For additional information on these loan repayment opportunities, visit http://nhsc.hrsa.gov/loanrepayment/.

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

By Christopher E. Overtree:

When I went to college, all students were required to have a voicemail account, enabling college administrators to send campus wide messages.  Voicemail served an important social purpose too; we checked hourly to see whether we would be enjoying burritos at the Wa Wa or foot-longs at Hoagie Haven.  But, we had a choice about whether we wanted email, and without realizing what I was doing, I selected one.  Thus begins my story of the race for information, constant availability, and the battle for privacy amidst a world of transparency.  Sometimes I wish I had that choice back.

But there was no one to email back then, unless I wanted to shoot some computer jock a note about “how cool this is” or a message to Steve Jobs reserving a Newton.  Now I am plugged in, and my suspicion is that you are too.  If not, you are probably told you are hard to reach, asked for your email rather you’re your name, or have been told that your family’s photos are on Facebook rather than in an album.  It’s been a bumpy ride.

For psychotherapists, this has created unique challenges.  Our profession understands the role that self-disclosure can play in therapy.  But in the Internet age, self-disclosure happens to us as information is gradually absorbed by the searchable Internet.  We used to think we could opt out, but now realize that it is often better to manage our information than to keep it hidden.  In my view the question is not whether psychotherapists should embrace technology, but rather, how should this be done.  Our economy frequently asks what jobs and services can be moved to the Internet.  My plumber recently ordered parts for my washing machine on his Blackberry.  But what about psychotherapy?

As this question brings positive and negative associations to your mind, ponder additionally where discussions about our field are taking place.  Where is the dialogue about modern psychotherapy happening?  Where do early career psychologists and psychology students find their information, their mentors, and their outlets for dialogue?  Where do critics post their harangues?  Where is the role of psychotherapy, its utility, its billability, and its very livelihood being discussed?  Why the Internet of course!  Shouldn’t the Division of Psychotherapy have a loud voice amidst the cacophony?  Our own www.divisionofpsychotherapy.org is this opportunity.

Taking over as the Internet Editor for the Division of Psychotherapy was like knocking down the top floor of a skyscraper and rebuilding the penthouse.  Obviously, any discussion of the future of our website begins with gratitude to Abe Wolf, past President and first Internet Editor who built things from the ground up and gave the Division such an outstanding online presence.  New changes are not referendums on how things used to be done, but rather opportunities for the evolution of ideas and possibilities.  But rebuilding the penthouse is no small task, and requires us to ponder its design, its selling points, and how it will stand out in the very crowded web.

The New Web

The new web is not a place where paper documents are scanned and stored.  It is not a redundant back-up of printed content, nor is it a secondary source of information.  The new web is a primary source, the place where more and more original content is created, displayed and made searchable.  Printed documents have become secondary sources because their information is anchored to their publication date.  Sad, but true, your morning Times is already out-of-date when it arrives at your doorstep.

The new web is also extremely interactive, not static.  It is an interconnected network of information that evolves in response to its users.  In essence, the web is a wiki, which represents the collective wisdom (and interests) of the global online community.  A website that does not adapt to user interactions, or update its content in real time, comes to resemble the dusty leaves of a silk plant; attractive maybe, but certainly not alive.

In 2004, Google began an experiment in which flu-related search terms were used to map flu activity in different regions of the United States.  By aggregating the data, essentially a collection of users searching flu symptoms and remedies, Google was able to map flu outbreaks roughly two weeks before the CDC.  The power of their algorithm was in the interactions between users and the web, not in the web itself.  This success reminds us that the web is a primary source, an interactive endeavor, and one that relies on its users to establish its relevance.

Division 29’s growth and influence in the field of psychotherapy is intimately tied to its web presence, perhaps as much as its publications and activities.  Our website is a portal for our members, but also for the public, policy makers, our critics and supporters.  Our website has the opportunity to play a valuable role in the dissemination of information about psychotherapy, establishing Division 29’s leadership in the field.

If you google the word, “psychotherapy,” our website comes up third in the hit list (Wikipedia is number one).  However, if you google the phrase, “psychotherapy bylaws,” we shoot to the number one spot.  This says a lot about how our website has been used in the past, but also gives us a clear picture of our future direction.  A focus on documenting Division activities can shift to one that plays a vital role in the exchange of information about psychotherapy.  It can be a resource for early career psychologists and students seeking colleagues and information.  It can be a tool for leadership.

Our New Website

Our new website looks very different from the old, and is built on a different set of design principles which bring unique strengths and weaknesses.  The website was built using WordPress, an Open Source, self-hosting blogging tool used by millions of sites to display everything from pictures of puppies engaging in humorous antics to international corporations reporting news and earnings.  Our site has a custom-built exterior, backed by a powerful infrastructure that is very stable and feature-rich.  For those of you not familiar with the Open Source movement, it is based on the notion of collectively authored software platforms with code made available to the public for editing, troubleshooting, and the incorporation of new features.  Open Source software is often more stable, adaptable, and typically faster than commercial platforms, and in case you still need to be convinced, is available free.  Our choice of WordPress thus represents a shrewd financial decision as well as a statement of support for Internet freedom and transparency.  It also brings some excellent features.

Now first and foremost, forget what you know about “blogging,” as our site does not operate like some of the blogs you may have come to enjoy or despise.  A blog-style website simply means a design that highlights and organizes new material as “posts,” placed at center stage to get the viewer’s attention.  Posts can be articles, commentaries, announcements, book reviews, or even pictures from social events.  Each post is optimized for keyword search, grouped into categories for easy sorting, and also “tagged” with specific keywords that tell readers which topics occur most often (check out the Tag Cloud on the homepage which graphically represents hot topics).  So new posts get highlighted on the homepage, categorized and tagged.  As a post ages, it fades into the background, but is always ready to be called up by a targeted keyword or category search.  A post can be authored by anyone, and readers can respond with comments that are monitored to prevent spam.

Our homepage does lots of other things too.  Using widgets, we can display many other items including reminders, hyperlinks, Really Simple Syndication (RSS) feeds to display content from other sites, slide-shows and much more.  Currently, we are highlighting the Division’s 40^th Anniversary celebration, Jeffrey Magnavita’s “Re-envisioning the Division” slide show, an events calendar, and an RSS feed coming right from our Psychotherapy Journal showing the latest articles.

Across the top of every page is a selection of static pages, where the informational content of a traditional website is located.  These pages are updated less frequently, and are designed to contain information regarding governance activities.  New and emerging content will always be showcased on the homepage, but the backbone of the Division’s structure is contained in these permanent pages.

One of the best features of the new website is the ability to add users with different privileges, enabling them to create their own content, manage their own posts, and make changes to the site.  One excellent example of this is Jeffrey Barnett’s Ask the Ethicist column, which accepts questions on ethics in psychotherapy, and receives responses directly from Dr. Barnett.  Whenever Dr. Barnett responds to a question, readers see a new post highlighted on the home page.  A description of the Ask the Ethicist column, a place to post your own questions, and a link to view the archives can be found under the Continuing Education tab.  We hope that other Division 29 members will author their own columns, and there are currently plans for an Early Career Psychologist mentoring column, a Technology column, and a column for student members.

What is Different About the New Website

One of the major changes for the new website is its focus.  As was mentioned above, much of the previous content was “Division-only” business and paperwork.  While the new website still attempts to document these activities, it is not quite as useful for archiving documents given its focus on emerging content.  While members will still be able to find these documents, users will find this material well organized, but in the background.  There will be fewer PDF files, and more content is viewable directly on the page to improve access.

One of the other shifts our website is making is to be more attractive to web-surfers, particularly members of the public, policy makers, students and non-members with an interest in psychotherapy.  We hope to increase membership by expanding our reach throughout the Internet and by providing content that is useful to anyone interested in learning more about our field.

A Few Other Division 29 Internet Resources

For a while there, we watched, wallets in hand, as companies fought the format battle.  Vinyl to 8-track to cassettes to CD’s to MP3’s and back to vinyl.  VHS to DVD to Blueray to 3D ESPN.  But the ubiquitous role of information and the ability of computer code to adapt to any device has slowed these battles, and allowed us to focus on the point of all these formats and devices, the enjoyment and sharing of content.  Our online presence is also designed to be adaptable to emerging communication trends.  Rather than a one-size-fits all approach, we hope that our Division can be flexible, garnering followers in different venues or devices.  Can you believe I can edit our Division’s website from my iPhone?  Actually, I could if my fingers were smaller, but I promise you it is possible!

One such example is the Division’s new Facebook Page.  Facebook makes room for businesses and educational organizations, allowing them to post information and relying on fans to propagate this information by forwarding or reposting items of interest.  On our own homepage, you will see an invitation to become a Fan of the Division’s Facebook page.  New posts on the Division website are automatically reposted on Facebook, connecting them to the vast social network of our fans.  For those of you who are not Facebook users yet (or will never be), it is important to understand that developing a web presence means adaptability.  Our Facebook page reaches an entirely different type of user, one that is generally younger and more apt to follow web trends.  Our Facebook page also helps us to benefit from the logarithmic effect of passing information socially as posts are automatically shared with friends once, twice and thrice removed.  Facebook is also a great place for members of the Division to share interesting pieces of information that would not necessarily warrant rent space on our own homepage.  Shrewd followers of Division 29 will Find Us On Facebook!  At press time, we have 47 fans, with a hope that when article hits mailboxes, we will see a spike.  I’ll be watching.

You may also notice that the electronic version of our Psychotherapy Bulletin is viewable directly on our website, as well as available for download as a PDF file.  This is made possible by a document-hosting site, known as Scribd (pronounced scribe-d).  Scribd focuses primarily on complete documents and online publications, but also has a social networking component.  Scribd users can choose to subscribe to our publications, receiving notifications when new ones arrive.

Finally, if you saw the photos from the 40^th Anniversary celebration on the website, these were hosted on our Picasa page which displays photos for public, private, or by-invitation-only viewing.  This is a popular photo-sharing site, making it easy to upload photos from events, or to establish an archive of our Division’s history.

The Role of Online Publishing

I read an analysis recently on the environmental impact of manufacturing and delivering an Amazon Kindle. The conclusion was that the deleterious environmental consequences of purchasing a Kindle were outweighed in a single year by the reduction in paper use and waste in the print industry.  This is an impressive triumph for a new electronic device, which typically places increased pressure on the environment.  The proliferation of information devices such as the Kindle, iPhone and Blackberry, and new generation tablet computers such as the iPad tell us to expect considerably more growth in the online readership of our Psychotherapy Journal and Psychotherapy Bulletin.

As such, it makes sense that we discuss the optimal means for adapting publications to the online environment, and that we encourage members to select electronic versions instead of print.  As is the case with our website, it is the content that is most important.  Our strategy is to promote broad appeal, across many devices and formats.  We hope that future publications will be compelling enough and improved enough by electronic dissemination, that members will choose to view documents electronically.  More importantly, choosing to reduce paper use and publication cost is an opportunity for us to Go Green, bringing the Division more inline with modern conservation standards for educational and business organizations.  As if the above were not enough, we also hope members will choose to opt-out of receiving print documents in order to free up financial resources for improving the benefits of membership in new and exciting ways.

Future Possibilities

There are innumerable opportunities provided by the Internet to strengthen the Division of Psychotherapy.  Future growth may see the development of a presence on YouTube or possibly other areas more specifically geared to the field of psychotherapy.  As the Internet is a highly interactive environment, wholly dependent on the contributions of its users for growth, I hope the Division of Psychotherapy’s website will be equally participatory and members will feel comfortable coming forward with new ideas for content or strategies for broader dissemination. I will be placing an electronic, hyperlinked copy of this article on our website with a place for comments, questions or suggestions.  I hope readers of this article will share their reactions and ideas for the growth of Division 29’s online presence.

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.