outside the profession of psychology, the goal
of doing good and not ill is accepted; the
means by which any good might be accomplished is not so clear. An article by Sharon
Begley entitled, “Get Shrunk at Your Own
Risk” appeared in the June 18, 2007 edition
of Newsweek with the highlighted quote,
“A study found that four in 10 people who
entered grief therapy after losing a loved
one would have been better off without
treatment.” Scott Lilienfeld, a psychology
professor at Emory University,estimates that
“10 to 20 percent of people who receive
psychotherapy are harmed by it.” Begley’s
article concluded, “Few patients have any
idea that ‘just talking’ can be dangerous to
their mental health.”
Evidence-Based Treatment
Currently,several trends in our profession
speak to the effectiveness of treatment or
lack thereof. The February practice conference in Chapel Hill highlighted one of
these trends with a discussion of evidencebased treatment (EBT). EBTs include those
psychotherapy techniques, practices, and
approaches shown to be effective through
scientific research. This is certainly a worthwhile goal. Which of us does not want to use
techniques that are effective? Which of us
would start with the absurd mental premise
of, “I want to work ineffectively with this
client and will do those things which I am
sure will not work”? To place EBT in the
Advancing Psychology in the Age
of Measurement
The importance of this issue is noted when
possible consequences of strict enforcement
are enumerated. For example, should insurance companies pay for a treatment that has
not been shown to be scientifically effective? Should insurance companies pay for
treatment of a depressed adolescent if the
therapist does not use cognitive-behavioral
therapy? Should the therapist be reported
to the licensing board for using a non-proven
strategy? Should the therapist be reported to
the National Data Bank? Should treatment
other than cognitive-behavioral for this adolescent be considered malpractice? While these
are questions that may appear outlandish and
ridiculous to many,they are questions that are
being asked around the country.
There is a continual give and take of ideas
with regard to what is effective treatment
and what is not. John Norcross of Scranton
University says that many therapists practice
“psychoquackery”rather than psychotherapy.
It is our duty as professionals to continue to
work towards treatments that are safe and
effective, and to help determine to the best
of our ability the circumstances under which
those treatments can best be used. The scientific revolution could easily be defined as the
age of measurement, and whether we like it
or not,the effects of psychotherapy are going
to be measured. It is our job to contribute
positively to this venture. 왕
context of questions like these shows the
almost automatic nature of such a search for
effective psychotherapy treatments.
Determining which procedures work
in which situations with which clients is
not an easy determination, however. Cognitive-behavioral therapy, an approach much
touted these days, has been “proven” to be
an effective intervention with depressed
adolescents. Does this mean, then, that
every depressed adolescent should be
treated with cognitive-behavioral therapy?
Most therapists would quickly exclaim in
the negative. How about this? Should depressed adolescents be treated with other
approaches only after cognitive-behavioral
therapy has not succeeded? Should cognitive-behavioral therapy be the treatment of
choice and implemented first? Again, most
clinicians would likely say maybe, or maybe
not,dependent upon the circumstances. The
complexity of psychiatric diagnosis makes
questionable any treatment approach which
would automatically be given
first priority, for often a depressed adolescent is not just
a depressed adolescent. He is
also an anxious adolescent, an
ADHD adolescent, etc. Even
adolescents who only have
depression as a diagnosis vary
greatly in their presentation
and personality dynamics. In
the same vein, much appears
in the newspaper about the
effects of mandatory sentencSaturday, February 9, 2008
ing which sounds good as a
concept but which breaks
down into a total miscarriage
2008 APAIT Risk Management Institute
of justice when specific cases
Get Your APAIT Insurance Discount
are presented. So, too, within
Saturday, June 14, 2008
psychology there is a concern
that a good idea can create
disastrous results if impleThe Friday Center
mented rigidly.
Mark Your
Calendar
2008 DIPP Practice
Conference
Chapel Hill
July–August 2007
9
The North Carolina Psychologist
Acceptance and Commitment Therapy
(continued from page 3 )
Verbal rules are constructed that overshoot the contexts in which
the rules were constructed.The person lives through their thought
as opposed to connecting to the situation, and finally engages in
avoidance to reduce uncomfortable private events at the expense
of living a valued life.
ACT: Theory of Change and Techniques
Change occurs through increased psychological flexibility, not
through changing the content or form of one’s thoughts or behaviors. ACT describes a number of different processes by which
change occurs, but each can be combined into three processes:
acceptance, mindfulness, and committed valued behavior.
Acceptance means “to take what is offered.” It is not merely
tolerance or “giving in,” it is the active nonjudgmental embracing
of the here-and-now. It is related to the Zen concept of “all is as it
should be,” and involves the undefended experience of distressing
private events. To increase acceptance, therapists first use psychoeducation, mainly through the use of a variety of metaphors,
to generate the experience of creative hopelessness as well as to
demonstrate that control is the problem not the answer. Creative
hopelessness refers to the experience of the unworkability of past
efforts and strategies to control unpleasant experiences. Individuals are then able to explore new ways of relating to their private
experiences.
Much has been written recently of the concept of mindfulness
in psychotherapy; it is a concept with a rich 2,500 year history in
Change occurs through increased psychological flexibility, not
through changing the content or form of one’s thoughts or
behaviors. ACT describes a number of different processes by
which change occurs, but each can be combined into three
processes: acceptance, mindfulness, and committed valued
behavior.
Eastern thought and spirituality. Mindfulness refers to experiencing the fluid aspects of reality as it unfolds, and includes detailed
examination of one’s perceptions. When being mindful, life is lived
in the present moment and living becomes an unfolding series of
present moments. Instead of living in (i.e., evaluating thoughts
and memories) the past or the future, one contacts the present
moment. Mindfulness training and meditation are used to increase
contact with the present moment and allow the individual to defuse
thoughts from experience.
Change occurs through commitment to behavior that brings
one closer to one’s values in spite of the possibility of suffering.
Suffering in the act of behaving in a valued direction is purposeful
suffering as opposed to the suffering that occurs in the context of
experiential avoidance. Developing patterns of committed valued
action involves techniques such as values assessment and clarification as well as behavioral activation and exposure techniques. In
this way,ACT resembles traditional forms of behavioral therapy.
Detailed, user-friendly descriptions of the many metaphors
and techniques, as well as session formats are offered by Eifert and
The North Carolina Psychologist
10
July–August 2007
Forsyth (2005). In addition, Hayes and Smith (2005) have published
a client workbook containing explanations and exercises.
ACT: New Bottle or New Wine?
While reading this, you may find yourself thinking that ACT is
CBT that uses different language. It is true there are similarities
in that language and cognition are viewed as critical to the formation of psychopathology, but ACT emphasizes the primacy of the
context as the determinant of behavior. From an ACT perspective,
traditional cognitive approaches focus on changing the form or
the content of the thought through challenging the validity of the
thought and replacing it with a more rational one. ACT concerns itself with changing the function of the thought through acceptance
of the thought as a thought (neither good nor bad) and “defusion”
of that thought from the experience of the current context. It is
purportedly more efficient and less likely to communicate that
the person’s thoughts are good or bad, thus breaking the cycle
of evaluation. So, taste the wine and judge for yourself. Whether
the wine is old or new, a growing number of clinicians, mounting
empirical data, and the changes made by many of my clients suggest that even if it is old wine, it is good wine.
References and Further Reading
Eifert, G.H. & Forsyth, J.P. (2005). Acceptance and commitment
therapy for anxiety disorders. Oakland, CA: New Harbinger.
Hayes, S.C., Barnes-Holmes, D., & Roche, D. (Eds.). (2001). Relational frame theory: A post-Skinnerian account of language
and cognition. New York: Plenum Press.
Hayes, S.C. & Smith, S. (2005). Get out of your mind and into
your life:The new acceptance and commitment therapy. Oakland,
CA: New Harbinger.
Hayes, S.C., & Strosahl, K.D. (Eds.). (2004). A practical guide to acceptance and commitment therapy. New York: Springer.
Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (1999). Acceptance and
commitment therapy:An experiential approach to behavior
change. New York: Guildford Press. 왕
Reach out
(continued from page 7)
future at www.ncpsychology.org, but professors and other
training directors can contact NCPA directly for the topic list
as well. This would be a great opportunity for students to learn
from practitioners active in the clinical practice of psychology
and those who can provide a unique perspective to students.
It may be that NCPA volunteers can fulfill specific teaching
needs for different classes as well.
What Are The Benefits?
• NCPA members involved in academic training
• Students gain increased awareness about NCPA
• Graduate departments and interns access a wide variety of
topic areas for student learning
We look forward to hearing from you!
Lyerly Honored with Hero Award
NCPA member Dr. Spencer Lyerly of Chapel Hill received a Hero
in the Fight Award from the Coalition for Persons Disabled by Mental
Illness at a luncheon on June 21 in Cary. Dr. Lyerly was honored as a
psychologist who has devoted his career to working with persons
with severe and persistent mental illness and for providing leadership in the development and implementation of services to improve
the quality of life of persons in the public mental health system in
North Carolina.
Current Contributions to Public Mental Health
In his current work, Dr. Lyerly is a founding board member of
Cross Disabilities Services. This private nonprofit corporation provides assertive community treatment (ACT), community support,
target case management, and diagnostic assessment to approximately 130 consumers. While many clinicians have opted out of
public mental health as North Carolina continues to reorganize, Dr.
Lyerly has stayed the course and provided valued clinical leadership – determined to insure availability of quality services and not
discouraged by changing rules, problems with reimbursement, and
mountains of paperwork.
Long History of Service to Public Sector
Dr. Lyerly’s contributions span his entire career. His work as the
director of a 275 bed inpatient psychiatric treatment and rehabilitation program, his tireless advocacy on state advisory committees,
his consultation as an associate faculty member of Duke University
Medical Center’s department of psychiatry, and his founding of the
Cross Disabilities Services, Inc. are but a few of his many accomplishments – all in the name of service to the public sector.
Dr.Lyerly was a dedicated and innovative administrator during his
years as director of the rehabilitation unit at John Umstead Hospital.
He facilitated the redesign of a “backward institutional warehouse”
into a state of the art program focused on rehabilitation that was
recognized for its excellence by the National Alliance for the Mentally
Ill and the Public Citizens Research Group. Not one to stay behind
a closed office door, Dr. Lyerly was the primary therapist for several
persons severely handicapped by mental illness and provided clinical supervision to other therapists. As an adjunct professor at Duke,
he trained psychiatry residents, psychology doctoral students, and
social work students, focusing on rehabilitation and inclusion of the
consumer in all care planning.
Dr. Lyerly’s superb skills and extensive knowledge in both treatment and public administration resulted in his becoming the clinical director of the Crisis Services Section, North Carolina Division
of Mental Health, Developmental Disabilities, and Substance Abuse
Services. He was a strong advocate for integrated treatment for persons with co-occurring mental illness and substance abuse and led
the Mental Illness/Substance Abuse Integrated Treatment Initiative
at the division of MH/DD/SAS.
Pioneer for ACT in NC
As the state moved to mental health reform, Dr. Lyerly focused
on the need for ACT to help consumers to live fuller lives and
achieve self-determination. He began this work as the psychologist
on a local community
ACT team and quickly
became a certified ACT
trainer. He continues to
provide consultation to
the NC Evidence Based
Practices Center, United
Cerebral Palsy of North
Carolina and Area Programs and Services,Educare, the NC Division of
HH/DD/SAS on this vital,
well researched model
Dr. Spencer Lyerly, left, receives the
of service delivery.
Heroes in the Fight award from John
Dr. Lyerly is a couraTote, Chair of the Coalition for Pergeous and caring psysons Disabled by Mental Illness.
chologist,whose constant
advocacy at the state and
local levels has truly improved the quality of care and the lives of
countless persons in need of mental health services, particularly
those with severe and persistent mental illness.
The Coalition for Persons Disabled by Mental Illness is a coalition
of non-profit advocacy, consumer, family and provider organizations
advocating for services for persons with mental illness. 왕
Rep. Martha Alexander, left, receives a special award from
the Coalition for Persons Disabled by Mental Illness for her
long-time advocacy for mental health parity in North Carolina.
The award is presented by NCPA Executive Director Sally
Cameron, right, who has worked closely with Rep. Alexander
on this issue over the years. See the article on the passage
of mental health parity on page 1.
July–August 2007
11
The North Carolina Psychologist
Psychologists in the Durham area and members of the NCPA Executive
Committee pose for the camera at the Outreach Meeting that was held on June
15, 2007. The meeting provided an opportunity for psychologists to dialogue
with the NCPA leadership about important topics for the profession.
MH Parity Passes in NC!!!
continued from page 1
limits must be the same as for physical illnesses. These other diagnoses do have durational limits of 30 days for inpatient and outpatient
day treatment and 30 outpatient visits.
The bill becomes effective July 1, 2008. While advocates of the
bill would have preferred an effective date of January 1, 2008, BCBS
and others persuaded the legislature they needed all that time to
implement the benefit.
Watch for NCPA emails with information about implementation.
Thanks to all of the NCPA members who worked hard making contacts this session on mental health parity. 왕
Resolution Honors
Ben Aiken
House Joint Resolution 886 was introduced in the 2007 session of the North Carolina General Assembly to recognize the late
Ben W.Aiken, NCPA’s lobbyist of 20 years who died in December,
2005. The resolution is titled, “A Joint Resolution Honoring the
Life and Memory of Ben W.Aiken,An Advocate for Persons Needing Services and Supports for Mental Illness, Developmental
Disabilities, and Substance Abuse.
The resolution was presented to the House and Senate on the
session held Monday evening, June 18. Mr. Aiken’s wife Helen,
along with her daughters Debra and Donna were present, along
with one granddaughter and son-in-law.
Also attending were NCPA Executive Director Sally Cameron,
Office Manager Carol Kulwicki, Legislative Liaison Randolph
Cloud, and Treasurer Dr. Dick Rumer. Dr. Rumer was involved in
legislative efforts in the mid-1980s when Mr. Aiken began work
with NCPA.
The resolution was introduced in the House by Representative
Jim Crawford (D-Granville) and in the Senate by Senator Martin
Nesbitt (D-Buncombe). Rep. Crawford represents the district
where Mr. Aiken grew up, and was a long-time friend.
The North Carolina Psychologist
12
July–August 2007
In making his remarks to the members of the House, Rep.
Crawford noted, “Ben Aiken was a giant in the field of mental
health advocacy and service to the people of North Carolina
with mental illness, developmental disabilities and substance
abuse services. He devoted his life to assure that life for others
would be better.”
Rep. Crawford cited Mr. Aiken’s long career with the Department of Mental Health and later the Department of Health and
Human Services.
“Began as Assistant Business Manager at John Umstead Hospital
in Butner in 1947. Ben was a strong, powerful, and clear voice
speaking out for the needs of those who cannot always speak
for themselves. He was a man of tremendous integrity – never
doing something because it is politically expedient, but doing it
because it is right.”
Rep. Crawford went on to say,“Ben was the lobbyist for the NC
Psychological Association for twenty years – and in that capacity
he helped many of the people who advocate for public mental
health services. I think the entire mental health community would
agree that Ben was an “ambassador extraordinnaire” for all of us
in the General Assembly.”
The resolution was also presented to the members of the
North Carolina Senate that same evening. It passed unanimously
in both chambers. The Speaker of the House and the Lieutenant
Governor recognized the family members and friends sitting in
the gallery. 왕
Thank You
NCPF and NCPA thank the psychologists listed
below who have contributed to the North
Carolina Psychological Foundation on the
contribution portion of their NCPA dues statement. These contributions help the work of
the Foundation and are greatly appreciated.
Bob Anderson
Landy Anderton
Dan Biber
Michael Bradley
Helen Brantley
Morris Britt
William Burlingame
James Byassee
Michelle Chabbott
Teri Chewning
Laura Clark
Madeleine Crockett
Lucy Daniels
Eric Deitchman
Wil Edgerton
Andy Jackson
Christy Jones
Henry Majestic
Steve Mullinix
Alexander Myers
Susan Neeley
Karen Rubin
Richard Rumer
Victoria Shea
Linda Silber
Reuben Silver
Pamela Trent
Barbara Vosk
Jennifer Walken
Laura Weisberg
Barbara Yelverton
Integrated Primary Care:
Psychology’s New
Frontier?
By: Angela D. Enlow, M.A.
Imagine that you are a primary care physician (PCP) seeing many
patients complaining of various physical ailments. Now imagine
that you have no answer to their distress; the tests run indicate that
all is normal and there is no reason for the experience of pain or
discomfort. What next? Who do you go to? If you refer patients to
a mental health provider, will they go?
It is estimated that less than 20% of patients that visit PCPs have
an organic cause to their complaints. Further, 10% of all visits are
psychological in nature. Common, non-organic complaints include
chest pain, fatigue, headaches, back pain, insomnia, abdominal pain,
and impotence (Blount, 1998). It is also estimated that between 5090% of patients with mental health needs rely only on their PCP for
services and treatment. When these patients are referred for mental
health services only 10% of those referred actually make it to their
first appointment (Aitken & Curtis, 2004).What’s more, the highest
10% of medical service users have more outpatient visits, as many
medications, and more specialist visits than all of the lowest 50% of
users (Blount, 1998).
What is Integrated Primary Care?
Integrated primary care (IPC) goes beyond what the PCP or
psychologist can do alone. Together, the team works with more
difficult to treat patients, creating joint treatment plans, facilitating
patient education, and conducting more involved patient follow-up
(Price et al., 2000). PCPs focus on the patient’s physical well-being,
while the psychologist takes a case-management approach by assessing mental health needs and linking the client with resources
in the community when appropriate.
IPC is the realization of the biopsychosocial aspect of treatment
in practice. It involves the collaboration between medical and
psychological professionals while working with shared patients. At
its best, integrated care professionals work from the same building
and often see patients in joint visits to determine the best treatment for the individual.
The PCP introduces the patient to the psychologist, who is presented as someone working on the medical team, who will help the
PCP work with the patient more effectively. The psychologist assesses social and psychological factors contributing to the patient’s
distress, and works in conjunction with the PCP to develop a plan
to which the patient is most likely to adhere. At times, this may be
all the consultation that will be needed.
More often, the psychologist will also work with the patient in
individual therapy sessions. However, in IPC, therapy sessions are
briefer and more solution-focused.The goal is to teach the patient
skills that can be used to alleviate distress and/or to cope with a
given disorder. Sessions can also be used to educate the client on
his or her diagnosis, what to expect, and ways to approach symptoms of the diagnosis (Blount, 1998).
Benefits of IPC
In an effort to provide services to those who typically are unable
or have been unwilling to seek help, integrated care is a means of
making psychological services more accessible. Having a mental
health provider in the same office as a PCP reduces stigma and
extra effort associated with visiting a separate mental health office,
and provides better collaboration between professionals seeking
the same outcomes. Further, knowing that the PCP endorses
the psychologist’s services and has confidence in the combined
treatment can result in patients’ increased willingness to accept
psychological help.
In a study conducted by Cummings (as cited in Aitkens & Curtis,
2004), 85% of clients identified as needing mental health services
in an integrated primary care setting received treatment. This
contrasts significantly with the previously noted 10% who attend
In an effort to provide services to those
who typically are unable or have been unwilling
to seek help, integrated care is a means of making
psychological services more accessible. Having a
mental health provider in the same office as a PCP
reduces stigma and extra effort associated with
visiting a separate mental health office, and provides
better collaboration between professionals seeking the
same outcomes. In the managed care environment in
which we all must now work, the efficiency and
effectiveness of this model is enticing.
their initial appointment when referred to an outside agency. Further, there is evidence that IPC reduces medical utilization costs
and symptom severity, and improves dosage of and adherence to
medications and treatment (Blount, 1998; Price et al., 2000). In the
managed care environment in which we all must now work, the
efficiency and effectiveness of this model is enticing.
The field of psychology has been moving away from the Cartesian dichotomy for some time. However, to fully abandon the
mind-body split will require more than theory alone. By embracing
the biopsychosocial model, can work together across disciplines
to create truly integrated care.
References
Aitken, J., & Curtis, R. (2004). Integrated health care: Improving
client care while providing opportunities for mental health
counselors. Journal of Mental Health Counseling 26, 321-331.
Blount,A. (1998). Introduction to integrated primary care. In A.
Bount (Ed.), Integrated Primary Care (pp. 1-43). New York:
W. W. Norton & Company.
Price, D., Beck,A., Nimmer, C., & Bensen, S. (2000).The treatment
of anxiety disorders in a primary care HMO setting. Psychiatric
Quarterly 71, 31-45. 왕
July–August 2007
13
The North Carolina Psychologist
CLASSIFIED ADS
POSITIONS
LICENSED PSYCHOLOGIST — An established private practice in
Wilmington, NC is looking for a licensed psychologist (master’s
or doctoral level). The practice has a solid referral base and is
growing quickly. Each member in the practice is independent
and contributes to overhead costs, which typically are 18-20%
of their collections. The overhead costs cover: a full-time office;
electricity; phone; voicemail; supplies; wireless internet; copier;
fax; printer; full-time office manager; part-time receptionist; all
billing and follow-up; and a small kitchen and break room. Please
contact Dr. Denise Hanson or Karen Gardener, LCSW at 910/7967848 if interested.
GROUP PRACTICE OPENING — Thriving Raleigh group practice
(www.gmhpsych.com) seeks licensed psychologists; referrals
provided. Resumes to [email protected] or fax 919/7839418.
OFFICE SPACE
CHAPEL HILL — Attractive office space for rent in Chapel Hill
at extremely reasonable rates. Part-time, hourly, or full-time
equivalent available. For more information, call Dr. Richard
Cooper at 919/942-3329.
DAVIDSON/LAKE NORMAN AREA — Full - or part-time. Share
suite with psychologist. Two offices available, mostly furnished.
Excellent location, attractive, very private, easy access to I-77
corridor. Waiting room, group room, access to work room with
fax and photocopier. Some help with referrals possible. Call
Bob Anderson at 704/892-5788.
RALEIGH — Near North Hills. Share part-time or full-time, 3 offices, small waiting room. Dorcas Miller 919/274-5360.
RALEIGH — Centrally located near Rex Hospital with easy access to I-40 & I-440. Share suite with other psychologists. Sunny
offices w/large windows, ample parking, easy access. Shared
waiting & admin area, group room & kitchen. Reasonable rates.
Myra 919/783-9418.
Dr. Timothy Swann, a long-time member of NCPA and the
Division of Independent Professional Practice, died unexpectedly
of injuries suffered in a fall in March of 2007. A graduate of
Davidson College, Dr. Swann earned his Ph.D. in clinical psychology
from the University of Rhode Island. Dr. Swann was in private
practice with his wife, Dr. Joan Wilkins, who is also a long-time
member of NCPA and DIPP.
Dr. Swann was greatly respected by patients and colleagues. NCPA
Executive Director Sally Cameron said,“Tim and Joan were one of
the early members of NCPA, recruited a year or two after I started.
I have always appreciated their support, loyalty and commitment
to their profession. Tim was always ready to help when asked.
One of the unsung things he did for NCPA was help us review our
financial investment policies for the Finance Committee. I will
miss his warm smile, his sense of humor and his wisdom.”
NCPA extends its sympathy to his wife, Joan Wilkins,
and his son, Lyle Swann.
EARN $25 NCPA BUCKS
By
RECRUTING A NEW MEMBER
USE YOUR $25 NCPA BUCKS TOWARDS
NCPA DUES
OR
MISCELLANEOUS
SEEKING A WISC-IV, WIAT-II, & WPPSI — Please call Lisa at
704/708-4112.
TESTING SOFTWARE — Have retired from practice. Sitting on
children’s testing software I will never use.Would like to sell to
best offer. To see all that I have, contact Dianne Occhetti, Ph.D.
@ 919/848-9442
Karen Rubin
Are You Going to the APA Convention?
Are you going to the APA Convention in San Francisco this
August? If you are interested in joining others from North Carolina
at dinner on Friday night, e-mail NCPA Executive Director Sally
Cameron at [email protected]. This is an excellent opportunity to network with colleagues from across the state.
The North Carolina Psychologist
In Memoriam
14
July–August 2007
NCPA CONFERENCES
Member News
Debbie Neel, Ph.D. of Raleigh recently co-authored A Celebration of Sex Guidebook:A Couple’s Guidebook to Passionate Intimacy with Doug Rosenau and
Ellen Fox. This is a workbook to accompany Doug Rosenau’s (2002) text, A
Celebration of Sex: A Guide to Enjoying God’s Gift of Sexual Intimacy.
Ginger Calloway, Ph.D. was recently elected Representative-at-Large to the
Board of the Society for Personality Assessment (SPA). In addition, Dr. Calloway
was recently asked to serve as editor for a special issue of the Journal of Child
Custody which will be devoted to attachment, its theory and application for
child custody matters. The issue is due to be released in 2008.
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July–August 2007
15
The North Carolina Psychologist
Membership News
FULL MEMBERS
The North Carolina
Psychologist
Jennifer L. Strauss, Ph.D., Editor
North Carolina Psychological Association
1004 Dresser Court, Suite 106
Raleigh, North Carolina 27609
Sheri Lyn Clark, Ph.D. — Boone
Delight C.A. Thompson, Psy.D. — Havelock
PRSRT STD
U.S. POSTAGE
PAID
PERMIT NO. 2483
RALEIGH, NC
STUDENT MEMBER
Katrina Kuzyszyn-Jones, M.A. — Durham
UNDERGRADUATE STUDENT
Cheryl D. Perry — Charlotte
NCPA’s Colleague Assistance HELP
LINE phone number—919/7853969. The Help Line has been
established for psychologists
concerned about their
substance use or abuse.
Please call the number
to leave a confidential
m e s s a g e , a n d yo u r
call will be returned by
a psychologist in recovery.
Continuing Education Opportunities
NCPA CE Offerings
February 9, 2008 - Chapel Hill
NCPF/NCPA Fall CE Conference
DIPP Pratice Conference
Friday Center — Chapel Hill, NC
June 14, 2008 - Chapel Hill
Legal and Ethical Risk and Risk
Management in Professional
Psychological Practice: Sequence
II - Risk Management in Specific
High Risk Areas
Jeffrey N.Younggren, Ph.D.,ABPP
Friday, October 5
Each presentation
offers 6 hours of
Category A credit
Exposure-based Treatment for PTSD
Lib Hembree, Ph.D.
Biofeedback
Ed Hamlin, Ph.D.
Saturday, October 6
Mindfulness Treatment for General
Anxiety Disorder
Liz Roemer, Ph.D., and Sue Orsillo,
Ph.D.
Bullying
Sam Song, Ph.D.
2008 Is NCPA’s 60th Anniversary Year
April 25 & 26 - NCPA Spring Institutes & Conference
September 19 & 20 -NCPF/NCPA Fall Conference
Go to www.ncpsychology.org
The North Carolina Psychologist
16
July–August 2007