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BULLETIN

PsychotherapyOFFICIAL PUBLICATION OF DIVISION 29 OFTHE AMERICAN PSYCHOLOGICAL ASSOCIATION

www.divisionofpsychotherapy.org

2012 VOLUME 47 NO. 4

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In This Issue

Psychotherapy IntegrationThe Broad Applicability of Integrative Principles

Psychotherapy ResearchNarrative-Emotion Process in Psychotherapy

Education and TrainingTraining in the Art of Psychotherapy

Psychotherapy PracticeTechnology and Psychotherapy:

A Study of Division 29 Members

Ethics in PsychotherapyEthics in Sport and Performance Psychology:

The Use of E-Therapy in Athletics

Early CareerStepping into Leadership Roles as an Early

Career Psychologist: Reflections on the Question“Why should I get involved in Division 29?”

PPrreessiiddeennttMarvin Goldfried, Ph.D.Psychology SUNY Stony Brook Stony Brook, NY 11794-2500 Ofc: 631-632-7823 Fax: 212-988-4495 E-mail: [email protected]

PPrreessiiddeenntt--eelleeccttWilliam B. Stiles, Ph.D. P.O. Box 27Glendale Springs, NC 28629Phone: 336-877-8890E-mail: [email protected]

SSeeccrreettaarryy Barry Farber, Ph.D., 2012-2014Dept of Counseling & Clinical PsychColumbia University Teachers College525 W 120th St New York, NY 10027Ofc: 212-678-3125 Fax: 212-678-8235E-mail: [email protected]

TTrreeaassuurreerrSteve Sobelman, Ph.D., 2010-20122901 Boston Street, #410Baltimore, MD 21224-4889Ofc: 410-583-1221 Fax: 410-675-3451E-mail: [email protected]

PPaasstt PPrreessiiddeennttLibby Nutt Williams, Ph.D.St. Mary’s College of Maryland18952 E. Fisher Rd.St. Mary’s City, MD 20686Ofc: 240-895-4467 Fax: 240-895-2234E-mail: [email protected]

DDoommaaiinn RReepprreesseennttaattiivveessPublic Interest and Social JusticeArmand Cerbone, Ph.D., 2012-20143625 N Paulina St Chicago, IL 60613Ofc: 773-755-0833 / Fax: 773-755-0834E-mail: [email protected]

Professional PracticeMiguel Gallardo, Psy.D., 2010-2012Pepperdine University 18111 Von Karman Ave Ste 209 Irvine, CA 92612Ofc: 949-223-2500 / Fax: 949-223-2575E-mail: [email protected]

Education and TrainingSarah Knox Ph.D., 2010-2012Department of Counselor Education and

Counseling PsychologyMarquette UniversityMilwaukee, WI 53201-1881Ofc: 414-288-5942/ Fax: 414-288-6100E-mail: [email protected]

MembershipAnnie Judge, Ph.D. 2010-20122440 M St., NW, Suite 411Washington, DC 20037Ofc: 202-905-7721 / Fax: 202-887-8999E-mail: [email protected]

Early CareerSusan S. Woodhouse, Ph.D. 2011-2013Counseling PsychologyDepartment of Education and Human Serv-ices Lehigh University111 Research DriveBethlehem, PA 18015Phone: 610-758-3269Fax: 610-758-3227E-mail: [email protected]

Science and ScholarshipNorm Abeles, Ph.D., ABPP, 2011-2013Dept of Psychology Michigan State University 110C Psych Bldg East Lansing, MI 48824Ofc: 517-337-0853 / Fax: 517-333-0542E-mail: [email protected]

DiversityCaryn Rodgers, Ph.D. 2011-2013Prevention Intervention Research CenterAlbert Einstein College of Medicine1300 Morris Park Ave., VE 6B19Bronx, NY 10461Ofc: 718-862-1727 / Fax: 718-862-1753E-mail: [email protected]

Erica Lee, Ph.D., 2010-201280 Jesse Hill Jr.Atlanta, Georgia 30303Ofc: 404-616-1876 E-mail: [email protected]

AAPPAA CCoouunncciill RReepprreesseennttaattiivveessJohn Norcross, Ph.D., 2011-2013Dept of Psychology University of Scranton Scranton, PA 18510-4596 Ofc: 570-941-7638 / Fax: 570-941-7899E-mail: [email protected]

Linda Campbell, Ph.D., 2011-2013Dept of Counseling & Human DevelopmentUniversity of Georgia 402 Aderhold Hall Athens, GA 30602Ofc: 706-542-8508 / Fax: 770-594-9441E-mail: [email protected]

SSttuuddeenntt DDeevveellooppmmeenntt CChhaaiirrDoug Wilson, 2011-2012419 N. Larchmont Blvd. #69Los Angeles, CA 90004Phone: 323-938-9828E-mail: [email protected]

CCoonnttiinnuuiinngg EEdduuccaattiioonnChair: Tammi Vacha-Haase, Ph.D.Dept of Psychology, Clark Bldg Colorado State University Fort Collins, CO 80523 Ofc: 970-491-5729 E-mail: [email protected]

EEaarrllyy CCaarreeeerr PPssyycchhoollooggiissttssChair: Rayna D. Markin, PhDDepartment of Education and Counseling302 Saint Augustine Center800 Lancaster AveVillanova, PA 19075E-mail: [email protected]: 610-519-3078

EEdduuccaattiioonn && TTrraaiinniinnggChair: Jairo N. Fuertes, Ph.D., ABPPDerner Institute of AdvancedPsychological StudiesAdelphi UniversityHy Weinberg Center - Rm 319158 Cambridge AvenueGarden City, NY 11530Ofc: [email protected]

FFeelllloowwssChair: Tammi Vacha-Haase, Ph.D.Dept of Psych, Clark BldgColorado State UniversityFort Collins, CO 80523Ofc: 970-491-5729E-mail: [email protected]

FFiinnaanncceeChair: Jeffrey Zimmerman, Ph.D., ABPP391 Highland Ave.Cheshire, CT 06410Phone: 203-271-1990333 Westchester Ave., Suite E-102White Plains, NY 10604Ofc: 914-595-4040E-mail: [email protected]

MMeemmbbeerrsshhiippChair: Jean Birbilis, Ph.D.University of St. Thomas1000 LaSalle Ave., MOH 217Minneapolis, Minnesota 55403Ofc: 651-962-4654 fax: 651-962-4651E-mail: [email protected]

NNoommiinnaattiioonnss aanndd EElleeccttiioonnssChair: William Stiles, Ph.D.

PPrrooffeessssiioonnaall AAwwaarrddssChair: Elizabeth Nutt Williams, Ph.D.

PPrrooggrraammChair: Rodney Goodyear, [email protected]

PPssyycchhootthheerraappyy PPrraaccttiicceeChair: Barbara Thompson, Ph.D.3355 St. Johns Lane, Suite F.Ellicott City, MD 21042Ofc: 443-629-3761E-mail: [email protected]

PPssyycchhootthheerraappyy RReesseeaarrcchhChair: Michael Constantino, Ph.D.Dept of Psychology University of Massachusetts Tobin Hall - 135 Hicks Way Amherst, MA 01003-9271 Ofc: 413-545-1388 Fax:413-545-0996E-mail: [email protected]

SSoocciiaall JJuussttiicceeRosemary Adam-Terem, Ph.D. 2009-20111833 Kalakaua Avenue, Suite 800Honolulu, HI 96815Ofc: 808-955-7372 Fax: 808-981-9282Cell: 808-292-4793E-mail: [email protected]

LLiiaaiissoonnssFederal Advocacy CoordinatorBonita Cade, Ph.D.63 Ash St New Bedford, MA 02740 Ofc: 508-990-1077 Fax: 508-990-1077E-mail: [email protected]

Division of Psychotherapy �� 2012 Governance StructureELECTED BOARD MEMBERS

STANDING COMMITTEES

PSYCHOTHERAPY BULLETIN

Published by theDIVISION OF PSYCHOTHERAPYAmerican Psychological Association

6557 E. RiverdaleMesa, AZ 85215602-363-9211

e-mail: [email protected]

EDITORLavita Nadkarni, [email protected]

ASSOCIATE EDITORLynett Henderson Metzger, Psy.D.

[email protected]

CONTRIBUTING EDITORSDiversity

Erica Lee, Ph.D. and Caryn Rodgers, Ph.D.

Education and TrainingSarah Knox, Ph.D. andJairo Fuertes, Ph.D.

Ethics in PsychotherapyJennifer A.E. Cornish, Ph.D.

Psychotherapy PracticeMiguel Gallardo, Psy.D. and Barbara Thompson, Ph.D.Psychotherapy Research, Science and ScholarshipNorman Abeles, Ph.D., andMichael Constantino, Ph.D.

Perspectives on Psychotherapy IntegrationGeorge Stricker, Ph.D.

Public Policy and Social JusticeArmand Cerbone, Ph.D., and Rosemary Adam-Terem, Ph.D.

Washington ScenePatrick DeLeon, Ph.D.

Early Career Susan Woodhouse, Ph.D. and

Rayna Markin, Ph.D.

Student FeaturesDoug C. Wilson, M.A.Editorial Assistant

Jessica del Rosario, M.A.

STAFFCentral Office Administrator

Tracey Martin

Websitewww.divisionofpsychotherapy.org

PSYCHOTHERAPY BULLETINOfficial Publication of Division 29 of the

American Psychological Association

2012 Volume 47, Number 4

CONTENTSPresident’s Column ......................................................2

Editors’ Column ............................................................5

Psychotherapy Integration ..........................................6The Broad Applicability of Integrative Principles

Psychotherapy Research ............................................15Narrative-Emotion Process in Psychotherapy

Education and Training ..............................................20Training in the Art of Psychotherapy

Psychotherapy Practice ..............................................24Technology and Psychotherapy: A Study of Division 29 Members

Ethics in Psychotherapy ............................................30Ethics in Sport and Performance Psychology: The Use of E-Therapy in Athletics

Nomination Ballot ......................................................35

Early Career ..................................................................39Stepping into Leadership Roles as an Early Career Psychologist: Reflections on the Question “Why should I get involved in Division 29?”

Feature ..........................................................................46Fortification Strategies for Supervisory Relationship Enhancement

Washington Scene........................................................51“Interesting Times,” as Always

Membership Application............................................68

References ....................................................................69

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PRESIDENT’S COLUMNMore on Closing the Gap between Research and PracticeMarvin R. Goldfried, Ph.D.Stony Brook University

As I end my term aspresident of Division29, I would like to thankall those with whom I have worked—far too numerous to acknow-ledge individually.Their dedication to

further the division’s mission is both im-pressive and heartening, and it has beenmost gratifying to have been able towork with them.

In this, my last column, I would like tooffer my final thoughts about what hasbeen happening lately in the attempts toclose the gap between research andpractice. Although this gap has existedfor well over 50 years (see Lazarus &Davison, 1971), the need to close it isnow more urgent than ever. The impor-tant question with which we as thera-pists are currently confronted is how torespond to the growing pressures for ac-countability coming from professionalorganizations, governmental agenciesand insurance companies. Who will re-spond to the challenge of determiningwhich therapies work? Will it be therapyresearchers? Practicing clinicians? Bothworking in collaboration? As both a re-searcher and clinician, I believe that ef-fective therapy must be rooted in bothclinical observation and empirical verifi-cation. At the risk of being overly opti-mistic, I believe I detect the beginningsof a movement in several quarters thatrepresent serious efforts to close thislong-standing gap between research andpractice.

What are the Recent Attempts toClose the Gap between Research and Practice?There have been a number of recent at-tempts that have been made to close thegap between research and practice, in-cluding the following: • The Division 12 and 29 initiative to

create a two-way bridge between re-search and practice is based on theassumption that any difficulties asso-ciated with applying empiricallysupported treatments in clinicalpractice may provide us with impor-tant information about those vari-ables that are in need of futureresearch. In essence, it provides afeedback mechanism from clinicianto researcher, offering clinically rele-vant questions and issues in need offurther investigation—giving thepracticing clinician a voice in the re-search process. The first three sur-veys will be published next yearfrom this initiative, dealing with sur-veys of clinical experiences in the useof empirically supported treatmentsfor panic disorder, social anxiety, andgeneral anxiety disorder. Two addi-tional surveys have also just beencompleted, providing feedback onthe clinical use of empirically sup-ported treatments for posttraumaticstress disorder and obsessive com-pulsive disorder.

• Those involved in practice-researchnetworks have pointed out that oneof the benefits of these clinician-re-searcher collaborations is the ability

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to identify those factors that maymake it difficult to implement empir-ically supported treatment in clinicalpractice, such as client, setting, ther-apist, and treatment variables(McMillen, Lenze, Hawley, & Os-borne, 2009; Zarin, Pincus, West,&McIntye, 1997). Thus, Castonguayand colleagues (2010) have collabo-rated with practicing therapists tosurvey their clinical experiencesabout what they have found to beboth helpful and hindering events intherapy.

• A chapter will be appearing in theforthcoming 6th edition of the classicHandbook of Psychotherapy and Be hav-ior Change, written by Castonguay,Barkham, Lutz, & McAleavy (inpress), that describes current para-digms where practicing clinicians are actively involved in therapy research.

• The Division 29 journal Psychotherapyhas recently published a special sec-tion that focuses directly on possibleways we may be able to close the gapbetween research and practice. Thetable of contents for this issue can be found at: http://www.jbo.com/jbo3/showtoc.cfm?volume=49&issue=2&journal=pst2

• The Journal of Psychotherapy Integra-tion will be offering a regular sectiondealing with translational research,whereby basic researchers will re-view relevant research findings, written specifically for practicing cli-nicians to help them enhance theirclinical effectiveness. The first threearticles to appear next year involveresearch findings on traumatic grief,person perception research on howpeople tend to distort their views of significant others, and clinicallyrelevant research findings on closerelationships.

• Several forthcoming conferences willhave the integration of research andpractice as their theme. Thus the 2013 international conference of theSociety for Psychotherapy Research(SPR) will have as its theme: “FromPsychotherapy Research to Practiceand Back.” The Australian chapter of SPR, also to be held in 2013, willdeal with: “A Dialogue between Psy-chotherapy Research and Practice:How best can we learn from eachother?” And th forthcoming SEPIconference, to be held in Barcelona in June 2013, will have the theme:“Psychotherapy Integration: Re-searchers and Clinicians Working Together toward Convergence.”More can be learned about these conferences at the following twowebsites: www.psychotherapyre-search.org and www.sepiweb.org

• SEPI, which was founded close to 30years ago, has had a presence in ourdivision over the past several years,and members of SEPI’s SteeringCommittee have regularly writtenarticles for the Psychotherapy Bulletin.SEPI was founded in response to aneed that existed at the time—the de-sire for therapists to know moreabout how their approach was simi-lar to and different from other orien-tations. As a result of these effortsover the years, SEPI has played animportant role in encouraging thera-pists to be more open to the possibil-ity of integrating potentially helpfulcontributions from other orienta-tions. Some three decades later, an-other important need has arisen inthe field, namely demands for theempirical accountability of our inter-ventions. As suggested earlier, Iwould maintain that such importantdecisions need to be a collaborativeeffort of clinicians and researchers.

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After much discussion, the SteeringCommittee of SEPI has expanded itsmission to facilitate these collabora-tive efforts in meeting this importantchallenge. Having had 30 years of ex-perience of encouraging meaningfuldialogues across theoretical orienta-tions, SEPI is now committed toapply its efforts to facilitate collabo-rative interactions between cliniciansand researchers. The goal is to enableclinicians to learn and utilize thefindings of cutting-edge research,and for researchers to learn from theobservations of clinicians workingwith the issues that arise in the actualpractice of therapy.

So, here’s the commercial: I am askingthat you support the efforts spear-headed by SEPI by becoming a member.Its expanded mission is to work towardclosing the gap between research andpractice. The dues are very modest, andthere is a special rate for students. Thiscan be done on line at the SEPI Web site(www.sepiweb.org).

I would like to conclude by saying thatthis effort is something that has beenprofessionally important to me for many

years—indeed, since graduate school.Some 30 years ago, I expressed my belief—which still holds: The experience and wisdom of thepracticing clinician cannot be over-looked. But because these observa-tions are often not clearly articulated...[and]...may be unsystematic or at timesidiosyncratic...it is less likely thatthese insights can add to a reliablebody of knowledge. The growingmethodological sophistication of theresearcher, on the other hand, is inneed of significant and...[clinically]...valid subject material. [In short], ourknowledge about what works in therapymust be rooted in clinical observa-tions, but it must also have empiricalverification. For the researcher andclinician to ignore the contributionsthat each has to make is to perpetuatea system in which no one wins (Gold-fried & Padawer, 1982, p. 33).

References for this article can be foundin the on-line version of the Psy-chotherapy Bulletin published on theDivision 29 website.

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The Psychotherapy Bulletin

is Going Green: Click on

www.divisionofpsychotherapy.org/members/gogreen/

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It is hard to believethat we are reachingthe end of anotheryear, presenting youwith the last issue of the PsychotherapyBulletin for 2012. Onceagain, we have appre-ciated the supportfrom Jeffrey Barnett,the Publications BoardChair, Marvin Gold-fried, Division 29 Pres-ident, Tracey Martin,

Central Office Administrator, and theContributing Editors, authors, and Do-main representatives who have submit-ted articles for your reading pleasure.

We are again delighted to present youwith papers we hope you will find cur-rent, informative, and useful. The piecesfrom Psychotherapy Integration and Ed-ucation and Training will definitely haveyou reflecting on your own career as apsychotherapist and considering the“art” of it all. To illustrate the broadreach of this division, you will also findin this issue an article on the ethics of e-therapy in sport and performancepsychology and a “status” update of Division 29 members’ use of technologyand psychotherapy. For all of us who arementors or looking for mentors, there isan important piece on increasing in-volvement in leadership roles within

APA and Division 29. In our feature ar-ticle, we are pleased to be able to con-tribute to the dialogue on the farreaching effect of supervisor relation-ships and strategies to enhance them.The Psychotherapy Research piece of-fers an interesting perspective on clientnarratives. We always look forward tothe Washington Scene.

In this issue you will find PresidentMarvin Goldfried’s final column, withan optimistic look at the field’s efforts toclose the gap between research andpractice. Please express your gratitudeto him for his outstanding tenure andleadership role in this effort.

Wishing everyone a healthy and happyholiday season, and a wonderful newyear in 2013. As usual, please contact uswith your ideas, suggestions, criticisms,and comments.

Lavita Nadkarni(303-871-3877, [email protected]) andLynett Henderson Metzger(303-871-4684, [email protected])

Correction: In issue 47-3, the article,Therapeutic Presence: A Fundamental Com-mon Factor in the Provision of Effective Psy-chotherapy, incorrectly listed KennethColosimo’s credentials. He is a studentat York University.

Lavita Nadkarni, Ph.D.Lynett Henderson Metzger, Psy.D., J.D.University of Denver – Graduate School of Professional Psychology

EDITORS’ COLUMN

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The integrative ap-proach is guided bykey principles that un-derlie the thinking ofintegrative therapistsand inform their clini-cal work. These princi-

ples are apparent upon review of theintegrative literature. Integrative clini-cians develop skill sets related to the nature of the work, its theory base, theopportunities it offers, and the chal-lenges it poses. The present paper ar-gues that these fundamental principlesand technical skills have broad utility inmental health settings, not only for theclinical work itself, but also for educa-tion, service management and programdevelopment. It outlines where themany strengths integration brings to thefield can find application, both withinand beyond the clinical work per se. Theintent is to highlight the full scope andpotential application of integration.These three domains comprise the focusof this article; the implications of the in-tegrative approach for research are notaddressed. The author’s thesis arose inthe context of the clinical, academic andadministrative workings of an ambula-tory general psychiatry program withina large academic mental health hospital,where he practises.

Integrative PrinciplesThe emergence of psychotherapy inte-gration reflected the recognition that nosingle psychotherapeutic modality

achieves consistent success with all pa-tients (Beitman, Goldfried, & Norcross,1989). Many treatments are potentiallyefficacious with a given client. Modali-ties are optimally utilized within theirdomains of relevance and strength(Beahrs, 1986; Roth & Fonagy, 2005b).

Whereas a given theoretical model tendsto pay preferential attention to particulardimensions of human functioning, suchas conscious cognition, unconscious men-tal processes, affect, or behaviour, the integrative perspective recognizes thatthese various layers interact in complexways (Beitman et al., 1989; Stricker &Gold, 1996). Furthermore, differentmodalities may demonstrate complemen-tarity by contributing additive benefits.

Complementarity amongst therapies isone of four forms of interaction whichcan be identified. Facilitation and syner-gism are additional positive interactionsthat can occur. Facilitation is the use ofone modality that makes possible theuse of a second. Synergism exists whentwo modalities combined producegreater than additive effectiveness.(Greben & Kaplan, 1995). True negativeinteractions, in which the inclusion ofone treatment modality diminishes thebenefit of another, are naturally ofgreater concern, and the skilled integra-tive clinician must be mindful of thisrisk (Marks et al., 1993).

PSYCHOTHERAPY INTEGRATIONThe Broad Applicability of Integrative PrinciplesDaniel Greben, BSc, MD, FRCPCDeputy Medical Director and Head, Ambulatory ServicesAccess and Transitions Program, Centre for Addiction and Mental HealthAssistant Professor, Department of PsychiatryUniversity of Toronto

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Specific values are embedded in the inte-grative approach. First, there is an explicitpreference for flexibility and inclusion, asopposed to dogmatism and division(Beitman et al., 1989; Greben & Kaplan,1995). Together, flexibility and inclusionenable integration of traditionally diver-gent modalities, combined on either atheoretical or technical basis. Respect fordiffering orientations and opinions isfundamental. This emphasis is to be ex-pected given the historical context inwhich the integrative movement arose(Beitman et al., 1989; Goldfried &Newman, 1992). Many in the field under-score the central role of common therapeu-tic factors in successful clinical workacross several modalities (Frank, 1971;Roth & Fonagy, 2005a). The selection andspecification of a therapy to optimallymatch the needs of the individual is inalignment with the philosophy that clientneeds should be given greater weightthan therapist allegiances (Greben &Kaplan, 1995). This is captured by theterm patient-treatment matching. It is com-plemented by the concept of stage-treat-ment matching, which allows for shifts inapproach in response to the course of thesymptoms and treatment over time(Greben & Kaplan, 1995). Empirical effi-cacy is similarly given precedence overclinician preference (Lambert, 1998;Lambert & Ogles, 2004; Roth & Fonagy,2005b). Empiricism can also inform theconduct of individual treatments, withthe therapist actively monitoringprogress toward identified goals. This setof values results in an approach whichstrives to maximize treatment effective-ness for the individual patient.

ClinicalThe integrative principles of respect,flexibility, inclusion, interaction, attention to common factors, patient-treatment matching, stage-treatmentmatching, and empiricism can be seen toimpact many aspects of clinical work.

Breadth: The inclusiveness fostered by anintegrative perspective invites cliniciansto capitalize on the differential potentialoffered by established treatment modal-ities. There is therefore support to obtainwide ranging skills and to tailor these asneeded to the work at hand. This poten-tially positions the integrative practi-tioner with the clinical tools required toassess and treat patients presenting witha broad range of problems. This breadthcan be seen to span multiple dimensions.

The first is diagnostic. Taken together,unimodal psychotherapeutic modalitiesand psychopharmacologic treatmentshave established utility across the diagnostic spectrum (Roth & Fonagy,2005b), as have specific integratedmethodologies (Garner & Garfinkel,1997; Livesley, 2001; Norcross &Goldfried, 2005; Stricker & Gold, 1993).The inclusion of several of these intoone’s therapeutic repertoire means oneneed not limit oneself to treating a relatively narrow subset of the manifes-tations of mental illness and personalsuffering.

The second is acuity. A flexible approachto therapeutic variables such as treat-ment duration, session frequency, theo-retical model, and activity level,combined with an expansive skill set,makes it possible to respond to theneeds of clients presenting in crisis, withacute symptomatology, with recurrent,episodic illness, and with chronic formsof suffering. Furthermore, the integra-tive practitioner can respond to theneeds of clients across the emergent-to-chronic spectrum by adopting and com-bining these tools as indicated. Certainforms of integration lend themselveswell to adaptation to crisis work(Lazarus, 2005), whereas others are wellsuited to treatment of individuals whosedysfunctional patterns remain longitu-

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dinally fixed and resistant to unimodaltherapies (Keller et al., 2000; Wachtel,1977; Wachtel, Kruk, & McKinney, 2005).

In clinical practice, individuals maypresent with mild degrees of subjectivedistress and minor symptomatology. Alternatively, patients may present se-verely ill, psychotic, behaviourally dys-regulated, medically ill, or suicidal.Severity represents a third variable thatmay characterize the scope of a clini-cian’s practice. Here too, an integrativeapproach and accompanying skill setprepare the therapist to handle such di-verse intensities of personal distress anddisturbance (Beutler & Clarkin, 1990;Johnston, 1998).

Treatment Complexity: Finally, unimodalmodels of therapy are limited in their ca-pacity to address therapeutic needs ofindividuals with significant comorbid-ity. A therapist who holds an integrativeperspective need not always utilize anintegrated therapy. When the situationis straightforward, the simplest solutionmay well be best and easiest to carryout. On the other hand, in the presenceof substantial clinical complexity and diagnostic comorbidity, an integratedtreatment may confer benefits andachieve success where more singulartherapies have failed (Garfinkel &Garner, 1982; Garner & Garfinkel, 1997;Keller et al., 2000).

Stage: Consideration of stage-treatmentmatching results in a treatment planwhich takes into account the natural his-tory of an illness, the trajectory of the pa-tient’s difficulties, the impacts of priortreatments, recent life events, and thecourse of therapy. It places the currentwork in the context of what has pre-ceded it. This allows integrative clini-cians to step in at a given point in time,decide collaboratively with the clientwhere the priorities lie, and formulatean intervention so informed.

Individualization: The integrative per-spective places strong emphasis on spec-ification of treatments to ensure they areresponsive to the symptoms, needs, vul-nerabilities, strengths, and circum-stances of the individual client. It is thecounter-point to a “one size fits all” ap-proach to therapy. This, in turn, allowsa clinician with broad-based training tofit into varied treatment settings, becomfortable to select from amongst var-ied techniques, and implement a man-agement plan suited to the clinicalsituation as it presents.

Alliance: The therapeutic alliance haslong been demonstrated to be a highlyimportant common therapeutic factoraccounting for substantial variability intherapeutic effectiveness across manytheoretical orientations (Roth & Fonagy,2005a). However, certain therapies, suchas psychodynamic psychotherapy, paymuch greater attention than others tothe vicissitudes of the therapeutic al-liance (Horvath, Gaston, & Luborsky,1993). Some integrative approaches em-ploy dynamic conceptualizations andtechniques, combining them with othersless focused on the alliance per se. Thesemethodologies provide ways to main-tain the all-important focus on the al-liance, and yet address symptoms orpatterns less responsive to traditionaldynamic therapy.

For example, Wachtel’s cyclical psycho-dynamics and integrative relational psy-chotherapy provide the psychotherapistwith a thoroughly articulated, inte-grated theoretical model, along withclear guidance as to how to incorporatetechniques derived from cognitive-be-haviour therapy. The method does sowhilst maintaining attunement to thestate of the alliance as it intersects withthe therapist’s active techniques(Wachtel, 1977; Wachtel et al., 2005).

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Assimilative integration incorporatestechniques from diverse models into abase model, which provides its theoret-ical and technical core. Interventionsdrawn from other models are reconciledusing the theory base and strategies ofthe primary model. In this approach, ac-tive interventions are utilized mindful ofpsychodynamic factors. It is explicitlyrecognized that active interventionshave dynamic meanings to patients, andtherefore processing these interventionsusing psychodynamic formulation andtechnique is intended to render themcompatible and acceptable to the patient(Stricker & Gold, 1996).

Plateaus and Impasses: In the conduct ofpsychotherapy, it is important to recog-nize when progress has plateaued or ifan actual therapeutic impasse has beenencountered. Therapists need guidanceas to how to respond to such challenges.Some impasses develop related to psy-chodynamic factors, as characterized byconstructs such as resistance, negativetherapeutic reaction, flight into health,projective identification, and enactment.Incorporation of a psychodynamic com-ponent as a facet of an integrative ther-apy provides a footing from which tounderstand and address such problemsarising in the course of therapy, (for ex-ample, see Atwood, Stolorow, and Trop,1989). This empowers clinicians using in-tegrative techniques to work with chal-lenging populations such as those withsubstantial comorbid characterologicaldifficulties, where the emergence of im-passes can be reasonably anticipated.

Psychopharmacology: It is primarily in theintegrative literature that the issues aris-ing when psychotherapy and pharma-cotherapy are provided concurrentlyhave been addressed (Beitman &Klerman, 1991; Schachter, 1993). Theseoccur during combined treatment deliv-ered by a sole provider, or in a split-treatment model, with the biological and

psychological treatments conducted bydistinct providers. This complex arenahas great relevance to modern clinicalpractice, in which such treatments havebecome much more commonplace andbetter accepted. An understanding of integrative principles, in particular theinteractions and complexities which potentially arise when treatments are co-administered, readies integrative clini-cians to conceptualize and conduct suchtreatments in a systematic fashion. Theinclusion of pharmacologic treatmentextends the range of individuals whocan be safely and effectively helped psy-chotherapeutically (Keller et al., 2000).Depending on their discipline and train-ing, some integrative therapists are in aposition to prescribe, whereas others arenot. However, those for whom prescrib-ing falls outside the scope of their practice may well participate in the roleof psychotherapist within a conjoint format. In this latter circumstance,knowledgeable and respectful commu-nication between colleagues is essential(Chiles, Carlin, Benjamin, & Beitman,1991; Kahn, 1993).

EducationalThe integrative psychotherapeutic ap-proach yields many benefits for educa-tional processes.

Overarching Framework for Learning: Thefields of psychotherapy and mentalhealth, more generally, are vast and everexpanding. The integrative perspectiveprovides learners with a rational overar-ching framework upon which to placethe various theories and techniques towhich they are exposed. Students seekto establish a coherent sense of theirfield, to reconcile competing conceptu-alizations. An integrative frameworkcan serve a central organizing functionfor that highly challenging developmen-tal task. The psychotherapeutic venture

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is fraught with ambiguity. Here too, in-tegrative therapists have consideredsuch challenges, and hence can providecarefully thought out guidance totrainees (Messer, 1986; Messer &Winokur, 1984; Strenger, 1989). The useof an overarching framework combinedwith explicit attention to comparativepsychotherapeutic theory (Messer &Gurman, 2011), may be one step towardthe establishment of an approach to as-sessment and therapy, which is system-atic without being unduly narrow.

Similarly, integration has potential util-ity for continuing professional develop-ment. Experienced practitioners whoseek to extend their current mode ofpractice into new territories can capital-ize on an integrative framework to facil-itate this process (Greben, 2004). Thissame literature can aid the learner in thecomplex cognitive task of incorporatinga new method into an established pro-fessional practice.

Attitudinal Set: The value placed onopen-mindedness, flexibility, inclusive-ness, and empiricism can help mentalhealth educators as they aim to fostersuch attitudes in novice therapists(Cameron, Leszcz, Rideout, & Wright,1998). Early introduction of integrativeideas may play a positive developmen-tal role in this regard before narrowerviews are instilled (Greben, 2004;Halgin, 1985; Norcross, 1988). Within anintegrative treatment context, therapistactivity level can be treated as a thera-peutic parameter adjustable to the par-ticulars of the clinical circumstances andmodality chosen. Viewed in this way, allowance is made for a relatively activedynamic therapeutic stance (Gold,1996).

Breadth of Clinical Exposure: One conse-quence of the broad clinical applicabilitydiscussed above is that training settingsdeveloped with integrative principles in

mind can provide trainees with a tremen-dous breadth of clinical experience. Thisin turn provides the range of clinical ma-terial with which to hone and consoli-date one’s skills under supervision,readying the trainee to confidently han-dle the varied clinical presentations theywill encounter in independent practice.

Breadth of Skill Development: A psycho -therapy training program informed byan integrative perspective is likely to beone which gives credence to a widerange of treatment modalities (Greben,2004). If didactic teaching and super-vised clinical exposure to a similarlywide range of therapies are provided,then these would be expected to providetrainees with a breadth of skill develop-ment paralleling the breadth of clinicalsituations they should encounter(Cameron et al., 1998).

Individualization: Specification of thera-pies for individual clients requires farmore than an attitude supportive of thisgoal. Clinicians must possess the requi-site knowledge base of the relevanttreatment options, understand the fac-tors upon which these options are differ-entiated, be skilled at psychotherapyassessment, and have the capacity to se-lect or compose a therapy drawing uponthe unimodal and integrated possibili-ties warranting consideration. Traininginclusive of integrative principles, liter-ature, and skills can be seen to con-tribute to these multiple educationalgoals.

Common Factors: The integrative litera-ture has long placed importance oncommon psychotherapeutic factors.Drawing on this emphasis, a trainingprogram can be organized so that coretechniques addressing common factorsare accorded greater emphasis, andtaught early on (Weerasekera, 1997). Indoing so, psychotherapy educators may

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further the training effort to instill intrainees an “open theoretical orienta-tion” (Cameron et al., 1998).

Multiple Educational Modes: Given themany educational benefits that can ac-crue from training informed by integra-tive principles, brief mention is dueregarding what optimally comprisessuch training. Multiple capacities are re-quired to practise integrative psycho -therapy. In addition to the attitudinal,theoretical, and technical ones alreadymentioned, integrative practitionersneed metatheoretical knowledge, prob-lem-solving abilities, appreciation andmanagement of unresolved theoreticaland clinical dilemmas, tolerance for andmanagement of increased uncertainty, aswell as support through unique aspectsof professional identity and role devel-opment (Greben, 2004).

As a result, training programs seeking to foster such professional capacities intheir trainees will need to address mul-tiple aspects of the program. The pro-grammatic expectations and curriculumformally set out by the program to guideits faculty and students represent an important starting point, which anchorsthe educational activities occurringwithin that setting (Cameron et al., 1998;Weerasekera, 1997). Supervised psy-chotherapy is well established as a cen-tral and necessary vehicle for learning tobecome a therapist. The order in whichunimodal and integrative therapies arebest introduced has been debated(Greben, 2004; Norcross et al., 1986), butas a rule, training in the former is a nec-essary component of expertise in the lat-ter. Seminars or courses are suited toconveying content knowledge, and forgroup discussion of challenging devel-opmental issues. The group setting pro-vides an effective format for trainees totackle meta-supervisory issues, in whichthey process the differing inputs re-ceived from supervisors of different the-

oretical perspectives. Didactic teachingshould be complemented by readingsselected from the integrative therapy literature. Clinical rounds provide a set-ting in which these varied forms oflearning can be applied to clinical casesand discussed with colleagues (Greben,2005; Greben & Seeman, 1992). Taken to-gether, the educational contributions ofthe integrative perspective, and the manypedagogic activities it calls for, have implications for faculty development.

ProgrammaticPractice, service, and programmaticmatters comprise a third territory inwhich integrative principles have rele-vance.

Practice Management: The integrativeperspective provides a helpful vantagepoint from which to monitor one’s clin-ical practice. The same flexibility thatshapes integrative clinical and educa-tional functioning can aid the profes-sional in establishing a balancedpractice, with the potential to remainchallenging and rewarding, yet manage-able and sustainable. A mix of long-termand time-limited work, drawing on a“piece-of-work” strategy, can accommo-date treatments targeting enduring char-acterologic change, alongside focusedinterventions responding to more acutepresentations.

Access and Utilization: As a rule, mentalhealth and addictions services operatewith substantial resource constraints, inan arena in which the human need isvast (Mental Health Commission ofCanada, 2012). This represents an ongo-ing challenge in acute care settings, asclinical staff attempt to respond to sogreat an unmet need. By no means a so-lution to this societal challenge in and ofitself, a general service organizedaround integrative principles has muchto contribute. Features such as patient-


treatment matching, stage-treatmentmatching, flexibility, support for an activetherapist style when indicated, and inte-gration of psychotherapy with pharma-cotherapy, enable service deliverymodels that prioritize their use of theclinical resources available. Clinical serv-ices which are capable of delivering tar-geted interventions as part of theirrepertoire are positioned to utilize whatclinical resources they do have more effi-ciently, thereby creating opportunities forimproved access. Additionally, in thearea of mental health and addictions, co-morbidity is the norm rather than the ex-ception. Integrative approaches to serviceprovision may lead to more patient-cen-tred and relevant treatment when indi-viduals seeking care are too complex tobe eligible for more standard treatments.

Interprofessional Teams: Interprofessionalteams are increasingly being recognizedas a key ingredient in the delivery of ac-cessible, quality health care services,particularly in the context of limited re-sources (Interprofessional EducationCollaborative Expert Panel, 2011). In theauthor’s experience, attitudes, knowl-edge, and skills developed as an integra-tive clinician and educator have provenhighly useful in taking a lead role withina large interprofessional ambulatorymental health team. Respect for ap-proaches divergent from one’s own pri-mary professional identification runsdeep in the ethos of the psychotherapyintegration movement. It is a natural fitfor effective function within an interpro-fessional team. A broad knowledge base,unconstrained by singular theoreticalboundaries, positions the integrativetherapist to serve as a content expert incontributing to team function. Capaci-ties such as group process managementskills, facility at management of ambigu-ity and conflict resolution when multi-ple competing strategies press forconsideration, are all important tools in

working proficiently with, and enhanc-ing the functioning of, an interprofes-sional team.

Program Development: Several features ofthe integrative approach can serve thosecharged with program development re-sponsibilities. Its emphasis on respon-siveness to the particular needs ofindividual clients with a wide range ofdifficulties and presentations can en-courage service development in a direc-tion of increasingly client-centred care.The inclusive, flexible therapeutic stancemodels adoption of similar values at thedepartmental and organizational levels.It provides clinical program leaders witha comparative organizing frame fromwhich specific models of care can beconsidered and adopted, as they poten-tially contribute toward the overall man-date of the service. Parallel benefits canbe found when an integrative approachinforms educational programmatic de-velopment. A training program alignedwith integrative principles would be ex-pected to value responsiveness to stu-dent learning needs, flexibility that takesinto consideration the variability inlearning styles amongst trainees, and abig picture view of the pedagogic activ-ities comprising that educational pro-gram. Although the focus herein hasbeen on potential positive programmaticimpacts, integration also poses chal-lenges for a program. These includeadded complexity regarding outcomeevaluation, the need for additional stepsin the training process, and faculty ac-ceptance (Greben, 2004; Schottenbauer,Glass, & Arnkoff, 2005).

DiscussionThe present paper has outlined eightkey integrative principles: regard for dif-fering approaches, flexibility, inclusive-ness, attention to interactions betweenmodalities, recognition of common fac-

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tors, individualization and staging oftreatment, and empiricism. It has iden-tified the potential for positive impactwhen these principles are applied inclinical work, psychotherapy education,and clinical service leadership, includ-ing program development. In this analy-sis, three themes are seen to recur. First,pervasive benefits accrue related to theflexible, adaptive stance characteristic ofthe integrative perspective. Second,much of the impact across these differ-ent professional activities and roles ismediated through the great breadth oftheoretical knowledge and technicalskill which experienced integrative cli-nicians possess. Third, the expansivetendency to inclusiveness leads integra-tive practitioners directly into greatercomplexity, both theoretical and techni-cal. Systematic efforts to master such

complexity prepare integrative clini-cians to tackle the complicated chal-lenges posed by the broader domains ofmental health practice discussed above.

Integration has made great contribu-tions to the field of psychotherapy. Theprimary goal of this paper is to demon-strate that its scope extends well beyondclinical psychotherapeutic practice. Thesecondary goal is to consolidate theplace of integration within the fieldmore broadly. Finally, the author seeksto empower and motivate colleagues toapply these core principles to their fullpotential.


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ROSALEE G. WEISS LECTURE AWARDThe Rosalee G. Weiss Award is a joint award, bestowed by the Divisions of Psychotherapy and Independent Practice in alternate years and administeredby the American Psychological Foundation (APF). It was established in 1994 byRaymond A. Weiss, Ph.D., to honor his wife, Rosalee. The award is administeredby Division 29 and by Division 42 (Independent Practice) in alternating years.

The criteria for receipt of this award are as follows:• Outstanding leader in arts or science whose contributions have significance for psychology, but whose careers are not directly in the spheres encompassed by psychology

• Outstanding leaders in any of the special areas within the spheres of psychology

Award recipients receive an $800 honorarium from the APF.Deadline for nominations for this award should be submitted to

Division 29 by January 1, 2013.Questions about this award should be directed to the Chair of the Professional Awards Committee,

Dr. Marvin Goldfried, at [email protected]

The narrative accountingof emotionally salient lifeexperiences is a centralfeature of most psycho -therapies. These personalstories integrate a com-plex array of emotional

and cognitive processes that form afoundation for therapeutic explorationand intervention (Angus, 2012). Never-theless, the initial narratives that clientsexpress in therapy often lack structureand coherence; they do not always havea recognizable narrative form (i.e., aclear beginning, middle, and end), andsometimes they may be accompaniedby distressing emotion disconnectedfrom a clear relational or situationalcontext. Alternatively, client narrativesmay be overly structured and rigid, asnew experiences become subsumed intofamiliar emotional and interpersonalthemes.

Establishing coherence in one’s narra-tives is necessary for establishing asense of continuity to experience andmeaning to action (Fireman, McVay, &Flannagan, 2003). Additionally, a certainlevel of fragmentation and disorganiza-tion is inevitable in psychotherapy, asclients struggle to reformulate their lifestories (Daniel, 2009). Accordingly, animportant therapeutic task in narrative-focused psychotherapies is to negotiatethe “dialectic between story-makingand story breaking, between the capac-ity to form narrative, and to disperse itin the light of new experience” (Holmes,1999, p. 59). Indeed, therapist attune-ment and responsivity to nuances inclients’ narrative-emotion processingmay be essential for promoting the con-

struction of more coherent, flexible, andemotionally differentiated narrative ac-counts. Through the facilitation of sto-ried explanations of ‘what happened’and ‘how it felt’ therapists can helpclients organize their painful emotionsfor further reflection by actively identi-fying specific narrative contexts and sit-uational cues; a process purported tohelp contain and explain emotional ex-periences and allow for the emergenceof new self-understanding and mean-ing-making (Angus, 2012).

Although the individual contributionsof narrative and emotion to psychother-apy process and outcome have been in-creasingly examined empirically (Angus,Hardtke, & Levitt, 1999; Goncalves,Matos, & Santos, 2009; Missirlian, Touk-manian, Warway, & Greenberg, 2005;Pos, Greenberg, & Warwar, 2009), theinterrelations between these processeshave remained largely unaddressed. Toaddress this gap, recent empirical inves-tigations have begun to explore narra-tive-emotion integration processes inbrief psychotherapy, with a particularfocus on the contribution of these pro -cesses to effective psychotherapy (e.g.,Angus & Greenberg, 2011; Boritz, Angus,Monette, Hollis-Walker, & Warwar, 2011;Lewin, 2010). Premised on the theoreti-cal position that the narrative organiza-tion of salient emotional experience isvital to identity construction and emo-tion regulation, we have recently devel-oped a coding system for identifyingdifferent types of narrative-emotionprocess markers in psychotherapy.

PSYCHOTHERAPY RESEARCHNarrative-Emotion Process in Effective PsychotherapyTali Z. Boritz, Ph.D.Centre for Addiction and Mental Health, Toronto, Ontario


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The Narrative-Emotion Process Coding SystemThe Narrative-Emotion Process CodingSystem (NEPCS; Boritz, Bryntwick,Angus, Greenberg, & Carpenter, 2010) isan observational coding system thatwas developed to identify observablein-session statements and behavioursthat mark underlying narrative-emotionprocess. Once identified, these markersindicate to the therapist that a particularnarrative-emotion processing state is ac-tivated and amenable to intervention.This paper will briefly describe theNEPCS, review recent empirical find-ings, and present relevant ongoing re-search and future research directions.

The NEPCS markers evolved from an original set of narrative-emotionprocess markers identified by Angusand Greenberg (2011) that were differ-entiated by the degree to which (a) spe-cific autobiographical memories wereevoked, (b) narrative context was appar-ent, (c) symbolization of bodily felt ex-perience and primary emotions wereevoked, (d) story coherence was pro-moted, and (e) client experiences ofchange were highlighted (Angus, 2012).To empirically validate these narrative-emotion markers, Bryntwick, Angus,and Boritz (2008) first elaborated and re-fined the marker subtypes in the contextof transcripts of therapy sessions, result-ing in the creation of a coding manualfor the systematic identification of narrative-emotion markers in therapytranscripts. The NEPCS and its corre-sponding coding manual were then de-veloped to extend the identification ofnarrative-emotion processing to videosof psychotherapy sessions, so as to cap-ture important paralinguistic informa-tion occurring in therapy sessions.

The NEPCS consists of eight narrative-emotion process markers that are di-vided into two subgroups: ProblemMarkers and Change Markers. Belong-

ing to the Problem Marker subgroup arethose markers that evidence under-reg-ulated, over-regulated or unintegratedemotion within an unfolding narrative,including: Same Old Story, Empty Story,Unstoried Emotion and Abstract Story.The markers belonging to the ChangeMarker subgroup demonstrate narra-tive-emotion integration, including:Competing Plotlines Story, InchoateStory, Unexpected Outcome Story, andDiscovery Story. Additionally, there is aNo Client Marker category for therapysegments in which there are no clientmarkers present. Preliminary reliabilityhas been demonstrated for the NEPCS(Boritz, Bryntwick, Angus, Greenberg,& Constantino, 2012).

Problem MarkersSame Old Story. This marker refers toclients’ stories that involve over-generaldescriptions of interpersonal/behav-ioural/thought patterns or emotionalstates, accompanied by an experientialsense of “stuckness.” Emotional experi-ence is similarly described in global,non-specific terms, and often appears tobe a secondary emotion (Angus &Greenberg, 2011). Finally, the client de-scribes a sense of low personal agency(e.g., helplessness, powerlessness, hope-lessness, or resignation in relation to thepattern or state being discussed).Empty Story. This marker refers toclients’ narratives that involve externalevents or information, accompanied byabsent or low expressed emotionalarousal. This marker is often indicatedby the client’s use of an “external voice,”which has a pre-monitored quality; itdescribes a rehearsed conceptual style ofprocessing and a lack of spontaneity thatsuggests that content is not freshly expe-rienced (Eells, 2007). Narrative attentionis focused almost exclusively on “whathappened,” which may include factualautobiographical memories about the

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self. Alternatively, there may be a no-table lack of self-focus in the recountingof events.

Unstoried Emotion. This marker refersto clients’ narratives for which emotionis disconnected or disembedded from anarrative context. It is also indicated bydysregulated or dissociative emotion(i.e., underregulation or overregulationof emotion). Whether the client is expe-riencing a dysregulated or dissociativeemotional response, there is an accom-panying sense that the cause of the af-fective response is disconnected from aclear relational or situational context.Further, clients may demonstrate little orno understanding of what the emotionalstate means. Accordingly, clients mayreference points of tension, pain, orother somatic complaints.

Abstract Story. This marker refers toclients’ narratives for which emotionalstate and narrative expression are pre-sented vaguely. Clients may talk abouttheir own feelings or self-relevant ideas,but with little or no evidence of explo-ration or discovery. This marker is indi-cated by limited depth in reflection orexamination of one’s thoughts, feelings,or behaviours; the narrative contentoften includes self-descriptions that aresuperficial, overgeneralized, or intellec-tualized. When emotion is present, it istreated in a depersonalized style (Klein,Mathieu, Gendlin, & Kiesler, 1969).

Change MarkersCompeting Plotlines Story. This markerrefers to narratives in which the clientexpresses competing emotional re-sponses or lines of thinking in relationto a specific event or narrative context,accompanied by confusion, uncertainty,self-doubt, frustration, or protest. It isoften indicated in clients’ language (e.g.,“on the one hand...on the other hand”;“one part of me...the other part of me”).There is usually moderate expressed

emotional arousal in voice and body; although there is some freedom fromcontrol and restraints, arousal may still be somewhat restricted (Warwar &Greenberg, 1999).

Inchoate Story. This marker reflects adisjointed, unclear, or hard to under-stand narrative, of which the clientstruggles to make sense. This is often ac-companied by a fragmented descriptionof subjective experience of the protago-nist, indicated by pausing and/or dis-rupted speech, as clients attempt toarticulate an internal experience ormove into contact with an emotion(Levitt, 2001). Additionally, clients mayexpress confusion or uncertainty aboutthe causes, factors, and/or details of thenarrated event (e.g., “how do I makesense of this?” or “why has this hap-pened to me?”).

Unexpected Outcome Story. This markerrefers to narratives in which the clientdescribes engaging in “new” and posi-tive behaviours (actions), emotional responses, and/or thought patterns, accompanied by expressions of surprise,excitement, contentment, protest, and/or relief. Clients may also describe new, adaptive actions, reactions, and/oremotions in the context of previouslytroubling events/scenarios. Importantly,clients identify their own role in theevent (White, 2007).

Discovery Story. This marker refers toclients’ narratives for which a new ac-count is constructed from their explo-ration. It is indicated by a generaloverview of an event or a description ofa specific incident or event (past, pres-ent, or future; actual or imagined) thatincludes an experiential description ofhow one feels or felt during the specifiedevent. As well, there is a reflexive com-ponent, or interpretive analysis of


current, past, or future events and/orsubjective experiences.

No Client MarkerThis category is used to code segmentsin which there are no client markerspresent. This most often occurs whenthe predominant task is the provision ofinformation (e.g., psychoeducation, ses-sion scheduling) or when there is ‘chit-chat’ between the client and therapist.

Empirical SupportEmpirical investigations of the NEPCShave focused on exploring the contribu-tion of the individual NEPCS markersand their subgroups to therapeutic outcome. The first set of studies wasconducted to extend the current under-standing of narrative and emotionprocesses in psychotherapy to includethe identification of recurrent patterns ofnarrative-emotion processing in videosof psychotherapy sessions (Boritz et al.,2012). The NEPCS was applied to a sam-ple of 12 depressed clients (N = 36 ther-apy sessions) in client-centered (CCT),emotion focused (EFT), and cognitivetherapy (CT) to examine the associationbetween the narrative-emotion processmarkers and therapeutic outcome (re-covered versus unchanged at posttreat-ment)1, stage of therapy (early, middle,late), and treatment type (CCT, EFT, CT).The primary results of this investigationdemonstrated significantly higher pro-portions of Change Markers in therapysessions of recovered clients, whereasthere were significantly higher propor-tions of Problem Markers in therapy ses-sions of unchanged clients, irrespectiveof treatment modality. Within the Prob-lem Marker subgroup, there were signif-icantly higher proportions of theAbstract Story at the middle stage oftherapy in unchanged versus recoveredclients. No significant relationships werefound between the remaining ProblemMarkers – Same Old Story, Empty Story,Unstoried Emotion—and therapeutic

outcome. Within the Change Markersubgroup, higher proportions of the Inchoate Story, Competing PlotlinesStory and the Discovery Story were eachsignificantly associated with therapeuticoutcome. Additionally, there was a sig-nificant outcome x stage x treatment effect for the Competing Plotlines Story:recovered CCT clients evidenced higherproportions of Competing Plotlines atall treatment stages versus unchangedCCT clients; recovered EFT clients, rela-tive to unchanged EFT clients, evidencedhigher proportions of Competing Plot-lines at middle therapy.

In an effort to extend the breadth of theNEPCS to other diagnostic populationsand therapeutic modalities, a pilot studywas conducted to investigate the appli-cation of the NEPCS to a sample of 4clients (N = 24 therapy sessions) receiv-ing emotion-focused therapy for trauma(EFTT; Paivio & Pascual-Leone, 2010)(Carpenter, 2012). The NEPCS was ap-plied to two early, two middle, and twolate therapy sessions of two recoveredand two unchanged clients in EFTT. Primary results demonstrated large ef-fect sizes for the Problem and ChangeMarkers, indicating strong relationshipsbetween the proportions of NEPCS sub-groups and therapeutic outcome. Specif-ically, there were significantly higherproportions of Problem Markers in ther-apy sessions of unchanged relative to re-covered clients, with 31% of the variancein the proportion of Problem Markers attributed to therapeutic outcome. Con-versely, there were significantly higherproportions of Change Markers in therapy sessions of recovered relative tounchanged clients, with 18% of the vari-ance in the proportion of Change Mark-ers attributed to therapeutic outcome.Within the Problem Marker subgroup,there were significantly higher propor-tions of Unstoried Emotion in un-


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changed versus recovered clients acrossall therapy stages. This finding was par-ticularly compelling given the highprevalence of emotion dysregulationand alexithymia evidenced in individu-als diagnosed with complex trauma(Paivio & Pascuale-Leone, 2010). It wasalso a divergence from previous find-ings with the depression sample, whereUnstoried Emotion was barely evidentand did not differentiate recovered fromunchanged clients. Within the ChangeMarker subgroup, there were signifi-cantly higher proportions of the Com-peting Plotlines Story in early andmiddle stages in the recovered grouprelative to the unchanged group. In latetherapy, unchanged clients evidencedsignificantly higher proportions of the Competing Plotlines Story than recovered clients. There were also signif-icantly higher proportions of the Unex-pected Outcome Story in recoveredversus unchanged clients at late therapy.Finally, there was significantly higherproportions of the Discovery Story atearly and late therapy in the recoveredversus unchanged groups.

These early empirical findings suggestthat the NEPCS offers researchers andclinicians alike a new psychotherapyprocess tool that allows for the (a) classification of therapy segments intonarrative-emotion process markers andsubgroups, (b) comparison of the pro-portions of various NEPCS markersand subgroups within session, stage of therapy, and treatment type, and (c)examination of the effects of varyingproportions of NEPCS markers on therapeutic outcome. Beyond this, theNEPCS has potential clinical utility astherapists can use its markers to identifypatterns of narrative-emotion process-ing that may warrant therapeutic atten-tion. Along these lines, Angus andGreenberg (2011) identified a five-step

process for narrative and emotion inte-gration for productive change in psy-chotherapy, which begins with theawareness and contextualization ofemotion and works toward new self-identity reconstruction.

Future Research DirectionsSeveral additional current and ongoingresearch efforts include (a) extendingNEPCS coding to additional psycho -therapeutic modalities and diagnosticpopulations, (b) exploring the impact ofNEPCS shifting—movement betweendifferent types of NEPCS markers orsubgroups—on therapeutic outcome, (c)investigating the impact of therapist ef-fects in NEPCS shifting, and (d) articu-lating a model of narrative-emotionintegration as a mechanism of change inpsychotherapy.

ConclusionAlthough future research is necessary tounderstand further the contributions ofnarrative-emotion process to therapeuticoutcome, the NEPCS has begun to shedlight on this relation. It has also illumi-nated preliminarily the process throughwhich the lived emotional experienceemerges into narrative consciousness,how it then becomes symbolized in nar-rative form or alternatively how it resistsintegration, and finally how this processchanges over time or recapitulates.

1 Therapeutic outcome for both thisand the following study was based onJacobson and Truax’s (1991) methodfor determining clinically significantchange.


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At the start of each Fallsemester I stand up infront of a brand newgroup of bright-eyedgraduate students inmy basic therapy skillscourse with a monu-

mental task ahead of me. As I see it, myjob in this course is to help these gradu-ate students begin to learn the art of psychotherapy. This job would be easyif all I had to do was help them becomeskilled technicians who can delivermanualized interventions. However, my goal is to help these students ontheir journey to become master psy-chotherapists who can effectively usethe common factors (e.g., genuineness,unconditional positive regard, empathy,therapeutic alliance), in combinationwith specific techniques, to bring aboutchange in their clients. Hill and Lent(2006) have provided a thorough narra-tive and meta-analytic review of the ef-fectiveness of training in the basichelping skills. While there is some over-lap with the content reviewed by Hilland Lent, this less formal review goesbeyond the initial step of training thera-pists in helping skills and discusses ad-ditional methods for helping studentslearn the common factors to furthermaster the art of psychotherapy.

In the last semester of my undergradu-ate training at Brigham Young Univer-sity I took a course in Chinesecalligraphy. I had already learned thespoken language and was proficient inmy writing of the characters, but now Iwanted to learn the art of this ancientwriting style. My instructor was a mas-

ter artist in the subject and I have foundthat a number of his teaching methodshave particular application to training inthe common factors.

Begin with the Basic TechniquesAs with any art, it is important to startwith technique. In my Chinese calligra-phy class we began with proper postureand the basic strokes. Although all of thestudents in the class were eager to writesomething meaningful and beautiful,we spent weeks just making sure wehad the proper grip on our brushes, thatour backs were straight and our armswere positioned correctly, and that wecould simply paint straight lines. Thethorough development of these tech-niques provided a foundation for ourlater advancement.

Similarly, training in the art of psy-chotherapy should start with the foun-dational techniques that underlie thecommon factors. Rather than simply instructing students to listen to theirclients, be therapeutically present withthem, or express empathy, it is impor-tant that we teach the mechanisms fordoing each of these things. A number of great textbooks provide this type ofinstruction. For example, S. C. Shea inPsychiatric Interviewing: The Art of Under-standing (1998) provides excellent in-struction on ways to pay attention toclients’ nonverbal behavior to gain adeeper understanding of their problemsand how clinicians can use their ownnonverbal behavior to help facilitatechange. C. E. Hill in Helping Skills: Facil-itating Exploration, Insight, and Action

EDUCATION AND TRAINING

Training in the Art of Psychotherapy

Joshua K. Swift, Ph.D.University of Alaska Anchorage


(2009) teaches students how to most ef-fectively format/structure questions, re-statements, reflections of feelings, andmore. Among other things, D. Hutchin-son in The Essential Counselor: Process,Skills, and Techniques (2012) provides ed-ucation on the basic techniques associ-ated with starting and ending therapywith clients. And D. G. Martin in Coun-seling and Therapy Skills (2011) teachesstudents how to turn basic reflectionsinto expressions of evocative empathy.A trainee must learn the basic tech-niques before he or she can put anythinginto practice. Research has indicatedthat even just listening to a lecture on thebasic helping skills and techniques canlead to improved performance in ses-sion (Baum & Gray, 1992).

Practice Makes PerfectOf course, just reading about or listeningto lectures on techniques is not enoughto master the art of psychotherapy or theuse of the common factors – practice ofthe basics is also needed. In my Chinesecalligraphy course our instructor did notsimply tell us how to hold our brushesor posture our arms, he had us repeat-edly practice these basic techniques. Atfirst, we practiced in class where hecould watch and make corrections ifneeded. Then, we were assigned thesame practices to complete every day athome. Through these beginning levelpractices I noticed that my arm gotstronger and my basic strokes becamemuch more even.

Similarly, it is important that beginninglevel trainees have plenty of opportuni-ties to practice their common factorskills and techniques in a relatively safeand pressure free environment. In thebeginning therapy skills course that Iteach, I include practices of skills inevery class meeting. Students pair upwith one student playing the role of theclient and one student playing the roleof the therapist while I walk around lis-

tening to the role-plays and providinghelpful feedback based on what I hear.Partners are then assigned to practicethose same skills for at least an hour out-side of class. Anecdotally, I have noticedthat these practices allow the students toreally develop a solid grounding in theirfoundational skills; and empirically, Hilland Lent (2006) found a large effect size(d = .89) for training that includes prac-tice with feedback compared to no train-ing at all.

Watching OthersAnother valuable way to learning an artis through observation. My Chinese cal-ligraphy teacher often first demon-strated the characters at his desk that wewould be learning that day while all of the students in the class crowdedaround to watch and see how he wouldproduce his masterpieces. I often foundit helpful to observe him paint a charac-ter a couple of times, go practice on myown, and then watch him again afterhad a better idea of the parts of the char-acter that I struggled with.

Observing the sessions of others is an-other way to help students develop the art of psychotherapy. A number ofvideos are now available for this pur-pose. Many therapy skills textbooksnow come with DVD demonstrations.Additionally, the American Psychologi-cal Association and many others haveput together entire series demonstratingthe therapeutic work of experts in thefield. Students can even watch mastertherapists such as Carl Rogers or IrvinYalom on YouTube. Although I am by nomeans a “master therapist,” I also allowmy students to watch some of my ther-apy sessions. In watching the work ofothers, students can see demonstrationsof the skills they have been learning aswell as the human/personal side thateach individual therapist brings to his or her clinical work. Videos also allow


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students the opportunity to see “experts”make mistakes, which can help free themfrom the rigidity and pressure to performperfectly in session. In using videodemonstrations Keats (2009) recom-mends that students first be prepared bybeing told about the nature of the videoand having a chance to think about andreflect on the topic area that is going to bedemonstrated. Keats also recommendsthat students have a specific goal in mindwhen watching the video and that in-structors take some time to point out spe-cific things that were done well. Lastly,Keats recommends that after a period ofreflection students should be given anadequate amount of time to discuss theirreactions.

A number of studies have found videoobservations of others to be a usefultraining tool. In Hill and Lent’s (2006) re-view of the literature they found that ob-servation of models produced a largeeffect size (d = .90) in helping skill devel-opment. The same observation opportu-nities can be used throughout students’training to help them further developtheir use of the common factors.

Practice to Become MoreIn the beginning of developing an artis-tic talent, rigorous practice precludesfoundational skills and techniques. Oncethe foundational skills are developed,continued practice leads to a deepeningof the artistic ability. In my Chinese cal-ligraphy class I noticed that about 30minutes of daily practice was enough toproduce characters that were technicallycorrect. But, I also noticed that the moretime I spent on practicing, the morebeauty I was able to incorporate into my paintings.

Training programs are often designed toprovide increased levels of experience asstudents progress through their educa-tion. For example, students may beginwith role plays and mock clients in class

and then, when ready, move on to see-ing actual clients in a department clinicwhere a high level of supervision andguidance can be provided. Following an“in house” experience, students may beready to move on to an outlying place-ment where perhaps they will havemore independence or be asked to workwith a slightly more challenging clientpopulation. These graduate practice ex-periences may culminate in a pre-doc-toral internship where students get tofocus intensely on further developingtheir clinical skills. During these contin-ued practices and experiences studentsare able to learn first-hand what worksin psychotherapy and they grow to de-velop their own style. It is importantthat students receive consistent supervi-sion as they continue to practice. In ad-dition to guidance in conceptualizationskills and the use of specific techniques,this continued supervision should focus on common factors development.Throughout their supervised experi-ences students may also want to watchand evaluate their own videos. Researchhas found that self-observation alsoleads to improved therapy performance(Baum & Gray, 1992).

Taking Care of the Artistic ToolsMaintenance of one’s tools is importantfor any art. At the start of my Chinesecalligraphy class our instructor gave alecture on choosing and maintaining ourbrushes. He had specific brushesbrought over from China that he pro-vided to us for use. He also had specificinstructions for getting our brushesready for the first time use and for rins-ing, drying, and storing the brushes be-tween each use.

Similarly, it is important that studentslearn the art of self-care while they arestill in school. In terms of the commonfactors, learning self-care strategies can

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help trainees better develop the abilityto be therapeutically present with theirclients. For example, a number of stud-ies have found that training clinicians inmindfulness leads to treatment benefitsfor clients (Grepmair, Mitterlehner,Loew, Bachler, Rother, & Nickel, 2007;Grepmair, Mitterlehner, Loew, & Nickel,2007; Swift, Callahan, Dunn, & Ivanovic,2012). Mindfulness practice has been hy-pothesized to help therapists develop a number of qualities related to the common factors such as acceptance,awareness, compassion, interest, non-judgment, openness, and warmth (Bruce,Shapiro, Constantino, & Manber, 2010;Davis & Hayes, 2011; Geller & Green-berg, 2012). Mindfulness is an attitudethat can be cultivated through informaland formal daily practices at home or inthe clinic. Dunn, Callahan, Swift, andIvanovic (2012) recently found that pre-ceding a session with a simple fiveminute mindfulness centering exerciseleads to increased therapist presenceand improved session effectiveness.Other aspects to self-care that therapistsshould seek to develop while they are intraining include taking care of one’sbody (i.e., diet, sleep, exercise), settingboundaries, and engaging in pleasura-ble activities outside of work (Norcross& Guy, 2007).

Further Developing the ArtistFinally, artists need a pool of rich experi-ences to draw from. Throughout my Chi-nese calligraphy course our instructorgave us credit for visiting exhibits dis-playing Chinese calligraphy art pieces,viewing other types of Chinese art, orparticipating in Chinese cultural events.By absorbing the splendor of the Chineseart and culture we were better able to in-clude that beauty into our paintings.

In addition to self-care activities, stu-dents can develop their artistic therapyabilities by fully engaging in life. Inother words, activities such as meetingnew people, cultivating relationships,watching great movies, reading classicliterature, traveling, and volunteeringcan help students better see the richnessand depth of the human experience.This richness and depth can then bebrought into the therapy encounter.Along these same lines, trainees shouldconsider engaging in personal therapy.Not only can personal therapy for stu-dents serve the functions of increasedwell-being and personal growth duringa very stressful and challenging time, itcan also provide first-hand experiencebeing on the recipient end of the com-mon factors. Through personal therapystudents get a chance to observe theartistic nature of this work from theother chair (Norcross & Guy, 2007).

ConclusionsAlthough I have a long way to go tomaster the art of Chinese calligraphy, theapproach that my instructor used in thatintroductory course helped me begin todevelop my artistic abilities. Similarly,students are not likely to perfect the artof psychotherapy just during their grad-uate training. However, by helping themlearn to effectively use the common fac-tors in combination with specific tech-niques, we can start them on the path tobecoming master psychotherapists.


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O F P S Y C H O T

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If your time to you is worth savin’Then you better start swimmin’ oryou’ll sink like a stoneFor the times they area-changin’

Bob Dylan, The Times They are a Changin’

The ways in which we communicate witheach other are rapidlychanging. Email com-munication, relativelyrare in the 1990s, isnow, for many of us,virtually incessant.Facebook, launched in2004, recently reported

(October, 2012) its 1 billionth user.LinkedIn has 135 million members. Cell-phones, tablets, and laptops areseemingly ubiquitous, allowing andseemingly demanding our constantavailability via email, texts, and tweets.The Internet, and social media in partic-ular, have become a significant part ofeveryday life.

These and related innovations (e.g., theproliferation of phone apps) have begunto affect the expectations, concerns, andbehavior of those practicing and receiv-ing psychotherapy. In recent years, arash of articles has focused on the impli-cations of technological change for thepractice of psychotherapy. For the most

part, these papers have fallen into threecategories. The first has been a consider-ation of the ways in which new technologies (e.g., Skype; specific ther-apy-directed phone apps; diagnosis-spe-cific websites) may be used to practicepsychotherapy. As Clough and Casey(2011) noted, the major goal here hasbeen on determining ways that technol-ogy can “replace or duplicate face-to-face therapy” (p. 280). In this vein, theAPA recently released a draft of Guide-lines for the Practice of Telepsychology,noting the “expanding role of technol-ogy in the provision of psychologicalservices” (2012, p. 1).

A second focus has been on consideringthe ways in which new technologieshave led to new problems (e.g., Internetand Facebook addiction, sexting, cyber-bullying) for therapists to deal with (Farber, Shafron, Hamadani, Wald, &Nitzburg, 2012); a related focus has beenon ways in which technological ad-vances have affected the ways in whichour patients, particularly our youngerpatients, develop, sustain, and end relationships. Lastly, the literature hasfocused on the ways in which new tech-nologies have provided unprecedentedopportunities for each participant intherapy—patients, therapists, supervi-sors, and supervisees—to learn abouteach other, for example, through on-linesocial media or by “googling” one an-other (Tunick, Mednick, & Conroy,2011). In this regard, the ethical implica-

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PSYCHOTHERAPY PRACTICE

Technology and Psychotherapy: A Study of Division 29 Members

Barry A. Farber, Ph.D., Teachers College, Columbia UniversityNicole E. Norcross, Boston UniversityJohn C Norcross, Ph.D., Scranton University

tions of psychologists’ on-line presencehas been scrutinized (e.g., Barnett, 2010;Kolmes, 2012). Clinicians have typicallybeen discouraged from following or be-friending clients or potential clientsthrough on-line social networks inas-much as digital connections can too eas-ily lead to breaches of confidentialityand/or privacy (Gutheil & Simon, 2005;Van Allen & Roberts, 2011). A relatedline of inquiry has been focused on hownew technologies affect the ways inwhich therapists and patients communi-cate with each other outside the boundsof therapy sessions (e.g., through textingor emailing to schedule or re-scheduleappointments).

The present paper extends recent efforts(e.g., American Psychological Associa-tion Practice Organization, 2011;McMinn, Bearse, Heyne, Smithberger, &Erb, 2011) to investigate the extent towhich psychotherapists’ practices havebeen influenced by technology. McMinnand colleagues, for example, found thatof the 51 technologically-related therapypractices listed in their survey of mem-bers of Division 42 (Psychologists in Independent Practice), 39 items were“almost never used in practice;” in fact,almost none of their respondents hadever provided services via Skype. Theynoted, however, that their findings,based on a survey of independent prac-titioners, “may not generalize well to licensed psychologists with other typesof employment” (p. 178).

Attempting to investigate a broader rangeof questions related to technology andpsychotherapy than previous research,we surveyed members of Division 29.Guiding our study was a trio of overarch-ing questions: How much has technologypermeated the practice of psychotherapy?What social medial tools are used by psy-chologists conducting psychotherapy?How often is email or texting used inscheduling or rescheduling sessions?

MethodIn summer 2012, we mailed a four-pagequestionnaire, a cover letter, and a pre-paid return envelope to 1,000 randomlyselected members and fellows of theAPA Division of Psychotherapy (Divi-sion 29) residing within the UnitedStates. The questionnaire containedmany items from our previous studies ofmembers of this Division (e.g., Norcross,Hedges, & Castle, 2002; Norcross, Pro-chaska, & Farber, 1993). The cover letterexplained the purpose of the study andguaranteed the anonymity of the partic-ipants. One follow-up request was sentto non-respondents. A total of 428 ques-tionnaires were returned (43% responserate); however, 27 were not usable be-cause these psychologists were retired.The final sample, therefore, consisted of401 members of Division 29. These par-ticipants were employed predominantlyin private practice (62%) and universi-ties (15%), and subscribed primarily topsychodynamic (27%), integrative (25%),and cognitive (17%) orientations. Morethan a third (34%) were women but only 5% self-identified as ethnic/racial minorities.

This article concerns the results from thenew questionnaire section entitled Tech-nology and Psychotherapy. Sixteen ques-tions were grouped into severalsubsections; the items and response op-tions are presented below with the results.

ResultsThe first set of items asked psychologistswhat percentage of their clients usedtechnology as part of their psychother-apy. These items asked, “In the last year,what percentage of your clients…• have had at least one full, sched-

uled phone session with you?• have had at least one full, sched-

uled video (e.g., Skype) session?


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• have you “googled” to find infor-mation about them?

• have informed you that they“googled” you to find information?

• have emailed you about issues/problems other than scheduling?”

Table 1 summarizes the responses toeach item. As shown there, both psychol-ogist and client use of technology as partof their psychotherapy was minimal. Anaverage of 8.6% of clients participated inscheduled phone sessions and only 1.5%participated in scheduled video sessions;only 1.8% of psychologists said they had“googled” a client to find information,while, according to these therapists’ re-ports, 7.5% of their clients had “googled”them. Email was more prevalent, with anaverage of 8.7% of clients emailing psy-chologists about issues and problemsother than scheduling.

The second set of items asked psycholo-gists more detailed questions regardingcell phone usage by clients. Psycholo-gists were asked, “In the last year, re-garding cell phones, what percentage ofyour clients have…• answered a cell-phone call while in

session with you?• read or replied to a smart-phone

message while in session?• used a smart-phone to show you a

picture, website, or message?• your cell-phone number?”

The results, also summarized in Table 1,show that the prevalence of cell phoneuse by clients during psychotherapywas typically minimal: an average of8.8% of clients answered a call in ses-sion, 4.5% read or replied to a message,and 9.9% showed the psychologist a pic-ture, website, or message. On the otherhand, about a quarter of clients had theirpsychologist’s cell phone number.

The third set of items asked psycholo-gists about their use of social mediawebsites and smartphones. Specifically,psychologists were asked, “Do youuse/have Facebook, LinkedIn, Twitter,Webpage, and a smartphone” for profes-sional, personal, or both purposes. Thefindings in Table 2 demonstrate thatmost psychologists do not actively usesocial media sites: only four in ten usedFacebook or LinkedIn and only one inten used Twitter for either personal orprofessional purposes. The use of web-pages and smartphones was far higher:four in ten used the former and six in tenused the latter.

The final set of questions asked psychol-ogists how often they scheduled clientappointments by email or text: 12% ofpsychologists frequently schedule clientappointments via email, 20% do so oc-casionally, 24% rarely, and the remaining44% never do so. Even fewer psycholo-gists schedule client appointmentsthrough text-messaging: 3% frequently,9% occasionally, 15% rarely, and 73% ofpsychologists never.

Responses to all 16 technology itemswere statistically analyzed by psycholo-gist gender and age. T-tests were calcu-lated between the female (34%) and male(66%) respondents, with two statisticallysignificant differences (all ps < .001).Women were more likely to hold sched-uled phone sessions with their clients(mean of 13% versus 6% of clients) andwere more likely to be shown a pictureor website on a smart phone (27% ofclients versus 21% of clients).

More pronounced differences were ob-served in the use of technology as afunction of psychologist age. Pearsoncorrelations between psychologist ageand their responses revealed, in eachcase, that younger age was associatedwith higher use of technology. For ex-


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ample, psychologist age was negativelycorrelated with use of email to sched-ule/reschedule clients (-.21) and withuse of Facebook (- .21), LinkedIn (- .16),Twitter (-.22), webpage (-.13), and smart-phone (-.16). In concrete numbers, 75%of the psychologists below 40 wereusing Facebook, as opposed to 40% ofpsychologists over the age of 40. For an-other example, 62% of psychologistsbelow 40 had a webpage compared tothe 38% of their peers over 40.

Discussion and Practice ImplicationsAccording to a 2011 on-line survey ofAPA Practice Assessment psychologists,the percentages of psychologists usingsocial media for professional purposeswere Facebook 12.1%, LinkedIn 28.4%,and Twitter 3.6%. Those numbers corre-spond closely to the results obtained inthe current survey of Division 29 mem-bers: Facebook 10%, LinkedIn 36%, andTwitter 5%.

The APA Practice Survey also asked psy-chologists whether they used a smart-phone or hand-held device routinely toreceive email, information or other webservice––52.3 % responded “yes” and47.7 % responded “no.” Our more fine-grained question yielded a slightlyhigher affirmative of 59% (7% profes-sional use, 14% personal use, and 38%for both professional and personal use).Smartphones are clearly the most popu-lar source of technology among our sam-ple. Overall, though, our respondentsindicated that neither they nor theirclients were likely to incorporate tech-nology—including email, smartphones,or Google—into the realm of treatment.Some of these findings, though, may beseen as other than simply “old-fash-ioned”: that few (less than 10%) of clientsemail their therapists about problems oranswer a cell phone while in sessionseems reflective of therapists’ adherenceto traditional and arguably appropriatetherapeutic boundaries.

In accord with McMinn et al.’s (2011)findings among independent practition-ers of many statistically significant (negative) correlations between age ofrespondent and likelihood of using specific technological innovations inpractice, our data indicated a greaterpercentage of younger therapists (i.e.,less than 40) using social media in theirprofessional lives. While adherence totraditional boundaries is a part of thestory here, another part is the “technolog-ical reticence” (McMinn et al.) that seemsto characterize the work habits of manypracticing psychologists, especially thosewho are not “digital natives.”

Our survey did not include items that re-flect some of the more innovative uses of technology in psychotherapeuticpractice, including phone apps and newvirtual reality simulations for treatment ofsuch disorders as PTSD. In addition, our survey respondents were drawn exclusively from the ranks of one APA Di-vision (29) and as such, likely included adisproportionate number of more experi-enced therapists; a more representativesampling of therapists across multiple set-tings, including those practitioners notbelonging to APA, might have revealed agreater use of technology in practice. Con-sistent with this speculation, other recentdata have shown far higher rates of ther-apists’ seeking out client informationthrough the internet than what we foundin the current study: one study (Kolmes& Taub, 2010), for example, reported that48% of doctoral student had sought infor-mation online about a client. What is al-most certainly to be the case, however, isthat the use of new technology (e.g., inroutine communication with patients,and in actual practice applications) will beincreasing as technological innovationsgrow and as our field incorporates newer,more technologically savvy members.

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The inescapable fact that technology is af-fecting practice likely leaves many prac-titioners, particularly more seasonedones, somewhat ungrounded. Stayingup-to-date on technology seems impossi-ble for many. While some will surely con-tinue to practice therapy-as-usual andabstain from taking advantage of even“minor” technological innovations (e.g.,professional websites), others will adopt,if slowly, to change, allowing their prac-tices to reflect changes in the culture.Thus, in our sample, 32% of our respon-dents at least occasionally scheduled ap-pointments by email or text. But other,mostly younger psychologists, will moreeasily and enthusiastically embracechange, presenting an opportunity foryounger therapists to train more experi-enced therapists in the use of technology.For virtually all psychologists, however,the rules seem to be changing and thefield is scrambling to catch up. APA isworking on creating principles for the useof telepsychology, including ethicalguidelines and record-keeping proce-

dures that reflect these developments.Meanwhile, training programs will needto develop policies about Internetsearches, student therapists’ cell-phonecommunication with clients, studentblogs and Facebook accounts, and on-line(e.g., Skype-mediated) supervision. Someare also likely to be in the vanguard of de-veloping technological tools that will aidfuture therapists and their clients. Al-though our survey of Division 29 mem-bers reveals a membership that is stillmore traditional than otherwise, there canbe no mistaking that technological changewill increasingly affect the way we learn,promote, and practice psychotherapy.

Author NotesThe authors gratefully acknowledge theparticipation of the 428 Division of Psychotherapy members, whose re-turned questionnaires constituted thedata for this study. We also thank JessicaD. Rogan and Rory A. Pfund for their assistance in data collection and entry.

Table 1Percentage of Psychologists’ Clients in the Last Year Using Technology as Part of their PsychotherapyActivity M % Mdn SD% of clients who had at least one full, scheduled phone session 8.64% 2 18.73

% of clients who had at least one full, scheduled video session 1.46% 0 6.68

% of clients you have “googled” to find information 1.78% 0 7.70

% of clients who informed psychologist that they “googled” psychologist to find information 7.53% 0 16.11

% of clients who have emailed psychologists about problems other than scheduling 8.69% 2 16.62

% of clients who answered a phone-call while in session with psychologist 8.85% 5 12.86

% of clients who read or replied to cell-phone call while in session 4.52% 0 8.91

% of clients who used a smartphone to show psychologist a picture, website or message 9.99% 10 12.55

% of clients who possess the psychologist’s cell phone number 23.33% 0 38.90


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Table 2Prevalence of Psychologists’ Social Networking for Professional and Personal Use

PURPOSESocial professional use personal use both professional Does notNetworking and personal useMethodFacebook 4.9% 32.1% 4.6% 58.5%LinkedIn 33.5% 4.6% 2.3% 59.5%Twitter 3.9% 5.0% 1.6% 89.5%Webpage 34.6% 0.8% 4.1% 60.5%A Smartphone 6.9% 14.1% 38.4% 40.7%

References for this article can be found in the on-line version of the Psychother-apy Bulletin published on the Division 29 website.

DISTINGUISHED PSYCHOLOGIST AWARDFOR CONTRIBUTIONS TO PSYCHOLOGY

AND PSYCHOTHERAPYThis award was established in 1970 as the Distinguished Professional Award inPsychology and Psychotherapy. At the Mid Winter meeting in 1984, the Board ofDirectors changed its name to Distinguished Psychologist Award for Contribu-tions to Psychology and Psychotherapy.

The criteria for receipt of this award are loosely defined and are flexible in orderto embrace the breadth of contributions that psychologists/psychotherapistsmake that distinguish them from their peers. However, the following aspects ofeach candidate are considered in this order:• Length of time of service to psychotherapy• Membership in the Division• Significance of contributions to the practice, research, and/or training in psychotherapy

• Significance of contributions to the Division

Application materials should include: (1) a nomination letter outlining the nom-inee’s career contributions (self-nominations are welcomed) and (2) a currentCurriculum Vitae.

Award recipients receive an honorarium of $500 and an award plaque from theDivision at the Division’s Awards Ceremony at the APA Convention.

Deadline for nominations for this award is January 1, 2013, although the AwardsCommittee may grant extensions.Letters of nomination outlining the nominee’s credentials and contributions

(along with the nominee’s CV) should be emailed to the Chair of the Professional Awards Committee,


The emergence of technology in Westernsociety has erupted invarious forms withinschools, workplaces,homes, and the gov-ernment, presentingopportunities and challenges for the delivery of psychother-apeutic services (Finn& Barak, 2010; Midkiff& Wyatt, 2008). Theconcept of electronicpsychotherapy (e-ther-

apy), or “e-counseling,” is defined as therendering of “therapeutic services by aprofessional through the Internet viatext, audio, and/or video” (Finn &Barak, 2010, p. 268). More specifically,online therapeutic services are separatedinto one of two categories: (1) synchro-nous (real-time) exchanges, includingInternet chat, Skype-like facilities, andvideo conferencing, or (2) asynchronous(delayed) exchanges, including emailand website forums (Shandley et al.,2011). Several governing bodies, such asthe American Psychological Association,National Association for Social Workers,American Counseling Association, In-ternational Society for Mental HealthOnline, and the National Board for Cer-tified Counselors have defined a set ofethical guidelines for e-therapy concern-ing the welfare of clientele and the as-sessment of risk involved in suchinteractions (Midkiff & Wyatt, 2008).Though it does not include specific eth-ical guidelines, the Association for Ap-

plied Sport Psychology (AASP), hasbegun addressing the impact of moderntechnology on this field. Watson andEtzel (2000) discussed the impendingtechnological impact of e-therapy on theway that sport psychology research andservices will be provided. As the field ofsport psychology advances, profession-als must recognize and incorporate theopportunities and challenges that e-ther-apy presents.

Sport psychology as a discipline focuseson performance enhancement, skillbuilding, and excellence. In order toachieve these three standards, consult-ants and students must develop an intimate awareness of the increased po-tential for violations of the current ethicalguidelines (Aoyagi & Portenga, 2010). Asa result of the malleable nature of con-sulting in a performance setting, manyexisting ethical issues present themselvesconsistently over the course of treatment.Previously, ethical concerns—includingboundary crossings and violations, multiple relationships, and certification—constituted main sources of concern. Astechnology progresses toward playingan increasingly influential role in norma-tive communication, the need for regu-lation of competency in internet-basedinteractions should be addressed.

The many facets of Internet-based com-munication create a wide scope of bothsynchronous and asynchronous oppor-tunities for therapeutic interventions.Specific to sport psychology, there are

ETHICS IN PSYCHOTHERAPY

Ethics in Sport and Performance Psychology:The Use of E-Therapy in AthleticsCarly J. Schwartz and Brooke LamphereUniversity of Denver Graduate School of Professional Psychology, Master’s Program in Sport and Performance Psychology


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many avenues of execution of services,including marketing and disseminationof information, counseling and perform-ance enhancement, future education, supervision, and proficiency assessment.Each of these arenas encompasses bothpositive and negative implications con-cerning the ethical obligations and scopeof practice; therefore, it is critical to re-main educated and informed in order toincorporate best-practice techniques.

With the increasing dominance of theconsumer-oriented client and Internet-based marketing (Zur, Williams, Lehavot,& Knapp, 2009), accessible and detailedinformation describing the parameters ofany provided service or product has be-come a social mandate. Without ready ac-cess to credentials, description ofservices, and practitioner history/orien-tation, potential clients may feel less in-clined to become involved. Greateraccessibility of information available toconsumer-oriented clients naturally de-lineates the opportunity for fraudulentpractitioners or professionals without ad-equate competencies to appear as legiti-mate contributors in the field. Therefore,defining a set of credentials for both syn-chronous and asynchronous e-therapycertification would ensure legitimacy andnonmalfeasance, while promoting the ex-ecution of the highest quality service.

Sport psychology counseling and per-formance enhancement often requiresgreater practitioner availability, as thedemands of an athlete can be numerous,fluctuating, and unpredictable. The fi-nancial stipulations of athletes’ travelschedules do not always allow for theinclusion of sport psychology consult-ants; thus, the benefits of e-therapy be-come apparent as it provides anotheravenue of cost-effective communicationdespite geographic limitations. As thesettings for interventions in the field ofsport psychology tend to be much morevaried than the typical clinical or coun-

seling office, consultants routinely facethe ethical dilemma relating to practic-ing therapy across state lines (Watson &Etzel, 2000). In order to be available toclients who consistently travel in theirrespective athletic domains, consultantsmust be aware of the ethical guidelinesin relation to practicing across state lines(e.g., guest licensure and/or obtainingthe interjurisdictional practice certificatecreated by the Association of State andProvincial Psychology Boards [DeAn-gells, 2012]). In comparison to face-to-face interactions, research supportse-therapy and highlights some of the ad-vantages of dealing with clients in a lessinvasive and more relaxed setting (Shan-dley et al., 2011), characteristics also ad-vantageous to sport psychology. Clientsreport increased comfort in disclosingin-depth information in an environmentin which they feel safe (e.g., their homes,practice arenas, or closed hotel rooms).E-therapy provides a critical degree ofprivacy and anonymity uncharacteristicof the typical face-to-face interaction.

Many developing professionals have ex-posure to e-therapy; yet, it is likely manyof them have not reached a level of com-petence in this particular domain. Inorder to claim competency, a consultantmust complete a specified number ofhours and appropriate supervisionmeeting the regulatory standards set bythe governing body. Therefore, the needfor a separate certification becomes ap-parent in order to maintain an appropri-ate ethical baseline in a society with anincreasing dependence on technology.According to the experiential learningmodel, the application of therapeutictechniques is a key factor in the reten-tion and proficiency level of the consult-ant (Shandley et al., 2011). Whilecoursework allows students to exploreverbal communication styles, the essen-tial written component is rarely ad-

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dressed (i.e., asynchronous e-therapiessuch as email). In order to gain the nec-essary competencies of e-therapy, suchcertifying boards as the Australian Psy-chological Society (APS) College ofCounseling Psychologists in Australiaidentify a certain number of online contact hours needed for certification(Shandley et al., 2011). Though sportpsychology students in the UnitedStates have the opportunity to becomeAASP certified, the lack of specificguidelines pertaining to the onlinemodality leaves much room for growth.In an emerging field of prestigious pro-grams, there is an evident ethical needto certify professionals on the properusage of e-therapy.

Media-based services provide an unpar-alleled advantage of expanding and enhancing supervision and assessmentsin the field of sport psychology. Sportspsychology remains in its early stagescompared to other, more establishedprofessions, and the more prominentsport psychology professionals tend tobe dispersed throughout the country.Therefore, in order for students to gainaccess to a professional with concentra-tion-specific experience, the use of synchronous and asynchronous media-based communications alleviates thedistance component in communication,while allowing increased opportunityfor supervision, job searches, network-ing, and overall professional develop-ment (Watson & Etzel, 2000). Further,the contribution of Internet-based as-sessment makes materials more readilyaccessible to consultants by allowing 24-hour access to client results and infor-mation (Watson & Etzel, 2000). Onbehalf of both consultant and client, this system creates a more efficient ther-apeutic process that assures high qualitysupervision and autonomy in schedul-ing, communication, and interventionapplication. Media-based supervision

and assessment materials, as salientcomponents of post-graduate education,will offer a wealth of resources to pro-mote this unique field.

Despite the many positive implicationsof Internet-based therapy, current re-search sheds light on the potential draw-backs of such practices, specificallypertaining to ethical guidelines and con-siderations. Throughout their discussionof the five most prominent types of e-therapy (email, web-based messaging,real time chat, video conferencing, andvoice-over Internet protocol), Kananiand Regehr (2012) highlight the special-ized nature of this relationship as well asthe many challenges involved withmaintaining ethical practice. A majordrawback of e-therapy involves the dif-ficulty in building strong therapist-clientrapport due to the absence of non-verbalcues. Asynchronous e-therapy does notallow for interpretations of many non-verbal cues such as facial expressions,body language, and other mannerismsand emotions which may aid in identify-ing, addressing, and interpreting under-lying issues (Kanani & Regher, 2012).Additionally, asynchronous e-therapyprevents access to the depth of sociocul-tural, location-based, and other individ-ual-specific information, while alsocreating speculation concerning thera-pist identity, credentials, and jurisdiction(Kanani & Regehr, 2012). The potentialfor misinterpretations increases becauseonly one aspect of the conversation ishighlighted, while face-to-face commu-nications incorporate both semanticsand emotions to infuse the perceptualmeaning within the interaction. Whileconsultants rely on nonverbals to delvedeep into the clients’ subconsciousworlds, the use of e-therapy prohibitsthat option.

The execution of e-therapy services de-continued on page 33

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mands important ethical and profes-sional considerations revolving aroundconfidentiality. Kanani and Regehr(2012) identify two areas of risk to eitherthe consultant or client with regard toconfidentiality and e-therapy: (1) duringthe transmission of therapy and (2) out-side the session. Rapid online transmis-sion of information across sourcesprovides numerous risks for both inten-tional and unintentional interception ofinformation (e.g., use of an unsecure orpublic server, security breach throughhacking, unintentional inclusion of irrel-evant contact information [Kanani &Regehr, 2012]). In a casual environment,it is increasingly important to maintainawareness of confidentiality issues andto identify confidentiality risks andother potential ethical setbacks of e-ther-apy. In order to prevent any infringe-ment on human rights, additionalprecautions should be taken to ensure ahigher level of security for e-therapy.

Much of an athlete’s self-perception andbehaviors derive directly from interpre-tations of the surrounding environmentor primary social groups, such as an individual’s culture, team, or family. The socially constructed expectations,norms, and values within the culturalcontext directly impact his/her behav-iors, emotions, thoughts, and most pertinently, interactions with others(Watson & Etzel, 2000). E-therapy nar-rows the consulting lens to focus onmerely the immediate thoughts/behav-iors/actions of clients, regardless of thecurrent context or location-based expec-

tations. Therefore, e-therapy has the potential to minimize therapeutic effec-tiveness as the consultant will receiveonly one perspective—that of theclient—and be unable to include any ex-ternal influential factors.

As the technological world is everwidening, the usage of e-therapy willcontinue to flourish. In an expandingand increasingly demanding field, theevolution of certification requirementsand the infusion of resources to identifybest-practice techniques will regulateand enhance professional uses of e-ther-apy. While various governing bodieshave created and maintained a set of eth-ical guidelines revolving around e-ther-apy, it is in the best interest of AASP andof future professionals to create clear andspecific guidelines addressing thismodality. A certification allowing com-petent individuals to practice synchro-nous and asynchronous e-therapy willmaintain the nonmalfeasance and benef-icence necessary to excel as professionalpractitioners (Midkiff & Wyatt, 2008). Asan actively growing field, the domain ofsport psychology must expand andtravel parallel to technology instead ofremaining in a stagnant state. Recogniz-ing and incorporating synchronous andasynchronous e-therapy into post-gradu-ate programs will instill standards ofcompetency and excellence.


DIVISION 29 AWARD FOR DISTINGUISHEDCONTRIBUTIONS TO

TEACHING AND MENTORINGIn 2007, the Division’s Board established the Division 29 Award for DistinguishedContributions to Teaching and Mentoring, with the first award presented in 2008.

The criteria for receipt of this award are as follows:• Membership in Division 29• Contribution to the field of psychotherapy through the education and train-ing of the next generation of psychotherapists

• Evidence that the individual exerted a significant impact on the developmentof students and/or early career psychologists in their careers as psychotherapists

Application materials should include: (1) a letter of nomination (self or othernominations are welcome) describing the individual’s impact, role, and activitiesas a mentor; (2) current Curriculum Vitae; and (3) letters of reference for the men-tor, written by students, former students, and/or colleagues who are early careerpsychologists that describe the nature of the mentoring relationship (when,where, level of training), an explanation of the role played by the mentor in fa-cilitating the student or colleague’s development as a psychotherapist, and atten-tion to behaviors that characterize successful mentoring (helping students toselect and work toward appropriate goals; providing critical feedback on individ-ual work; providing support at all times, especially encouragement and assis-tance in the face of difficulties; assisting students in applying for awards, grants,and other funding; assisting students in building social network connections,both with individuals and within organizations that are important in the field;serving as a role model and leader for teaching, research, and academic and pub-lic service in psychology; offering general advice with respect to professional de-velopment (e.g., graduate school, postdoctoral study, faculty positions), awards,and publications; treating student/colleagues with respect, spending time withthem, providing open communication lines, and gradually moving the studentinto the role of colleague).

Individuals who were nominated in previous years for the Teaching and Mentor-ing Award may carry over their complete application to a subsequent year bywriting a letter to the Chair of the Professional Awards Committee requestingresubmission of the previous application.

Award recipients receive an honorarium of $500 and an award plaque from theDivision at the Division’s Awards Ceremony at the APA Convention.

Deadline for nominations for this award are January 1 2013.

All items must be sent electronically. The letter of nomination must beemailed to the Chair of the Professional Awards Committee,


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Dear Division 29 Colleague:The Division of Psychotherapy (29) seeks creative individuals and great leaders! We’d likeboth new and experienced voices to help further our increasingly important work on behalfof the advancement of psychotherapy.

NOMINATE YOURSELF OR SOMEONE YOU KNOW TO RUN FOR OFFICE IN THE DIVISION OF PSYCHOTHERAPY.

THE OFFICES OPEN FOR ELECTION IN 2013 ARE:• President-elect • Domain Representative for Early Career Psychologists

• Domain Representative for Science and Scholarship• Domain Representative for Diversity • Council Representative

All persons elected will begin their terms on January 2, 2014A Domain Representative is a voting member of the Board of Directors. The open positionswill be responsible for creative initiatives and oversight of the Division’s portfolio in the respective Domains. Candidates should have demonstrated interest and investment in thearea of their Domain.The Division’s eligibility criteria for all positions are:1. Candidates for office must be Members or Fellows of the division.2. No member may be an incumbent of more than one elective office.3. A member may only hold the same elective office for two successive terms.4. Incumbent members of the Board of Directors are eligible to run for a position on the Boardonly during their last year of service or upon resignation from their existing office prior toaccepting the nomination. A letter of resignation must be sent to the President, with a copyto the Nominations and Elections Chair.

5. All terms are for three years, except President-elect, which is one year.Return the attached nomination ballot in the mail. The deadline for receipt of all nominationsballots is December 31, 2012. As per the Division’s bylaws changes, you may now email yournominations to: [email protected]. Please put DIVISION 29 NOMINATIONS in the headerof the email. You may also fax your form to: 480-854-8966.

EXERCISE YOUR CHOICE NOW!If you would like to discuss your own interest or any recommendations for identifying talentin our division, please feel free to contact the division’s Chair of Nominations and Elections,Dr. Raymond DiGiuseppe at 718-990-1855 or E-mail: [email protected],Marvin Goldfried, Ph.D. William Stiles, Ph.D. Raymond DiGiuseppe, Ph.D.President President-elect Chair, Nominations & Elections

NOMINATION BALLOT (INCLUDING SELF-NOMINATIONS!)

2013 NOMINATIONS BALLOT

President-elect Domain Representative Early Career Psych____________________________________ ________________________________________________________________________ ________________________________________________________________________ ____________________________________

Domain Representative Science & Scholarship Domain Representative Diversity____________________________________ ________________________________________________________________________ ________________________________________________________________________ ____________________________________

Council Representative____________________________________________________________________________________________________________

Name your nominees, and mail now!

FOLD THIS FLAP IN.

Fold Here.

__________________________________

__________________________________

__________________________________

Division29Central Office6557 E. Riverdale St.Mesa, AZ 85215

Fold Here.

______________________________________Signature

______________________________________Name (Printed)

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DIVISION 29 AWARDS CEREMONY – APA ANNUAL CONVENTIONAugust 3, 2012 – Orlando Florida

Division 29 President Marvin Goldfriedpresents the 2012 Norine Johnson Research

Grant to Cheri Marmarosh

Division 29 President Marvin Goldfried presents the 2012 Charles Gelso

Research Grant to Marilyn Cornish

Division 29 Treasurer-elect received hisFellows certificate from Marvin Goldfried

The Division 29 Student Paper DiversityAward recipient Kristin Miserocchi receivesher plaque and check from Marvin Goldfried

(l to r) Division 29 Awards Chair

Libby Williams, Joshua Swift, John C. Wiley Representative

Patricia Rossi, and Division 29President Marvin Goldfried, asDr. Swift receives the Division

of Psychotherapy DistinguishedPublication of Psychotherapy

Research (co-sponsored by John Wiley Publishing)

American Psychological Foundation/Division of Psychotherapy Early Career Award recipientJesse Owen is congratulated by Division 29 President Marvin Goldfried and Awards ChairLibby Williams

Paul Wachtel receives the Division of Psychotherapy Distinguished Psychologist

Award for Contributions to Psychology andPsychotherapy from Marvin Goldfried and

Libby Williams

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NOTICE TO READERSReferences for articles appearing in this issue can be foundin the on-line version of Psychotherapy Bulletin published

on the Division 29 website.

EARLY CAREER

Stepping into Leadership Roles as an Early Career Psychologist: Reflections on the Question “Why should I get involved in Division 29?”Susan S. Woodhouse, Ph.D.Lehigh University

When I first joinedAPA, Division 29 (Psy-chotherapy), Division17 (Counseling Psy-chology) in my doc-toral student days Ireally just did it ini-tially because my fac-

ulty advisor and mentor, Charlie Gelso,told me that I should. At that time I did-n’t really know much about APA or theDivisions of APA, other than that mymentor saw it as a really important partof developing my professional identityas a Counseling Psychology graduatestudent who had a very strong interestin psychotherapy and the psychother-apy relationship—and that it would bea really great idea to start reading thejournals associated with Division 29 andDivision 17. I remember finding thenumbers associated with each divisiona little confusing—but the fact that, atthat time, the student membership costswere exactly the same as the divisionnumbers humorously emblazoned thedivisional numbers in my mind! Overthe past couple of years I’ve been hear-ing a lot of ECPs talk about how disori-enting the numbering system for APAdivisions is, and how hard it is to keeptrack of the numbers—so when I’m talk-ing to people I make sure to use both Di-vision 29 and Division of Psychotherapyso I know ECPs are getting what I mean.

A lot has happened since then when Iwas just a beginning doctoral student,and I have learned a lot about what itmeans to get involved in leadership inDivision 29—and why it’s actually a

great idea to do so for students andEarly Career Psychologists (ECPs). Myexperience has been that people seem tonot talk a lot about why it’s a good ideato get involved in one’s division andleadership of that division. It strikes methat the result is that a lot of studentsand ECPs really don’t know why theyshould get involved in Division 29—they’ve just never thought about it be-cause it really hasn’t come up. I think itmight be a good idea to begin some con-versations about what divisions do, whydivisions are relevant to our lives, howstudents and ECPs end up getting in-volved with divisions, and how it’shelpful for our careers. I think it’s im-portant to start talking about these ques-tions because these are questions thatI’ve been hearing a lot when I talk toECPs, either at APA or elsewhere.

I represented the Division of Psy-chotherapy (Division 29) at a meetingfor ECPs at APA this past summer in Or-lando, FL. The goal of that meeting wasto talk about how ECPs could get in-volved in leadership in APA. One of thethings that struck me at that meeting, aswell as in meeting with ECPs elsewhereat APA, was how curious people wereabout finding ways to be involved, buildtheir networks, find mentoring, and feelconnected with their profession—buthow little anyone was talking to ECPsabout all that. It struck me that ECPswere really confused about how to gettheir needs met, and weren’t reallyaware of some of the opportunities thatare available for ECPs to fill those needs


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for networking, mentoring, and connec-tion. After APA I decided that maybe itmight be meaningful to other ECPs if Italked some about my own journey ingetting involved in the Division of Psy-chotherapy and the benefits that I’vegotten as an ECP from being involved.Since my involvement in Division 29 haspretty much evolved out of mentoringthat I’ve received along the way, Ithought it might be a good idea to try topass along some of what I’ve gottenfrom others.

My mentors in graduate school madesure that I went to APA (at least some-times), and that I got involved in otherprofessional societies related to my in-terests. Charlie Gelso got me connectedwith the Society for Psychotherapy Re-search, which turned out to be a warmand welcoming place for students andECPs to present their psychotherapy re-search. Jude Cassidy, got me connectedwith professional organizations relatedto my developmental interests, and Istarted to present at the Society for Re-search in Child Development and attendconferences put on by the InternationalSociety for Infant Studies. I have alwaysbeen amazed at how much I learn atconferences, and the many researchideas that get stimulated when I gothere. The other great thing about con-ferences is seeing all my old friends,meeting new people, and also getting tosee the “famous” people whose work Iadmire talking about what they do. Be-cause I had become used to going toconferences when I was a graduate stu-dent, it was easy to keep doing that as apost-doc and then an ECP in my firstjob. Ever since getting licensed a coupleof years ago, it’s been great being able togo to APA and get all of my continuingeducation credits for the year done inone fell swoop for a really low pricewhile taking my CE credits with leadersin the field. I really learn a lot and it’s agreat deal. But for a long time I honestly

never even considered the idea of get-ting more involved in divisional gover-nance, or being involved in a division inany other way beyond being a memberor reading the journal.

I first started realizing some of the goodwork that Division 29 does when I sawsome of my friends winning awardsthrough the Division of Psychotherapyand ultimately received one of thoseawards myself. That process helped mesee how the Division valued supportingyoung people in getting involved in workrelated to psychotherapy. I wonder if stu-dents and ECPs realize all the opportuni-ties for awards that are available to them(and are listed on the Division 29 web-site), including a number of studentawards and awards for which ECPs couldbe eligible. This number of awards avail-able to students and ECPs is likely to onlyincrease over time, so I would encourageECPs to keep checking back in over the coming year(s) for upcoming opportunities. There are awards relevantto researchers, clinicians, and teachers/mentors. There are some years in whichfew students or ECPs apply for awards—I hope you won’t let that be you! It’s goodto at least throw your hat in the ringwhether you get the award or not.

My first experiences in getting involvedin Division 29 centered around servingas a judge for some of the awards. Thisis a really easy way to dip your toe intothe possibility of getting involved in thedivision—and you get to be a part of en-couraging and supporting others in thefield of psychotherapy as well as readsome really interesting submissions. Ifsomeone asks you if you’d like to servein this way, I would encourage you togive it a try because it’s a great way tosee if you like it while doing somethingpositive that really doesn’t take muchtime at all. One thing that some ECPs

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might not think about is the fact thateach one of us has a unique and impor-tant perspective to lend to the judgingof awards. It’s a great feeling to knowthat your perspective counts and haveyour voice be heard. If you’re interestedin getting involved in this way, but noone has asked you yet to do so, I’d en-courage you to contact the person incharge of the specific awards you mightbe interested in helping out with (thiswould be the person to whom the appli-cations are submitted). Committeechairs who administer awards wouldmost likely warmly welcome yourhelp—or at least would be able to putyou in touch with someone who couldreally use your help.

Another initial experience I had in get-ting involved in Division 29 was in serv-ing as a reviewer for the APA programsubmissions. If you’d like to be a part ofdeciding what presentations (some onresearch, some on clinical issues) shouldmake up our Division 29 program atAPA it’s easy to get involved—justwatch for the announcement that goesout every year on the Division 29 listserve. By the way, the Division 29 listserves are a great resource so if youhaven’t joined, that’s something to consider (http://www.divisionofpsy-chotherapy.org/members/list-serv/ tosign up). You can also sign up for the e-newsletter there. All kinds of interestingthings that are relevant for ECPs go outon the e-news—including calls for stu-dents and ECPs who might want to getinvolved in something the division isdoing, special programs being offeredfor students and/or ECPs, news aboutwhat the division is doing to support avariety of initiatives (like Marv Gold-fried’s article about a project calledBuilding a Two-Way Bridge BetweenResearch and Practice, which provides away for clinicians to document their ex-periences in providing empirically sup-ported treatments, similar to the way

that the Food and Drug Administrationprovides physicians with a method forgiving feedback on their experiences inusing empirically supported drugs inclinical practice).

Being an ad hoc reviewer for Psychother-apy, the division’s journal was anotherearly experience I had with Division 29.It’s relatively low-commitment, interest-ing, and a fun way to start getting in-volved. Ultimately, I ended up being onthe editorial board of Psychotherapy, butstarting out as an ad hoc reviewer is agreat way to get your feet wet. If you’dlike to do that, just let it be known thatyou’d like to serve as a reviewer. This isa great journal to be involved in whetheryou’re primarily interested in practice,research, or training because this journalstraddles all three.

My next steps towards getting involvedin leadership in Division 29 were thanksto the mentoring of a couple of moresenior colleagues when I first became anECP and was in my first job after mypostdoc. Jeff Hayes suggested that Ireach out to some of the leaders in Divi-sion 29 to let it be known that I was in-terested in getting more involved. I gottheir e-mail addresses from the Division29 website (http://www.divisionofpsy-chotherapy.org/members/officers-board), and just wrote to them. I wasn’tsure what I wanted to do, but when Iheard back from Jean Carter that therewas a need for someone to serve as theChair of the Psychotherapy ResearchCommittee, it sounded really interestingto me, so I volunteered. There are allkinds of committees that students andECPs can be involved in—if you checkout the website, you’ll see the wide vari-ety (e.g., social justice, psychotherapypractice, education and training, earlycareer psychologists, diversity, andmembership). Each of these committees

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works with a Domain Representative todo whatever projects it decides aregoing to be important in its particulararea. Committees are great place to getto know other people who share yourinterests and have your voice be heard.For example, during my time on the Re-search Committee, we worked to createsome new research awards, selected re-search award recipients that we recom-mended to the Board of Directors, andencouraged people (both ECPs andmore senior people) to write articlesabout their research and its implicationfor clinical practice. These articles wentout in the Bulletin or in what was thencalled the “News You Can Use” featurein the e-newsletter. But other commit-tees work on other projects. The EarlyCareer Psychologists committee, for ex-ample, plans a Lunch with the Master’sevent every year at APA at which stu-dents and ECPs can get to know somesenior people in the area of psychother-apy on a more intimate level over lunch.We also raffle off books by senior peoplefor students and ECPs. Division 29members get involved in a lot of differ-ent projects—for example, creation ofthe Multicultural Toolkit (http://www.divisionofpsychotherapy.org/re-sources/multicultural-toolkit) or webposting on the most up-to-date writingson training and education (http://www.divisionofpsychotherapy.org/cat-egory/education-and-training). The bot-tom line is that there many differentprojects, both big and small, that youcould get involved in if you wanted to.Many of these projects would really notinvolve much time commitment at all(e.g., doing a one-time informationalevent for ECPs or writing a piece for theBulletin or e-newsletter about some-thing that interests you). Some projectswould be more involved. Some projectshave yet to be dreamed of—that couldbe your contribution to the field.

My hope is that senior people continue

to talk to students and ECPs about themany ways they could get involved.That was a tremendous help to me in myprocess. But if you are a student or ECPand even just a little bit interested in fig-uring out how you could get involved ina way that is meaningful to you (and bythe way, have something to add to yourCV!), let someone know. You can e-mailme ([email protected]) or e-mailsomeone on the Board or in charge of acommittee—everyone’s e-mails arelisted on the Division 29 website. My in-volvement in the division just startedwith a couple of e-mails.

I started out by serving as a CommitteeChair, but you don’t have to start bychairing a committee. You can start byjust serving as a member of a committeeif that sounds better. The nice thingabout serving as a Committee Chair wasthat I was invited to attend one of theDivision 29 Board of Directors meetingseach year. (By the way, if you’re worriedabout the expense, you don’t need tobe—APA pays for the travel expenses ofBoard Members and whenever I was in-vited to attend as a Committee Chair mytravel expenses were also paid.) TheBoard meetings were great experiencesfor me and really opened up my eyes to the important work Division 29 was doing. I also learned a lot about the structure of the Division and howthings work.

Initially, it was a little intimidating—butthanks to the then Division 29 President,Nadine Kaslow, taking all of us newbiesunder her wing, it was a great experi-ence. Nadine met with all the newbieswho were attending their first Boardmeeting to help us get oriented to theBoard and answer all our questionsabout how we could get the most out ofbeing there and contribute our voices tothe discussion. The group of us newbiesalong with Nadine Kaslow created a

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manual for new participants in Boardmeetings—that manual is still availableby the way. It was a great resource forme because it had all the little bits of in-formation I needed to really understandthe structure of the Board, how it oper-ated, and how my role fit into thegreater whole.

Nadine was also really helpful in gettingeach of us newbies set up with a mentorwho sat with us at the Board meeting tohelp us figure out how to best contributeto the process—and help get our voicesheard. Since then, I’ve always made sureto sit next to a mentor on the Board thatI can talk to during the meeting whenI’ve got questions or am wonderingabout how to best participate. Now thatI’ve been there a while, I’ve also startedto sit next to more junior people to offeradvice during meetings. I recommendthat every person that’s new to theBoard check out the manual and sit nextto a mentor during the meetings. It’s agreat experience—for one, I’ve learneda lot about participating in a Board ofDirectors meeting. But most impor-tantly, I’ve developed some wonderfulrelationships with both senior peoplewho’ve been kind enough to reach outto me, and others who are more juniorwho are great people in the field toknow. If you’re longing to feel more con-nected with the field, being an activemember as a Committee Chair (non-vot-ing but active member at some Boardmeetings) or actually on the Board of Di-rectors itself. Yes! You can do it. Every-one wants you to be involved and willsupport you in succeeding. At the sametime, you will build relationships withinteresting people in the field and buildyour CV. What could be better? It mightseem intimidating, but really it’s not. I’mhoping that hearing my story will helpto demystify how it all works and thesupports that are in place for you ifyou’d like to do this kind of professionalwork as an ECP (Even students can be

involved too, as there is a student repre-sentative position).

After I served as the Research Commit-tee Chair for a couple of years, I agreedto run for the Early Career Domain Rep-resentative position that was going to beopening up. Domain Representativesare actual voting members of the Boardof Directors. The process of running waseasy—I just submitted my name to beput on the roster of candidates when thecall for candidates came out. I had towrite up a little one-paragraph descrip-tion of myself for the Bulletin and sendin a photo. That was it. The advice I gotwas to just go ahead and submit myname—if I didn’t get elected, that wouldbe fine. The wisdom is that if you runand don’t win the first time, at leastyou’ve gotten your name out there andif you run again later then you’ll bemore familiar face and are more likely toget elected later on. Bottom line—it wasan easy process and not at all traumatic(in case the thought of running in anelection is scary for you). There wereeven examples of previous candidate’sstatements that I could use to help mefigure out what I should be writingabout in my description. It was defi-nitely easy, so I hope you feel encour-aged to try it out.

Initially I just ran for office because mymentors were telling me that it would begood for my career to start getting somemore national visibility by being in-volved at a national level. The job itselfseemed meaningful to me, so it felt likea good fit to run for that particular posi-tion. Since the position was open—well,it all came together.

But the more time I spent on the Board,the more I saw how important the workthe Board was doing really was. Yes, theBoard was doing things to support thenew up-and-coming people in the field

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of psychotherapy, giving awards to sen-ior people who had made significantcontributions, and doing the day-to-daybusiness of running the division. In ad-dition, though, I began to see how initia-tives put forward by Division 29 Boardmembers were actually having a big im-pact on the national stage. For example,you may have heard that APA recentlypassed a resolution stating that psy-chotherapy is effective (along with theevidence; http://www.apa.org/news/press/releases/2012/08/resolution-psychotherapy.aspx ). This is a big dealthat could have a lot of implications forthe field of psychotherapy, but it was noteasy in coming. Division 29 CouncilRepresentatives who sit on the Board ofDirectors of Division 29, Linda Camp-bell and John Norcross, worked to getthis attended to in APA Council andworked to respond to all the input thatcame from all the other constituentswho had something to say about this.There was a crucial moment in theprocess in which many responses had tobe submitted in a very short time frameand the Board was able to provide somesmall assistance with that project. Whyis something like this important? Well,right now, despite all the evidence sup-porting the effectiveness of psychother-apy, psychotherapy is still not the go-totreatment for conditions like depressionand anxiety, for example. But, APA’s for-mal adoption of this resolution is a partof a beginning to change attitudes andmove towards psychotherapy beingwidely seen as a first-line treatment.That is important for the field, but alsofor people who would benefit frombeing able to experience psychotherapy.The Division is likely to become increas-ingly involved in public education ef-forts, and it feels good to know that wecan be a part of that.

Because my mentors in graduate schoolplayed such an important role in gettingme involved in the Division of Psy-

chotherapy, I hope that other mentors arealso talking with their students andmentees about the benefits of beingmembers and being involved. Some-times I think those of us who have stu-dents or mentees are not aware of howimportant we are in helping studentsand mentees get connected with the pro-fession. Just as my mentors did with me,I advise all my students to think aboutwhich divisions and professional organ-izations are closest to their interests. I en-courage them to attend conferences inorder to start meeting people and gettingconnected with role models and key peo-ple they’ll need to know. I let them knowthat I expect that they will join at leastone professional organization and startreceiving their publications. Whetherstudents are heading for research ca-reers, teaching, or clinical careers, thereare important benefits that I want themto be able to take advantage of. I wantthem to feel empowered to make a dif-ference to their fields in some way—inwhatever they may feel called to. A greatway for them to start figuring out howthey can make a difference is to startingseeing how others are making a differ-ence, and then start to model themselveson what they see others doing, addingtheir own perspectives to the mix.

When I talk with ECPs, one thing I fre-quently hear is that ECPs are concernedabout the costs of attending APA, espe-cially if one has a young family. SomeECPs say they’re not sure why theyshould go to conferences. Other ECPswho do go to conferences talk aboutfeeling like they need to make hardchoices about which conferences to go tobecause it’s hard to go to two separateconferences that are close together intime. These are all real issues because it’strue that ECPs are at a time in their liveswhen money tends to be tight. For metoo, there were years that I had to forgo

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APA because I also wanted to attend acouple of other conferences. One sug-gestion I’ve heard repeatedly from ECPsis the idea of using the internet as a wayof helping to get information out toECPs, for example through webinars. Ithink that is a wonderful idea, and Iwould love to hear more from otherECPs about what you think would bethe most relevant and helpful informa-tion that you would like to get. If youhave ideas please email me (wood-house@ lehigh.edu), because as yourECP Domain Representative, I’d like usto think about how we can best serveECPs in areas related to psychotherapy

practice, research, and education.

I hope that hearing some about my jour-ney towards getting involved in the di-vision and in divisional leadership willhelp to demystify the process and en-courage some more ECPs to get in-volved at whatever level feels right.Please let me know if there is any way Ican be helpful to you in getting more in-volved. I want to be sure to representyour interests as ECPs. Feel free to con-tact me if you’d like to become more in-volved or if you any ideas about howthe division can better serve your needs.

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Swift, Greenberg, Whip-ple, and Kominiak (2012)recently identified anddescribed six practicestrategies for reducingpremature terminationand strengthening thetherapeutic relationship:

(a) providing education about durationand patterns of change; (b) providingrole induction; (c) incorporating clientpreferences; (d) strengthening earlyhope; (e) fostering the therapeutic al-liance; and (f) assessing and discussingtreatment progress (pp. 381-384). Thosesix fortification strategies—moves de-signed to build, strengthen, and main-tain the therapeutic relationship—seemparticularly helpful in getting therapy“started off on the right foot” (DeFife &Hilsenroth, 2011) and continuing tomaintain its building momentum. Thisis perhaps because they address somecommon factor elements that are so critical across all psychotherapy ap-proaches—fostering positive expecta-tions, educating patients about thetreatment experience, and collabora-tively formulating reasonable treatmentgoals (DeFife & Hilsenroth, 2011). Yetthose strategies potentially have reachbeyond the therapeutic relationship andmay be of value in most helping-ori-ented relationships (e.g., teaching,coaching; Lampropoulos, 2001). Inslightly adapted form, those strategiescan indeed be of supreme relevance forpsychotherapy supervision; in what fol-lows, I would like to briefly summarizehow that is so. Because supervision iswidely recognized as a, if not the, pri-

mary means by which the traditions,practice, and culture of psychotherapyare taught, transmitted, and perpetuated(Watkins, 2012b), it is equally criticalthat the activity of supervision itself get “started off on the right foot” and its building momentum be accordinglyencouraged. But how do we as supervi-sors do that? What particular factorshave been identified as substantially increasing the likelihood of making supervision work?

As with psychotherapy, several supervi-sion fortification strategies can similarly be identified: (a) providing educationabout supervisee patterns of change andstrengthening of early hope; (b) provid-ing role induction; (c) incorporating su-pervisee preferences; (d) fostering thesupervisory alliance; and (e) assessingand discussing supervision progress.Those five supervision strategies, inslightly adapted form from the practicestrategies outlined above, have increas-ingly come to be viewed as central andpivotal to successfully initiating, estab-lishing, and maintaining the supervisionrelationship as well as keeping super-visees meaningfully and consistently engaged throughout the supervisionprocess (Bernard & Goodyear, 2009; Fal-ender & Shafranske, 2004; Watkins, 1997).

Providing education about superviseepatterns of change and strengtheningof early hopeBecoming a psychotherapist has longbeen viewed as a developmental process(Ford, 1963; Spiegel, 1956), but in the last

FEATUREFortification Strategies for Supervisory Relationship Enhancement

C. Edward Watkins, Jr., Ph.D.University of North Texas, Department of Psychology


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approximate 30-year period, attention toand scrutiny of the developmental tra-jectory of psychotherapist growth hasratcheted up to a whole new level ofanalysis. With the advent of develop-mental approaches to supervision the-ory and practice, beginning in articulateform in the late 1970s and early ‘80s, wehave come to see as never before that su-pervisees tend to: (a) proceed throughtheir own patterns and vicissitudes ofchange; (b) experience some degree ofanxiety, confusion, turmoil, demoraliza-tion, and learning regression during thetherapist growth process, particularlyearly on; (c) struggle with issues of ther-apist identity development and becom-ing a “healer”; (d) wrestle with theself-exposure and self-disclosure that areso requisite for therapist growth; and (e)question their fitness for therapeuticservice and whether they truly havewhat it takes to be a healer (Alonso &Ruttan, 1988; Chessick, 1971; Ecklar-Hart, 1987; Friedman & Kaslow, 1986;Lerner, 2008; Stoltenberg & McNeill,2009; Tsuman-Caspi, 2012; Weatherford,O’Shaughnessy, Mori, & Kaduvettoor,2008; Weiner & Kaplan, 1980). To ad-dress those issues in supervision, wehave further come to see that supervi-sors can ease supervisees’ developmen-tal transitions by means of education andremoralization. Two helpful steps includeproviding supervisees with the ongoingsupport, encouragement, and hope (orremoralization) that they may need inmaking it through the travails of thetherapist growth process (Watkins,2012a); and providing supervisees witheducation about the ambiguous natureof clinical training itself and the devel-opmental trajectory of the therapistidentity formation experience (Orlinsky& Ronnestad, 2005; Pica, 1998; Skovholt& Ronnestad, 2003). Such steps offer su-pervisees a facilitative roadmap of sortsfor a journey that is new and exciting,yet can also be quite trying, agonizing,

unsettling, and challenging. Providingeducation about patterns of change andstrengthening early hope can be criticalfor psychotherapy; these tasks appear tobe no less important for effective psy-chotherapy supervision—particularlyfor supervisees early on in the trainingexperience.

Providing role inductionIn supervision, role induction reflects astudied effort to address two key inter-related questions: (a) How can I as su-pervisor best introduce my superviseeto the various features of the supervisionprocess in which we are to jointly en-gage? and (b) How can I best informher/him about the elements of the re-spective roles that we each will inhabit?Role induction seems to be born of themindset that the more fully informedthe supervisee is about the totality of thesupervision experience, the more easilyand meaningfully the supervisor andsupervisee will be able to work togetherover the course of supervision. Whilehaving been around in some form forsome time, role induction appears tohave gained particular traction in thelast couple of decades in the form of the supervision contract or informedconsent agreement. Such an agreementis a good-faith effort initiated by the su-pervisor to spell out the specifics of the supervisory encounter, including supervisor and supervisee roles and re-sponsibilities, supervision structure,evaluation procedure, confidentialitylimits, supervision risks and benefits,and professional disclosure (see Alonso,2000; Bernard & Goodyear, 2009; Ellis,2012; Ellis, Siembor, Swords, Morere, &Blanco, 2008; Falender & Shafranske,2004; Sutter, McPherson, & Geeseman,2002; Thomas, 2007). As Osborn andDavis have stated, the supervision con-tract (or agreement) is a way of “makingit perfectly clear” (1996), and some valu-

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able reasons for doing so include clarifi-cation of methods, goals, and expecta-tions; encouragement of professionalcollaboration; upholding of ethical prin-ciples; documentation of services to beprovided; and alignment of supervisionwith treatment services (pp. 123-126).While informed consent agreements areby no means a panacea, they do offerone useful role induction method bywhich meaningful structure and under-standing can be brought to the begin-ning of the supervision process(Thomas, 2010). In that sense, such aprocedure has the potential to serve atype of grounding and securing function(which can be especially vital to traineesat the start of practicum experience) andcan indeed contribute to informativelyeducating supervisees and fosteringtheir positive expectations about the su-pervision situation. While supervisionresearch on role induction is virtuallynonexistent (Bernard & Goodyear, 2009),clinical opinion has increasingly con-verged on its validity for getting super-vision started off well. Just as providingrole induction can be critical for psy-chotherapy, it indeed appears to play animportant role in the successful initia-tion and maintenance of psychotherapysupervision.

Incorporating supervisee preferences Perhaps if there is one mantra that hasincreasingly gained high currency in thesupervision literature across the lastgeneration of practice and scholarship,it would be that “one size does not fitall.” As developmental considerationshave become part and parcel of supervi-sion conceptualization (Bernard &Goodyear, 2009), and as developmentaldifferentiation has itself come to be rec-ognized as an important diversity vari-able (Bernard & Goodyear, 2009),supervisors appear to have increasinglyembraced the view that supervision bestproceeds when supervisee learning

needs and learning style are taken intoaccount, and when those particularlearning needs and preferences are thenused to structure the supervisory experi-ence accordingly. As supervisors, wewant to know what our superviseeswant, how they optimally learn, andhow we can best address their prefer-ences, wishes, and needs. Whereas su-pervision in times past may have beenprimarily undertaken to “fit the tailor,”we now more so than at any other timein supervision’s history are preemi-nently concerned with tailoring supervi-sion to fit our supervisees. That realityappears to hold transtheoretically,whether operating from a psychother-apy-focused, developmental, or role/process supervision perspective (seeCarroll, 2009, 2010; Falender &Shafranske, 2012; Farber, 2012; Hol-loway, 1997; Ladany, Friedlander, & Nel-son, 2005; Reiser & Milne, 2012; Sarnat,2012; Scaturo, 2012; Watkins, 2012b). Justas incorporating client preferences canbe critical for psychotherapy, the mean-ingful incorporation of supervisee pref-erences into supervision also appears tobe equally important for the vitality andviability of the entirety of the supervi-sory experience.

Fostering the supervisory alliance Over 40 years ago, Chessick (1971)stated that “development of … [the su-pervision] alliance is the primary task ofsupervisory sessions, just as the devel-opment of the therapeutic alliance is theprimary task of psychotherapy” (p. 275).In decades hence, clinical convictionborn of a multitude of practical experi-ences and accumulating empirical datahave compellingly combined to showhow right Chessick’s words were then,and how they remain so today. In con-temporary practice, we have increas-ingly come to strongly believe that thesupervision alliance is the very heart of

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supervision itself. As supervisors, wetend, nurture, and foster the alliance,holding it as sacrosanct; we strive to de-velop a solid supervisory bond and es-tablish mutually agreed-upon goals andtasks to guide our efforts—and, whenneeded, we strive to repair and restore aruptured alliance (Bordin, 1983; Ladany,2004; Ladany et al., 2005). Furthermore,such focus on the supervision alliancedoes not lack for empirical foundation.Supervision alliance research, a productof the last 15 to 20 years, has thus farbeen highly consistent: Across all stud-ies, the importance of the supervision al-liance has tended to be affirmed timeand time again (see Inman & Ladany,2008; Ladany & Inman, 2012; Watkins,2010, 2011b). Favorable superviseeperceptions of the alliance have beenfound to be related to favorable percep-tions of supervision, supervisor ethicalbehaviors, supervisor self-disclosurebehaviors, task and goal clarity, andagreement on the importance of cul-tural/diversity issues in treatment/su-pervision, whereas unfavorable allianceperceptions have been found to be re-lated to perceptions of supervisionconflict, supervisor gender-role stereo-typing, stress and burnout, dissatisfac-tion with supervision, and supervisorunethical practices. While those empiri-cal findings have been primarily corre-lational and ex post facto in design, theyunderscore a degree of unmistakableconsistency across studies and, in thatregard, provide fruitful guidance for re-flective supervision practice. The super-vision alliance currently enjoys a highdegree of clinical validity and a bur-geoning base of empirical validity(Bernard & Goodyear, 2009; Falender &Shafranske, 2004; Hess, Hess, & Hess,2008; Watkins, 2012c). Just as fosteringthe therapeutic alliance is consideredcritical for psychotherapy, the establish-ment and ongoing fostering of the su-pervision alliance is now generally

considered to be the cement that makesor breaks the process and outcome of thesupervision experience itself, with theimpact of the alliance on supervisionseemingly unparalleled in its power andpreeminence. As Levenson (2012) re-cently commented, when it comes to su-pervision, it now is really all about threecrucial variables: “Relationship, rela-tionship, relationship.”

Assessing and discussing supervision progress Perhaps if there has been and continuesto be a thorn in the side of supervision,evaluation would be it. Evaluation,while a chief defining feature of supervi-sion, has unfortunately not been knownfor its rigor and robustness (Ellis &Ladany, 1997; Ellis, D’Iuso, & Ladany,2008). Still, over the course of the recentdecades, increasing attention has beengiven to how we as supervisors canmake the evaluation process more user-friendly and constructive for our super-visees. Clinical opinion has tended touniformly converge on the position that:(a) supervision evaluation should be anopen, transparent process where super-visees are fully informed from the outsetabout how and in what way(s) they willbe evaluated; (b) supervision evaluationis best when treated as a continuousprocess where supervisee progress orregress are monitored consistently; (c)supervisor feedback appears to workbest when provided to supervisees inongoing fashion, formatively (prefer-ably every session) and summatively (atperiodic intervals); and (d) supervisionevaluation ideally is a process whereboth supervisor and supervisee examineand freely provide input about supervi-sion performance and work together toconsider how to improve upon it(Bernard & Goodyear, 2009; Borders,2012; Falender & Shafranske, 2004;Green, 2011; Hughes, 2012; Phelps, 2011;

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Welfare, 2010). As supervisors, we wantno evaluation surprises and have cometo realize that a collaborative, mutual,open, ongoing, sharing, informing, re-spectful, and considerate approach toevaluation serves everyone optimally.Just as assessing and discussing thera-peutic progress is deemed important inpsychotherapy, the consistent evalua-tion and discussion of superviseeprogress tends to now be seen as criticalfor a fair, just, and constructive supervi-sory process.

ConclusionI have wished to briefly indicate howSwift et al.’s (2012) practice strategies(with slight modifications) are every bit ascrucial for building, establishing, andmaintaining the supervisory relationship.Much as these strategies find favor be-cause they attend to certain common fac-tor elements so critical in psychotherapy(i.e., foster patient positive expectations,educate patients about the treatment ex-perience, and collaborate in the formula-tion of reasonable treatment goals), thefive supervision fortification strategiesperhaps find favor because they in turnattend to certain common factor elementsso critical in supervision (i.e., foster super-visee positive expectations, educate su-pervisees about the supervisionexperience, and collaborate in the formu-lation of reasonable supervision goals).However, if there is one stark differenceto be found between these therapeuticand supervision fortification strategies,that difference would lie in the research:

Whereas Swift et al. (2012) were able toprovide a base of empirical support foreach of the strategies that they discussed,we unfortunately are not able to do thatfor supervision at this time. With the ex-ception of the supervision alliance, any re-search on the other supervision strategiesmentioned here would range from lim-ited to nonexistent. Supervision researchhas long lagged behind psychotherapyresearch (Reiser & Milne, 2012; Watkins,2011a), and its current state has even beenlikened to psychotherapy research in the1950s and ‘60s (Milne, Leck, James, Wil-son, Procter, Ramm, ... & Weetman, 2012).While these supervision fortificationstrategies seemingly have a strong foun-dation in clinical validity (i.e., havingcome to be embraced by a wide cross-sec-tion of supervision practitioners becauseof their apparent positive supervisory im-pact), their empirical validity generallyhas yet to be proven. But as psychother-apy supervision research continues togrow and expand, I suspect that the clin-ical-empirical divide will begin to closeconsiderably in the years and decadesahead. Until that day comes, however,these supervision strategies still havemuch to commend them, and offer ussome clinically tested strategies by whichwe as supervisors can work to enhanceand fortify our supervision practice now.


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The Institute of Medi-cine: With the enact-ment of PresidentObama’s health care re-form legislation, the Pa-tient Protection andAffordable Care Act

(ACA) [P.L. 111-148], and the subsequentaffirmation of its constitutionality by theU.S. Supreme Court, we feel it is impor-tant for psychology to appreciate the ex-tent to which those engaged in craftingand administrating this far-reaching lawhave valued the views of the Institute ofMedicine (IOM) over the years, regard-less of political affiliation. The Directorof the National Cancer Institute and theDirector of the Office of Managementand Budget, as well as the Director ofthe CDC National Center for Immuniza-tion and Respiratory Diseases, were in-ducted in 2008, the year that I receivedthat honor. In 2010, the IOM released itsreport “Clinical Data as the Basic Stapleof Health Learning: Creating and Pro-tecting a Public Good.” The goal of theworkshop participants was that by 2020,90% of clinical decisions would be sup-ported by accurate, timely, and up-to-date clinical information, and wouldreflect the best available evidence. Itwas envisioned that the nation’s health-care system would draw on the best ev-idence to provide the care mostappropriate to each patient, emphasizeprevention and health promotion, de-liver the most value, add to learningthroughout the delivery of care, andlead to improvements in the nation’shealth. The objective was to transformthe way evidence on clinical effective-ness is generated and used to improve

health and health care by developing alearning health system designed to gen-erate and apply the best evidence for thecollaborative healthcare choices of eachpatient and provider; to drive theprocess of discovery as a natural out-growth of patient care; and to ensure in-novation, quality, safety, and value inhealth care. The decisions that shape thehealth and health care of Americans–bypatients, providers, payers, and policy-makers alike–would be grounded on areliable evidence base, would accountappropriately for individual variation inpatient needs, and would support thegeneration of new insights on clinical ef-fectiveness.

Because of the potential to enable the de-velopment of new knowledge and toguide the development of best practicesfrom the growing sum of individualclinical experiences, clinical data repre-sent the resource most central to health-care progress and are essential tobuilding a system that continually learnsfrom, and improves upon, care deliv-ered. Ultimately, advancing the notionof clinical data as a public good versusprivate property is essential to a health-care system that learns and is transfor-mative in nature.

The participants suggested that thegreatest challenge associated with estab-lishing a medical care data system toserve the public interest lies in the factthat today such data largely reside in theprivate sector, where commercial inter-ests and other factors inhibit sharing.Although the public should have con-

WASHINGTON SCENE“Interesting Times,” as AlwaysPatrick Deleon, Ph.D.Former APA President


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siderable interest in this information, thelimitations of the data system as cur-rently structured severely inhibitdemonstration of the value propositionfor consumers, both individually andcollectively. It was felt that concerns re-garding individual privacy rights couldbe satisfactorily addressed once the pub-lic became engaged and appreciated thepotential long-term benefits involved.Public policy and public awareness lagbehind the technical, organizational, andlegal capacity for reliable safeguardingof individual privacy and data securityin mining clinical data for new knowl-edge. An earlier IOM report noted: “Theprivacy justification for protecting per-sonal privacy is to protect the interestsof individuals. In contrast, the primaryjustification for collecting personallyidentifiable health information forhealth research is to benefit society.” Atits core the discussion is about whetherclinical data should be considered apublic or private good. These are, in-deed, “interesting times” with advancesin technology providing the opportunityfor intriguing paradigm shifts.

Diverse Views Surrounding Oba-macare: The enactment of ACA has gen-erated strong support and equally vocalobjections from psychologists. RayHavlicek and I have “debated” its po-tential impact upon psychology in vari-ous venues. Ray’s position: “I wouldlike to provide my opposing views re-garding the real new opportunities forpsychologists, which issues have beenignored in the context of Obamacare. Ibelieve psychologists, believing theseprograms will help, mistakenly signedon to Managed Care ‘back in the day,’and have done the same with Oba-macare, much to the detriment of ourprofession. Whenever the governmentor insurance companies get in betweenus and our patients there is anxiety. It istime for psychologists to avoid being

backed into a corner by Obamacare and lose our ability to adapt to changingdynamic forces in the healthcare market-place. Our ability to practice independ-ently, while interacting with other healthprofessions where appropriate should inmy opinion be paramount. Certainly,our friends in medicine are fully awareof how our patients’ mental health af-fects our patients’ physical health. Samecan be said about the law and ourCourts.

“Consolidating psychology into a hospi-tal based ‘treatment team’ will surelylead to psychology being more con-trolled by medicine and cause us to risklosing some of the considerable prestigewe have gained. Psychology has doneseveral major things well, one of whichis that we have created a magnificentprofession, which if managed appropri-ately needs no assistance from the gov-ernment. What we need to do is to bringdemand and supply into balance by en-suring that there are enough psycholo-gists for the demand, not more, and bydoing even more to promote psychologyand expand our professional capacitiesand authorizations.”

“The hyperbole about Medicare, Medi-caid and Obamacare reflects a funda-mental concern that psychologists are ormay become underemployed, or underpaid. If we are underemployed we needto address that issue by producing fewerpsychologists. Once supply and de-mand are brought into balance psychol-ogists will take the needed steps toappropriately and sufficiently addressour needs for economic prosperity. Psy-chologists are an intelligent, creativegroup of highly trained individuals fullycapable of succeeding as long as there isbalance between supply and demand. Imake these comments after 44 years inmental health. Best of regards.”


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Integrated Healthcare: I recently at-tended the 2012 Fall Semiannual Meet-ing of the American Association ofColleges of Nursing–“Taking Advan-tage of Technology in Nursing HigherEducation.” The presentation by therepresentative of the National Gover-nors Association highlighted the un-precedented changes occurring withinour nation’s health care environmentand the expectation, regardless of theoutcome of the November elections, thathealth reform is here to stay, and further,that, as Katherine Nordal has repeatedlyemphasized, the most critical decisionswill ultimately be made at the local andstate level. There is growing awarenessby the governors that mental health, be-havioral health, and physical health areintimately intertwined. It was noted thatACA will soon result in over 30 millionadditional Americans seeking access toprimary health care which will be a chal-lenge to every state. Interestingly, anIOM report released earlier this year ex-pressly explored the relationship be-tween primary care and public healthand referenced the “inextricable link be-tween mental health and primarycare…. Primary care providers addressa broad range of health issues to whichmental health conditions are integral.Mental, behavioral, and physical healthare so closely entwined that they mustbe considered in conjunction with oneanother.” The speaker proffered that thePatient-Centered Medical Home and theAccountable Care Organization provi-sions of the law could mature into excel-lent vehicles for fostering integrated,comprehensive team care for all en-rollees. It is important that psychologybe aware that neither the underlyingstatute nor the proposed implementingregulations currently address our poten-tial contribution. There is a real need forpersonal involvement at the local andnational level.

Exciting New Horizons — Retirement?“After serving for 32 years in the ArmyNurse Corps, I had the great opportunityto teach at the School of Nursing at theUniversity of Texas in Austin and thenspent six great years at the UniformedServices University of the Health Sci-ences (USUHS) in Bethesda, MD where Ihad the opportunity to work beside edu-cators and researchers who were focusedon educating the next generation of lead-ers, clinicians and researchers in our threemilitary services, the VA, and the U.S.Public Health Service. I concluded mytime at USUHS this past January and ac-cepted a position as Senior Advisor withthe Jonas Center for Nursing Excellenceout of New York City. The Jonas Centerwas started in 2006 by New York Cityphilanthropists Barbara and DonaldJonas. They decided they wanted to focustheir philanthropic efforts with a pro-gram dedicated to advancing the profes-sion of nursing. Since its inception, theyhave funded 297 grants totaling over $9.5million. They have funded over 250nurse scholars in all 50 States and the Dis-trict of Columbia. In 2011, they decidedto add an additional scholarship programto their Center—the Jonas VeteransHealthcare Program. This program isspecifically dedicated to improving thelives of our veterans by delivering criticalfunding and support for nurses who areat the forefront of advancing the care pro-vided to our Wounded Warriors. TheCenter provides funding for nurses pur-suing their doctoral degrees (either Ph.D.or DNP) focused on the healthcare needsof our military members and our veter-ans. The healthcare needs given priorityfor funding are based on those identified by the White House and the Veterans Ad-ministration and include mental healthdisorders, PTSD, Traumatic Brain Injury(TBI), and suicide prevention. This focuson the healthcare needs of our veterans iswhat drew me to this unique program.


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“As we all know, both DoD and the VAare incredibly dedicated to caring forour service members and our deservingveterans, but we also know that there isstill much to be learned in the areas ofmental health, PSTD, TBI, and suicideprevention. We feel strongly thatthrough continued research efforts andthe advances in clinical practice thatcome about as a result of that research,we will be able to provide an evenhigher level of care to this incredibly de-serving population of American heroes.And, in addition, we feel it will then beimportant to educate the next genera-tion of nurse educators so that these newadvances in caring for our veterans canbe taught to the next generation of clini-cians. I feel very fortunate to be able tocontinue to serve those who have sacri-ficed so much for our Nation by being apart of the Jonas Veterans HealthcareProgram [Brigadier General (Ret.) BillBester, former Chief of the U.S. ArmyNurse Corps].”

A Maturing National Priority: This FallPresident Obama issued a visionary andin our judgment, most timely ExecutiveOrder: Improving Access to MentalHealth Services for Veterans, ServiceMembers, and Military Families. Hecalled for the Departments of VeteransAffairs and Defense to jointly developand implement a national suicide pre-vention campaign focused on connect-ing veterans and service members tomental health services. An InteragencyTask Force is to be established to be co-chaired by the Secretaries of Defense,Veterans Affairs, and Health andHuman Services, or their designees. Inresponse to a critical question for psy-chology, as well as for other non-physi-cian health care providers—“What willour role be?”—Toni Zeiss, Chief Con-sultant Mental Health Service, notedthat her colleague Dr. Petzel will be theVA Co-Chair of the Task Force and that

her current Deputy, Sonja Batten, will becoordinating VA’s efforts on the Execu-tive Order. Sonja has attended severalAssociation of VA Psychology Leaders(AVAPL) conferences and will undoubt-edly bring a strong psychological per-spective. Toni unfortunately will beretiring at the end of this year havingmade history as the first non-physicianand first woman appointed to her posi-tion. She has served psychology andour nation extraordinarily well duringher illustrious career.

Kindred Reflections: Floyd Jennings isone of the first federal prescribing psy-chologists. “It was long ago and faraway, in the hot, wind-swept Tewaspeaking Pueblo tribe communities ofnorthern New Mexico that I began exer-cising prescriptive privileges (on a lim-ited formulary) in the summer of 1988.Viewed from the vantage point ofmodernity, with its polarization of pro-fessions (as well as political parties) andall too much rancor and acrimony, theSanta Fe Service Unit of PHS/IndianHealth Service was of a different time.For in 1988, the medical staff had createdstanding orders which were exercisedby the Mental Health Director under theChief Medical Officer, and with the ad-vice and consent–but even more—theunmitigated support of the area psychi-atrist. Every case was reviewed by telephone with the area psychiatrist. Pa-tients were served, and there were nountoward medical events. But a mael-strom of discontent, coupled with pre-dictions of dire effects to patients, wasraised by the psychiatric establishmentwhen this information became public al-most a year later. Santa Fe had had con-sultative monies but no psychiatricphysicians were clamoring to provideservices to the then 12 tribal communi-ties. After pressure from many externalsources, the practice ceased and the sen-


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The Psychotherapy Bulletin is Going Green: Click on www.divisionofpsychotherapy.org/members/gogreen/

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ior psychiatrist for IHS conducted a re-view of each of the almost 300 cases. Hefound no evidence of malpractice andhas since retired. I left the service for rea-sons unrelated and carried with me anaward from the Area Director and Asst.Surgeon General–and memories of hav-ing been among the relatively few Ang-los invited to ceremonies held in thetribal communities–otherwise closed tooutsiders. Decades later, IHS still has nopsychiatric consultants in the communi-ties, though they have been fortunate tohave one Native American psychiatricphysician in that service unit. It was aspecial time… and New Mexico has inrecent years approved a procedure per-mitting specially trained psychologiststo exercise prescriptive privileges.”

Aloha: “This is very exciting! I am nowusing SKYPE and Google Chat with afew clients–busy teens or folks who areon vacation and need some contact.Even grandparents often know how to use the technology as they use it as away to stay in touch with children/grandchildren. Some insurance compa-nies will reimburse but not for justphone contact [Sallie Hildebrandt].And, Reflections from a former Univer-sity President: “Grandchildren are thegift you get to reward you for aging.”Aloha,


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About the American Psychological Foundation (APF) APF provides financial support for innovative research and programs that enhance thepower of psychology to elevate the human condition and advance human potential bothnow and in generations to come.

Since 1953, APF has supported a broad range of scholarships and grants for studentsand early career psychologists as well as research and program grants that use psychol-ogy to improve people’s lives.

APF encourages applications from individuals who represent diversity in race, ethnicity,gender, age, disability, and sexual orientation.

About the Randy Gerson Memorial FundThe Randy Gerson Memorial Fund awards grants for graduate student projects in familyand/or couple dynamics, and/or multi-generational processes. Work that advances the-ory, assessment, or clinical practice in these areas is eligible. Preference will be given toprojects using or contributing to the development of Bowen family systems. Priority willalso be given to those projects that serve to advance Dr. Gerson’s work.Program Goals• Advance systemic understanding in the above topic areas through empirical,methodological, or theoretical contribution

• Encourage talented students toward careers in specified areas

Amount: One $6,000 annual grant

APF does not allow institutional indirect costs or overhead costs. Applicants may use grantmonies for direct administrative costs of their proposed project.

Eligibility RequirementsApplicants must:• Be a graduate student in psychology enrolled full-time and in good standing at anaccredited university

• Have demonstrated competence in area of the proposed work• IRB approval must be received from host institution before funding can be awarded if human participants are involved

Evaluation Criteria• Conformance with stated program goals• Magnitude of incremental contribution in topic area

• Quality of proposed work• Applicant’s competence to execute the project

Proposal Requirements• Description of proposed project to include goal, relevant background, target population, methods, anticipated outcomes, and dissemination plans(Format: not to exceed 7 pages double - spaced, 1 inch margins, no smaller than 11 point font)

• Timeline for execution• Full budget and justification (indirect costs not permitted)

• Current CV• Two letters of recommendation

REQUEST FOR PROPOSALSRANDY F. GERSON MEMORIAL GRANT

Submission Process and Deadline

Submit a completed applicationonline at http://forms.apa.org/apf/grants/ by February 1, 2013.

Please be advised that APF does notprovide feedback to applicants ontheir proposals.

Questions about this programshould be directed to: Parie Kadir, Program Officer, at [email protected].

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Tammi Vacha-HaaseChair, Fellows Committee

The Division of Psychotherapy is now accepting applications from individualswho would like to nominate themselves or recommend a deserving colleaguefor Fellow status with the Division of Psychotherapy. Fellow status in APA isawarded to psychologists in recognition of outstanding contributions to psy-chology. Division 29 is eager to honor those members of our division who havedistinguished themselves by exceptional contributions to psychotherapy in avariety of ways such as through research, practice, and teaching.

The minimum standards for Fellowship under APA Bylaws are:• The receipt of a doctoral degree based in part upon a psychological disser-tation, or from a program primarily psychological in nature;

• Prior membership as an APA Member for at least one year and a Memberof the division through which the nomination is made;

• Active engagement at the time of nomination in the advancement of psy-chology in any of its aspects;

• Five years of acceptable professional experience subsequent to the grant-ing of the doctoral degree;

• Evidence of unusual and outstanding contribution or performance in thefield of psychology; and

• Nomination by one of the divisions which member status is held.

There are two paths to fellowship. For those who are not currently Fellows ofAPA, you must apply for Initial Fellowship through the Division, which thensends applications for approval to the APA Membership Committee and to theAPA Council of Representatives. The following are the requirements for initialFellow applicants:

Completion of the Uniform Fellow Blank;• A detailed curriculum vitae;• A self-nominating letter (which should also be sent to your endorsers);• Three (or more) letters of endorsement of your work by APA Fellows (atleast two must be Division 29 Fellows) who can attest to the fact that your“recognition” has been beyond the local level of psychology;

• A cover letter, together with your CV and self-nominating letter, to eachendorser.

Division 29 members who have already attained Fellow status through anotherdivision may pursue a direct application for Division 29 Fellow by sending acurriculum vitae and a letter to the Division 29 Fellows Committee, indicatingspecifically how you meet the Division 29 criteria for Fellowship.

CALL FOR FELLOWSHIP APPLICATIONS DIVISION 29—PSYCHOTHERAPY


APA’S NEW ONLINE FELLOWS APPLICATION PLATFORM Beginning September, 27, 2012, the process to apply to be an APA Fellowis now done via the APA Online Fellows Application Platform. This newsystem will allow nominees, endorsers and division fellows chairs to sub-mit all required documents online.

The online system will replace the previous, paper-based process and allfellows applications must be added to the system to be considered by theFellows Committee.

Please visit the Fellows webpage for more information and to access the new online system:

http://www.apa.org/membership/fellows/index.aspx

If you need help or have any questions, please contact Sonja Wiggins inAPA’s Central Office at 800-374-2721 (ext. 5590) or email [email protected].

DEADLINE FOR SUBMISSION:The deadline for submission to be considered for 2013 is December 15, 2012.

Initial nominees (those who are not yet Fellows of APA in any Division)must submit the following electronically using APA’s on-line system:(a) a cover letter, (b) the Uniform Fellow Application, (c) a self-nominating letter, (d) three (or more) letters of endorsement from current APA Fellows (at leasttwo Division 29 Fellows), and (e) an updated CV.

Current Fellows of APA who want to become a Fellow of Division 29 needonly send a letter attesting to their qualifications with a current CV.

For questions about the submission process, or for guidance and adviceabout the application and forms, please contact:

Tammi Vacha-Haase, Ph.D.Chair, Division 29 Fellows Committee [email protected]: 970.491.5729

Incomplete submission packets after the deadline cannot be considered for this year.

Please feel free to contact Tammi Vacha-Haase or other Fellows of Division 29if you think you might qualify and you are interested in discussing your qual-ifications or the Fellow process. Also, Fellows of our Division who want torecommend deserving colleagues should contact Tammi with their names.

Call for Fellowship Applications, continued from page 57

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DIVISION OF PSYCHOTHERAPY (29)AMERICAN PSYCHOLOGICAL ASSOCIATION

Enter the Annual Division of PsychotherapyStudent Competitions

The APA Division of Psychotherapy offers four student paper competitions:� The Donald K. Freedheim Student Development Award for the best paper on psychotherapy

theory, practice, or research.

� The DiversityAward for the best paper on racial/ethnic, gender, and cultural issues in psychotherapy.

� The Mathilda B.Canter Education andTrainingAward for the best paper on education, supervision,or training of psychotherapists.

� The Jeffrey E. Barnett Psychotherapy Research Paper Award for the best paper that addressespsychotherapist factors that may impact treatment effectiveness and outcomes, to include typeof training, amount of training, professional degree or discipline of the psychotherapist, and therole of psychotherapists’ personal characteristics.

What are the benefits to you?� Cash prize of $500 for the winner of each contest.

� Enhance your curriculum vitae and gain national recognition.

� Plaque and check presented at the Division 29 Awards Ceremony at the annual meeting of theAmerican Psychological Association.

� Abstract will be published in the Psychotherapy Bulletin, the official publication of the Divisionof Psychotherapy.

What are the requirements?� Papers must be based on work conducted by the first author during his/her graduate studies.

Papers can be based on (but are not restricted to) a masters thesis or a doctoral dissertation.

� Papers should be in APA style, not to exceed 25 pages in length (including tables, figures, andreferences) and should not list the authors’ names or academic affiliations.

� Please include a title page as part of a separate attached MS-Word or PDF document so that thepapers can be judged “blind.” This page can include authors’ names and academic affiliations.

� Also include a cover letter as part of a separate attached MS-Word or PDF document.Thecover letter should attest that the paper is based on work that the first author conducted whilein graduate school. It should also include the first author’s mailing address, telephone number,and e-mail address.

Submissions should be emailed to:MegTobias, M.S.

Chair, Student Development Committee, Division of PsychotherapyE-mail: [email protected]

DDeeaaddlliinnee iiss AApprriill 11,, 22001133

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Brief Statement about the Grant:The Charles J. Gelso, Ph.D., Psychotherapy Research Grants, offered annually to quali-fying individuals, provide three $5,000 grants toward the advancement of research onpsychotherapy process and/or psychotherapy outcome.

Eligibility: All doctoral-level researchers with a successful record of publication are el-igible for the grant. Two of the grants will be reserved for Early Career Psychologists(up to 7 years past their doctoral degree). For the ECP Gelso Grant, the two most highlyrated submissions will be awarded grants. The research committee reserves the rightnot to award a grant if there are insufficient submissions or submissions do not meetthe criteria stated.

Submission Deadline:April 1, 2013

REQUEST FOR PROPOSALSCHARLES J. GELSO, PH.D. GRANT

DescriptionThis program awards grants for research projects in the area of psychotherapy processand/or outcome.

Program Goals• Advance understanding of psychotherapy process and/or psychotherapy outcomethrough support of empirical research

• Encourage talented graduate students towards careers in psychotherapy research• Support psychologists engaged in quality psychotherapy research

Funding SpecificsThree annual grants of $5,000 each to be paid in one lump sum to the researcher, to his orher university’s grants and contracts office, or to an incorporated company. Individualswho receive the funds could incur tax liabilities. A researcher can win only one of thesegrants. (see Additional Information section below).

Eligibility Requirements• In 2013, doctoral level psychologists and early career psychologists (up to 7 years pasttheir doctoral degree) will be eligible. ECP applicants should mark their submissions“ECP SUBMISSION” on the first page.

• Demonstrated or burgeoning competence in the area of proposed work.• IRB approval must be received from the principal investigator’s institution beforefunding can be awarded if human participants are involved.

• The same project/lab may not receive funding two years in a row.

Evaluation Criteria• Conformance with goals listed above under “Program Goals”• Magnitude of incremental contribution in topic area• Quality of proposed work• Applicant’s competence to execute the project• Appropriate plan for data collection and completion of the project

Proposal Requirements for All Proposals• Description of the proposed project to include, title, goals, relevant background, targetpopulation, methods, anticipated outcomes, and dissemination plans: not to exceed 3single-spaced pages (1 inch margins, no smaller than 11-point font)

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


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Request For Proposals, continued from page 60

• CV of the principal investigator: not to exceed 2 single-spaced pages and should focuson research activities

• A 300-word biosketch that describes why your experiences and qualifications makeyou suited for successfully carrying out this research proposal. This will be a blind review so please exclude identifying information.

• Timeline for execution (priority given to projects that can be completed within twoyears)

• Full budget and justification (indirect costs not permitted), which should take up nomore than 1 additional page (the budget should clearly indicate how the grant fundswould be spent)

• Funds may be used to initiate a new project or to supplement additional funding. Theresearch may be at any stage. In any case, justification must be provided for the requestof the current grant funds. If the funds will supplement other funding or if the researchis already in progress, please explain why the additional funds are needed (e.g., inorder to add a new component to the study, add additional participants, etc.)

• No additional materials are required for doctoral level psychologists who are not post-doctoral fellows

Additional Information• After the project is complete, a full accounting of the project’s income and expensesmust be submitted within six months of completion

• Grant funds that are not spent on the project within two years must be returned• When the resulting research is published, the grant must be acknowledged• All individuals who directly receive funds from the division will be required to com-plete an IRS w-9 form prior to the release of funds, and will be sent a 1099 after the endof the fiscal year (December 31st)

Submission Process and Deadline• All materials must be submitted electronically• All applicants must complete the grant application form, in MSWord or other text format

• CV(s) may be submitted in text or PDF format. If submitting more than 1 CV, then allCVs must be included in 1 electronic document/file

• Proposal and budget must be submitted in 1 file, with a cover sheet to include thename of the principal investigator and complete contact information (address, phone,fax, email)

• Submit all required materials for proposal to: Tracey A. Martin in the Division 29 Central Office, [email protected]

• You will receive an electronic confirmation of your submission within 24 hours, whichwill provide you with an assigned application number. If you do not receive confirma-tion, your proposal was not received; please resubmit.

DEADLINE: APRIL 1, 2013

Questions about this program should be directed to the Division of Psychotherapy Research Committee Chair (Dr. Cheri Marmarosh at [email protected] ), or theDivision of Psychotherapy Science and Scholarship Domain Representative (Dr. NormanAbeles at [email protected]), or Tracey A. Martin in the Division 29 Central Office, [email protected]

The Psychotherapy Bulletin is Going Green!Click on


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BRIEF STATEMENT ABOUT THE GRANT:The Norine Johnson, Ph.D., Psychotherapy Research Grant, offered annually to qualify-ing individuals, provides $210,000 toward the advancement of research on psychother-apist factors that may impact treatment effectiveness and outcomes, including type oftraining, amount of training, professional degree or discipline of the psychotherapist,and the role or impact of psychotherapists’ personal characteristics on psychotherapytreatment outcomes.

Eligibility: Doctoral-level researchers with a successful record of publication are eligiblefor the grant.

Submission Deadline: April 1, 20123

REQUEST FOR PROPOSALSNORINE JOHNSON, PH.D., PSYCHOTHERAPY RESEARCH GRANT

DescriptionThis program awards grants for research on psychotherapist factors that may impacttreatment effectiveness and outcomes, including type of training, amount of training,professional degree or discipline of the psychotherapist, and the role or impact of psychotherapists’ personal characteristics on psychotherapy treatment outcomes.

Program Goals• Advance understanding of psychotherapist factors that may impact treatment effec-tiveness and outcomes through support of empirical research

• Encourage researchers with a successful record of publication to undertake research inthese areas

Funding SpecificsOne annual grant of $210,000 to be paid in one lump sum to the researcher, to his or heruniversity’s grants and contracts office, or to an incorporated company. Individuals whoreceive the funds could incur tax liabilities (see Additional Information section below).

Eligibility Requirements• Doctoral-level researchers• Demonstrated competence in the area of proposed work• IRB approval must be received from the principal investigator’s institution beforefunding can be awarded if human participants are involved

• The selection committee may elect to award the grant to the same individual or research team up to two consecutive years

• The selection committee may choose not to award the grant in years when no suitable nominations are received

Evaluation Criteria• Conformance with goals listed above under “Program Goals”• Magnitude of incremental contribution in topic area• Quality of proposed work• Applicant’s competence to execute the project• Appropriate plan for data collection and completion of the project

Proposal Requirements for All Proposals• Description of the proposed project to include title, goals, relevant background, targetpopulation, methods, anticipated outcomes, and dissemination plans: not to exceed 3single-spaced pages (1 inch margins, no smaller than 11-point font)

NORINE JOHNSON, PH.D., PSYCHOTHERAPY RESEARCH GRANT


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• CV of the principal investigator: not to exceed 2 single-spaced pages and should focuson research activities

• A 300-word biosketch that describes why your experiences and qualifications makeyou suited for successfully carrying out this research proposal. This will be a blind re-view so please exclude identifying information.

• Timeline for execution (priority given to projects that can be completed within 2 years)• Full budget and justification (indirect costs not permitted), which should take up nomore than 1 additional page (the budget should clearly indicate how the grant fundswould be spent)

• Funds may be used to initiate a new project or to supplement additional funding. Theresearch may be at any stage. In any case, justification must be provided for the requestof the current grant funds. If the funds will supplement other funding or if the researchis already in progress, please explain why the additional funds are needed (e.g., inorder to add a new component to the study, add additional participants, etc.)

Additional Information• After the project is completed, a full accounting of the project’s income and expensesmust be submitted within six months of completion

• Grant funds that are not spent on the project within two years of receipt must be re-turned

• When the resulting research is published, the grant must be acknowledged by foot-note in the publication

• All individuals directly receiving funds from the division will be required to com-plete an IRS w-9 form prior to the release of funds, and will be sent a 1099 after theend of the fiscal year (December 31st)

Submission Process and Deadline• All materials must be submitted electronically• All applicants must complete the grant application form, in MSWord or other textformat

• CV(s) may be submitted in text or PDF format. If submitting more than 1 CV, thenall CVs must be included in 1 electronic document/file

• Proposal and budget must be submitted in 1 file, with a cover sheet to include thename of the principal investigator and complete contact information (address,phone, fax, email)

• Submit all required materials for proposal to: Tracey A. Martin in the Division 29Central Office, [email protected]

• You will receive an electronic confirmation of your submission within 24 hours,which will provide you with an assigned application number. If you do not receiveconfirmation, your proposal was not received. Please resubmit.

Deadline: April 1, 20132

Questions about this program should be directed to the Division of Psychotherapy Research Committee Chair (Dr. Michael ConstantinoCheri Marmarosh at [email protected]@psych.umass.edu), or the Division of Psychotherapy Scienceand Scholarship Domain Representative (Dr. Norman Abeles at [email protected]), orTracey A. Martin in the Division 29 Central Office, [email protected]

Request For Proposals, continued from page 64



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CALL FOR NOMINATIONSDIVISION 29 EARLY CAREER AWARD

About the American Psychological Foundation (APF) APF provides financial support for innovative research and programs that en-hance the power of psychology to elevate the human condition and advancehuman potential both now and in generations to come. Since 1953, APF has supported a broad range of scholarships and grants forstudents and early career psychologists as well as research and program grantsthat use psychology to improve people’s lives. APF encourages applications from individuals who represent diversity in race,ethnicity, gender, age, disability, and sexual orientation.

About the Division 29 Early Career AwardThis program supports the mission of APA’s Division of Psychotherapy (Divi-sion 29) by recognizing Division members who have demonstrated outstand-ing promise in the field of psychotherapy early in their career.

AmountOne $2,500 award

Eligibility Requirements & Evaluation CriteriaNominees should demonstrate and will be rated on the following dimensions:• Division 29 membership• Within 7 years post-doctorate• Demonstrated accomplishment and achievement related to psychotherapy theory, practice, research or training

• Conformance with stated program goals and qualificationsNomination Requirements• Nomination letter written by a colleague outlining the nominee’s career contributions (self-nominations not acceptable)

• Current CVSubmission Process and Deadline Submit a completed application online at http://forms.apa.org/apf/grants/by January 1, 2013.

Please be advised that APF does not provide feedback to applicants on their proposals.

Questions about this program should be directed to Parie Kadir, Program Officer, at [email protected].

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From APA’s Interactive Classroom ProgramsCultural Competence in Trauma Treatment • CE Credit: 3

This workshop introduces participants to a paradigm for thinking about the range and variety of cultural locations and intersectingidentities that come into play when a personexperiences trauma.

Presented by: Laura S. Brown, PhD, ABPP http://www.apa.org/ed/ce/

From APA’s Online Academy ProgramsBrief Therapy • CE Credit: 2.5

Numerous case examples, including video, willillustrate brief therapy techniques both in initialsessions and in the course of longer treatments.

Presented by: Michael Hoyt, PhDhttp://www.apa.org/education/ce/aoa0061.aspx

Find Division 29 on the Internet. Visit our site atwww.divisionofpsychotherapy.org

THE DIVISION OF PSYCHOTHERAPYThe only APA division solely dedicated to advancing psychotherapy

MEMBERSHIP APPLICATIONDivision 29 meets the unique needs of psychologists interested in psychotherapy.

By joining the Division of Psychotherapy, you become part of a family of practitioners, scholars, and students who exchange ideas in order to advance psychotherapy.

Division 29 is comprised of psychologists and students who are interested in psychotherapy. Although Division 29 is a division of the AmericanPsychological Association (APA), APA membership is not required for membership in the Division.

JOIN DIVISION 29 AND GET THESE BENEFITS!

Name ____________________________________________ Degree ____________________

Address _____________________________________________________________________

City _______________________________________ State ________ ZIP________________

Phone _________________________________ FAX ________________________________

Email _______________________________________________

Member Type: � Regular � Fellow � Associate

� Non-APA Psychologist Affiliate � Student ($29)

� Check � Visa � MasterCard

Card # ________________________________________________ Exp Date _____/_____

Signature ___________________________________________

Please return the completed application along with payment of $40 by credit card or check to:

Division 29 Central Office, 6557 E. Riverdale St., Mesa, AZ 85215You can also join the Division online at: www.divisionofpsychotherapy.org

FREE SUBSCRIPTIONS TO:PsychotherapyThis quarterly journal features up-to-datearticles on psychotherapy. Contributorsinclude researchers, practitioners, and educators with diverse approaches.Psychotherapy BulletinQuarterly newsletter contains the latest newsabout division activities, helpful articles ontraining, research, and practice. Availableto members only.

EARN CE CREDITSJournal LearningYou can earn Continuing Education (CE)credit from the comfort of your home oroffice—at your own pace—when it’s con-venient for you. Members earn CE creditby reading specific articles published inPsychotherapy and completing quizzes.

DIVISION 29 PROGRAMSWe offer exceptional programs at the APA convention featuring leaders in the field ofpsychotherapy. Learn from the experts in personal settings and earn CE credits atreduced rates.

DIVISION 29 INITIATIVESProfit from Division 29 initiatives such asthe APA Psychotherapy Videotape Series,History of Psychotherapy book, and Psychotherapy Relationships that Work.

NETWORKING & REFERRAL SOURCESConnect with other psychotherapists sothat you may network, make or receive referrals, and hear the latest important information that affects the profession.

OPPORTUNITIES FOR LEADERSHIPExpand your influence and contributions.Join us in helping to shape the direction ofour chosen field. There are many opportu-nities to serve on a wide range of Divisioncommittees and task forces.

DIVISION 29 LISTSERVAs a member, you have access to our Division listserv, where you can exchangeinformation with other professionals.

VISIT OUR WEBSITEwww.divisionofpsychotherapy.org

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MMEEMMBBEERRSSHHIIPP RREEQQUUIIRREEMMEENNTTSS:: Doctorate in psychology • Payment of dues • Interest in advancing psychotherapy

If APA member, please provide membership #

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President’s MessageCastonguay, L. G., Barkham, M., Lutz,W. & McAleavy, A. (in press). Prac-tice-oriented research: Approachesand applications. In M. J. Lambert(Ed,) Bergin and Garfield’s Handbookof Psychotherapy and Behavior Change(6th ed.).Hoboken, NJ: Wiley.

Castonguay, L. G., Boswell, J. F., Zack,S. E., Baker, S., Boutselis, M. A.,Chiswick, N. R.,...Holtforth, M. G.(2010). Helpful and hindering eventsin psychotherapy: A practice re-search network study. Psychotherapy:Theory, Research, Practice and Training,47, 327- 345.

Goldfried, M.R., & Padawer, W. Cur-rent status and future directions inpsychotherapy. In M. R. Goldfried(Ed.), (1982). Converging themes inpsychotherapy: Trends in psychody-namic, humanistic, and behavioral prac-tice (Pp. 3-49). New York: Springer.

Lazarus, A. A., & Davison, G. C. (1971).Clinical innovation in research andpractice. In A.E. Bergin and S.L.Garfield (Eds.), Handbook of psy-chotherapy and behavior change (pp.196-213). New York: Wiley.

McMillen, J.C., Lenze, S.L., Hawley, K.M.,& Osbourne, V.A. (2009). Revisitingpractice-based research networks asa platform for mental health servicesresearch. Administration and Policy inMental Health, 36, 308-321.

Zarin, D.A., Pincus, H.A., West, J.C., &McIntyre, J.S. (1997). Practice-basedresearch in psychiatry. American Jour-nal of Psychiatry, 154, 1199-1208.

Ethics in Sport and Performance Psychology: The Use of E-Therapy in AthleticsAoyagi, M., & Portenga, S. (2010). Therole of positive ethics and virtues inthe context of sport and performancepsychology services delivery. Profes-sional Psychology: Research and Prac-

tice, 41(2), 253-259.DeAngells, T. (2012). Practicing distancetherapy, legally and ethically. Monitoron Psychology, 43(3), 52.

Finn, J., & Barak, A. (2010). A descriptivestudy of e-counselor attitudes, ethics,and practice. Counselling and Psy-chotherapy Research, 10(4), 268-277.

Kanani, K., & Regehr, C. (2003). Clini-cal,legal, and ethical issues in e-ther-apy. Families in Society, 84(2), 155-165.

Midkiff, D. M., & Wyatt, W. J. (2008).Ethical issues in the prevention of on-line mental health services (etherapy).Journal of Technology in Human Services,26(2/4), 310-329.

Shandley, K., Klein, B., Kyrios, M.,Austin, D., Ciechomski, L., & Murray,G. (2011). Training postgraduate psy-chology students to deliver psycho-logical services online. Australian Psychologist, 46, 120-125.

Watson II, J. C., & Etzel, E. F. (2000, Fall).Considering ethics: Using the Internetin sport psychology. AAASP Newslet-ter, 15(3). 13-16.

Zur, O., Williams, M. H., Lehavot, K., &Knapp, S. (2009). Psychotherapist self-disclosure and transparency in the In-ternet age. Professional Psychology:Research And Practice, 40(1), 22-30.

Technology and Psychotherapy: A Study of Division 29 MembersBarnett, J. (2010). Psychology’s bravenew world: Psychotherapy in thedigital age. Independent Practitioner,30, 149-152.

DeLillo, D., & Gale, E. B. (2011). ToGoogle or not to Google: Graduatestudents’ use of the Internet to accesspersonal information about clients.Training and Education in Profes-sioal Psychology, 5, 160-166.

Kolmes, K. (2012). Social media in thefuture of professional psychology.Professional Psychology: Researchand Practice,

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DIVISION OF PSYCHOTHERAPY (29)Central Office, 6557 E. Riverdale Street, Mesa, AZ 85215

Ofc: (602) 363-9211 • Fax: (480) 854-8966 • E-mail: [email protected]

PSYCHOTHERAPY BULLETINPsychotherapy Bulletin is the official newsletter of Division 29 (Psychotherapy) of the American PsychologicalAssociation. Published four times each year (spring, summer, fall, winter), Psychotherapy Bulletin is designedto: 1) inform the membership of Division 29 about relevant events, awards, and professional opportunities;2) provide articles and commentary regarding the range of issues that are of interest to psychotherapy the-orists, researchers, practitioners, and trainers; 3) establish a forum for students and new members to offertheir contributions; and, 4) facilitate opportunities for dialogue and collaboration among the diverse mem-bers of our association.Contributors are invited to send articles (up to 2,250 words), interviews, commentaries, letters to theeditor, and announcements to Lavita Nadkarni, PhD, Editor, Psychotherapy Bulletin. Please note that Psy-chotherapy Bulletin does not publish book reviews (these are published in Psychotherapy, the official journalof Division 29). All submissions for Psychotherapy Bulletin should be sent electronically to [email protected] the subject header line Psychotherapy Bulletin; please ensure that articles conform to APA style. Dead-lines for submission are as follows: February 1 (#1); May 1 (#2); August 1 (#3); November 1 (#4). Past issues of Psychotherapy Bulletin may be viewed at our website: www.divisionofpsychotherapy.org. Otherinquiries regarding Psychotherapy Bulletin (e.g., advertising) or Division 29 should be directed to TraceyMartin at the Division 29 Central Office ([email protected] or 602-363-9211).

PUBLICATIONS BOARDChair : Jeffrey E. Barnett, Psy.D., ABPP Department of PsychologyLoyola University Maryland4501 N.Charles StreetBaltimore, MD 21210(410)-617-5382Email: [email protected]

Raymond A. DiGiuseppe, Ph.D., 2009-2014Psychology DepartmentSt John’s University 8000 Utopia Pkwy Jamaica , NY 11439 Ofc: 718-990-1955 Email: [email protected]

Laura Brown, Ph.D., 2008-2013Independent Practice3429 Fremont Place N #319 Seattle , WA 98103 Ofc: (206) 633-2405 Fax: (206) 632-1793Email: [email protected]

Jonathan Mohr, Ph.D., 2008-2012Department of PsychologyBiology-Psychology BuildingUniversity of MarylandCollege Park, MD 20742-4411Ofc: 301-405-5907 Fax: 301-314-5966Email: [email protected]

Beverly Greene, Ph.D., 2007-2012Psychology St John’s University 8000 Utopia Pkwy Jamaica , NY 11439 Ofc: 718-638-6451Email: [email protected]

William Stiles, Ph.D., 2008-2011Department of Psychology Miami University Oxford, OH 45056 Ofc: 513-529-2405 Fax: 513-529-2420 Email: [email protected]

On sabbatical: Jean Carter, Ph.D.

\EDITORSPPssyycchhootthheerraappyy JJoouurrnnaall EEddiittoorrMark J. HilsenrothDerner Institute of Advanced Psychological Studies220 Weinberg Bldg.158 Cambridge Ave.Adelphi UniversityGarden City, NY 11530Email: [email protected]: (516) 877-4748 Fax (516) 877-4805

PPssyycchhootthheerraappyy BBuulllleettiinn EEddiittoorrLavita Nadkarni, Ph.D.Director of Forensic StudiesUniversity of Denver-GSPP2460 South Vine StreetDenver, CO 80208Ofc: 303-871-3877Email: [email protected]

Associate EditorLynett Henderson Metzger, Psy.D.University of Denver GSPP2460 S. Vine St.Denver, CO 80208Ofc: 303-871-4684Email: [email protected]

DDiivviissiioonn ooff PPssyycchhootthheerraappyy IInntteerrnneett EEddiittoorrIan Goncher405 Lake Vista Circle Apt JCockeysville, MD 21030Ofc: 814-244-4486Email: [email protected]

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