Stephanie is currently a doctoral candidate at the University of Wisconsin-Madison in the Department of Counseling Psychology. At present, she is a pre-doctoral intern at the University of Minnesota-Twin Cities counseling center (UCCS). In April, she successfully defended her dissertation regarding mental health outcomes for transsexual individuals throughout their transitioning process. As the recipient of the Charles Gelso Psychotherapy Research Grant, she will be conducing three separate meta-analyses regarding the efficacy of research trials for personality disorders. The first meta-analysis will be conducted regarding trials that compared evidence-based treatments to treatment-as-usual for personality disorders. The second meta-analysis will determine differences in efficacy for bona-fide treatments for personality disorders. Last, a cost-effectiveness analysis will be conducted on those trials that have compared treatments for personality disorders.

Please see the awards section of the Division 29 website for more information on the grant program and watch for upcoming details of the call for applications for the coming year’s grant awards. Eligibility for the Charles J. Gelso Psychotherapy Research Grant rotates biannually between graduate students/predoctoral interns and doctoral level psychologists/postdoctoral fellows. In 2011, doctoral level psychologists and postdoctoral fellows will be eligible.

A Review of

Bringing Psychotherapy Research to Life: Legacies from the Society of Psychotherapy Research

Editors: Louis G. Castonguay, J. Christopher Muran, Lynne Angus, Jeffrey A. Hayes, Nicholas Ladany, and Timothy Anderson

Review by Donald K. Freedheim, PhD

Louis Castonguay and his team of editors (six all together) have undertaken a gigantic task in organizing this biography of renowned psychotherapy researchers, the veritable “hall of fame” of the Society of Psychotherapy Research (SPR).

Sixty authors were enlisted to chronicle the works of 28 national and international researchers who have been responsible for the major directions and the majority of the studies in the field over the last half century.   From personal experience I know that editing such a volume is no ‘walk in the park,’ and having five co-editors does not simplify the effort.  Each author was given a standard format to follow in writing the brief—but not insufficient—biographies.  The information to be gathered included personal history, early influences, theoretical foundations, major accomplishments, students, and collaborative efforts.  Although various authors emphasized different aspects of the outline, for the most part, the chapters reflect a balanced mix of interesting and useful information.

The book begins with a helpful overview that lays out the very logical organization of the text.   First, the foundations for the scientific study of psychotherapy are represented by the works of Carl Rogers, Jerome Frank, Lester Luborsky,  Hans Strupp, and Aaron Beck[1].  All but the latter are now deceased, Luborsky, most recently.

After the foundations are explored, sections are divided by the following questions:

Does therapy work?  Answered by four outcome researchers: Irene Elkin, Ken Howard, Allen Bergin, and Klaus Grawe, also recently deceased.  How does it work?  Fifteen researchers are referenced here, with topics divided by therapist’s contributions, client contributions, relationship variables, etc.  And lastly, What works for whom?  Sol Garfield (deceased), Larry Beutler, Sid Blatt, and William Piper are covered in this section.

The common threads that run through the biographies are predictable: academically oriented families—with a few exceptions, notably Bill Piper and Larry Beutler, who was a cowboy in his early years—varied interests before psychology (music for Irene Elkin and Lorna Benjamin, engineering for Les Greenberg), talented students with endless intellectual curiosity.  But it is interesting to note the varied backgrounds of the researchers from cultural environments to religious differences.  Several were in families that fled the European holocaust.

The volume concludes with an ample six-author summary which rounds out the coverage of therapeutic approaches and research centers and looks into future directions.

Despite the necessary brevity of the chapters, each includes extensive references, listing the major publications of the researchers. It might be pointed out that despite the separate chapters for each researcher, many have collaborated with each other through the years and some are part of large collaborative studies.  This is both a source of elucidation and confusion.  At times this reviewer wished for a chart indicating the interactions of the theoretical perspectives, research methodologies, etc. to clarify the relationships among the various researchers.  It might be helpful to design a sociogram, which would provide an interesting picture of the clusters that emerge within the ‘families’ of researchers.

In reading through the methodologies of the researchers, one is struck by not only the complexities of the researchers’ tasks, but the increasingly sophisticated techniques that are being employed to record and analyze the data.  From self-report and observational methods to computing hundreds of data points, researchers have improved the reliability of findings.  So, too, sample sizes have grown (e.g., Piper directs a large coalition of international researchers).  And findings are subjected to more and more rigorous scrutiny.

An added question to the ones above might be, “Who is this book for?”

Certainly it is for the archives and members of the Society for Psychotherapy Research.  The work is a great historical document for the Society and stands as a tribute to the founders of SPR.

Beyond SPR, advanced students and potential researchers seeking an overview of the field would be enlightened, if not amazed, by the persistent attempts to unravel the mysteries of the psychotherapeutic process.  Unlike many remedies that seek to heal physical ills, understanding the complex interactions of therapy presents almost insurmountable challenges.  There is no question that somehow much of therapy is successful with many patients.  Yet even when it “works” we often don’t know how that happens in any real operational sense.  Teasing out the therapist, client, problem variables of the equation, much less the interactions among them, is a daunting task.

Castonguay, et al. have brought to life the pioneers of the psychotherapy research enterprise, as well as many contemporary researchers who have waded into the troubled waters of investigating this elusive phenomena we call ‘psychotherapy.’  The book is a benchmark that serves as a perfect springboard for future decades of the ongoing study of psychotherapy.

Gains for Psychology in Health Care Reform

Due in large measure to the combined advocacy efforts of APA and APAPO government relations staff and our members, numerous legislative provisions favorable to psychology were included in the final health care reform legislation. These offer new and expanded opportunities for psychologists in our various roles as practitioners, educators, and researchers.

What follows are several highlights related to our APA priorities for health care reform. I would also like to direct your attention to a more comprehensive listing of legislative provisions of interest to psychology and to an APAPO article for a discussion of the significance of this legislation for psychologist practitioners.

1. Integrated Health Care

• Inclusion of psychologists on community-based interdisciplinary, interprofessional health teams to support primary care practices as part of a new grant program
• Participation of psychologists as part of health teams or designated providers of health home services to provide health care to eligible individuals with chronic conditions (including mental disorders) through a new Medicaid state option

2. Mental and Behavioral Health Care

• Inclusion of mental health and substance use disorder services, along with behavioral health treatment, at parity with medical/surgical services in essential benefit packages
• Extension of the 5% Medicare psychotherapy payment restoration from January 1 through December 31, 2010, which will increase access to mental health services

3. Prevention and Wellness

• Elimination of cost sharing for eligible preventive health services and expansion of prevention and wellness initiatives to address depression, postpartum conditions, and elder abuse
• Directive for the Clinical Preventive Services Task Force to consider best practices presented by scientific societies, such as APA, in developing recommendations

4. Psychology Workforce Development

• Designation of a separate $10 million set-aside for doctoral, postdoctoral, and internship-level training through accredited programs and internships in professional psychology
• Establishment of a loan-repayment program for psychologists in pediatric care and expansion of eligibility to psychologists, psychology programs, and psychology students for geriatric education and training programs

5. Elimination of Health Disparities

• Data collection and quality measure development to further the elimination of health disparities
• Development of a national strategy to improve the delivery of health care services and patient health outcomes

6. Support for Psychological Research

Creation of an infrastructure to support comparative effectiveness research (which received a $1.1 billion infusion of funds through the economic stimulus package last year) to enhance treatment decisions

7. Involvement With Consumers, Families, and Caregivers

Promotion of long-term care services and supports for adults with functional limitations and family caregivers

Hundreds of Psychologists Have Their Voices Heard on Capitol Hill

On March 9, the voices of psychologists from across the country who participated in the APAPO State Leadership Conference (SLC) echoed in the halls of Congress. The psychologists conducted over 300 meetings with members of Congress and their staffs to request extending through 2011 the 5% outpatient mental health reimbursement, adding psychologists to the Medicare “physician” definition, and making psychologists eligible for reimbursement for “psychotherapy with evaluation and measurement” codes. Psychologists also discussed their support of health care reform that integrates psychological services into primary care, preventive services, and benefit packages.

This year’s SLC was entitled “The Power of Advocacy” and featured sessions on such critical topics as the new mental health and substance use parity law and its ongoing implementation. Special programs honored two of our mental health champions in Congress—Representative Patrick Kennedy (D-RI) and Senator Olympia Snowe (R-ME)—and offered a memorial tribute to Senator Edward M. Kennedy, a staunch mental health advocate, who died last year.

Approval of Medicare Access Provisions of Vital Importance to Psychology

The day after the SLC congressional visits, the Senate passed highly favorable legislation that would retroactively extend the 5% Medicare psychotherapy payment restoration through the end of 2010. The legislation would also prevent the 21.2% Sustainable Growth Rate (SGR) cut from going into effect through September 30. These vital provisions were included in the American Workers, State, and Business Relief Act of 2010 (H.R. 4213). Six Republicans joined with 56 Democrats to pass the bill in a bipartisan 62-36 vote.

The newly enacted health care reform law mirrors the recent Senate action by extending the 5% Medicare psychotherapy payment restoration from January 1 through December 31, 2010. This will restore about $30 million to Medicare mental health reimbursements. APAPO continues to push for passage of Medicare legislation that extends the restoration through the end of 2011 and further delays the SGR cut from taking effect, ideally by changing its flawed formula.

The Reality of Health Care Reform

The enactment of health care reform legislation is a momentous achievement that has been likened to the adoption of the Social Security Act in 1935 and Medicare legislation in 1965. Over the past 15 months, APA and APAPO government relations staff have effectively advocated for our health care reform priorities with Congress and the White House. Yet, much of the credit for psychology’s legislative gains is due to you, our members, for your calls, e-mails, and visits to members of Congress. Thank you on behalf of APA, APAPO, and the field of psychology for your valiant efforts. We now look forward to working with you to get the word out that psychology also has much to contribute to the effective implementation of health care reform through the regulatory process at the federal and state levels.

As always, your thoughts on our health care reform activities are welcome. While I am unable to respond individually to each message, your views are carefully considered. I also encourage you to visit our APA health care reform website for more information about our health care reform priorities and initiatives.

By. Norman B. Anderson, PhD
Chief Executive Officer
American Psychological Association
750 First Street, NE
Washington, DC 20002-4242

Learn more about the members of the Task Force and their agenda.

Michael J. Constantino & Jeffrey Magnavita

Jeffrey Magnavita

Michael Constantino

This evidence-based treatment update column was designed to keep clinicians abreast of the most current findings in clinical science. In this section of our website we draw information from recent reports published in a variety of cutting edge journals, and highlight what we believe are relevant findings that can be used to guide evidence-based practice. We also provide the primary references so that the reader can review the complete works. Although we will regularly update this column, we welcome suggestions for relevant works to highlight.

Suggest Research by Sending Us Your Ideas Below

CHARLES J. GELSO, PH.D., PSYCHOTHERAPY RESEARCH GRANT

Division 29 created the annual Charles J. Gelso, Ph.D., Psychotherapy Research Grant to provide annual grants (up to $2000) supporting the advancement of research on psychotherapy process or psychotherapy outcome. Grant eligibility rotates biannually between graduate students/predoctoral interns and doctoral level psychologists/postdoctoral fellows.

The grant program was established in honor of Charles J. Gelso, Ph.D., who has made major contributions to theory and empirical research related to the psychotherapy relationship, including the working alliance, transference, countertransference, and the real relationship. In addition, his research has brought about important advances in our understanding of the research training environment in graduate education, as well as in the application of psychoanalytic concepts to short-term and long-term psychotherapy. He received his M.S. from Florida State University in 1964 and his Ph.D. from Ohio State University in 1970, and is a professor in the Department of Psychology at the University of Maryland, College Park. He has mentored many new investigators in the area of psychotherapy research.