Council of Representatives Report

Sally Barlow, Ph.D.

The Council of Representatives met in Washington DC February 24-25th, 2017. A lot of business was conducted, some of which I cannot report on because it occurred in Executive Session. Sorry about that. Wish I could. But we have been harshly warned by our legal counsel not to divulge anything. Perhaps I will be able to do this later.

Of interest was a vote on apportionment—long history of this squabbling that has gone back and forth. You can refer to pdf below for status. A very nice thing that happened from the floor of Council was that we all agreed to make sure all the geographic locations (e.g. Virgin Islands) weren’t stripped of their votes. I have also attached the minutes from the meeting if you are interested. Most of you are no doubt up to your eyeballs in work: serving the public, teaching the next generation of group clinicians, running groups etc. The happiest thing I must report is that the CRSPPP petition for specialty status just ended its comment period. The petition itself can be read at  http://apaoutside.apa.org/EducCSS/public/  along with the almost 50 pages of comments, which are primarily quite supportive. We have Nina Brown to thank for this tremendous effort: THANK YOU NINA!!

Although group is recognized by the American Board of Professional Psychology as a specialty it has yet to be recognized by CRSPPP—the committee on recognition of specialties and proficiencies in professional psychology. In related action, the PTSD guidelines were voted upon.  It was an almost 2-hour debate. APA staff in charge of the PTSD guidelines apparently have been working on this document for 4 1/2 years to compete with psychiatry guidelines. The committee (staff and psychologists) were given the charge to follow the guidelines from the Institute of Medicine (IOM).  I believe that is what set the agenda here–so that only PTSD research under-girded by RCTs was the norm. It is no wonder CBT and its offshoots along with medication won this horse race. Comments from the floor ranged from defensive (the APA staff essentially said, “If we want to be a player here with psychiatry we need to get these guidelines out now”; representatives from division 39, psychoanalysis, claimed unfair treatment of psychoanalysis and psychodynamic TX,) to accurate (the president of the Women’s division strongly suggested that decontextualizing PTSD was dangerous to those who suffered from it,) to the idiotic (sorry about casting aspersions here–but I am always fascinated when psychologists in love with RCTs and meta-analyses as the only viable evidence base stand at the mic and spout effect sizes etc.–overlooking the important contributions from qualitative research, and misunderstanding how RCTs are based on drug trials that simply do not translate to humans. Here is what I said at the mic (you can only talk 2 minutes):

“I am Sally Barlow from Division 49 Group Psychology and Group psychotherapy. I am against these PTSD guidelines in their current form, extensive as they are.  Because the freeway was closed from Park City to SLC due to an oil tanker fire, I spent an extra 8 hours at the airport re-reading the 2,000-page document and accompanying 1,000 no and yes comments–the no’s outweighing the yes’s by 30-1. The document never mentions treatment delivery modalities, only treatment types such as CBT. In particular, I am persuaded by Dr. Moench’s comments on page 1649 who suggests this document goes against expert international guidelines for PTSD. Further, Les Greene and associates from science to service task force of American Group psychotherapy Association on page 1678 suggest the guidelines fail to sufficiently delineate differential and unique effects of different treatment modalities such as individual vs. group treatment. In clearly growing data bases for group investigations, group treatment is often superior to, certainly equivalent to treatment as usual and wait list controls. Finally, clinical expertise appears to be obviated by the report’s overly strong and narrow recommendation of CBT treatments and medication.”

I wrote it down to read because it is truly nerve-wracking to stand at the mic.

Several council members followed suit. However, there was strong support from the floor not to send this back to the drawing board as it would take another 5 years, and we would “lose” to psychiatry. Before we voted on the motion, the Practice Directorate promised to put out an accompanying document on professional psychology guidelines highlighting clinical expertise, in order to encourage psychologists treating patients with PTSD,  to 1) take cultural/diversity context into account, 2) properly contextualize PTSD interventions so that individual patients issues were attended to, 3) report some of the growing body of research from EMDR, Psychodynamics and emotion focused therapies, and 4) pay more attention to treatment delivery such and individual and group therapy. (Because I had carefully read the entire document I did note that there was a nod to “brief psychodynamic therapy” in the treatment of PTSD already, but there is nothing about group vs individual.) I look forward to these accompanying comments. The vote to accept the PTSD guidelines, along with this forthcoming document from the practice directorate, passed at almost 80%. (I have the 2,000 page document if you would like to read it—just email me at shb@byu.edu.) I voted against it as I think it needs to be re-written but I was clearly in the minority. I am also uncomfortable with the notion that these narrow guidelines were passed in what appears to be a turf war; but maybe I am unrealistic.

Here is what I think we should do next: Write a succinct document highlighting the efficacious and efficient use of groups as a delivery model for PTSD intervention and send this to Kathryn C. Nordal, email: knordal@apa.org. She strikes me as a smart, very competent person who will listen to us. Recently at the American Group Psychotherapy Association annual meeting in NYC I attended the Science-to-Service-Taskforce where we discussed this. Gary Burlingame agreed to send this information to Dr. Nordal at the APA Practice Directorate.  This is all good news for all of us in this division who understand the power of small group dynamics.

Other business of interest was a presentation on diversity on implicit attitudes (check out www.slido.com for interesting details about this North Star project presented by Glenda Russel and Andrea Iglesias.) Budget items were reviewed—sadly too many of our colleagues have dropped out of APA because of the bad publicity we have gotten from the Hoffman fallout. A proposed policy and procedures document on implementing transparency was discussed. Item 12, removal of barriers to admission to doctoral programs in psychology using the GRE was passed. Trial delegation of authority to the board of directors was discussed; this is all part of the Good Governance Project designed to make APA nimbler. Let’s hope it works. Until next time. Thanks for allowing me to represent you from Division 49. Sally H. Barlow

http://www.apa.org/about/governance/council/minutes-winter-2017.pdf

http://www.apa.org/about/governance/council/2017-apportionment.pdf



Categories: Committee Reports

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