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Highlights from the August 2012 Board of Directors (BoD) meeting

Includes a visit from the APA president-elect, a new public education campaign and 2013 candidates for APA president-elect

By Bill MacGillivray, PhD, ABPP

The August meetings are usually sultry affairs and never more so than when APA selects a southern city to hold its Annual Convention. That was never more true than this August, on surely one of the hottest (take-your-breath-away hot) weeks of the year. The other thing about Orlando is that it is big, very big. While I was able to eventually find my way around, I never had any clear sense of where I was in the hotel, constantly surprised to find myself lost and found without knowing exactly how I got there. The convention center was somewhat more navigable, thanks largely to the fact that about 80 percent of the place was unoccupied and APA meetings there took up only a compact fraction of the available space.

Another thing about August Board meetings is that a large portion of our time is spent welcoming visitors; and this year was no exception. We had four guests: Don Bersoff, Katherine Nordal, Doug Haldeman and Nadine Kaslow.

APA President-Elect

Dr. Bersoff is president-elect of APA and he came to tell us about his initiatives as president. He wants to highlight the role of psychologists working with military personnel, reservists and their families to address medical, physical and psychological impact of war as well as issues of suicide, domestic violence and sexual victimization.

He asked the division to provide him with some of our program hours for next year's Annual Convention in Hawai'i. This has become a routine practice in recent years as presidents have tried to carve out program time to advance particular concerns. Since APA is busy revising how is allocates division hours, we will have to wait until the fall before knowing if we can support Dr. Bersoff's request.

His other initiative is to invite and retain academics and researchers within APA. While this is a laudable goal, and Dr. Bersoff agreed the psychodynamic researchers were included in this initiative, I cannot but be wary of the attitude so ably expressed by Alan Kazdin last year that practitioners are of only marginal use to APA. It is certainly no surprise that researchers and practitioners both feel misunderstood by the other (the division has had and continues to have similar complaints from each group) and I will welcome an effort to genuinely address these concerns.

APA Practice Organization

Katherine Nordal had some uncommonly cheerful news to offer as the Practice Directorate is getting ready to launch a new public education campaign that specifically addresses psychotherapy as a viable and effective treatment for emotional problems. She warned us that we may not like the ads, assuring us that market testing of ads typically finds that the public likes what the psychologist hates and vice versa. Regardless, this new campaign is an extension of previous efforts; but the addition of a specific focus on psychotherapy is a real step forward. We have a long way to go to break the hold of Big Pharma over the public's imagination; but perhaps this will help. The ads directly take on the drug ads by having a physician "prescribe" psychotherapy for the patient's difficulties.

While we are on the subject, APA Council passed a motion "Resolution on Recognition of Psychotherapy Effectiveness," which is the first time APA has gone on record endorsing the effectiveness of psychotherapy. The resolution is worth reviewing and noticing how many of the citations are from psychodynamic researchers. Thanks to APA past-president Melba Vasquez and Council Representative Linda Campbell for spearheading this initiative.

Never one to leave us feeling too cheerful, however, Katherine reviewed the increasing threats to adequate reimbursement and in particular the likely impact of Medicare cuts as insurance companies gleefully follow a "race to the bottom" in limiting compensation. While there are some ways to hit back under the protection of parity and other laws/regulations, psychotherapists are facing continued ratcheting of rates downward. There remains the (slight) possibility that a review of Medicare codes scheduled this year to address "psychotherapy" and the relative value of this code compared to every other will result in a slight uptick in the perceived relative value.

If you want more information, read on, but it gets tedious about now. I actually participated in the review of the "psychoanalysis" code last year and have some idea how it works. First of all, this is a process dominated by American Psychiatric Association and the overall code revision is more or less controlled by the American Medical Association. The value of "psychotherapy" will be computed against the relative value of every other code, that is, every other medical procedure. The medical codes are equally geared up, of course, to protect the relative value of "their" codes and one of the ways this is accomplished is by invoking two mantras dear to the heart of bureaucracy: technology and new and innovative procedures. Since "psychotherapy" does not typically claim to rely upon new technologies and innovations, it tends to lose out in the valuation game

I will note, however, that our team that addressed the value of the "psychoanalysis" code, made the argument that psychoanalysts are treating far more troubled individuals with far fewer resources (e.g., hospitalization) than in the past and proposed that this constitutes an innovation, and secondly that our "technology" has changed in that analysts are much more open, emotionally available, and so on. It was amusing to consider that relational approaches in psychoanalysis can be touted as a "new technology" that all analysts have embraced. More to the point, however, these arguments carried the day and "psychoanalysis" may be in for an uptick in relative value once the government completes its reviews of the other codes up for examination, including "psychotherapy."

APA Candidates for President Elect

The next two guests were candidates competing to become APA president-elect beginning in 2013. Both Doug Haldeman and Nadine Kaslow are Division 39 members and both described their plans should they be elected. While Doug is well known to us, having run for president last year, Nadine is also a long time member of the Division.

Both candidates addressed the failure of APA to fully implement the policy on psychologist participation in illegal detention settings and both promised to review and do their utmost to carry out the policy. Doug addressed the need to develop one "final" policy on psychologist involvement in interrogations, which he felt would supersede the PENS Report. Nadine spoke forcefully on what she sees as a failure of leadership on the part of APA and a need to fully address and apologize for this failure, specifically a failure to align our organization solidly behind the other professional organizations that took much more forceful measures to oppose involvement of behavioral and psychiatric interventions with detainees.

  • Nadine Kaslow, PhD
    Nadine Kaslow work at Emory University School of Medicine has been primarily in the area of family violence, cultural diversity, women's issues, and training concerns, including supervision. She is the editor of Family Psychology. Her presidential initiatives include addressing the role of psychology within a health care system that will greatly change as a result of impact of ACA, developing new and innovative ways to ensure that graduate students and ECPs are able to successfully navigate the "pipeline" (graduate school to internship to postdoctoral to career), and working to sustain APA's vision as an organization dedicated to science, practice, and public service.

  • Doug Haldeman, PhD
    Doug Haldeman at the University of Washington has worked and taught primarily in the area of cultural and sexual diversity. He has been instrumental in bringing issues of cultural, ethnic, and sexual diversity to the forefront of APA policy including development of APA Guidelines for Psychotherapy Practice with Lesbian, Gay and Bisexual Clients. His presidential initiatives include expanding the definition of family in research and treatment efforts (that is, to provide a more inclusive and culturally sensitive definition of family), addressing the "mind-body" connection in developing comprehensive approaches to treatment (for example, including the role of exercise, diet, body work and breathing techniques, and so on), and developing interventions to address "ordinary life traumas," such as bullying, subtle racism/sexism/ageism, etc.

Both candidates are extremely well versed in APA governance and politics, an essential for success of any presidency. While we had set aside time to discuss possibility of endorsing one or the other candidate, the BoD quickly came to the decision that both candidates would be excellent in various ways and we voted to support each of them.

Please remember to vote (balloting begins on September 14) and we urge you to vote for both of these candidates. Also remember to completely fill out your ballot. Although I have no idea why APA uses the Hare system, or how it works the one thing I know (or have been told) is that filling out the ballot completely actually helps elect your preferred candidate.

Transitions

We also had some basic housekeeping items to announce.  Shortly after the Spring Meeting, Tamara McClintock Greenberg announced she was resigning from the Board and from editorship of InSight. This left some important positions to fill and Marsha McCary was appointed by the Board to complete Tamara's term on APA Council. Kristi Pikewiecz was appointed by Henry Seiden for the Publications Committee to assume role of editor of InSight. Tamara conceived and launched our online newsletter, InSight, and her contributions in this role as well as her work on the BoD and APA Council will be missed.

As previously announced, we will be welcoming a new BoD member in January, Dana Castellano, as secretary (who helpfully subbed as secretary for part of the August meeting). While Past President Mary Beth Cresci, Secretary Dennis Debiak, and Members-at-Large Marilyn Charles and Jill Bellinson will be completing their terms at the end of the year, they will return as newly minted members in January, with Marilyn as APA Council Representative and Mary Beth, Dennis, and Jill serving as Members-at-Large.

And All the Rest

You should be able to delve further into some of the following issues by reading reports on the web site, but I want to highlight some important news and initiatives.

  • We have a new Task Force, Psychoanalysis and the Humanities, with Spyros Orfanos as chair. Frank Summers has been working with Spyros and other task force members to increase integration of the humanities in our overall mission, for example, to have a wider range of the liberal arts professions represented as both presenters and participants at our meetings.
  • While the budget situation for 2013 is uncertain at this point, the BoD approved in principle a request from the Multicultural Committee (and an initiative from Frank Summers as incoming president) to greatly increase support for minority graduate students and ECPs to attend the Spring Meeting. This is part of our larger commitment to diversity and development of a new generation of members and leaders to keep the mission of the Division alive and revitalized by being more inclusive in reaching out to new members. While we will need to plan and evaluate this investment (for example, should we focus more on ECPs versus graduate students, we have certainly found that reaching out with financial support has paid dividends in retaining those awarded support as members, and has led to their increased involvement in Division leadership.
  • Also, the Multicultural Committee has worked with the Awards Committee to develop a new award that will be announced in 2013 for members who have made significant contributions in the area of racial, cultural and sexual diversity.
  • Our Fund for Psychoanalysis initiative has been successful in that we currently have more than enough in pledges to begin thinking about the actual mechanics of distributing funds once available. We still need some contributions to get us "over the top" and hope to be in operation by 2014. Dennis Debiak reported on some of the details we will need to address before sending out a "call" for grant requests.
  • The BoD approved a contribution to the 2013 Child Mental Health Summit. In the two years since the last Summit, Jill Bellinson has been working actively with this group and has been able to make the case that psychoanalytic thought and treatment need to be represented at the Summit next year. Her participation with this group has yielded significant recognition of the importance of a psychoanalytic perspective within APA governance.
  • We had what we hope is only the first of many future meetings of Division members who are also Directors of Clinical Training (DCT) as they came together to share their troubles, concerns, and successes in maintaining psychoanalytic theory and training as part of their graduate programs. There was a lively discussion and a wide range of experiences, from those who felt the accreditation process by the Committee on Accreditation (CoA) to be wholly biased against psychoanalytic programs, to those who had more positive (or at least neutral) experiences. Nancy McWilliams has previously written about this meeting and her summary can be found on our web site under Education and Training Committee Reports. The important point is that our Division may help spearhead efforts to both assist DCTs in their task of coping with CoA, as well as work to have more influence with CoA. We are also considering either including internship directors in these discussions or developing separate venue, since they are facing similar concerns in meeting APA accreditation standards while being true to a psychoanalytic vision for training interns.
  • The Publications Report is also on the web site but some quick observations. First of all, the journal has vastly improved on a number of measures, with the most understandable being that it is the third most cited psychoanalytic  journal, that is, our journal articles have been cited by other articles at a rate that places us third (and ahead of JAPA!). Also, our editor, Elliot Jurist, reported substantial submissions from graduate students and early career professionals applying for the Stephen Mitchell Prize, a vast increase over past years.

There were many other issues discussed at the meeting, some of which may be found under committee reports on the web site, some of which I will address in future blogs. As always, you may comment directly at this site, or email me. Hope the rest of your summer goes well