letters

Be bold in your career choices

CHEERS TO THE MONITOR for highlighting emerging careers in psychology in the January issue. Focusing on the rich applications of psychology training in varied careers is increasingly important in a managed-care environment where simply hanging out the shingle isn?t enough to survive. In my career, experience gained in private practice and group work led to three published books and conference speaking, which opened the door to a lucrative opportunity as author/educator for an advanced training program affiliated with a mental health service provider. Essentially, I am paid for what I most enjoy: writing, teaching, and occasional groupwork.

My encouragement to colleagues and new graduates is to identify which aspects of psychology that you love and merge that professional knowledge with your other areas of expertise. Define the work you want and don?t arbitrarily exclude business, government, or nontraditional sources in your search. What you know about people and relationships is valuable in many places. Be bold.

K.T. Erwin, EdD
St. Petersburg, Fla.

?Cherrypicking? the outcomes research

OVER THE LAST SEVERAL years, we have followed the shifting position of the APA leadership on the issue of managed care. The recent front-page article on ?cherrypicking? in the December Monitor demonstrates once again that expediency and guild issues may win out over science when addressing the important problems facing mental health care in this country. The problem is not simply that research on brief therapy is being misused by some managed-care companies, but rather that our profession has, until very recently, failed to offer valid and reliable alternatives to measure and insure accountable practice. Clearly, using selective research findings to curtail or avoid needed treatment is unacceptable. However, claiming the high moral ground by attacking ?brief therapy? (which is not synonymous with ?time-limited or short-term?) or by using buzzwords like ?flexibility? misses the point and is a poor disguise for an antimanaged-care, pro-long-term treatment agenda.

In 1986, then-APA president Nicholas Cummings warned psychologists about the dire consequences of failing to engage in constructive dialogue about the problems in American mental health care (e.g., poor pay, little respect and the loss of control over mental health policy and decision-making). Sadly, as psychologist Carol Shaw Austad (1996) has pointed out in her recent book on managed care, ?His message met with provided resistance and was ignored by the leadership of the APA.?

We shudder to think where as psychologists we will end up 10 years from now if proprietary interests and guild issues are once again allowed to dictate APA policy.

Michael F. Hoyt, PhD
Hayward, Calif.

Scott D. Miller, PhD
Chicago

THE OBVIOUS OMISSION IN the Monitor ?cherrypicking? article is the failure to acknowledge that therapy is an individual pursuit, not a compilation of means and Analyses of Variance. That a mean of six or even 60 cognitive behavioral sessions may be shown to cure depression in a segment of any sample group belies the fact that certain of the human beings involved may not respond to that treatment. Some of the group may respond only to Prozac, psychoanalysis, etc. Each of these people has the right to get better even if he or she is not part of the modal group. Psychology will never make headway with overbearing, profit-driven HMOs until this point is understood. We all know that sometimes an ear infection doesn?t respond to the first course of Ampicillin and a physician needs the ability to extend or modify the prescription. For therapists, the required treatment latitude is even greater because the variables are so numerous. If the Monitor doesn?t make this point for us more cogently, how can we expect the HMOs to grasp the issue?

Russell Karasik, PhD
St. Remy, N.Y.

A fetus is a person

Thank you for publishing the articles on the prenatal environment in the December 1997 issue. As a professional psychologist, I have found myself ambivalent regarding abortion. The research reviewed, however, convinces me that the fetus is a ?person? and, therefore, abortion for birth control is wrong.

Daniel J. Kuna, PhD
Toledo, Ohio

More research needed

WITH SUPERB CLARITY AND incisiveness, Martin Seligman has sounded the call for APA to provide ?massive research on human strength and virtue? and to ?create a science of human strength whose mission will be to foster these virtues in young people? (Monitor, January 1998, page 2. Italics added). Seligman specified these virtues as ?courage, optimism, interpersonal skills, work ethic, hope, honesty and perseverance.?

I, for one, enthusiastically applaud Dr. Seligman?s own courage and honesty in bringing the word virtue back into our professional vocabulary.

And I would echo the need to ?foster these virtues in young people.? So, what better way for APA to model these virtues than by having the honesty and the courage to acknowledge the social and political prejudices in APA?s publication policies; namely (1) the ban on all military-sponsored advertising, and (2) the virtual exclusion of research to reparative therapy for homosexuals and to the post-traumatic stress correlates of abortion. Until such an in-house demonstration of courage and honesty takes place, Seligman?s laudable call for virtue will remain as sounding brass and tinkling cymbals.

Ed D. Lauritsen, PhD
Phoenix, Ariz.

Arguing over prescription privileges

I WONDER AT THE PERSISENT difference of opinion over the value of prescription privileges. It is clear to any practitioner who has engaged in continuing education (CE) that psychologists who confine themselves within the bounds of psychotherapy deprives their clients of essential services. In fact, the deprivation can constitute malpractice. Not long ago, the Monitor reported a malpractice suit against a psychologist whose depressed client sought the services of a psychiatrist who prescribed a standard antidepressive that brought quick relief.

The risk of malpractice is not the only reason for undertaking training in psychopharmacology. The proper study of that subject provides essential knowledge of the brain?s biochemistry and organic functioning. Ignorance of psychoneuroimmunology limits the psychologist in making an adequate assessment of neuropsychological impairments. It is well established that severe, persistent depression or anxiety is the cause of neural impairment. Psychologists who are not trained in pharmacology are likely to overlook organic complications and thereby fail to treat critical aspects of psychological problems.

I suspect that the practitioners who discount the value of prescriptive privileges are among the great number who pursue continuing education only to the minimum credit requirement. I have found that the number of psychologists who attend the many advanced courses offered by the department of psychiatry of Harvard Medical School, the Prescribing Psychologists? Register and various institutions is a minute fraction of the professional population. They may believe they can improve their proficiency and effectiveness through experience. Instead, they are ensuring that they will become obsolete.

Martin Haydon, PhD
North Brunswick, N.J.

Re-evaluating internships

I BELIEVE IT'S TIME for clinical graduate programs to re-evaluate the role and nature of internship training for their students, especially with the question of ?supply and demand? being so much on everyone?s mind. With internship frenzy having passed, and the anxiety ebbed, I wonder if the meaning and importance of the internship experience has changed over the last many years.

Fielding questions from student supervisees over the last few weeks concerning how one should choose the absolute ?best possible? internship, I?ve become convinced that the internship needs to be considered differently from in years past. Formerly, the internship was the singular most important professional experience before entering the real world of the psychologist, meant not only to teach hands-on skills, but also to professionalize the student to the role. Nowadays, when graduate training includes multiple externships, and many students work (for pay) as therapists, evaluators, teachers and researchers long before the formal end of classes, the internship has become only one of many professionalization experiences. Although it may be the first full-time experience for many students, it no longer holds the unique place in clinical training that it once did. In fact, my recommendation to many students was that they use the required time to expand their clinical training in some new way and treat it as more of an extended and extensive placement, not the great do all and end all of their graduate training as they are still being told in their schools.

Neil Berger, PhD
White Plains, N.Y.

Leave us alone, please

WHEN WILL I OPEN THE MONITOR to read about the debate over the sickness and etiology of heterosexuality? It offends me as a gay man and a psychologist to see the endless focus on gayness and lesbianism without the corresponding percentage of verbiage on what causes heterosexuality and leads so many heterosexuals to unhappiness, relationship failure and criminal acts.

When you consider the fact that heterosexuals end their unions in failure the majority of the time, or that nearly all crimes are committed by heterosexual males, wouldn?t you think several stories an issue every issue on heterosexuality and its obvious foibles and pathology would be called for?

Why can?t we invest the energy to determine what it is about heterosexuality that makes men so prone to criminal behavior? Let?s do brain studies on heterosexual cadavers for a few years to determine what made these people heterosexual.

And leave us alone for a while. Please.

Peter Eric Olson, PhD
Watertown, Minn.

Psychotherapy is dead

THANKS TO MANAGED CARE, psychotherapy is basically dead. What was supposed to be, and out of necessity was, a meandering, evolving, interesting, complicated journey has now been reduced to S.S.S.S. (superficial symptom solution sessions). It used to be that people emerged from therapy wiser, calmer, more realistic and truly changed. Now they are merely momentarily relieved of a current ?problem.? How sad that we let this transformation happen.

Robert Neufeld, PhD
Chicago

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