LETTERS

On Suinn's vision

I ENJOYED THE Suggestions in Richard Suinn's column (September Monitor), "What if psychology had a revolution?" with one exception. That was his hope that: "For each patient session, psychologists [will write] a detailed treatment plan and a concrete intervention plan."

The problem with this suggestion is that it is based on a model of therapy that not all of us share, namely that therapy is akin to medical "treatment" and that "interventions" are the major reason it works. Many approaches do not view therapy as treatment. Treatment plans are antithetical to client-centered therapy (for which there is considerable empirical support).

Many clients prefer exploratory approaches in which interventions arise out of therapist-client dialogue rather than being targeted and planned in advance by the therapist. In fact, the research shows that most clients value having a time and place to talk more than they do therapists' interventions.

Finally, research also seriously questions the idea that interventions play an important role in therapy's effectiveness. Therefore, my counter-hope to Suinn's is that in the future, psychologists will pay attention to this research and be pluralistic in their provision of therapy, rather than imposing one model of practice on all therapists and clients.

Arthur C. Bohart, PhD
Carson, Calif.

RICHARD SUINN'S September column advocates some changes for the new millennium. He envisions "one-stop shopping" for primary and mental health care, crisis management, consultation and community services. The psychologists working in these mega-malls would write for each session, a "detailed treatment plan with targeted goals and a concrete intervention plan." In addition, following each session, psychologists would "plot some form of outcomes assessment. Through later review, patient progress and factors influencing such progress could be readily identified."

Suinn's proposals are alarmingly similar to the mandates of the managed-care industry, which many of Suinn's constituents are organizing to oppose. As reported on the front page of the September Monitor, psychologists in New York, Texas and Pennsylvania, angered by managed care, are looking to unions and other options. "We feel it's worthwhile," argues James Dean, PhD, "because of the stranglehold managed care has on us." In Dean's case, the companies have "cut his income by 30 percent in the last three years," and "smothered him in paperwork in an increasingly intense effort to control his treatment plans."

The industrialization of mental health care, and the transfer of decision-making from individuals to bureaucracies, is hardly a "revolution." And it should not be spearheaded by the president of APA.

Arlene Amidon, PhD
Washington, D.C.

I READ WITH INTEREST THE September president's column. While I admire and agree with its contents, some of Richard Suinn's proposals betray his youth. It was more than 35 years ago that neighborhood clinics had sprouted all over the country (with excellent results, I might add) and that community consultation constituted a large part of my and my professional colleagues' activities. These were called Community MH/MR Centers.

Then state hospitals dumped their population on the community, and Community MH/MR Centers were required to care for this influx of chronic patients without adequate funding. As a result, the original purpose for which these centers came into existence was soon forgotten. I, for one, would lobby and become more active to see that purpose restored. At the risk of sounding mercenary and greedy at a time when managed care has cut my income by 30 percent and I have to work much harder to maintain a moderate life style, I, for one, am unwilling to volunteer my services for free when a mechanism for the delivery of such services has been set up and gutted by politicians and public apathy. I would rather choose deserving patients to whom I provide pro bono services in the comfort of my office. Bitterness, apathy, anger, greed--perhaps all these are true--but that is how I feel.

Ray Narr, PhD
Pittsburgh

Data sharing: a myth?

BETH AZAR WRITES (September Monitor) that "psychologists are bound by the ethical guidelines of APA.to hand over data to any colleagues who make reasonable requests."

Not true.

In June, I wrote to the corresponding author of an APA journal article: "I would like to obtain the variance-covariance matrices to which the models [in your article] were fitted. Please tell me how to proceed.I would like to explore alternative models with your data set, comparing their implications with those you report, a task for which I am professionally qualified."

Receiving no response, I sought help from the journal editor, who passed me, and the author, on to APA's chief editorial advisor, who informed the author that " the phrases in Principle 6.25. verify the substantive claims through reanalysis and who intend to use such data only for that purpose." are somewhat vague. If you believe that Professor Goldberger is asking for the data for another purpose, you are not obligated to provide the data.

Astonished, I sought clarification. The advisor (without probing my intentions) responded: "As I understand it, you requested the data for purposes that go beyond verifying 'substantive claims through reanalysis.'.Under those conditions, the author is not obligated to provide you with data to explore additional questions."

In practice, Ethical Principle 6.25 to the contrary notwithstanding, no psychologist is bound to honor a request for data.

Arthur S. Goldberger, PhD
Madison, Wis.

I WRITE WITH REFERENCE TO the article on data-sharing in the September Monitor. Readers interested in the pros and cons of data-sharing from the viewpoint of social and behavioral science disciplines other than psychology per se (but including psychology as well) might wish to examine the report of a 1998 conference funded by the National Science Foundation and sponsored by the Association for the Advancement of Science. The report was published by the Russell Sage Foundation in 1991 under the editorship of psychologist Joan E. Sieber. It is titled "Sharing Social Science Data: Advantages and Challenges."

Murray Aborn, PhD
Kensington, Md.

Debating Thought Field Therapy

I AM DEEPLY CONCERNED about the Arizona Board of Psychologist Examiners' recent decision to reprimand a psychologist for using "Thought Field Therapy" (TFT) and "Voice Technology" in his psychology practice (September Monitor).

The board's decision seems to be based on the outmoded idea that psychological practice is based within a traditional psychodynamic, verbal approach to treatment. Psychotherapy is a "therapy of the mind" that teaches people to understand their bodies and psychological issues through the imparting of knowledge and skills.

TFT attempts to expand cognitive behavioral therapy approaches by helping people help themselves in more active ways. We [psychologists] are practitioners of psychophysiology and have offered the mental health community new ways of approaching "solutions" to life's problems. To isolate doctors of psychology to "the couch," where the therapist passively listens and hopes that patients find their own solutions, only constricts and hinders us from providing "real" services in "real life" situations.

Doctor does not mean "physician or healer." Doctor means "teacher." We are to be active in "teaching and imparting knowledge" that can help to change lives--just as it does in the academic learning situation.

I would hope that the Arizona Board would reconsider its opinion, as such a decision hurts a profession that has an extensive background of training in providing "psychological therapy." This decision also hinders innovation by psychologists, who, though scientists and practitioners of service, may be fearful of reaching out to find new active approaches and solutions for patients.

Ron Lechnyr, PhD, DSW
Eugene, Ore.

FIRST LET ME SAY THAT IT was courageous of the APA Monitor to bring this issue to light considering that TFT has been a regular advertiser in the Monitor, and the APA itself ignored the issue when it approved TFT training for continuing education credits.

It was at least 10 years ago that Roger J. Callahan, PhD, claimed at an APA Convention booth that his TFT technique could cure depression, phobias and other psychological problems in minutes.

I spoke to people, wrote letters and never heard from anyone, though I wondered how he could publicly get away with such claims without an empirical basis. Indeed, I am very much put off by the recent attempts to make some psychological techniques (if that is what they are claimed to be) a secret process--purportedly for the sake of safety and quality control--known only to those who take training from a franchised trainer.

It seems similar to the way that Freud and the medical professionals tried to keep Freud's techniques as part of the practice of medicine. But where would psychology be if our most innovative researchers and clinicians had followed this path? And what becomes of peer review when some techniques are known only to the elect?

I hope that there will be some dialogue about these problems rather than just an adversarial legalistic battle regarding only the issues raised in the Arizona Board's actions.

Henry Steinberger, PhD
Madison, Wis.

Missing from the cancer issue

UPON READING THE special June issue of the Monitor devoted to psychology and cancer, I saw that there was little discussion of institutions actually putting research into practice. For the past three years, Burrell Behavioral Health, an affiliate of Cox Health Systems, has been providing psychosocial services to cancer patients through Oncology-Hematology Associates at the Hulston Cancer Center in Springfield, Mo. Three dedicated oncologists, recognizing their multidisciplinary team was incomplete, sought a psychologist to work with them.

I am the clinical psychologist they selected, and I see every new chemotherapy patient for an initial visit. During this visit, I am able to introduce myself and educate the patient about the resources available through our program, such as orientation, informational, and support groups, an educational class called "Coping with Cancer," and individual and family therapy.

It should be noted that I had no specific training in this area. I have learned largely through experience, self-study and consultation and scouring the literature. This research has been enormously helpful, but what I found missing in these articles is precisely that which no research can possibly teach you. That is, I have learned the depths of compassion necessary to work with cancer patients. I have learned that with cancer patients, there are many things not normally found in conventional therapy, such as a lot of hugging, hand holding and sharing. You become part of the patients' support system.

Barbara Wachtel-Nash, PsyD
Springfield, Mo.

AS AN ACADEMIC PSYCHOLOGIST whose research involves cancer patients I was eager to read the Monitor's special issue on psychology and cancer. However, I was disappointed that the patients with whom I work--those for whom the disease is terminal--were absent.

The diverse aspects of psychology that Richard Suinn identifies as relevant to the prevention and treatment of cancer can also contribute to the well-being of both patients receiving palliative care and the medical staff and family members who provide this care.

Despite improvements in survival rates, a very large number of people die as a result of cancer. Such people often report that they became invisible when their illness was judged to be terminal: They were no longer of interest to medical specialists, family and friends no longer knew what to say and governments reduced services, knowing they would not vote again. I hope that terminally ill persons with cancer (and other diseases) will not continue to be invisible in the Monitor and the agenda of relevant presidential miniconventions. The terminally ill remain fully human.

Their issues are as real and pressing as those of other people. The only difference is that, if we fail to meet their needs now, neither they nor we will get another chance.

Julie A. Robinson, PhD
Adelaide, Australia

Getting Skinner straight

IT'S RARE TO FIND FIVE FACTUAL errors in a three-paragraph article, but such is the case. The September "Time Capsule" on B.F. Skinner's air crib states that the crib was "germ-free," but Skinner said merely that the crib "is relatively free of spray and air-borne infection." The article states that Skinner "marketed" the crib. He gave out plans to anyone who wanted to build the crib but it's misleading to say he marketed it. The article states that he used the crib to raise two daughters, but the crib was used only with his younger daughter, Deborah. The crib's front was made of safety glass, not "plexiglass," as your article states.

Of greater significance, the article states, "Instead of being won over by the improved environment of the 'air crib,' the [Ladies' Home] Journal painted it as a device intended to allow parents to ignore their infants, letting the crib, instead of the parents, care for their babies." But the Journal's article was written by Skinner himself, and his portrayal of the crib was entirely positive.

This misreporting will help perpetuate the negative myths that surround the air crib. A few years ago, Shelly Bailey and I tracked down 50 former air-crib children or their parents, and, as we reported in a 1995 article, all of the evaluations were wholly positive. Alas, both the air crib and its inventor have been largely misunderstood.

Robert Epstein, PhD
Cardiff by the Sea, Calif.

I SUPPLIED THE CONTENT for the "Time Capsule" entry about B.F. Skinner's baby tender and any inaccuracies reflect my own negligence, not that of the Monitor staff. As a card-carrying radical behaviorist who is offended by polemic distortions of Skinner's work, I am especially chagrined by errors in this particular entry. The inaccuracies came from quick drafted comments I sent to the Monitor about the baby tender. Readers can judge for themselves the gravity of each inaccuracy. I apologize for any misunderstanding created by the article and encourage interested readers to consult Ludy T. Benjamin, Jr. and Elizabeth Nielsen-Gammon's excellent recent article on the baby tender (Benjamin, L. T., Jr., & Nielsen-Gammon, E. (1999). B. F. Skinner and psychotechnology: The case of the heir conditioner. Review of General Psychology.

Warren R. Street, PhD
Ellensburg, Wash.

All letters to the editor must be 250 words or fewer. Mail them to APA Monitor, 750 First St., N.E., Washington, DC 20002-4242, or e-mail them to letters.monitor@apa.org. We regret we cannot run all the letters we receive.



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