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Passport.jpeg (166477 bytes)Welcome to the Passport Series in marketing your services to a fee-for-service client population. This is the first in a series on how to develop and market specialty services in psychology. You will be pleased to know that this section of the Bulletin is part of a larger, overall marketing plan for division members.

By Spring of 1998, we will offer to our members 8 professional marketing brochures, which we developed in collaboration with the Division of Psychotherapy. The brochures are targeted to the public. They offer your services in 8 problem areas: breast cancer/cancer; separation and divorce; heart disease; ADHD; serious and chronic illness; managing difficult children; child/adolescent issues; aging and getting younger. Many thanks toPeter Sheras for coordinating this project.

To cap it all off, the Division 42 advertising project will be underway by the time you read this article. Under the auspices of Elaine Rodino, this national advertising project will promote the marketing brochures, along with a listing of participating division 42 providers from the reader's zip code area. .

You can further implement your marketing plan by attending the series of skill building/marketing symposia scheduled for the August APA annual convention in San Francisco. These sessions, again offered jointly with the Division of Psychotherapy, will feature 4 tracks: Women's Health; Parenting/Relationships; Forensic Psychology; and Psychology for the Business World. Each skill building symposium will be followed by an informal, 2 hour marketing workshop where you will learn how to use the marketing brochures and how to market your practice directly to the public and to other professional groups.

And be sure to take advantage of the personalized marketing workshops that will be offered in the hospitality suite during the convention.

Finally, a new feature introduced for the first time at the San Francisco convention will be the Marketing Expo offered during the division social hour. During this event, division 42 members will be able to have free consultations with marketing experts, book agents and public relations firms.


Sandra Haber, Ph.D., Psychologist and Psychooncologist

"Pychooncology" is a 50 cent word used to describe psychological services provided to cancer patients and their families.

Is there a niche market for psychooncologists? You bet there is. Unfortunately, cancer will effect a mindboggling 1 out of 3 people in the United States during their lifetime. There are presently over 10 million cancer survivors in the United States. Although there are some psychological services available in major teaching hospitals, by and large, mental health for cancer patients has been neglected by both professionals and the public. The good news is that the research data on the effectiveness of psychological interventions is strong. Some studies that are noteworthy include findings on the effectiveness of hypnosis and relaxation on diminishing the side effects of chemotherapy (Redd et al, Journal of Consulting and Clinical Psychology, 1982, 50,(1), 14-19; Lyles et al Journal of Consulting and Clinical Psychology, 1982, 50(4), 509-524)) and the effectiveness of support groups on increasing survival time(Spiegel et al. The Lancet, 1989, #8668, 888-891; Fawzi,et al. et al 1990, Archives of General Psychiatry, 47, 729-735).

As a psychooncologist, I am aware that different psychological issues arise for patients depending upon where they are in the medical treatment process. For example, issues at diagnosis tend to be around medical consultations, assertiveness, information gathering, and personal decision making. During the active treatment phase, issues of anxiety and depression around surgery, radiation or chemotherapy are typically present. Patients frequently need help coping with the treatment's iatrogenic effects such as scarring and disfigurement, nausea, weight gain, infertility and/or hair loss as well as the psychological reactions of family members. During the post treatment phase, adjustments to permanent bodily changes, anxiety about recurrence, and posttraumatic stress symptoms are frequently observed.

I think it is instinctive to want to avoid dealing with cancer because for most people, cancer means death. When my mother would describe someone as VERY sick, I knew that she meant that they had cancer. We actually never said the word itself. Susan Sontag documents this experience beautifully in her book, Illness as Metaphor and AIDS and Its Metaphor (Anchor Books, 1990) and it is definitely worth reading. So with this background, cancer would have been my last area of interest.

Unfortunately, none of us is immune from the risk of cancer. Statistically, it affects such a huge proportion of the population that it is simply a matter of time before it hits you personally in your family or with friends. In my case, cancer touched my best friend. And it was the process of caring for her that broke through my avoidance of cancer. The personal "high" of being helpful suprised me and got me to consider this as a specialty area. I think it also helped that my best friend had a positive outcome and is still alive today.

Soon after the first incident, another friend/colleague was also diagnosed with cancer. This case was not as fortunate. But my own cancer-anxiety had been tamed and we were able to use her last year of life to write a psychological manual on the treatment of breast cancer. Once I decided that I wanted to specialize in psychooncology, I embarked on an extensive reading program which helped bring me up to speed.

(l.) Selected Readings* Haber, S. Specialization in Psychotherapy: From Psychotherapist to Psychooncologist. Professional Psychology, 1995, 26(4), 427-432. Haber, S., Acuff, C., Ayers, L. Freeman, E.L., Goodheart, C., Kieffer, C.C., Lubin, L.B., Mikesell, S.G., Siegel, M., and Wainrib, B.R. Breast Cancer: A Psychological Treatment Manual. New York: Springer, 1995.

Holland, J.C. and Rolland, J.H. (Eds) Handbook of Psychooncology. New York: Oxford University Press, 1990.

Lerner, Michael. Choices in Healing: Integrating the best of conventional and complementary approaches to cancer. Cambridge: MIT Press, 1994.

There are helpful publications, from the National Cancer Institute (1-800-4-Cancer) and the American Cancer Society (1-800-ACS-2345) that give useful information on the specifics of cancer and its treatments.

* A more extensive list of resources is included with brochure orders.

(2.) Useful Courses Following this, I was fortunate enough to be admitted to a 2 week full time residency program at Memorial Sloan Kettering Cancer Center where I was able to accompany medical and psychological personnel on their rounds and sit in on their courses. This was an invaluable experience. Swayed by the research data, I then completed a formal certification program in hypnosis from the American Society of Clinical Hypnosis. This too has been quite helpful in my work with cancer patients. I use it primarily to decrease anxiety before surgery and chemotherapy, to manage cancer pain and to promote healing through positive visualizations. I also attended the Conference on Alternative Medicine which is given every year (contact Harvard Medical School, Dept of Continuing Education) and the World Congress on Psychoonocology (contact Memorial Sloan Kettering Cancer Center-Department of Psychiatry).

(3.) Patient Interviews About 4 years ago, as Chair of the Division's Task Force on Psychooncology, I put out a call to psychologists who had dealt with cancer either in themselves or a partner. I received many responses and interviewed about 50 individuals. These interviews helped me crystallize my understanding of what psychological services are needed and helpful. I am indebted to these patient-psychologists for their contribution. I will also suggest that if you haven't worked with many cancer patients, but would like to consider doing so, then this interview technique is quite useful.

(4.) Staying Current To keep up with current materials I attend the World Congress on Psychooncology and subscribe to (and read) Oncology Times (800-638-3030); Advances: The Journal of Mind-Body Health (Fetzer Institute, Kalamazoo, Michigan); and Alternative Therapies in Health and Medicine (800-345-8112). On the computer I have a number of bookmarks including:

National Cancer Institute
University of Pennsylvania Cancer Center Resource
National Alliance of Breast Cancer Organizations (NABCO)

(5.) Have We Got A Brochure for You!

The breast cancer brochure along with your personal imprint will be available early this spring. When you order brochures, you will be getting a complete package of materials that includes a resource list and marketing tips. You can preorder brochures by calling the central office of division 42 (phone: 602-246-6768; fax: 602-246-6577; email:

The brochure offered for this niche is targeted to women with breast cancer because of their large numbers and grass roots organizations as well as their success in government funding. Significant media attention has helped organize this group from the early public statements of Nancy Reagan and Betty Ford to the recent television sitcom of Murphy Brown. The effectiveness of this media attention and tight organization is symbolized by the new breast cancer postage stamp that President Clinton recently approved.

(6.) Practice Tip My basic philosophy is that "False Hope" is an oxymoron. "Six months to live" may be true for 99% of the people with a certain prognosis but it may not be true for the person in front of you. No matter how grim the statistics look, there is no certainty for a particular case.

(7.) Most Useful Intervention: Building the Treatment Team The following technique is useful with new patients who are recently diagnosed with cancer or are in the early stages of treatment. The initial meeting for this type of intervention runs from 2 to 3 hours. During the initial contact telephone call, I will suggest, if appropriate, forming a buddy team composed of 2 or 3 people who agree to help out with a variety of tasks involved in cancer diagnosis and treatment. If it is geographically possible, and if the patient is open to this intervention, I then use our first session to meet separately with the patient as well as the key members of the team. This gives the patient an opportunity to tell me his/her story, as in any traditional first session It also affords me the opportunity to meet with each member of the team so that they have an opportunity to tell me if there is a particular task or issue that they are uncomfortable with. Following these individual meetings, we meet as a group and designate a "captain". The captain and I will speak fairly frequently during the treatment process. I then suggest an appropriate "game plan" which varies according to the problem at hand. An example of a typical game plan for making a treatment decision would involve research on medical treatments, visits to physicians for second opinions, and exploration of complementary and alternative medicine etc.

My initial fee covers the time spent both in and out of this extended session plus the follow-up phone calls. If there are subsequent visits, patients pay on a per session basis (brief telephone calls are absorbed as in my regular therapy practice).

I find that patients respond positively to this "organizing" intervention. It deals both with the medical and psychological reality and tends to help the patient feel safe and secure. I use this technique when I am the primary psychologist as well as when I am called in as a "cancer consultant" for another psychologist. In the latter case, I review the game plan with the primary psychologist.

(8.) Personal Qualities That Are Helpful Be able to manage one's own cancer phobia to some extent. Enjoying very intense, focused work that tends to be time sensitive and fairly pressured; being able to manage "roller coaster" affect on the part of the patient and family members. You should be comfortable taking charge, developing a game plan, knowing the details of physical illness and moving beyond the boundaries of traditional psychological care.


Breast Cancer Marketing Tips
Laurie Kolt, Ph.D., Psychologist and Marketer of Psychological Services

How do you develop a practice marketing plan for breast cancer patients? Start by getting into the mindset of a breast cancer patient. Imagine what she is experiencing, feeling and needing. Then ask yourself how she will know that you are out there and what will make her interested enough to pick up the phone and give you a call.

Think in terms of building a one year marketing plan. Divide the year into four quarters and plan activities for each quarter. Early and thorough planning will help you stay organized as well as maximize your chances of building solid referrals. Set goals that are clear and specific.

1) Develop And Reach Your Initial Referral Sources. Start by creating a mailing for all the oncologists, OB/GYN's and other cancer related referral sources that are in your community. The yellow pages is an excellent place to find them. The APA has recently created a working relationship with The American Cancer Society so include your local ACS branch as well any other natural links for referrals that you can think of. Don't forget to add therapists who do not have an interest or expertise in working with cancer. Put the list into a computer mailing program. When you see the stack of envelopes you will feel a sense that you're are doing something.

Your initial mailing should be a cover letter and a copy of your cancer brochure. It will demonstrate that you are a competent and professional community expert in this area - and you are interested in meeting them. Unless you have a lot of free time, I recommend that you send out only 10 per week. After your contact with them, plan to mail something to them every quarter. A breast cancer group announcement, a cancer article you have written or a speaking engagement you are giving are good examples of quarterly mailings. The goal is keep them remembering that you are a visible community expert that they can refer to.

2) Become Known As The Community Expert. A key to good practice building is to stand out in the eyes of your referral sources. If you like public speaking, call the local AMA and ask if you can be a speaker at one of their physician meetings. If you enjoy writing, call the editor and explain how an article on the psychology of breast cancer will benefit readers. Your topic can range from "the psychological issues breast cancer patients face" to "how doctors can best respond when the patient is in emotional distress." If you really want to become an expert in their eyes, arrange to teach them a continuing education class on "psychological dimensions of breast cancer patients."

4) Constantly Look For Timely Opportunities. Train yourself to always search for openings to talk about psychology and breast cancer. For example you could write a letter to the editor of your local newspaper commenting on how the recent episodes of The Murphy Brown Show present an accurate portrayal of such an important health issue. Start the letter with something like, "As a local psychologist...." so people begin to see your name associated with community expertise in this area.

Don't forget that National Breast Cancer Awareness Month is in October (Quarter 3) so plan to develop a series of seminars, workshops and articles in the second quarter so you have plenty of lead time. You can send out press releases to the media whenever you do anything related to breast cancer for the public.

5) Give Psychology Away. If you really are committed to building your practice, get out and touch the lives of people who need your services. Know that your marketing vehicle can make a profound difference in someone's life. When a new client makes the decision to come and see you, the door opens for important change to occur. It can take a woman who is feeling frightened, out of control, or overwhelmed and guide her to a place where she can develop the courage and peace to go on.

So stretch yourself and learn all you can about breast cancer. Get into the heart of what it must feel like for women to cope with breast cancer, and make a commitment to help them. This energy will boost your confidence, vision and enthusiasm to build your specialty. When you develop this kind of energy, people will remember you. Whether you use writing, speaking, networking, doing media work or even coordinating mammogram screenings, pull up your sleeves and get involved.


October -- National Breast Cancer Awareness Month

The heightened awareness being generated by Murphy Brown provides a good opportunity for submitting a letter to the editor of your local paper.

Send a letter to surgeons, oncologists and primary care physicians in your area to bring attention to how psychological intervention can enhance a patient's immune function and increase survival rates. As a starting place, offer to provide campaign brochures for use in their office waiting rooms.

Contact libraries in your community to offer information and resources on the mind/body connection. Several state and local associations are using libraries to place color campaign "ad" posters (available for a minimal charge through the 800 numbers) fact sheets and brochures to set-up special displays.

In difficult times, some people visit their churches/synagogues for guidance and support. Provide fact sheets and information to the clergy in your area.

Community health centers are some women's only source of health care information. Contact local health care centers to inquire about disseminating campaign brochures and posters.

Breast Cancer - Just the Facts

APA is creating a new fact sheet focused specifically on breast cancer. Call Tricia Alvarez at 202-226-5910 to order your copies.


Kolt, L. (1996) Business And Marketing Training Manual, Self Published, 3rd Edition

Kolt, L. (1997) Building A Lucrative Practice Despite Challenging Times: Part L, Practice Builder Column, Practice Management Monthly, February.

Sample Physician Letter


National Breast Cancer Awareness Month has generated much needed attention to the challenges women face when confronted with breast cancer. It is my hope that we might take advantage of this surge in public awareness to help educate your patients on the full range of services available to combat this disease.

As you may know, research over the past thirty years suggests that psychological intervention can enhance immune functions and increase survival rates, while improving emotional adjustment after surgery and increasing healthy behaviors.

Although the benefits of psychological services to breast cancer patients have been firmly established, many women remain unaware of them. As a means of informing these patients, I would be pleased to supply your office with American Psychological Association (APA) brochures to help women understand when and how to access help, should they desire to do so. A copy of the brochure is included for your reference.

I would also be happy to meet with you to discuss other opportunities to provide your patients with information that my prove helpful to them.

I will call you in the next few days to answer any questions. Thank you for your time and interest.


Jeff McKee
Saturday, April 25, 1998