PRIMUM NON NOCERE. THE enormity of the atrocious events of Sept. 11 is difficult to grasp. There can be little doubt that the psychological impact of these horrific events will be felt at both individual and community levels for days, months and even years to come. As psychologists, our instinct is to help, and indeed there is much that we can do. As citizens, we can give blood and make financial contributions to emergency organizations. As specialists in human behavior, we can offer our support to victims and their families. We can do our best to empathize with their suffering, and we can reinforce constructive coping responses. In concert with other health-care providers, we can offer appropriate psychological services to those who develop psychological disorders such as post-traumatic stress disorder or depression. For example, there is evidence that cognitive behavior therapy provided a few weeks after a traumatic event in those with persistent problems can be effective.
But, in times like these, it is imperative that we refrain from the urge to intervene in ways that--however well-intentioned--have the potential to make matters worse. Several independent studies now demonstrate that certain forms of postdisaster psychological debriefing (treatment techniques in which survivors are strongly suggested to discuss the details of their traumatic experience, often in groups and shortly after the disaster) are not only likely to be ineffective, but can be iatrogenic. Unfortunately, this has not prevented certain therapists from descending on disaster scenes with well-intentioned but misguided efforts. Psychologists can be of most help by supporting the community structures that people naturally call upon in times of grief and suffering. Let us do whatever we can, while being careful not to get in the way.
Naomi Goldstein, PhD
Richard Gist, PhD
University of Missouri--Kansas City
Richard J. McNally, PhD
Ron Acierno, PhD
Medical University of South Carolina
Morag Harris, PhD
Texas A&M University
Grant J. Devilly, PhD
University of Melbourne
Richard Bryant, PhD
University of New South Wales
Howard D. Eisman, PhD
Coney Island Hospital
Ronald Kleinknecht, PhD
Western Washington University
Gerald M. Rosen, PhD
University of Washington
Edna Foa, PhD
University of Pennsylvania
RESPONSE FROM APA: IT IS important to separate what psychologists, under the auspices of the APA/American Red Cross Disaster Response Network, are actually doing and what is being suggested is happening at the New York and Pentagon disaster sites.
The APA/Red Cross program is not based on debriefing techniques. Anyone who volunteers to provide mental health services at a Red Cross disaster site has to be a licensed professional. It is not the case that anyone can show up at a disaster site and go to work interacting with victims. Access to the disaster site is strictly controlled and the ability to volunteer as a Red Cross mental health worker is also controlled. It's also important to note that the great majority of the work done by psychologists at the Pentagon and in New York, as has often been the case since the inception of the Disaster Response Network in 1992, has been with the fire and emergency personnel and other Red Cross responders involved in the recovery effort, rather than with victims of the attack.
Also important to consider when determining what is helpful to both victims as well as recovery personnel is the critical role of clinical judgment used by the psychologists working on site. They are experienced clinicians with specific disaster mental health training and they know firsthand that a "one-size-fits-all" mental health intervention is not going to be effective. Some people find it very helpful to talk about their experience, thoughts and feelings soon after a disaster while others do not. The important point is that experienced clinicians work to help people marshal their own individual strengths and coping strategies that work best for them.
APA fully supports paying attention to the research and doing more research to determine the best practices when responding to disasters. Meanwhile, psychology should also be careful not to misdirect criticism by misapplying labels.
What message are we sending?IN LIGHT OF THE RECENT circumstances in the United States I am struck by some of the contradictions in our governmental policies and the standards by which we attempt to hold our clients. I work with children and adolescents, frequently on issues of impulse control, anger management and conflict resolution. I have been taught to discourage clients from retaliating with violent or aggressive behavior when feeling wronged. Television has frequently been blamed for the violent behavior of America's youth.
However, over the course of the last week, I am left to wonder if it isn't something a little larger than television. Our country is being asked by foreign leaders to use means other than military action to resolve our current crisis. Yet, leaders are marching our country to war, vowing to give Osama bin Laden what he deserves. My question is how (when our country is failing to exercise impulse control and conflict resolution skills) are we to expect America's youth to not receive this message? How are children and teens not to learn that the messages we are providing for them are not what our country truly values? Self-defense? After a delay and investigation? If this were a personal attack, a father pursuing the killers of his child, it would be vigilantism--and he would be subject to prosecution and jail time.
My heart aches with the rest of America, but I shudder at the thought of the loss of more innocent lives. Furthermore, I shudder at the message that we are sending to the youth in our country about how to handle crisis or violence.
Repositioning psychology in the mass media I READ WITH DELIGHT September's Monitor, which highlighted APA's collaboration with PBS on an upcoming film to be broadcast about adolescent girls. Positive visibility is imperative for the future of psychology. What good are our professional services if few fully understand what it is that we offer?
Twenty-first-century media are the most efficient means to disseminate good information to the masses. Until now, I believe that we have ineffectively used this powerful resource. It was not until as recently as about 12 years ago, for example, that psychologists were even ethically permitted to broaden the spectrum of advertisement of their services.
As a result, I believe that APA, and our profession as a whole, is mostly to blame for the many public misunderstandings which persist about psychology and psychotherapy. Other medical professions seem to have found the positive balance that helps create a tactful visibility beneficial to both their respective professions and overall public welfare.
I trust that the PBS collaboration is a start in the right direction of helping psychology achieve the same balance. My hope is that unlike last year's work with MTV, APA's collaborative role (and not just the message itself) will be more prominently highlighted on PBS. If not, we need to view our profession's propensity for reticence as a potential shortcoming that needs to be changed, lest we become lost in the sea of media clutter.
GERALD A. SOLFANELLI
A friend to students HOW WONDERFULLY APPROPRIATE FOR THE Monitor to run a cover story on psychology student wellness in the same issue introducing Kurt Salzinger as the APA executive director for science. Kurt is not only an exceptional educator, but also a great advocate for students. His dedication to education is unquestionable. (He edited my dissertation with me at his beach house during his August vacation.) His enthusiasm for basic and applied work in psychology will be a great asset to psychologists of all stripes, and a benefit to all the people they serve.
DANIEL J. MORAN, PHD
Fighting for reimbursement THE SEPTEMBER ARTICLE regarding Dr. DiCowden's struggle to establish cognitive rehabilitation as a legitimate service offered by clinical psychologists ("Winning one with Medicare") is not a new issue for Illinois psychologists. As a salaried hospital rehabilitation unit staff member over five years ago, I petitioned for CPT code 97770 to be accepted by the Illinois Medicare intermediary as reimburseable to psychologists. My request was initially denied. Apparently, the Illinois intermediary felt that "cognitive rehabilitation" was the domain of the occupational therapist or speech pathologist. With the assistance of Dr. Puente and APA staff, I was able to obtain a HCFAWashington memorandum alluding to reimbursement to psychologists for CPT Code 97770. I forwarded this memorandum to the psychiatrist whose responsibility included reviewing such reimbursement issues. Several months after my request, an Illinois Medicare Bulletin was published that included a couple of sentences acknowledging that psychologists could be reimbursed for CPT Code 97770. One final update, however: The April 2001 Illinois/Michigan Medicare B Bulletin noted that effective Jan. 1 CPT Code 97770 was deleted and replaced by CPT Codes 97532 (essentially cognitive rehabilitation, 15 minutes, one-on-one with patient) and 97533 (essentially sensory-motor integration, 15 minutes, one-on-one with patient). While there was a "grace period" from Jan. 1 until March 31 for using CPT 97770, after April 1, CPT Code 97770 was no longer accepted. Psychologists offering such services need to keep themselves well-informed regarding such changes because billing for a nonexistent code will result in denial of payment.
ALEXANDER ADAM ESCHBACH, PHD
Hoffman Estates, Ill.
Does positive psychology have a dark side? THE POSITIVE PSYCHOLOGY movement has received much attention in the Monitor over the years. But positive psychology raises questions. First, does not the basic premise that psychology has neglected the positive aspects of human behavior disserve the many psychologists who have worked to understand and alleviate human suffering? The implication appears to be that these researchers are not concerned about positive feelings.
Second, is it really the case that the positive side of human experience has been ignored? My own teaching of a variety of courses suggests otherwise. As one example, much of what is taught in developmental psychology concerns the normal development of children, the qualities of effective parents and similarly positive topics. Before diverting too much attention to positive psychology, it might be prudent to put the premise of neglect on firmer empirical footing.
Third and most important, has the positive psychology movement made alliances that are detrimental to psychology's scientific roots? The John Templeton Foundation, which funds positive psychology awards and grants, has the long-standing and explicit agenda of promoting a rapprochement between science and religion. Scientists with AAAS have expressed concern about the array of Templeton-funded activities, but psychologists appear to have been silent.
The positive psychology movement appears so well-intentioned that psychology's normal scientific skepticism is in danger of being suppressed. But that skepticism is what would protect psychology from the negative consequences of positive psychology should there turn out to be a darker side to this movement.
JAMES M. CLARK, PHD
University of Winnipeg
RESPONSE FROM MARTIN E.P. SELIGMAN, PHD, UNIVERSITY OF PENNSYLVANIA: As for "firm empirical" footing of the neglect of the positive side of human experience, Dr. Clark might do a scan of the psychological literature for the past 50 years, using keywords like depression and anxiety, versus happiness, kindness and integrity. He will find a 10- or 100-to-one preponderance for suffering.
If Dr. Clark somehow believes that funding ever comes without an agenda, he is mistaken. As a veteran supplicant (my knees are almost worn out), I have had funding from the National Institute of Mental Health (NIMH), the National Science Foundation (NSF), the National Institute on Aging (NIA), Consumer Reports and about a dozen others in addition to the Templeton Foundation. I have also refused funding from a number of sources. The agenda of NIMH is decidedly psychiatric: It's about healing diseases in the medical model. The agenda of NIA is helping old people. The agenda of NSF is basic research; if it has obvious application to mental illness, you'd better go elsewhere. The agenda of Templeton is about moral and spiritual values.
The right question is not "Is there an agenda?" but "Are there strings attached?" "Do they micromanage?" "How much investigator freedom is there?" On these criteria Templeton does very well, better than NIMH or NIA and about tied with NSF, in my experience. If Templeton is pushing any particular religion or any particular moral values, I have not been able to detect it. Moreover, there have been no strings, no micromanaging and total investigator freedom--the scientists, in peer review, are completely in charge of the awards we make. In fact, I have only held one grant with an even lighter agenda in my life, this from Atlantic Philanthropies, also for positive psychology. "We pick good ideas, this is a winner, we don't micromanage, and we give you what you need."
The discipline of psychology should be grateful to foundations like Templeton and Atlantic Philanthropies, not only for their generosity, but for the freedom and respect they accord their awardees.
Thanks to APA for its International Affiliate status I WISH TO EXPRESS MY profound gratitude and appreciation to APA for making it possible for international students like myself to become members. My association with APA over the past three years has contributed significantly to my improved academic achievement and performance during my undergraduate level and now. APA's publications, journals and the Monitor have always provided me with the most current research work and findings in psychology, and psychological theories can and have been applied in practice settings and in other related fields of study such as education. In view of this, the periodicals and publications of APA always put me two steps ahead of all my course-mates in class during my undergraduate studies of educational psychology at the University of Cape Coast, Ghana. The publications also served as major reference materials for most of the faculty members in my department. It was therefore not surprising, but was great news when I was named "The Best Educational Psychology Student" for the 200001 academic year in the Department of Educational Foundations this year.
My association with APA as an International Affiliate and the subsequent academic and professional benefit that I received helped me attain that academic height and receive that prestigious award.
NANA OPOKU OWUSU-BANAHENE