The APF Walter Katkovsky Scholarships seek to support first-year students enrolled in APA designated programs in psychopharmacology.
APF will distribute funds to the students’ institutions, which must be non-profit or governmental entities operating exclusively for charitable and educational purposes. The institution must agree to administer the scholarship before the funding will be released. APF does not allow institutional indirect costs.
The Katkovsky Scholarships support early career postdoctoral licensed psychologists in clinical or counseling to obtain training in psychopharmacology. The scholarships are intended to encourage opportunities for psychologists to join healthcare teams and benefit patients who have psychological and medical problems.
2016 Alfred M. Wellner Lifetime Achievement Award Winner
John Robinson, Ed.D, ABPP was just presented with the National Register’s Wellner Lifetime Achievement Award. Given his affiliation with Division 49 as a Fellow, we are sharing this information with society of group psychotherapy & group psychology members. The press release is available through the following link:
As of June 2016 the only thing to report is that Council continues to wait for an updated report from Hoffman et al (promised weeks ago) regarding the inconsistencies as well as possibly left-out information in the original Hoffman report. This original report, as you will no doubt recall, was leaked to the New York Times last July causing a firestorm. The CoR list serve is currently active with denunciations of the original Hoffman report, not least because the members who have been linked to support for torture have not had any opportunity to reclaim their reputations, and most because clearly inconsistencies do exist. Of late a small minority has also called into question the Good Governance Project (GGP) that has taken Council 5 years to bring to pass. As your Council Representative for The Society of Group Psychology and Group Psychotherapy, I must admit I cannot imagine trying to undo all this hard work on the GGP, which was instigated in order to make the Council and the BOT more nimble. I do however support the move to obtain more answers from Hoffman. I am including a recent email from Jean Maria Arrigo who continues to be our conscience.
The current Div. 42 Board’s vote of no confidence in the APA Board brings to mind the 2012 Div. 42 Board’s historical support of the PENS process and PENS Report. Div. 42 members on both boards include Armand Cerbone, June Ching, Gerry Koocher, Michael Schwartz, Lori Thomas, Robert Woody, and Jeffrey Younggren.
The Gerwehr emails and PENS listserv constitute documentary evidence for the manipulation of PENS process and the PENS Report, in addition to documentation provided by the Hoffman Report. In 2012, in advance of the Hoffman Report, the Coalition for an Ethical Psychology had called for annulment of the PENS Report.
The 2012 Div. 42 Board “vehemently oppose[d]” the Coalition’s call for annulment. In the attached letter (URL: http://www.ethicalpsychology.org/materials/Div42-Response-to-Coalition-10-26-2012.pdf), the Div. 42 Board insisted there was nothing wrong with the PENS process nor with APA’s related policies. The Div. 42 Board particularly enjoined the Coalition to mind the reputation of the APA:
Therefore, our Board makes the following response to your Coalition;
We request that your Coalition stop using the press to spread all negative information about its dissatisfaction with APA. You are harming our practice of psychology by giving false and biased information and therefore, impacting negatively on the ability of people who need psychological services to receive them from ethical and competent psychologists in independent practice.
By distributing copies of this letter, we will ask APA to maintain a vigorous response to any further complaints publicized by the Coalition in the media that may damage our members’ independent practice of psychology. We believe that by giving only a partial story to the media, the Coalition is damaging the entire field of psychology.
Our activities since the Spring 2016 report have included:
We divided into small groups to address goals 2-4 of our 2016 goals, which are: 1) recruit new members to our division, with a focus on student and early career psychologists; 2) create a student diversity award; 3) provide opportunities for multicultural competency development through suite programming at APA in Denver; 4) seek nominations and select a Diversity Award recipient for 2016.
We all discussed creating a student diversity award and Joe and Keri volunteered to work on a request to create a student diversity award. We decided we would put this into action for 2017.
Eric and Carol completed a proposal for Division 49 suite programming to draw in new student members to our division and address goals related to education/building multicultural competency in our members/APA.
Maria was instrumental in gathering materials and putting forth nominations of recommended candidates from the committee. The committee members voted and we selected a candidate and forwarded our recommendation to Craig. Our recommendation this year was Dr. Kathryn Norsworthy.
Items Needing to be Discussed:
Agenda for August meeting; selection of new chair.
Items Needing Action:
Follow up on Suite Programming.
Follow up to confirm Dr. Norsworthy was accepted for the 2016 Diversity Award and notified.
Collaborate with committee for August agenda
All additional action items will be discussed by the end of June.
These are a selected compilation of meeting notes, as they might be relevant to the Division 49 Board of Directors and Members. For full details of the meeting, please request them from Dr. Leann Diederich.
Legal Risk Management (presentation by APA Office of General Counsel Ann Springer, JD)
CAPP members were briefed on the fiduciary duty that Board members have. This includes duty of care, duty of loyalty, and duty of confidentiality. If you represent multiple groups, you have a duty to clarify which group you are speaking on behalf of. For instance, a conflict may exist when a Board member has professional business or a volunteer interest that could predispose the member one way or another regarding an issue. A conflict of interest should be disclosed to the Board and the appropriate steps can be taken (e.g., recusal or abstention on voting). Conflicts of interest are to be expected when professionals are involved and carry multiple roles and aren’t inherently negative or something to be ashamed of.
Updates on Government Relations and Legal and Regulatory Initiatives
Government Relations: CAPP members were briefed by Government Relations staff on legislative efforts that followed the 2016 State Leadership Conference, including the following: (1) the Medicare Mental Health Access Act to include psychologists in the Medicare physician definition (H.R. 4277/S. 2597), and (2) legislation to reform federal mental health funding, specifically the Helping Families in Mental Health Crisis Act (H.R. 2646) and the Mental Health Reform Act (S. 1945). In addition, a new government relations initiative that engages psychology students in advocacy was outlined by staff: the TEAM Project.
Legal and Regulatory: Legal and Regulatory affairs are working on the following: collaborative Summits with state psychological associations to educate members on alternative practice models; advocacy approaches to insurance and parity; and advocacy in coordination with the education directorate to expand opportunities and reimbursement in Medicaid systems for psychologists, including managed Medicaid. One specific example that was highlighted was the fight to get a higher reimbursement rate for the CPT code 90837 (as in Washington state it was being paid at the same level as 90834, despite being a longer therapy session). If you know of instances where there is little to no difference in the rates being paid for these two codes, please contact Legal and Regulatory Affairs.
Committee on Divisions:
Beginning in 2016, CAPP combined its various committees that oversee outreach to the various APA Divisions into one committee, entitled the CAPP Committee on Divisions, which will now oversee and make recommendations related to outreach to the Divisions. Dr. BraVada Garrett-Akinsanya, Chair of the CAPP Committee on Divisions provided an update on the discussions to-date of the Committee, including discussions defining the mission of the Committee, and initiatives that are focused on developing and creating alliances with specific Divisions and creating value-added products for divisions that will encourage membership in APAPO. Also, discussed was the possibility of surveying current members of APAPO in regards to their Division memberships and roles within the Divisions.
Updates on Initiatives Impacting Practitioners:
Council of Specialties Summit: CAPP members received a report on the upcoming Specialties Summit that will focus on the continuum from generalist to specialty training and practice, in addition to, issues related to licensure, scope of practice, competencies, specialty practice and the impact of healthcare reform on practice patterns.
APA Work Group on Test User Qualifications:
Dr. Toni Zeiss, BPA Chair, provided an update on recent discussions, held during the APA Consolidated Meetings in March 2016, by the Board of Professional Affairs (BPA) and the Committee on Psychological Tests and Assessment (CPTA), related to the possible formation of a Joint Working Group on Recommended Competencies for Users of Psychological Tests. Dr. Derek Phillips, from the CAPP Assessment Workgroup will be the CAPP liaison to this group.
Psychologists and Scope of Practice:
During recent CAPP meetings, CAPP has discussed several initiatives related to developing strategies to address developments by new/or other professions advocating for inclusion of language in state legislation, in addition to, recent initiatives that included the development of a focus group of psychologists in managed care, and the development of a collaborative strategy with SPTAs to encourage psychologists involvement in medical staffs. The April-May CAPP meeting provided CAPP members an opportunity to discuss the development of a new computer based examination that will be complementary to the existing knowledge-based Examination for Professional Practice in Psychology (EPPP). The new exam, the EPPP Step 2, which was approved in January 2016 by the Association of State and Provincial Psychology Boards (ASPPB) will assess the skills necessary for entry-level licensure. It is anticipated that the exam will begin to be used in 2019.
Update on the Board of Director’s Initiative on the Master’s Degree:
In 2015, the APA/APAPO Board of Directors formed a workgroup related to addressing issues and areas of interest that have arisen in the past related to the Master’s Degree. CAPP has a liaison to this workgroup. Discussions during the CAPP meetings in the past have focused on the need to articulate the value-added aspect of doctoral level training and the need to protect the use of the title of psychologist for those trained at the doctoral level. At the present time, priority issues related to the Independent Report have taken the Board’s time and updates will be provided at future meetings.
This paper serves as a proposal for a therapeutic support group for those with type 1, type 2, and gestational diabetes in university/college environment. While a great deal is known about the medical implications of diabetes, those living with the conditions find very few opportunities in which they are able to gain psychological support to help come to terms and cope with the condition. This paper outlines a professional therapeutic diabetes support group, in which professionals would come together to learn more about diabetes and increase compliance and accountability. Over the span of the group, members will learn details about diabetes, learn ways to cope with and fight stigma, and also build rapport and develop a community from which they can obtain support in the future. The aim of the group is to have members end up with a better understanding of diabetes and develop ways to help maintain a healthier lifestyle physically and psychologically.
Keywords: diabetes, type 1, type 2, gestational diabetes, group therapy, therapeutic support group, diabetes stigma, university
University/College Therapeutic Diabetes Support Group Therapy
Diabetes is a medical condition in which your body has issues that cause blood glucose (sugar) levels to rise higher than normal (American Diabetes Association, 2015). There are two main types of diabetes: Type 1 and Type 2. In type 1 diabetes, the body, more specifically the pancreas, does not produce insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Type 2 diabetes is the most common form of diabetes. With type 2, the body does not use insulin properly, referred to as insulin resistance. At first, the pancreas makes extra insulin to make up for it. Over time it is not able to keep up and cannot make enough insulin to keep the blood glucose at normal levels (American Diabetes Association, 2015). In addition to problems with insulin regulation, diabetes can cause complications with high blood pressure that can raise the risk for heart attack, stroke, eye problems, and kidney disease if left untreated (American Diabetes Association, 2015).
Purpose of Group
The prevalence of type 1 and type 2 diabetes has been increasing worldwide in the last few decades (Unnikrishnan, Bhatia, E., Bhatia, V., Bhadada, Sahay, Kannan, & Sanjeevi, 2008). Diabetes is a growing challenge for health care systems worldwide. Recent estimates have predicted that more than 300 million people will have the condition by the year 2025 (Gomersall, Madill, & Summers, 2011; King, Aubert, & Herman, 1998; Zimmet, Alberti, & Shaw, 2001). These numbers are shocking, and preventions and interventions for diabetes are crucial now more than ever. While the medical field is doing what it can to aid developing these interventions and preventions, assistance from the experts in psychology would help to bolster the effort even more.
While it is known that there is currently a diabetes epidemic, little attention is given to the ever growing young adult population diagnosed with diabetes (Wolpert & Anderson, 2001). Young adults with diabetes face unique challenges as they transition to self-care, and yet they fail to fit into neither pediatric nor adult medicine to help address these challenges. Because of this, they tend to be a forgotten group within the university/college population and counseling centers. University/college counseling centers, according to Gallagher (2014), typically include groups for students struggling with, anxiety disorders, crises requiring immediate response, psychiatric medication issues, clinical depression, learning disabilities, sexual assault on campus, self-injury issues, (e.g. cutting to relieve anxiety), and problems related to earlier sexual abuse.
However, there is a paucity of diabetes support groups in these counseling centers. When they are present, utilization and participation of these groups are low. Many young adults are affected by serious disorders, such as epilepsy, diabetes, or autism, and support for these groups of people on college campuses falls short. People in general tend to close their eyes and are blind to these groups. Research has shown us that these disorders, specifically diabetes, come with a number of negative implications, such as depression, anxiety, and poor self-esteem (Schabert, Browne, Mosely, & Speight, 2013). However, the research is limited in that it does nothing to provide these groups of people with the psychological support they need when dealing with diabetes. For all of these reasons, the need is greater now more than ever for a support group that targets under serviced groups.
The diabetes epidemic is much more of an issue than the public realizes (Schabert et al., 2013). While the above facts give examples of how the medical field acknowledges the severity of the disease, the ways in which the field of psychology and counseling helps to support people with diabetes are few. There is a huge stigma and misconception around diabetes (Schabert et al., 2013). People with diabetes know all too well the reality of living in a world where they are labeled and judged because they have a medical condition. Many people with diabetes experience constant worry, and many consistently face feelings of self-blame, fear, disgust, and feeling the need to fit into societal norms and avoid their disease. They also fear being judged, rejected, and discriminated against due to their condition (Schabert et al., 2013). This concept may give indication as to why compliance and accountability are huge issues with diabetes. People with the diagnosis may be in denial about their condition, where admitting that they have diabetes would mean admitting that there is something wrong with them (more than a medical condition). Because of this, they may be more likely to be noncompliant with their diabetes self-care and have little accountability over the decisions they make. The stigma has been found to cause serious issues with a person’s psychological well-being (Schabert et al., 2013). There is a great shame in people with diabetes; that somehow it is their fault that they have this medical condition. For that reason, therapeutic diabetes support groups need to be established to help people realize that they are not alone in their disease and that it is not a character fault.
The young adult period marks a critical point in a person’s life, where lifelong routines of self-care are set (Wolpert & Anderson, 2001). This presents a window of opportunity to intervene and influence habits that will help maintain good health later in life. For that reason, this paper proposes that we target this young adult group during college and as they start settling into their careers. In addition, the incidence of diabetes is so high and steadily increasing and more people are left with having to come to terms and deal with the ramifications of this condition. A therapeutic diabetes support group would aim at making the transition easier on people new to the diagnosis, as well as allowing people who have lived with the condition for many years to have much needed support. The overall purpose of the group would be two-fold: help with the medical aspects of the condition, such as education on what diabetes is, information about blood glucose/testing, and dietary/exercise information, as well as provide support and accountability to help increase compliance. The focus will be to not only provide emotional and psychological support to those with diabetes, but to help normalize the concept of diabetes and to try to help end the stigma as well.
Type of Group
The therapeutic diabetes support group plans to focus on psychoeducation, skill development, and support for emerging adults with diabetes. Research has found that self-management is the most used approach to diabetes control (Gomersall, Madill, & Summers, 2011). In this self-management approach, patients are awarded the responsibility for managing their illness, for example adopting new diets and regular exercise. To control diabetes, individuals must oversee daily behavior and long-held habits that often have to be changed (Gomersall, Madill, & Summers, 2011). Understandably, this leaves room for the client to curb or even ignore compliance to these guidelines. It has been found that for people with diabetes, adhering to these programs of self-care is often problematic (Nagelkerk, Reick, & Meengs, 2006). In addition to compliance in general, a number of other barriers have been cited to cause problems. The most frequently reported barriers were lack of knowledge of a specific diet plan, lack of understanding of the plan of care, helplessness and frustration from a lack of glycemic control, and continued disease progression despite adherence to the guidelines (Nagelkerk, Reick, & Meengs, 2006). In light of these findings, a support group that focuses on the development of skills needed for diabetic maintenance, as well as psychoeducation on the disease in general, will be the most effective approach in working with this population. The therapeutic support group will focus on developing a collaborative relationship between the facilitator and group members, maintaining a positive attitude that prompts proactive learning, and having a support person who provides encouragement and promotes accountability.
Screening criteria for the therapeutic diabetes support group will be simple but rigid. Members must have a diagnosis of type 1, type 2, or gestational diabetes. The main caveat with this group is that it will aim to be a professional diabetes group. Professionals are people with the standards of education and training that prepare members of the profession with the particular knowledge and skills necessary to perform the role of that profession. For that reason, members should be working graduate level students or professionals in emerging adulthood. Making the group a professional association works to ensure stricter compliance, accountability, attendance, and higher group rapport. The group will have a rolling admissions, and members will be able to pick up where they need. Members can be selected through a referral program or through their job place/college campus.
In addition, each member must have a blood glucose meter or a continuous blood glucose monitoring system readily available. They must have access to a computer and/or smartphone for tracking of blood sugar levels. There will be a strict attendance policy due to the fact that compliance and accountability are key components of the group. Missing a session will result in termination from the group (extenuating circumstances will be evaluated on a case by case basis). Members must agree to these conditions and sign a contract at the beginning of the initial session. Finally, research has suggested that “stage of change” may be a good predictor of attendance at diabetes prevention and intervention sessions and have implications for intervention design and assessment (Helitzer, Peterson, Sanders, & Thompson, 2007). Because of this, the group should include only people in at least the preparation stage of change. The stage of change model explains that there are five stages a person goes through when they are making a behavior. The stages include pre contemplation, contemplation, preparation, action, and maintanence (Prochaska & DiClemente, 1983). The success of the group will be based heavily on each member’s willingness to change and devotion to the rules and regulations of the group. An evaluation by the member’s therapist, doctor, and/or an interview with the group facilitators as to what stage of change the client is believed to be in will be necessary for admittance into the group. This will help ensure a higher chance that the members will attend the sessions and therefore have higher chance for success with compliance.
Role of Group Leaders and Facilitation Issues
The biggest facilitation issue will be the compliance and attendance of the group members. Because of this, the attendance policy will be very strict and groups will run weekly. The group should include a small, even number of people – preferably around six. There will be two group leaders. One should have diagnosis of diabetes themselves, and the other should be a person without diabetes who can act as a neutral, non-invested party. At least one should be therapist as well. The role of the group leaders will be to facilitate group discussions, answer questions, hold group members accountable, and provide support.
Methods and Techniques
Each session will begin with the group leaders checking in with all of the members and discussing any issues that arose from the previous week. Every session will focus on a specific topic surrounding diabetes maintenance. The group will be highly collaborative in nature, and each session topic for the following weeks will be picked by the group in the first session. Topics may include things like diets and exercise, psychoeducation on diabetes, how to maintain accountability and compliance, blood glucose meter training, and tracking of blood glucose levels. When appropriate, the group leaders will arrange a guest speaker to come into the session to discuss that week’s topic. This may include help from a dietician, for example, where every group member will be given their own personalized diet plan to follow.
In addition, medical specialists in the field of diabetes will come to educate the group on what diabetes actually is and the science behind what is going on in the body. A session will be devoted to the discussion of the psychological and emotional impacts of diabetes and how to cope with them. A nurse practitioner will attend one session to administer initial blood glucose readings (to serve as a baseline for comparison after the group has ended) and demonstrate proper use of blood glucose meters, as well as appropriate times to test blood glucose throughout the day (typically 1-2 hours after meal times). A personal trainer will attend one group to educate the members about the importance of physical activity and will help each member develop personalized exercise routines. Finally, a guest speaker will come teach the group how to track their levels in a smartphone/computer app. The members will then be able to bring their results to session every week for analysis and discussion. This will also serve as data throughout the length of the group.
Accountability will be the main component of this group. Within the group itself, everyone will be paired up with another individual. In addition to the accountability to the entire group, each member will form a therapeutic alliance with their own personal partner to further facilitate compliance. Weekly check-ins with the therapeutic partner (in addition to the actual group meeting) will be necessary. Further, members should utilize their therapeutic partners on an as needed basis throughout the week for added support. Every group member will also be given the group leaders’ contact information as a last source of support. The group leader will focus on one member every week to stay accountable to and will check in with this person daily.
Duration of Group and Expected Outcomes
Depending on the number of topics selected by the group in the first session, the group will run anywhere from 8-12 weeks. Sessions will be on a weekly basis on the assigned day and time. They will be held in the evening or on weekends to accommodate the members. After the group has ended, it is hypothesized that compliance and accountability towards their diabetes maintenance (adherence to diet, exercise, blood glucose monitoring, etc.) will increase. In addition, the members’ levels of depression, anxiety, and stress involving their diagnosis are hypothesized to decrease. Overall health and well-being (as reported in self-report form and in regards to weight loss, stamina, and overall better sense of self) is expected to increase. Finally, it is hypothesized that there will be a decrease in the overall average blood glucose levels.
Process of Evaluation
Evaluation will take place in the form of self-report, scales, and data collected throughout the span of the group. At the end of the group, the members will submit journal entries detailing their progress and how they feel the group has helped them. Depression, anxiety, and stress will be measured using pre and post scores from the Beck Depression Inventory, the Holmes-Rahe Stress Inventory, and the Health Anxiety Inventory. In addition, the data collected from each member’s smartphone/computer app will be analyzed to review the overall progress of each member and the group as a whole. The more precise blood draw taken by the nurse practitioner to measure blood glucose levels pre and post group will be used in addition to the data collected personally by the members to ensure that their true progress is calculated, and to counteract any deception by the members on their personal recording of levels. Finally, attendance and a self-report of the number of compliance days (diet, exercise, check-ins with partner, etc.) will be recorded as a final measure to check for compliance and accountability.
The aim of the therapeutic diabetes support group is to end with a better understanding of diabetes and how to best maintain a healthy lifestyle, both physically and psychologically, as well as to increase compliance and accountability. Through psychoeducation and a better medical understanding, the group members should be able to combat the stigma against them in better ways. Hopefully, they will be able to spread strength, knowledge, understanding, and positivity to help end the stigma altogether. By using a model of professionals with diabetes, the hope is that there will be more compliance and accountability. These concepts are extremely important in the initial stages as the group in general as it is just starting out. As the number of cases of diabetes continues to increase, creating a group that will help this population is critical. The proposed group will help people to come to terms with their diagnosis, get the emotional and psychological support they need, and ultimately end the stigma.
American Diabetes Association. (2015). Retrieved from http://www.diabetes.org
Gomersall, T., Madill, A., & Summers, L. M. (2011). A metasynthesis of the self-management of type 2 diabetes. Qualitative Health Research, 21(6), 853-871.doi:10.1177/104973231 1402096
Gallagher, R.P. (2014) The national survey of college counseling centers. Retrieved from http://www.collegecounseling.org/wp-content/uploads/NCCCS2014_v2.pdf
Helitzer, D. L., Peterson, A. B., Sanders, M., & Thompson, J. (2007). Relationship of stages of change to attendance in a diabetes prevention program. American Journal Of Health Promotion, 21(6), 517-520.
King, H., Aubert, R., & Herman, W. (1998). Global burden of diabetes, 1995-2025. Prevalence, numerical estimates and projections. Diabetes Care 21(9), 1414-1431. doi:10.2337/ diacare.21.9.1414
Nagelkerk, J., Reick, K., & Meengs, L. (2006). Perceived barriers and effective strategies to diabetes self-management. Journal Of Advanced Nursing, 54(2), 151-158. doi:10.1111/ j.1365-2648.2006.03799.x
Prochaska, J. and DiClemente, C. (1983) Stages and processes of self-change in smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology, 5, 390–395.
Schabert, J., Browne, J. L., Mosely, K., & Speight, J. (2013). Social stigma in diabetes: A framework to understand a growing problem for an increasing epidemic. The Patient: Patient Centered Outcomes Research, 6(1), 1-10. doi: 10.1007/s4027-012-0001-0
Unnikrishnan, A. G., Bhatia, E., Bhatia, V., Bhadada, S. K., Sahay, R. K., Kannan, A., & …Sanjeevi, C. B. (2008). Type 1 diabetes versus type 2 diabetes with onset in persons younger than 20 years of age. Annals Of The New York Academy Of Sciences, 1150239-244. doi:10.1196/annals.1447.056
Zimmet, P., Alberti, K. G., & Shaw, J. (2001). Global and societal implications of the diabetes epidemic. Nature, 414, 782-787.doi:10.1038/414782a
Why Can’t I Get a Job with a Four-Year Degree in Psychology?
As you have probably noticed in the Monitor on Psychology, in both the February and June 2016 issues, discussions over employment opportunities with a four-year psychology degree have intensified. In the February 2016 issue of the Monitor on Psychology, the APA Center for Workforce Studies stated that 38.2% of college students who graduate with a four-year degree in psychology take jobs that are “not related” to psychology. Career counselors often suggest that four-year psychology majors look for jobs as a business manager, in labor relations, as a library assistant, probation officer, in sales, real estate, insurance, marketing, case management, and in social services. In June, the Monitor reported that “sales” was the most common job for four-year bachelor degree graduates. As one student stated, “not exactly what I expected when I majored in psychology.”
The sad fact is that it doesn’t have to be this way. We are losing many outstanding students in psychology because financially they need to be able to qualify for a good paying career oriented job upon graduation with a four-year degree.
Just the other day, I was confronted on campus by a student who had worked at my community-based clinic for at-risk children. “I’m changing my major,” she said, “I won’t be able to work for you this year. My parents insist that I get a degree that will get me a job. I can’t go to grad school. I have to pay off student loans.” I naturally tried to persuade the student to stay in psychology, but in the end, I couldn’t argue that a four-year degree in psychology really only prepared you to go on to graduate school. Even the Bureau of Labor Statistics states that most four-year psychology majors do not end up working in psychology related fields. This dilemma is the background for our editorial question today.
Editorial Question Posed:
Dear Prevention Corner:
I’m a graduate student, and I attended your symposium at the 2015 APA convention in Toronto on effective training methods. I really liked what everyone said about prevention programs. Why are schools not offering training in prevention groups? This would have been perfect for me. Is it possible to get a four-year degree in prevention? Does your university offer a program?
I’m always happy to hear from students who are excited about prevention. I’m glad you enjoyed the symposium. Unfortunately, I must report that NO, the university where I presently work does not offer a four-year degree program in prevention. I also must admit that at present I do not know of a university offering a complete 4-year degree, specialization, or 4-year training emphasis in prevention groups. This is a problem that has been discussed extensively for years. Some universities offer prevention mixed in with other subjects, but few if any offer complete training programs in group prevention. Yet the need is astronomical: medical prevention groups (cancer, diabetes, heart attack), school-based prevention, violence and anger prevention groups, bully prevention, and health prevention groups (obesity, stress). The list could go on and on. In 2013, the Report of Healthy Development reported that there is a definite need for prevention groups and a definite need for effective training programs in prevention. In 2014, an APA task force stated that prevention group training programs at present are not effective and that most of the people presently conducting prevention group programs are poorly trained or not trained at all. So, what do we do?
Many of these prevention groups, such as diabetes or heart attack prevention, do not necessarily need a licensed therapist. What they need is a trained psychologist who specializes in organizing and conducting effective prevention group programs.
Such a job would be perfect for bachelor degree graduates. Such a program would also fill the needs of many communities.
We could expand our psychology student population if we offered a four-year degree in prevention groups. We could fill a desperate need and increase psychology’s outreach into the community, schools, and medical- health related world by expanding our curriculum choices and adding a four-year specialization in prevention groups. A four-year bachelor’s degree in group prevention would allow students like yourself the option of working in psychology rather than settling for a sales job after completing your degree.
The need is widespread. At present approximately 26% of all adults experience some form of mental health disorder, but very few actually seek help because of the stigma attached to therapy (Vogel et al. 2011). Prevention would not take away from or replace therapy. There will always be a need for therapy, but by expanding psychology’s prevention outreach, we could increase mental health services to those who refuse to seek therapy. Most prevention is conducted in groups; therefore, training in group prevention techniques is essential. Research also shows that approximately 50% of such mental disorders in adults originated or began before the age of 14 (Pirog & Good, 2013). There is a desperate need to reach people at an early age, especially since early prevention has been documented to eliminate or significantly reduce many mental health concerns (Kazak et al., 2010). Prevention groups could fill this need, especially through community and school-based settings.
We have the need. We have the ability to fill the need. We have psychology students, like yourself, interested in a four-year group prevention degree. So, why do we not have such a program?
Change is slow, but let’s dream for just a minute and outline what such a specialization could entail. We’ll highlight 13 possible classes that might be offered in a four-year specialization in prevention groups.
All students in psychology need a general overview course. Some have suggested that students looking at a four-year prevention degree might benefit the most from an introductory course on how psychology is applied to everyday life. There are already many excellent textbooks on the market and many schools even offer an introductory course in applied psychology. Developmental psychology would also be essential, especially a course that covered development across the lifespan. Social psychology, already offered by many schools, would need to emphasize interaction between individuals and within groups.
Introductory course in psychology applied to everyday life
Developmental psychology or life span development
Social psychology and the development of perceptions
At the point where traditional psychology majors turn to research methods and statistics, four-year psychology students in prevention groups need training in applied techniques and interventions. One of the major weaknesses in group psychology, regardless whether you are working in group prevention or group therapy, is the lack of training that we offer in understanding the intricacies of group process. Many people falsely believe that working with individuals in a group setting is the same as individual single-client therapy. This is not true. To work effectively with a group, all psychologists must be trained in group process. One semester when I was teaching group psychotherapy, I took my graduate students to observe an outpatient group therapy session where the licensed group therapist proceeded to go around the circle of clients talking and working with each client individually while others merely sat and waited their turn. That is not group therapy. In prevention, we have self-proclaimed experts going out and conducting “prevention groups” where children sit on the floor in gymnasiums and merely listen to a lecture. That is not a prevention group. We desperately need effective training programs in group prevention. The American Psychological Association (2014) avowed that existing prevention group training programs are not effective. Groups can offer a strong healing or corrective influence, but the healing power of a group is only unleashed when group process is used correctly.
Well designed and properly implemented prevention groups have been shown through evidence-based research to be effective. The key is a well-designed and effectively implemented prevention program. This is why effective training programs are essential. Research shows that how a program is used, even an evidence-based program, is the determining factor between success or failure (Pettigrew et al. 2013). Therefore, psychology majors must be taught how to conduct prevention groups effectively. Let’s look at a definition of what group prevention is and perhaps that will help to clarify the complexity of a prevention group.
Prevention groups utilize group process to the fullest extent: interaction, cohesion, group process and change. The purpose of prevention groups is to enhance members’ strengths and competencies, while providing members with knowledge and skills to avoid harmful situations or mental health problems. Prevention groups occur as a stand-alone intervention or as a key part of a comprehensive prevention program. Prevention encompasses both wellness and risk reduction. Preventive groups may focus on the reduction in the occurrence of new cases of a problem, the duration and severity of incipient problems, or they may promote strengths and optimal human functioning. Prevention groups encompass many formats. They may function within a small group format or work with a classroom of thirty or forty. Prevention may also be community-wide with multiple group settings. Prevention groups use various group approaches. Psychoeducational groups are popular and, while some prevention psychologists work within a traditional counseling group, others use a group-centered intervention approach. Two key ingredients for all prevention groups are that they be directed toward averting problems and promoting positive mental health and well-being and that they highlight and harness group processes (Conyne and Clanton Harpine 2010, p. 194).
So, as you can see organizing a prevention group involves more than just gathering a group of people together. You cannot learn to be an effective prevention group leader in a one-hour workshop. If prevention is to be effective, the group organizer must understand the intricacies of group process, interaction, and group cohesion. These intricacies must be taught. Community psychology offers courses to students working in the community and organizing community-based programs. This is why a four-year bachelor degree program would be perfect. Most community psychology programs stress prevention, but few if any, community psychology programs teach group process, how to initiate interaction in a group, or how to achieve group cohesion. You may be able to find psychology courses that talk about groups or discuss using groups, but we have very few courses which actually teach group process. Yet, understanding group process is essential for anyone working with groups.
Therefore, our next selection of courses for a four-year specialization in prevention groups would include courses in group process and prevention. Prevention group workers also need to touch on neuropsychology or the knowledge of how the brain works. A four-year student would not need the depth or research knowledge that a student going on to graduate school would, but prevention group specialists do need background knowledge in neuropsychology.
Group problems and how to handle difficult group situations
Group prevention techniques
Neuropsychology or knowledge of the brain and how it works
At this point, some readers may be saying: We have workshops, training programs, and evidence-based programs. What else do we need? A single workshop or training program is not enough. We need more in-depth training.
There are three approaches being used presently in group prevention: psychoeducational groups, traditional counseling groups, and group-centered prevention groups. A prevention group specialization would need to teach each of these approaches to group prevention. Again, textbooks are already available.
Research has shown that therapy is more effective when learning or an educational component is incorporated alongside therapy interventions (Baskin et al., 2010). The same is true with prevention groups. From a 20-year longitudinal study, Jones, Greenberg, and Crowley (2015) provide support for this concept of combining learning and counseling. They call it “combining cognitive and non-cognitive skills-training. The cognitive skills are the educational component. The non-cognitive skills include social emotional skills, behavior, personal control, self-regulation, persistence with a task, interpersonal skills or ability to relate to others, and group interaction skills. If you refer back to our definition of a prevention group, each of these skills must be incorporated in a prevention group training program. This level of understanding and training cannot be successfully taught in a single workshop or training session.
Group leaders cannot learn how to work with others effectively in a group setting without professional training (Erchul, 2013). Prevention groups need to offer skills training, especially interpersonal and group skills. Prevention group programs must also offer both a combination of knowledge and skills if such a program is to be effective (Long & Maynard, 2014). Knowledge incorporates the subject or what is being taught (diabetes or heart attack prevention), skills training involves application or how to use such knowledge in everyday life. Before group leaders can teach others, they too must receive skill-based training. One of the primary causes of prevention group failure is poor implementation and the way in which skills and knowledge were taught by the group leader (Coles et al., 2015).
Evidence-based programs sound fantastic, but in practice, they have not always been successful (McHugh & Barlow, 2010). Research has shown that many evidence-based programs result in ineffective practice because the program was not implemented as designed or was used incorrectly (Erchul, 2013). What many group leaders do not understand is that any time you change or only use bits and pieces of an evidence-based program; you have changed the program and thereby changed or reduced the effectiveness of the program (Rotheram-Borus et. al, 2012). Therefore, we need to provide training for group leaders using evidence-based prevention group programs. Knowing how to implement or use a prevention group program, regardless whether it is an evidence-based program or not, is essential if we are ever to have effective prevention programs and must be included in any four-year degree program.
Students must also be taught how to identify an effective prevention group program as well as learn how to design and develop effective prevention group programs. Evaluation techniques must be taught.
The principles of an effective prevention group
We also need to teach students how to design effective prevention group programs. Robert Conyne offers an excellent book for psychoeducational style programs (Conyne, 2010, 2013). I offer three books for group-centered prevention programs (Clanton Harpine 2008, 2011, 2013a). Textbooks are available. All that is missing is a 4-year undergraduate course of study in prevention groups.
Designing and conducting an effective group prevention program
Introduction to group counseling
Group-centered prevention: Combining counseling and learning in one prevention group program
Supervised internships working with actual prevention groups
Research states that courses incorporating service-learning result in higher test scores and more knowledgeable application of textbook and course content (Postlethwait 2012). Some universities are now even requiring service-learning courses or as much as 30-hours of service learning during a semester. Supervised internships working with some prevention groups should be a very vital component of any four-year degree.
We have organizations, hospitals, community groups, and schools crying out for trained personnel to organize and conduct prevention group programs. We have students seeking a four-year degree in psychology that will enable them to qualify for employment upon graduation. So, why do we refuse to offer college-level training programs in group prevention?
Students, like yourself, need to step forward and demand a four-year degree program in prevention groups. Faculty need to step forward and make it happen.
If you would like to join this discussion, let us hear from you. We welcome your participation. We invite psychologists, counselors, prevention programmers, graduate students, teachers, administrators, parents, and other mental health practitioners working with groups to network together, share ideas, problems, and become more involved. Please send comments, questions, and group prevention concerns to Elaine Clanton Harpine at firstname.lastname@example.org
American Psychological Association. (2014). Guidelines for prevention in psychology. American Psychologist, 69, 285-296. doi: 10.1037/a0034569
Baskin, T. W., Slaten, C. D., Sorenson, C., Glover-Russell, J., & Merson, D. N. (2010). Does youth psychotherapy improve academically related outcomes?: A meta-analysis. Journal of Counseling Psychology, 57, 290-296. doi: 10.1037/a0019652
Clanton Harpine, E. (2008). Group interventions in schools: Promoting mental health for at-risk children and youth. New York: Springer.
Clanton Harpine, E. (2011). Group-Centered Prevention Programs for At-Risk Students. New York: Springer.
Clanton Harpine, E. (2013). After-school prevention programs for at-risk students: Promoting engagement and academic success. New York: Springer.
Clanton Harpine, E. (2015). Group-Centered Prevention in Mental Health: Theory, Training, and Practice. New York: Springer.
Coles, E. K., Owens, J. S., Serrano, V. J., Slavec, J., & Evans, S. W. (2015). From consultation to student outcomes: The role of teacher knowledge, skills, and beliefs in increasing integrity and classroom management strategies. School Mental Health, 7, 34-48. doi: 10.1007/s12310-015-9143-2
Conyne, R. K. (2010). Prevention program development and evaluation: An incident reduction, culturally relevant approach. Thousand Oaks, CA: Sage.
Conyne, R. K., & Clanton Harpine, E. (2010). Prevention groups: The shape of things to come. Group Dynamics: Theory, Research, and Practice, 14, 193-198. doi:10.1037/a0020446
Erchul, W. P. (2013). Treatment integrity enhancement via performance feedback conceptualization as an exercise social influence. Journal of Educational and Psychological Consultation, 23, 300-306.
Jones, D. E., Greenberg, M., & Crowley, M. (2015). Early social-emotional functioning and public health: The relationship between kindergarten social competence in future wellness. American Journal of Public Health, 105, 2283-2290. doi: 10.2105/AJPH.2015.302630
Kazak, A. E. (2008). Evidence-based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63, 146-159. doi: 10.1037/0003-066X.63.3.146
Long, A. C. J., & Maynard, B. R. (2014). Treatment integrity as an adult behavior change: A review of models. In L. M. H. Sanetti and T. R. Kratochwill (Eds.), Treatment integrity: A foundation for evidence-based practice and applied psychology (pp. 57-78). Washington, D. C.: American Psychological Association.
Pettigrew, J., Miller-Day, M., Shin, Y. J., Hecht, M. L., Krieger, J. L., & Graham, J. W. (2013). Describing teacher-student interactions: a qualitative assessment of teacher implementation of the 7th grade keepin’ it REAL substance use intervention. American Journal of Community Psychology, 51, 43-56. doi: 10.1007/s10464-012-9539-1
McHugh, R. K., & Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments: A review of current efforts. American Psychologist, 65, 73-84. doi: 10.1037/a0018121
Pirog, M. A. & Good, E. M. (2013). Public policy and mental health: Avenues for Prevention. Thousand Oaks, CA: Sage Publications.
Postlethwait, A. (2012). Service learning in an undergraduate social work research course. Journal of Teaching Social Work, 32, 243-256. doi: 10.1080108841233.2012.687343
Vogel, D. L., Heimerdinger-Edwards, S. R., Hammer, J. H., & Hubbard, A. (2011). “Boys don’t cry”: Examination of the links between enforcement of masculine norms, self-stigma, and help-seeking attitudes for men from diverse backgrounds. Journal of Counseling Psychology,58, 368-382. doi: 10.1037/a0023688
Greetings from the Early Career Psychologist Task Force!
In the past six months, the ECP Task Force began hosting Community Conversation Hours (CCH) with our own Dr. Barbara Greenspan (a member of the ECP Task Force). She presented on the topic of Women in Leadership. She discussed unique challenges facing all women in leadership positions in the world, as well as group psychotherapy. Sixteen attendees were present and it was a great start to this new initiative. We utilized ZOOM as our new medium and our hope is to provide a space to discuss relevant group topics three times per year. Our next one is scheduled for July 13th 2016 on the topic of supervision and training (see flyer).
ECP Task Force will host the Divisions social hour at the APA Annual Convention 2016 on August 6th at 6:00 p.m. Be sure to join us! There will be wine, cocktails, and catered food. We welcome everyone!
At APA, check out our convention programming which features various skill-building sessions as well as symposiums. Skill-building session on the basics of interpersonal processing and the symposium on evaluating group psychotherapy processes might be especially useful for any ECPs!
Finally, don’t forget to check out our Facebook page!
Integrating Cognitive Behavioral Therapy with Psychodramatic Theory and Practice
Thomas W. Treadwell
Letitia E. Travaglini, Debbie Dartnell, Maegan Staats, and Kelly Devinney
As Director of Group Psychotherapy at McLean Hospital in Belmont, Massachusetts, I have ample opportunity to experience how important treatment models such as Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Motivational Interviewing, Mentalization – Theory of Mind, Mindfulness, Narrative Therapy, Acceptance and Commitment Therapy, Expressive Therapies, Interpersonal Therapy, Milieu Therapy, Psychopharmacology, Electro Convulsive Therapy, Group Psychotherapy, and other modalities are systematically utilized in a treatment environment encompassing inpatient, residential, partial hospital, and outpatient programs. Though falling under the rubric of “hospital-based” treatments with stabilization and step down programs to assist individuals and families, Cognitive Behavioral Therapy has emerged as an essential part of the hospital’s treatment repertoire across all treatment programs. In fact, one of our excellent partial programs, Adult Behavioral Health, is often described by participants as “being in college,” learning important information and strategies to assist recovery. Psychodrama, because of necessary limitations for more vulnerable treatment populations, is significantly less utilized as a method and finds more applicability as role playing.
Tom Treadwell’s contributions to the integration of action and experiential methods with Cognitive Behavioral Therapy are significant steps for both theoretical models. On the one hand, psychodrama, as practiced in classical styles, often relied on spontaneity and the importance of action rather than just telling. Cognitive Behavioral therapy developed a protocol with systematic methods that integrated thoughts, feelings, and behavior. Mirroring my first exposure to one school of CBT in New York City, a la Albert Ellis, Tom Treadwell has created a bridge in which each method can inform and expand the relationship in the cognitive triad. He introduces a group format that utilizes multiple measures to inform each group member concerning particular areas of concern, educates group members on the Cognitive Behavioral treatment model, and gives feedback that stimulates both the individual and the whole group in behavioral change.
This synthesis is not an easy endeavor. I would suspect that Treadwell, with the support of Aaron Beck, would have to establish a training program that initiates professionals in the utilization of action methods and cognitive behavioral methods and strategies. When I project an image of the two methods on to a Field Diagram created by Freed Bales, I would probably predict that CBT would be rated as an “intellectually controlled, rationally energized” method and Psychodrama would be “more emotionally expressive, intuitive.” Both mirror the oscillating patterns in groups, i.e., the need for task completion and, on the other hand, the need for socio-emotional connection. Treadwell’s Group Therapy Workbook makes a substantial contribution for practitioners in CBT and Psychodrama to practice in their accustomed method by expanding the range and applicability of each method.
I recommend this Workbook for practitioners in both methodological arenas: CBT therapists could well utilize action methods to expand their practice in important concepts such as the cognitive triangle and defeating schemas. Psychodramatists could well utilize the basic components of CBT in the practice of psychodrama, helping protagonists to better understand the internalized thought, feeling, and behavior patterns that are related to the here and now. Treadwell’s contribution is an important milestone in the connection of these two important modalities. As the process unfolds, more learning will emerge and the integration and development of “integrating Cognitive Behavioral Therapy with Psychodramatic Theory and Practice” will certainly make a significant contribution to peoples’ lives.