Proceed with caution

The January Monitor article "Offer a financial beak" discusses ways psychologists can offer financially strapped clients a payment plan. I am a mental health-care lawyer, also trained as a psychologist, who represents many psychologists. However well-intended such offers might be, there are potential legal problems with them. The debt that accrues, especially if it's large, may not be legally enforceable, and collection actions might even give rise to questions about the ethics of the psychologist in entering into such arrangements.

Courts will very carefully review any contracts between psychologists and patients because of the nature of the fiduciary and therapeutic relationships and concomitant assumed difference in bargaining power that exist between the parties. One court in New York that declined to enforce a deferred payment contract between a psychologist and patient said that psychologists must show a "scrupulously high degree of fair dealing" in entering into such agreements. See Geis v. Landau, (1983). The same court also said that psychologists have an obligation to patients not to permit them to expose themselves to lawsuits by the therapist. Those are much higher standards than are imposed on ordinary businesses or even on physical health-care practitioners.

Judges and juries often view health-care procedures as more important than the practitioners who render them. The personal relationship that is often essential to a therapeutic relationship may be unrecognized or dismissed as fungible. Most localities have community mental health centers with sliding fee scales. So if an argument is made by a debtor-patient that a debt accrued because of undue influence by a psychologist, or evinces a failure to properly refer to lower-cost care, the psychologist may not only lose the collection action, but also be exposed to allegations of unethical conduct in the lawsuit.

When despite these caveats, a psychologist is determined to extend credit to patients, I advise: Select only established patients who are able to appreciate the importance of continuity of care with the psychologist; document clinical reasons involving patient welfare for not transferring care; keep the credit balance manageable; and ascertain that there is a reasonable expectation of a change in financial circumstances of the patient such that payment in the future will not present a financial hardship.

Bruce V. Hillowe, JD, PhD
Mineola, N.Y.

Whitewashing history?

The January "Time Capsule" on the birth of American intelligence testing whitewashes the monumental influence of Henry Herbert Goddard, whose legacy of "scientific theories" continues to impact our society today. Goddard's pioneering use of psychological testing and interpretation to form the foundation of social engineering policies impacts the most vulnerable members of our society, even today.

A full illumination of professional psychology's past role in court-ordered sterilization of the poor, whether "feebleminded" or not, would serve us better than praising Goddard for translating the work of Binet.

In recent years, research to prove delinquency's inheritability or the social value of paying women to have their tubes tied has its fundamental theoretical foundation in the work of Goddard and his heirs in the field of psychological testing.

The legacy of Goddard's work is not in the past; it is very contemporary.

Annie Lee Jones, PhD
Hollis, N.Y.

A good cause

I am in sympathy with the suffering of some of the homeless and am impressed by APA President James Bray, PhD's, noble choice of their plight as one of his three areas of focus (January Monitor).

I believe homelessness has gone unresolved as part of the human condition for several thousand years because of a dynamic that is activated as soon as a problem-solving program is started. This dynamic was identified by Theodore Dalrymple (National Review 2-11-2002): "Misery increases to meet the means available for its alleviation."

Carl E. Begley, PhD
Jacksonville, Fla.

At whose expense?

To help practitioners cope with tough financial times, in the January Monitor article "Rolling with the changes" APA President James Bray, PhD, suggested that they might want to teach a class in a community college. "Not only does it provide a great public service, it will build your practice for the future," he is quoted as saying.

However, these times also are difficult for new PhD psychologists who want an academic job and may have had training and practice as teachers. It is unfortunate that many colleges are saving money by hiring adjunct faculty who receive few or no benefits (e.g., medical, retirement). Practitioners supplementing their incomes may easily find adjunct positions, but perhaps at the expense of someone with no other income who is better prepared for teaching.

The idea that this will help build one's practice might be encouraging dual relationships. Teachers should not take their own students and probably not their former students, as clients. If the practice building comes from referrals, perhaps it would be more effective to follow the practice of lawyers who advertise on television.

James H. Korn, PhD
St. Louis, Mo.

Marriage and health

In the December news brief on marriage and men's health, Dr. Hui Lui states that "getting married greatly increases one's chance of being divorced or widowed." I'd go further than that. There is no chance of being divorced or widowed unless one has gotten married. Dr. Lui's assertion is equivalent to saying that "being born greatly increases one's chance of dying." And just for the record, the photo caption referring to "never-married George Clooney" is incorrect. Mr. Clooney was married to Talia Balsam from 1989 to 1993.

Michael Morris, PhD
New Haven, Conn.

Editor's note: To clarify, the research suggests that being divorced or widowed "hurts people's health today much more than 30 years ago," according to Liu.

Please send letters to Sara Martin, Monitor editor, at the APA address. Letters should be no more than 250 words and may be edited for clarity or space.


The story "My elephant could have painted that" (December Monitor) incorrectly stated the authorship of "Patterns of Artistic Development in Chilren: Comparative Studies of Talent" (Cambridge University Press, 1998). The book was written solely by Cosntance Milbrath, PhD.

An article in the January Monitor incorrectly stated that Mary Karapetian Alvord, PhD, received her doctorate in clinical psychology. Dr. Alvord received her doctorate in school psychology with an emphasis in clinical.