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The Mentors’ Corner is a regularly featured column in the Independent Practitioner (IP) that highlights discussions from the MENTORS email group. In each issue of the IP, questions and answers pertinent to the Division 42 Student/Early Career Psychologist members will be addressed. If you are currently not signed on to the email group, we encourage all members to participate and share in the stimulating discussions that take place. The Division consists of members who have a wealth of knowledge and various areas of expertise that should be shared with our new colleagues.
Note the opinions expressed on the email group and in this column reflect individual perspectives and ideas only. As noted on the email group, there are more than one means to an end.
Division 42 Mentor Program:
Division 42’s mentoring program, Colleague to Colleague, is up and running. Clearly, it is meeting a need that is present in the Division. We already have 12 pairs of mentors and mentees working together. I hope C2C will continue to grow and be even more successful. If you are interested in being paired with a mentor to assist you to be successful in your practice or if you are interested and willing to share some of your knowledge and expertise with a colleague please contact the coordinator of our mentoring program, Frank Froman, at frankf@adams.net.
Bruce Bishop asked:
I am seeing a couple and one of the two would like a self-help approach to deal with intrusive thoughts about his partner with other men (his job forces him to spend time around one of her prior lovers). He notes that he does well with behavioral approaches. He’s used some thought stopping techniques, but would like a bit more. Does anyone have any self-help books they like for this kind of challenge?
Steven Walfish replied:
I think Edna Foa has a good self-help book on obsessive thinking.
Dana Powell added:
Intrusive thoughts are tricky. Thought stopping often does not work. Think back to social psych and the white bear experiment. Trying not to think about an intrusive thought results in you thinking about it more. Or even if you think of when you get a song stuck in your head, the more you tell your self to not think about it the more you do. You can use an exposure--response prevention approach, whereby you encourage the patient to think even more about the thought. This is paradoxical, but the idea is to make the thought irrelevant by habituating to it. A loop tape works well for this type of exposure. Listening to the intrusive thoughts over and over until they become meaningless background noise. Also you can take a mindfulness approach. Recognize the thought for what it is....”this is an intrusive thought and I am going to watch it float by.” Stress that the thought is neither good nor bad, it is just a thought and you don’t have to do anything about it.
The book the other person recommended is Stop Obsessing (Edna Foa). David Clark has a good clinical book “Intrusive Thoughts in Clinical Disorders”. Another good client book is the “OCD Workbook” by Pedretti and Hyman. This one is often available at Barnes and Noble or Borders.
Mike Jolkovski commented:
Now for something completely different...
Not that this list is to debate theoretical predilections, but I’d like to offer that there are other ways of handling upsetting thoughts. I am reluctant to join with the patient in getting rid of upsetting mental contents, at least until I know a great deal more. By the same token, I’m uneasy with Dana’s recommendation for rendering the thought “meaningless”. Bruce didn’t say they are part of an OCD presentation, by the way. What’s the rationale for asserting that the patient’s thoughts are meaningless?
I’m more likely to welcome a disturbing thought as an important representation of what ails the person. (This is contingent on the level of functioning of the patient and the working alliance.) I would tell him that he is having a fantasy that upsets him, and we need to know what it is. If I were working individually, I would ask him to tell all about the upsetting fantasy and his associations to it.
I would never assume that I know just what it is that is so upsetting. I’d be prepared to be surprised. The man could be having a stimulating perverse fantasy of watching his girlfriend with another man — or it could be panic at thinly veiled sexual feelings for the man. It might be narcissistic rage at not being able to possess his partner utterly. It might be a masochistic fantasy of being humiliated by his woman being taken by a more potent man — or a retaliatory wish to see her degraded. It might emanate from overall feelings that sex is disgusting, and difficulty integrating his different feelings about women (e.g., the Madonna/whore splitting). This is just to illustrate some possibilities -- the sky’s the limit for what might be discovered.
Elizabeth Morey Campbell added:
These are some very interesting ideas. And a wonderful reminder that exploring a symptom is important, prior to trying to “get rid” of it. Where does this “insecurity” (if you want to call it that) come from?
Also, in keeping with Mike’s final comment, I’ll never forget a family I worked with as a co-therapist in which the husband appeared overly insecure and jealous of his wife’s coworker...I learned a few months after ending with the family that the wife was in fact having an affair. Just one possibility among others to keep in mind.
Brian Levine asked:
This is my first time posting to this, or any, list... but I would like to seek the input of others “out there”. I am an early career psychologist - recently licensed in August this year. I completed my post-doc hours working with people with chronic mental illness in a nonprofit community mental health organization. For three years I was steeped in the psychiatric rehabilitation literature and picked up much knowledge related to serious and persistent mental illness.
Three years later, massive budget cuts closed the program I was running and rather than take a parallel move back to case management, I opted to study for the EPPP and get my license.
I got it, and now here I am needing to get employed (more and more urgently as days pass), but I’m not sure how to sculpt the next piece of my career. I value variety and multiple roles - I want to do assessments, teach, do individual, group, couples, and family therapy, supervision, training, and program design and evaluation. But I’m clearly not competent enough to do all of these things. As I apply for and interview for jobs, I am finding that those jobs that I am most qualified for (and therefore most likely to get) are those that are most in line with what I have been doing previously.
So in, by now, too many, words, I’m wondering how professionals have branched out; that is, sculpted a career in line with their desires and aspirations, diversified their competencies - and at the same time made some modicum of money to support a family, and reserved enough personal time to enjoy said family. Right now I am looking at some kind of full time job at a community mental health center to pay the bills and get health insurance, and independent contractor work with a group practice to provide opportunities for expansion. I am very worried about being stretched to thin with this regiment, but I’m also aware that them’s the breaks sometimes, and many professionals have gone through that wringer and emerged with sanity and family intact (more or less). I’d love to hear your stories and advice.
Warren E. Icke replied:
I have been in the process of re-sculpting for the past few months because I became weary (burnt-out) working with sexually violent predators (a legal classification in my state), so I joined with a contracting company and they sought out the positions in which I would be interested. Locum Tenens is a good one. NMR is another. Google to find a contracting agency that is best for you, that serves your area and the different populations in which you may be interested working with and then sign six month contracts to get experience, help in choosing the best career or strategic moves for a permanent job. Of course you could just contract your whole career if you wanted. Thereby obtaining maximal freedom.
Rachel Fox-Weinberg asked:
I am planning to take the EPPP in February or March. I’m seeking advice and recommendations about prep materials. The companies I’m aware of are AATBS, Academic Review, and PsychPrep. Does anyone out there have feedback regarding materials from these or other companies?
Stacy Jones replied:
I had success with AATBS. Their books are concise and very easy to read and their online practice exams were a critical part of my preparation.
Elizabeth Morey commented:
I second the Academic Review materials. The AR package I used included 7 or 8 study volumes, computer-based and hard copy practice tests, and cassettes. I felt well prepared when the time came to take the exam. Although study packages from any of the three companies are quite expensive, they are absolutely worth it in my eyes.
Julie Nelligan added:
There are also 2 Yahoo groups focused on EPPP issues. There have been discussions about the differences between the 3 packages on the EPPPPrep group. You might be able to find more information in the archives.
Dave Gluck replied:
I used AATBS and had pretty much the same experience with Academic Review. I also took their 4-day course, which helped me get a good overview and kind of jumpstarted my studying.
Doing the practice tests, looking up the answers and explanations, and putting the subject of each item I got wrong on an index card and then reviewing the cards helped me a lot. The questions on the exam were very similar to the practice questions. Going over the exams was much more helpful to me than spending a lot of time reviewing the subject volumes, but the books were helpful for filling in gaps of knowledge.
I found the AATBS web-based practice exams most helpful and worth getting access to. Taking the exams on the computer was good practice for the actual exam, which is administered on the computer.
Todd Snyder asked:
I’d like to start a discussion about emergency/on-call practices. I am trying to decide what my policy will be as I have just begun work in the private practice setting. I know there are different opinions about what constitutes the standard of practice when it comes to accessibility for emergency issues in the private practice setting. I would be interested to hear what some of you have decided regarding several questions: 1) Do you carry a cell phone or pager 24hrs for crises calls? (2) Do you offer emergency services only to clients who you feel are more likely to need them? (3) Do you facilitate finding a hospital bed for a patient that needs it or do you simply recommend that they go to the nearest ER? (4) How do you handle vacations when you may not be accessible? (5) Do you know about any relevant decisions passed down by an ethics board regarding these issues?
Geri replied:
I do carry a cell phone or pager, though of course there are times when I can’t answer it. In that case it has the standard message, “in case of emergency please hang up and dial 911.”
My policy is that clients are welcome to make short calls to me between sessions, but that I will start billing at the pro-rated session rate if we go over 20 minutes of contact time between sessions in a given week. In 3+ years of private practice I have not had a client abuse the privilege; in fact, they use it less often than I’d like (I’d rather get the call when the client is thinking about cutting than after they have all ready self-abused).
I’ve had relatively few clients actually use the between-session calls, and it feels worthwhile to provide this service. I make sure clients know in my intake paperwork that I may not be able to return the call right away. Those who have (rarely!) opted to talk more than 20 minutes by phone in a week have been fine with paying for it.
It can be hard to know in advance which clients will have the emergencies sometimes; so I give the cell number to all of them.
As for vacations, it depends on the length and how inaccessible I am. For a couple weeks, I’d simply let them know in advance of the absence, and tell them to call my cell phone if an emergency came up and they needed to talk. I don’t mind the odd phone session on vacation, since my clients tend not to use the option much. If a client was really fragile I might offer them a colleague’s name while I was gone, with the permission of the colleague of course.
Laurie Ferguson added:
As a psychologist who worked in an ER doing the crisis evals you mention, it is extremely difficult and maddening for us when a client’s therapist merely sends them to the nearest ER without any facilitation or collaboration. You as a therapist have the ethical responsibility to collaborate with the mental health professionals who will be helping your client. We would need to know your take on why the client needs to be seen, diagnosis, meds, your recommendations for treatment, etc. Often the client knows none of this, or has his or her own perceptions, which, while extremely valuable to the evaluation team, frequently does not tell the entire story.
Also, we often would not have a bed available and this creates double work for the entire “system” of emergency care, as the next facility we send the client to would need to do their own eval. Lastly, it is not uncommon for the hospital to find that the client falls quite short of needing hospitalization, so it is imperative for mental health professionals to understand the hospitalization criteria of their local facilities so as to avoid emergency room visits that can overburden the ER and, more importantly from your perspective, alienate a client from seeking emergency services in the future.
Open up a dialogue with your local emergency services providers to better understand what they have to offer and how/when to make a referral, and stay involved -- they are your patient. That said, you should always direct a patient to the ER if they are a danger to self or others, and enlist the help of local law enforcement agencies to facilitate their transport to an ER if necessary.
Cheree Clarizio asked:
I am applying for internship for the 2006-2007 year and one of my current practicum supervisors at the prison I work at encouraged me to do an advanced practicum rather than accepting an internship from a non-APA accredited site.
I am interested in the forensic field, prisons, detention centers, mental hospitals etc., where she stated most of those will not hire anyone from a non APA per doc internship site. Won’t this just affect us until licensure if at all? It seems weird that after we are licensed psychologists anyone would care about what site we went to.
A few of us are a bit nervous, so any insight on this matter would be appreciative.
Chris Loftis replied:
According to this document on the APPIC site: http://www.appic.org/downloads/UNH_Licensure_Project_8-3-05.pdf eleven states require an APA approved internship or otherwise increase the number of hours needed to be completed. This information could be outdated, so check the states where you think you are most likely to be licensed.
The Eleven States:
- Alabama or 1800 if not-APA internship
- Alaska or 1500 if not-APA internship
- Colorado or 1500 if not-APA internship
- Georgia or 2000 if not-APA internship
- Hawaii or 1900 if not-APA internship
- Louisiana or 1500 if not-APA internship
- New Mexico or 1500 if not-APA internship
- Texas
- Virginia or 12 consecutive months
- Washington or 1500 if not-APA internship
- West Virginia
Mike Jolkovski added:
Chris, what a great piece of information! It doesn’t quite answer Cheree’s question about the requirements of employers, however. The problem is to separate rumor and fantasy from the reality. The simplest thing would be to call some institutional employers, look on the personnel web sites, etc. You want to find out what the formal policy is, and also you want to find out, if you can, if employers look askance at non-APA internships — that is, if it makes them put your folder on a different pile when they are sorting though job applicants.
I suspect that it matters more if the graduate program is APA-accredited than if the internship site is, but I wouldn’t count on this. I remember when I was going up for licensure in VA around 1990, there was a different form to complete for people from non-APA programs. It required all sorts of detail about what courses were taken, etc. and it looked to be a huge pain. I was glad to have an APA accredited PhD -- the state just accepted my graduate education outright.
Geneva Reynaga commented:
I think it’s very important to look at internships and future jobs, but also to consider what your state requires for licensure. In this way, my bias is to always attempt your hardest to stick with APA-accredited sites (programs, internships, etc.), even if you think that you will never move and your state does not care about such things.
Having worked for a time in forensics/corrections, I have never heard of prisons not wanting you if you don’t have an APA-accredited internship. However, I worked for state prisons. It is possible that the federal system is different. If you are thinking VAs, I believe they require APA-accredited internships. Again, I think it would behoove you to try to get an APA-accredited site if at all possible. Chances are, they would pay better, and there are quite a few sites around the country that are in correctional facilities. It also makes the licensure process easier, especially if you ever move to another state. However, to answer your original question, I can’t imagine it would matter after licensure, it’s just that the road to licensure would be much easier with APA-accredited programs on your record. And, trust me, licensure is hard enough without adding to it!
Darryl Young asked:
I have a dilemma. I work at a methadone clinic and my fellow therapist and agency are violating Federal and State regulatory laws when it comes to allowing clients to take methadone home. I have brought it up on several occasions. I even spoke with the clinic director about how records are being falsified and take-home methadone doses are being given to clients whom do not meet the minimum requirements. I have also spoken with the corporation higher headquarter about my concerns and what is going on in violation of Federal and State law (Methadone is regulated by Federal government). Since I have spoken up about these issues, I have been verbally reprimanded. I have been written up for refusing to violate the ethical code and my moral beliefs in order to make it easier for the clinical supervisor. I have been told to see the client for half time but still bill for the full session. When I refused, I was written up for insubordination.
Since I have not had the best experience at work and have voiced my refusal in this matter, my dilemma is that according to ethical standards, I’m obligated to report this violation. However, I don’t want to seem like I’m trying to retaliate because of the way I have been treated. This is strictly a blatant violation against the law and the ethical code. Therefore, I’m writing for the list advice.
Steven Walfish added:
My advice is for you to consult with an employment attorney.
Warren Icke responded:
Yes. You need a good employment attorney and perhaps a criminal attorney to protect your interests should this move to criminal proceedings. You need to document that you have not participated in the behavior as they could attempt to make it seem that it is you who are in violation. Document. Document. Document. Consult with professionals in your community.
Van Vilet asked:
I am a newly licensed clinical psychologist, starting my own practice treating children, adolescents, and families. I’ve been gathering various intake, assessment, and consent forms to administer to new patients and throughout treatment (biopsychosocials, etc). I would greatly appreciate any direction, advice, or sample materials any of my fellow colleagues may offer me.
Dennis Given replied:
Take a look at “The Paper Office” by Ed Zuckerman. It comes with a CD that you can use to print out forms to meet the needs of your practice. You might also consider practice management software like “QuicDoc” or something similar, which has built in forms and assessments.
Bruce Bennett added:
I would suggest that you take a look at some of the forms listed on the Insurance Trust’s home page at www.apait.org <http://www.apait.org>. Go to “Resources,” then “Risk Management,” then check out the documents under “Helpful Documents” such as the Sample Informed Consent Contract, Sample Forensic Informed Consent Contract, and the Sample Outpatient Services Agreement for Collaterals. You should also consider looking at the information available under the “HIPAA” section of the homepage.
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