Academy of Medical Psychology ACADEMY UPDATE FROM THE PRESIDENT
BY WARD LAWSON, PHD, ABPP, ABMP
AUGUST 2015 VOL. 4 ISSUE 2 ACADEMY UPDATE FROM THE PRESIDENT
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BY DR WARD LAWSON
EXECUTIVE DIRECTORS COLUMN BY DR. JERRY MORRIS
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ADVOCACY BY PSYCHOL- 4 OGY PRACTITIONERS BY DR. JACK G. WIGGINS
HEALTH AND SCIENCE
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BY DR. JEFF D. COLE WHAT IF: LOOKING TO NATURE
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BY DR. RORY RICHARDSON BOOK REVIEW
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BY DR. SUSANA GALLE
EMERGING PRACTICE TRENDS BY DR. JERRY MORRIS
It is a pleasure and honor to be serving as the next president of the Academy of Medical Psychology in 2015! After having served on the board for three years, initially as a student representative and then as a full member, I can attest to the high caliber of leadership and teamwork this board possesses. Under the inspiring and visionary leadership of Dr. Morris, the Academy has established itself as a front runner among specialists in psychology, and as leaders in the current integrated health care environment. It is my goal to continue this positive momentum with regard to advocacy for medical psychology, as well as enhancing the benefits of membership, so that individual medical psychologists grow professionally, but that the specialty grows as well. Board certification in Medical Psychology requires extensive training at the post doctorate and post licensure level. This training surpasses simply becoming a psychopharmacologist, but follows
the tenets of those designing Integrated Care for the nation where specialists in Medical Psychology will need to be able to diagnose and treat mental disorders with psychotherapy and medications (at a prescribing or consulting; LIII and LII functions) and be able to treat the psychological aspects of physical disorders. Coronary heart disease, obesity, hypertension, diabetes (especially juvenile onset diabetes), nicotine and other addictions, and other disorders identified as negative cost drains on healthcare resources that have psychological and lifestyle components are the purview of the Medical Psychologist. Never before have Medical Psychologists had such a broad healthcare landscape in which to impact the quality of life for so many people and to establish our specialty as premiere healthcare providers. We have analyzed the evolving healthcare models and systems and attempted to position psychology and the specialty to become an es-
sential component of the Primary Care and Hospital Systems of America. It is our view that the specialty of Medical Psychology fills such an important gap that exists in America’s Primary Care Systems that Diplomates in the specialty should be mandated in all healthcare configurations, primary care clinics, hospitals, nursing homes, assisted living and residential care facilities, etc., that are funded by government health insurance, e.g., Medicaid and Medicare. An expanding Academy of Medical Psychology continuing education program and the work being done by Dr. Morris to establish an on-line master’s level Medical Psychology program attest to our confidence that Medical Psychology holds an indispensible place in quality healthcare. There is much more exciting work to be done! I look forward to being a part of the ongoing evolution of the Academy and this specialty!
14 American Board of Medical Psychology Board of Directors: Susan Barngrover, PhD, AMBP - Secretary; Brian Bigelow, PhD, ABMP; James K. Childerston, PhD, ABMP; Jeffrey D. Cole, PhD, ABMP, Newsletter Editor; Ward M. Lawson, PhD, ABPP, ABMP, Archives Editor, President; Jerry Morris, PsyD, MBA, MSPharm, ABPP, NCSP, NBCC, CCM, Executive Director, Gil Sanders, EdD, ABMP-Treasurer; Bethany Nevins administrative contact main office-660-200-7135. Editorial Consultant: Cherie Van Putten, M.ED., Training Associate at Binghamton University
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Executive Director’s Column By Jerry Morris PsyD, MBA, MS (Pharm), ABMP, ABPP, ABBHP, NCSP, CCM I am happy to report that we have a vibrant, successful, and increasingly well recognized and forward looking advocacy organization. We have a stable and constantly growing specialty with top psychologists who are willing to do extensive post-doctoral and post licensure study in medical science, medical psychology, and psychopharmacology to enrich their basic psychology and clinical psychology training and skills and abilities. This continues to attract and showcase the top psychologists in the healthcare workforce. Still there are challenges. We need more volunteers to assist the evolution and substantiation of a new and growing specialty. We need volunteers on the Publications, Government Relations and Advocacy, Continuing Education, Preceptorship, Credentials, and other committees. We are and grow at your involvement rate and pace. We have never been assisted in any way from the APA, but have received many and helpful assistance from numerous other organizations. These include the National Practitioner Association (National Alliance of Professional Providers in Psychology; www.nappp.org), medical societies and organizations, and governmental agencies. Our members have spoken by invitation and made presentations at these psychology practice and medical
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society conferences and workshops. Still, it is a shame that the largest organization of psychologists in the world has not reached out to us, or responded to our efforts at collaboration (which have been numerous). Our specialists and members of the society who are jointly a member of APA should make their disappointment at the APA’s behavior and lack of efforts to support credible psychological groups and specialties known to their colleagues in APA (as I and others on your board have done repeatedly). We are financially solvent, have a good and evolving central office and data base and web site, excellent journal, fantastic Credentials Committee led by Dr. Gary McClure and a great team of trained specialists doing Oral and Written Examinations. We have a listserv and a great Facebook (Medical Psychology) page that reaches both an US and international audience. We have standards for what it takes to become a medical psychologist and how we are more than “a psychopharmacologist” and this definition and these minimum training standards are published widely, including on easy access web pages such as Wikipedia when you look up Medical Psychology. We have taken important positions, along with such prestigious organizations as NAPPP, the American College of Lifestyle Medicine, the WHO, the IOM, the FDA Science Committee, and others in psychology, psychiatry, the research establishment, top European science agencies, and others concerning such important
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scientific topics as; a. the limits of pharmacotherapies and that they represent a technique and not a “Treatment or Treatment Plan” for mental disorders and substance abuse, b. that training in non-healthcare or clinical psychology does not qualify a doctor to treat mental illness (MI) or substance abuse disorders (SUDs) or become a Medical Psychologists, c. that general physicians are not qualified to do more than screening and referral for specialty diagnostic evaluation of MI or SUDs patients and that they should have collaborating internal staff at their facilities or linkages with these professionals, d. that psychologists can learn to understand basic medical science, to integrate it with psychological science, and learn to prescribe or choose and monitor psychotropic medications and related techniques adequately and safely for the benefit of patients, the public, and the quality of care in the healthcare system, e. that post-doctoral and post-masters graduate training can enhance the (continued next page)
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(“Executive Director”. Cont’.d from previous page) psychologist’s ability to qualify for, participate, and improve the mainstream US healthcare system, f. that archaic conceptualizations about one disciplines unique brains and abilities (prejudice of superiority) has held back deploying the most effective workforce in the healthcare system and allowing them to practice within their recognized license and scope of practice and has devastated our US healthcare system, g. that every Primary Care Clinic of 5 or more physicians and/or nurse practitioners should be required to staff 1.0 FTE of clinical (preferably Medical) psychologist, h. that standards need to be modified/developed which allow Medical Psychologists in health facilities to admit and discharge patients (collaborating with medical providers to get H&Ps and medical collaboration), to write treatment orders, guide treatment teams where the life-style, behavioral, and psychological dynamics are the most dominant on the case, and to direct mid-level, and bachelor’s level assistants (be they RNs, BSWs, BS in psychology, MSWs or MS in Counseling or Psychology, case managers-increasingly part of the workforce in healthcare) in the delivery of psychologist defined and ordered treatment interventions and plans, h. that general physicians are overwhelmed, are on a treadmill with high volume and pressurized expectations, and excessive productivity requirements that limit what they can do with patients. They need psychologists in their practices and health facilities that can accept patients requiring extensive and specialized psychological, behavioral, life-style, and family interventions that require specialty skills and training, specialist time and focus, and systems resources, in the Hospital System has been the Cash Cow that has funded the Primary Care System in America and that has changed and primary care system must change and become more financially and clinically efficient and successful in order to stabilize the system of declining hospitals. Thus, the revenue stream form adding a Psychologist and psychological and prevention and life-style programs to Primary Care Centers in the US is an essential ingredient to shifting the system from the current expensive and inefficient and often ineffective Status Quo System.
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inaccurate”. Still, the proliferation and dissemination of the scientific and outcomes data has vindicated them. Their fight to improve the current system and their belief in science and reality has protected them against resistance and vested interests that resist change. We are a fortunate and bless part of a “scientific enlightenment period” that will change the direction of healthcare in the US and help us join our colleagues in Europe and The World. You will know the enlightened by the following characteristics: 1. They will be multidisciplinary of philosophy and nature, 2. They will be science and results oriented, rather than guild and tradition oriented, 3. They will be “early adopters” of new scientific, methodological, and systemic findings, 4. They will focus on development, prevention, long-term rather than palliative approaches to healing, 5. They will respect the science and experts in all the etiological and evolutionary windows to health (family, educational, developmental, psychological, community, lifestyle, nutritional, exercise and recreational, medical, biological, chemical, spiritual, phenomenological), 6. They will have personal attributes of intellectual curiosity, desire for and enjoyment of life-long learning, genuine interest in human beings, optimism, warmth and genuineness, tolerance of ignorance and other human mistakes and developmental arrests, capacity to endure complexity, patience, dedication to their work, empathy for their interdisciplinary colleagues, and toughness, 7. They will balance prurient desires related to grandiosity, greed, hostility, dominance with self-regulation and desire to help people, systems, and set a positive future.
It has been said, “may we live in interesting times”! These are interesting times! It has been said, “tall trees gather wind”! Many of the leaders in medicine, psychology, science, research, Government have met resistance and disdain, and have prevailed in the light of day! It has been said, “no matter who kills the buffalo, everyone wants to eat”! So, it is not surprising that everyone wants to benefit from their credentials and hard work to get them, whether they are insightful leaders and truly addressing the public’s and healthcare needs or not! We are lucky enough to live on the membrane between the old vision and traditions and the new! That existence on the membrane between the two can be viewed as “fractionation and awful”, or “THE ENELots of seminal psychologists who have been leaders in VITABLE FRACTIONATION THAT COMES JUST the top Psychological, Medical, and Scientific Societies PRIOR TO THE TIPPING POINT AND CHANGE!” have written about these things, and reticent to change You are fortunate to be right where you are! professional societies have branded them with aphorisms such as “renegades, rebels, hostile, rebellious, and
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Losing Members" in the World of Psychology blog on Google. He claimed that APA lost 7.6% of its Advocacy by Psychology Practitioners 91,306 members to 84,339 in the 2010 Year. That Should Focus on State Issues was the year when APA was sued for misrepresenting APAPO dues as "mandatory". He also reports by Jack G. Wiggins that the number of full members in APA with docNational headlines on political electioneering obtoral degrees is 75 ,000." APA still posts "nearly scure the continuing significance of the practice of 122,500.members in 2015. Regardless of differing psychology in States --- just as the twinkling of estimates of APA membership, advocacy for the stars vanish with the bright morning sun. APA ad- practice of psychology at the national level may be vocacy for practice of psychology has also been further curtailed by any mishandling of the APAPO diminished by the $9.02 M settlement of the claim membership dues re-funding. Some are questioning of APA membership requirement misrepresentawhether APAPO can survive as an advocacy ortion of contributions to the APA Practice Organiza- ganization in its present form. tion (APAPO). Attorney fees reduced this settlement by $2.7 M leaving $6.5 M to be returned to donors. Publication of the terms of settlement are Whatever moneys are returned to APAPO donors, available the plaintiff's attorneys (For further infor- it is clear that a plan for the best use of this money mation on the APA lawsuit filed by Tycko & must be devised. Simply buying a family dinner Zavareei, click on the following link: http:// with the money defeats the advocacy for which it www.tzlegal.com/case-information/current-case/ was given. Over the next few months news media class-action-by-members-of-the-americanattention will be is on political electioneering to psychological-association/.) sell newspapers and TV time rather than on public needs psychological services. Thus, psychological practitioners should focus on funding State advocaThis APA/APAPO debacle creates a window of cy for prescriptive authority for the benefit of the opportunity for State advocacy by psychology public. APAPO donors can contribute any returned practitioners. No donor funds have been distribut- funds to their State PACs (Political Action Comed, since final approval of the settlement will not mittees) to create a $6 M pool of funds for RxP adoccur until Aug 13, 2015. Donors will have until vocacy. Then. State PACs could set up cooperative Oct 12, 2015 to file a claim. Claimants recovery of alliances for advocacy on issues of mutual interest. proceeds can be further reduced by the costs of the certifications of claimants and by the number of practitioners filing claims that are yet to be deter- My contributions to practice have been to State mined. With a possibility of up to 50,000 claimants PACs and practice organizations supporting RxP over the 10 years , the actual returns may be about directly without the 20% overhead costs charged the cost of a dinner at a good restaurant! APA is by APA on APAPO membership dues. I have not seeking re-donation of these returned funds. There contributed to APAPO since the APAPO Board are verbal reports that about $7 M of the 9.02 M was made one and the same as the elected Board of settlement costs may be recovered by APA through Directors of APA. The APA Bylaws stipulate that its liability insurance that protects APA's financial the APA elected Board member consist of 3 memstatus. ber from practice and 3 from academic and other interests. .Non-practitioners on the APA Board of Directors are exempt from contributions to In 2012, John Grohol, Psy.D. posted "Why APA is APAPO, yet, non-practitioners have"de facto"
FROM THE EAGLE’S NEST:
(“Advocacy…” Continued next page.)
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(“Advocacy….” cont.’d from previous page) representation on the Board of APA Practice Organization., This representation of nonpractitioners on the APAPO Board is unfair to practitioner interests, in my judgment. Besides, the Educational Directorate has now set up its own advocacy organization to which teaching practitioners are urged to contribute. Although prescriptive authority is a central issue for health care practitioners, there are many other practice issues in States that are not regulated by the federal government. For example, the Veterans Access, Choice and Accountability Act of 2014 authorizes licensed psychologists to diagnose and treat eligible Veterans living outside of driving distance to VA facilities. However, the VA underutilizes independent contracting for care for eligible Veterans. State psychological associations can facilitate VA contracting with licensed psychologists with public statements that licensed psychologists can provide their services through independent contracting. Independent contracting circumvents archaic VA hiring policies that prohibit the VA from hiring of licensed psychologists that have not graduated from an APA approved doctoral program or have not completed an APA approved internship program. There are 10,000 such psychologists that lack these credentials required by the VA. These psychologists with doctoral degrees and meet State experience requirement have been licensed as psychologists over the last decade. Public statements that licensed psychologists can do independent contracting with the VA will enable Veterans to put pressure on local VA facilities for their health care as eligible Veterans with the support of their Congressmen. There were 1262 published vacancies for psychologists in the VA as June 25, 2015! Psychologists employed by the are overloaded and the unpublished need for psychologists may actually be double this number. This is another window of opportunity for licensed psychologist to lobby their Congressmen for VA rule changes to enable the hiring of licensed clinical and medical psychologists. The Heiser Award needed a list of practice issues
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that could be recognized as supporting psychology. APA published by State a series on Law and Mental Health Professionals by James S. Wulack in 1993 that lists sections of the law where psychology is included. Though dated and in need of revision, it is still available and highlights where practitioner organizations can review for current practice opportunities. Recent changes in federal authorize new opportunities for licensed psychologists in States. For example, the Veterans Access, Choice and Accountability Act of 2014 authorizes licensed psychologists to diagnose and treat eligible Veterans living outside of driving distance to VA facilities. The VA should hire licensed psychologists under Title 38, like other doctors and nurse practitioners, and embed them in primary care panels to deal with the overload of Veterans with PTSD and other mental disorders. State psychologists could support this initiative, since they have a vested interest to lobby legislators on VA Committees from their State by virtue of the Veterans Choice Act. During the next 18 to 24 months, political electioneering will capture the national scene. This will also be complicated further by the confusion about the ACA national health insurance law and revision of the Veterans Administration to deal with health care issues of Veterans, such as PTSD and other mental disorders. Turmoil of control of Congress will make it difficult to pass any major new federal legislation. Therefore, I believe psychology practitioners should focus should be on State issues, such as RxP. Advocacy begins at home is an old political axiom. Practitioners must see the current scene as a window of opportunity for State advocacy for the practice of psychology! _________________________________________ In addition to serving as president of APA Dr. Wiggins is also a Board Member Emeritus of ABMP, the governing board of AMP and credentialing body for medical psychology. He has won multiple awards for his tireless work for the practice of psychology
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given responsibility for the institution’s drug abuse Dr. Gilbert O. Sanders, a long-time Board Member of program the American Board of Medical Psychology was recent- where he also ly awarded by the American Psychological Association provided edu(APA) at their annual convention in July 2014 in Wash- cation and oriington D.C. for his long and exemplary service to psyentation prochology. grams for the As well as a Board Certified medical psychologist correctional facility and regular counseling to through ABMP, Dr. Sanders is a Clinical Neuroinmates infected with the Human Immunodefipsychologist and has served many years as a psyciency Virus (HIV) and at the US Penitentiary chologist in the U.S. military, as a forensic psyat Leavenworth, Kansas where he developed chologist and as a civil psychologist working for the first comprehensive (1000 treatment hours) the military. drug treatment program offered by the Federal Bureau of Prisons at a maximum-security instiDr. Sanders earned his doctorate at The University tution. of Tulsa in Educational/Counseling Psychology in On assignment to Sitka Alaska at Mount Edge1974. He worked as Director of Humane Education for the Massachusetts Society for the Prevencumbe Hospital he changed the existing AA tion of Cruelty to Animals and the American Hubased program to a 35 day in hospital based mane Education Society. In Indiana he also served Cognitive Behavioral Based model and later to as an Assistant Professor of Psychology and Learnthe Alaska Native Medical Center where he ing Systems Coordinator at Calumet College, in developed a integrated care model for subEast Chicago, Indiana. In 1976 he was appointed stance abuse treatment. Gilbert’s dedication to the Northern Indiana Health Systems Agency's and care for the Native people of Alaska lead Committee on Substance Abuse, and the Indiana to his adoption as a member of the tribe. This State Department of Mental Health's Substance interest led him to seek additional training in Abuse Task Force. this field and eventually to seek additional training in psychopharmacology and neuropsyIn 1978 Dr. Sanders started work as an industrial/ organizational psychology serving with the US chology. While stationed in Alaska Dr. SandArmy Research Institute and the U. S. Army Trainers advocated for prescriptive authority for ing and Doctrine Command Systems Analysis Acpsychology and helped raise $12,000 by Intertivity. Dr. Sanders served many years in high-level net and obtained a $10,000 CAPP grant makappointments with the U.S. military overseeing ing Alaska one of the first states introduce legmental health and substance abuse treatment needs islation to permit properly trained psycholoof military personnel including as Personnel Psygists to prescribe psychotropic medications. chologist/Operations Analyst with the U.S. Army Selected in 1999 Gilbert became the first fullReserve Components Personnel Administration time USPHS Commissioned Corps PsycholoCenter (RCPAC) in St. Louis Missouri, as a gist assigned to the Immigration and NaturaliTOPSTAR selectee where he and as a research zation Service (INS) Division of Immigration psychologist guiding the Operational Tests and Evaluation Agency’s (OTEA) human factors evalHealth Care. The position located at the INS uation team in the planning and application of psydetention center in El Centro, California had as chological and aspects crew performance for each primary duties the provision of mental health developing Field Artillery system. service to nearly 600 detainees from over 80 nations and speaking over 30 different lanDr. Sanders worked extensively in forensic psyguages. chology including at the Federal Correctional Institution in El Reno, Oklahoma where he was (Dr. Sanders Honored, continued next page)
APA Honors Long-Time ABMP Board Member and Medical Psychologist Dr. Gilbert O. Sanders
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(Dr. Sanders Honored cont’.d from previous page) Dr. Sanders was appointed as the Western Region Behavioral Medicine consultant for the INS for the 13 state Western Region. In 1999 the average number of detainees on psychotropic medications averaged 78 persons per day. By December of 2001 that number had been reduced to an average number of 13 persons per day. This was accomplished while the average number of detainee in the camp remained near 600 per day. Dr. Sanders was selected by the Surgeon General of the United States to serve as the ViceChairperson for the Scientists' Professional Advisory Committee. Dr. Sanders served on the APA Division 18’s (Psychologists in Public Service) task force on Domestic Violence which was the forerunner to APA’s task force and aided in the development of federal legislation to protect domestic violence and develop prevention programs. He served as Chair of the Criminal Justice Section of Division 18. He was selected as the Federal Advocacy Coordinator for Division 55 ( the American Society for the Advancement of Pharmacotherapy). During his service with the USPHS he was awarded a US Public Health Service Citation, the USPHS Achievement Medal and two US Public Health Unit Citations. In 2001 Gilbert retired from the US Public Health Service but immediately embarked on a civil service career. He was the first psychologist assigned to the US Immigration Service. At El Centro, he was confronted with detainees who were problems to the Department of Immigration. He found that 40% of the detainees had been prescribed psychotropic medication with no psychological interventions being offered. He revamped the diagnostic mental evaluations program and treatments and in one year reduced psychotropic medications use for this population to less than 10% a cost savings of $500,000. For this accomplishment he was rewarded with the abolishment of his position when the senior psychiatrist of The Division of Immigration Health Services learned of this. Dr. Sanders returned to private practice in Oklahoma City where he began building a successful practice that included many returning veterans from Iraq and Afghanistan with PTSD and having trouble readjusting to civil life and their marriages.
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Dr. Sanders was the first psychologist assigned to the US Army Medical Clinic at Ansbach/ Katterbach, Germany. He was given hospital staff privileges at the US Army Hospital at Wurzburg and established psychologists as an integral part of the mental health delivery system. This use of psychologists as consultants on psychotropic medications as part of the Army healthcare team was a breakthrough for psychology based on the respect Dr. Sanders earned for psychology. Dr. Sanders was an Occupational Health Psychologist and Chief of Organizational Consulting where he was a behavioral trouble-shooter at Robins Air Force Base in Georgia where he introduced psychological programs that reduced the attempted suicide rate by 50%! Dr. Sanders has been recognized as a leader in the psychology practitioner movement and was elected President –elect of the American Society for the Advancement of Pharmacotherapy, Division 55. He has served as Treasurer of APA Division 18, and Treasurer of the American Board of Medical Psychology. Dr. Sanders recently retired from his position as Internal Behavioral Health Consultant (contractor) with the 72nd Medical Group, Tinker AFB, OK. In summary, Dr. Gilbert O. Sanders has been on the cutting edge for the advancement of the professional practice of psychology for services to the public both as private citizen and as a career public servant throughout his lifetime. He has developed psychological services in hospitals, military bases and operations, in private practice, and has been involved in practitioner advocacy associations that have established standards and opportunities for psychologists in both the private and public sectors. No profession practice project was too large or too small to merit his full attention and effort regardless of the personal or family expense. His loving and dutiful wife, Lidia, has supported him and his career as psychologist throughout and deserves the appreciation of the profession of psychology.
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HEALTH AND SCIENCE
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medical model itself — that could open additional doors for medical psychology — share a common element:
Emergence and Change: Shifting Change. Perspectives in Healthcare This issue’s “Health and SciBy Jeffrey D. Cole, PhD, FPPR, ence” column revisits a few of FICPP, ABMP these articles in the context of AMP has been developing a new this overarching theme of Academy of Medical Psychology change. Facebook page over the last year or so. It has gotten a lot of hits. Over 1000 new visitors in that time. There, and on our organizational Listserv we post many articles with accompanying commentary and elaboration on those articles, from a medical psychological perspective, by our ex-
Some of the changes have to do with shifts in our perspective on essential components in healing. These shifts in perspective have occurred both in domains we think of as conventionally “psychological” and those we think of as conventionally “medical” or psychiatric doperts. Some of the articles and mains. In psychiatric medicine commentary posted on our Face- emergent data putting the role of book page have “reached” over serotonin, in the treatment of de600 Facebook users. pression in question was presented in the article, "Marketing the While these articles and commyth of serotonin, the ‘happy mentary run the gamut of ideas pertinent to medical psychology, chemical'" (The Globe and Mail, May, 17 2015). The author, Adrithere is an emergent theme of late. Articles having to do with ana Barton, describes the oftchanges in our understanding of cited idea that low serotonin levthe essential healing mechanisms els in the synapse is a singular in both psychological and medi- cause of depression as misleadcal intervention, new, and unex- ing. This low-serotonin idea has pected findings in medicine with been wound into marketing of potential ramifications for medi- selective serotonin reuptake incal psychology, and tremors indi- hibitors (SSRI's) like Prozac, cating shifts in perspective in the Paxil and Zoloft since their appearance on the market. Howev-
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er, this conjecture has not been born-out by the evidence. From the article: "....the truth is, depression is not a serotonin deficiency. The idea that depression is caused by low serotonin levels is based on flimsy evidence dating to the 1950s. Pharmaceutical companies promoted the low serotonin story to sell Prozac and related antidepressants. They marketed a myth...." (end quote) Depression is a complex disorder with multiple factors -- developmental, relational, situational and learning as well as biological -contributing to its etiology. Our current understanding is that the serotonin piece is probably as much effect (dependent or determined) as cause (independent or determining) variable, but can have reciprocal effects. "For example, [from the article] severe depression is a side effect of interferon, a drug prescribed to spur the immune system in patients with skin cancer and Hepatitis C. Studies have shown that preventive treatment with SSRIs greatly reduces the risk of depression in patients on interferon. Based on these findings, “clearly the serotonin drugs have indirect (continued on page 13)
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SPECIALISTS IN MEDICAL PSYCHOLOGY: DR. ROBINSON AND DR. HAMMER
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observing the medicalization of pain services and the shift from more rehabilitative to interventional practice. When Oxycontin was introduced twenty years ago and opioid analgesia F. CAL ROBINSON, Psy.D., MSCP was made available for all patients and not just cancer patients, ABMP the belief was that pain would finally be obliterated. Instead, Dr. Robinson is a medical psycholo- as the cover of the most recent Time magazine of June 15, 2015 notes “The Price of Relief….Why America Can’t Kick gist with an extensive career in Its Painkiller Problem” reflects the serious public heath crises pain management and pain associated with the misuse and abuse of chronic opioid theramedicine. His early private py. What better evidence of why medical psychology is repractice in Indiana centered on the assessment and treatment of behav- quired to assist pain patients in finding less risky approaches in gaining improved skills for living with pain rather than just ioral medicine disorders. In addiinvesting in medications that may even complicate life with tion, while there, he was clinical addiction. Time focuses on how Opana one of the long acting director and co-owner of the Spine opiate formulations post OxyContin that is abused even in & Rehabilitation Institute. He was recruited in 2001 to the Elliot Health System and hospital in Manchester, New Hamp- rural Indiana where it is being crushed and injected now creating a catastrophic rise in HIV due to sharing needles for injectshire as clinical director of their interdisciplinary pain program. He led the organization to obtain full accreditation with ing accommodation from CARF, the Commission on AccreditaJOSEPH HAMMER LCSW MSW PhD ABMP tion of Rehabilitation Facilities for the Interdisciplinary Pain Dr. Hammer is a new diplomate of the ABMP. A graduate of Program. While in New England, he was active in the New England Pain Association (NEPA) the regional affiliate socie- the City College of New York in psychology and pre-med with honors in 1973, with a masters degree in social work ty of the American Pain Society. He became the state representative for New Hampshire, then Vice-President and eventu- from Hunter College in 1975, Dr. Hammer began his work as ally President of NEPA for the 2005-2006 year. During that a clinical social worker at the Jewish Child Care Association time frame, he was also the President of the state pain initiawhere he provided individual and family therapy. He went on tive representing New Hampshire, funded by the American to attend the psychoanalytic training program at the National Cancer Society. Psychological Association for Psychoanalysis in the New He was recruited in 2006 to the Marshfield Clinic in Wiscon- York City and subsequently sin as pain psychologist for the western division. He accepted enrolled in the Fielding Gradua one-year contract with the Department of Defense at Elmen- ate University program for clinical psychologists, where he dorf Hospital in Anchorage, Alaska as the Behavioral Health Consultant in 2010. He was subsequently recruited to become completed the clinical psythe director of Chronic Pain and Addiction at the Yale affiliat- chologist curriculum in 1983. ed psychiatric hospital, Silver Hill Hospital, in Connecticut. Two years later he graduated Seeing the opportunity to be closer to his daughter and grand- from the psychoanalytic trainchildren who lived in Oakdale, Minnesota, he rejoined the pain ing program with certification management program at Marshfield Clinic in 2011 as pain as a psychoanalyst and compsychologist for the western division. pleted the examination to be a New York State Licensed Psychologist. His most recent publication was feature article for the Carlat Psychiatry Report (November 2012), “Chronic Pain, ComorDr. Hammer has been in full-time private practice since 1985, bidity and Treatment Complexity.” His clinical interests center providing individual, couples, and family therapy utilizing a on the theory and practice of Acceptance and Commitment variety of treatment approaches. He receives most of his referTherapy (ACT) especially for chronic pain, suffering, abuse rals from primary care physicians whose patients require a and affective disorders. He is pursuing Board Certification in complex regimen of medications, and this has sparked his inMedical Psychology from the American Board of Medical terest in expanding his knowledge of medication management Psychology at this time. with a view toward prescribing independently. His daughter is now a PhD student at St. Louis University and In 2011, he entered the St. Lucas College of Medicine proson is a geologist studying at the University of Alaskagram and completed all the courses necessary to sit for the Fairbanks. Dr. Robinson is also a classically trained pianist and singer especially at his church. His interests include mu- U.S. Licensing Medical Examination. About eight month ago, he read an article in Psychologist about the American Board of sic, scuba diving, theology, social justice and antiques. He joined the Center for Pain Management at Heartland Health in Medical Psychologists that described psychologists’ progress St. Joseph, Missouri in May 2014. He is pursuing board certi- in being awarded prescription-writing privileges in several states. This article inspired Dr. Hammer to apply immediately fication with the American Board of Medical Psychology in March 2015. for membership in the ABMP to fulfill his desire to connect with his colleagues who share his interest. I have been a pain psychologist for twenty five years
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What If: Looking to Nature Rory Fleming Richardson, Ph.D., ABMP, TEP One of the rarest qualities in science and technology has been the maintenance of “humility”. Periodically, throughout time, some of our greatest scientists and thinkers, have warned of the risks of some of the technology that we have created or would seek to create. When things do go wrong, others dismiss the calamities as the “cost of advancement”. With the current understanding of the dynamic fields, and the natural process of the earth, we are now faced with a forboding question. . . “What if . . .”. Let us imagine that the earth and cosmos is in harmony in a complex dance. As the earth goes through it’s cycles of warming and cooling, the magnetosphere which protects the earth from the solar and cosmic radiation shifts, and changes to protect and nurture the process of healing. Volcanoes periodically erupt, providing fresh deep earth minerals while also providing cooling. As the earth is increasingly shielded from the solar and cosmic radiation, the activity of the volcanos reduce allowing for increased radiant energy to get through and nurture growth of the things on the earth. What if the changes in the gravitational fields and the magnetosphere interact with the ferrous materials in the brains of the animals, creating a sense of homing to safer locations? What if, in the
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electromagnetic silence of the primitive, non-technological world, animals developed a greater sensitivity to ebbs and flows of the earth and the cosmos, thus living in better harmony During the ancient times, prior to the construction of “time” measured by clocks with hours, minutes and seconds, we had a sensitivity to the seasons of growing and harvest. The interaction with earth was a part of life. We sought to learn and develop knowledge to better survive and function. Today, the motives have changed from surviving and living in harmony with the earth to controlling and changing it, and the very essence of reality, through our technology. Even when great scientists and thinkers, such as Einstein, Tesla and Hawkins, warn of potential disasters, these cautions are dismissed.
tion, and other side effects. Animals who depend on the ferrous elements in their brains have increasingly found themselves thrown off course, lost, or beached. There has been evidence suggesting that even our magnetosphere may be affected by the activities of projects like CERN’s Large Hadron Collider. Evidence of nonthermal damage has been presented supporting that Electromagnetic Frequencies are impacting human health and function. We have even designed weapons, using The question is two-fold. First, what have we lost in moving so far electromagnetic radiation, to wage away from being in tune with the wars and control people. energy, flow, and process of naWe have moved so far from listenture? Second, have we forsaken our duties as stewards of this plan- ing to the flow of the invisible language of the earth, that we continet and the life on it? ue to create newer and better ways Thanks to the work of Dr. Michael to alter nature and, potentially, Persinger at Laurentian University lead to our own demise. in Sudbury, Ontario, we know that Perhaps it is time that we considered the broad sweeping ramificathe changes in electromagnetic tion of our advancements and find stimulation of the temporal lobe more harmonious ways of living produces spiritual experiences. The use of the Transcranial Elec- together on this small planet. tromagnetic Stimulator can, in some cases, evoke faintness, seizures, transient cognitive dysfunc-
(
VOL 4, ISSUE 2
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[
BOOK REVIEW Review of: ANATOMY OF AN EPIDEMIC: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (2010) By Robert Whitaker
Reviewed by: Susana A. Galle, Ph.D., M.S.C.P., A.B.M.P., C.T.N., C.C.N., C.C.H., R.Y.T. Science Editor, Archives of Medical Psychology Director, The Body-Mind Center Washington, DC Medical/Prescribing Psychologist, Albuquerque, NM ANATOMY OF AN EPIDEMIC: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (2010), by Robert Whitaker (author of Mad in A merica), Broadway Books (Random House), New York, NY. This book documents a troubling epidemic: long-term disability due to mental illness in America. It won the 2010 award for best investigative journalism. Whitaker traces the explosion of mental illness to the proliferation of medicine's "magic bullets," i.e., pharmaceuticals. He skillfully discusses the "at best ambivalent" long-term outcomes of psychotropic drugs. He also links childhood psychiatric diagnoses and treatments to an increase in lifelong mental disability. Whitaker contrasts the abundance of diagnostic labels and pills with the dearth of psychosocial treatments addressing a patient's individuality. His heart-rendering interviews illustrate transformation in the lives of individuals who broke out of the mold and pursued non-pharmacological options. Among the medicated ones, those who fared best benefited from drugs up to a certain point, endured side effects, then weaned themselves-- often "AMA" (Against Medical Advice). They triumphed against the standard of care "consensus" while overcoming incapacitating effects. Today they lead full lives. Those who remained on medications wistfully look back on what could have been. A common thread in the less fortunate group is the wish someone had listened and understood their problems in childhood or adolescence. That means, had good psychotherapy been available to them during their formative years. The writer offers poignant case materials to judge the merits and hazards of open-ended, poly-pharmacy for mental/ emotional problems. In reviewing drug research, Whitaker uncovers the following factors: design flaws, hidden biases in the reported results, poor follow-up data, and financial collusion implicating Big Pharma along with prestigious academic psychiatrists, and national organizations such as NIMH and NAMI. On the other hand, his crusade for truth takes Whitaker to "alternative" treatment sites in Europe and the US, which combine the following resources and services: (1) psychodynamic and family therapy, (2) an accepting therapeutic community, (3) exercise/activity programs, and (continued next page)
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(Book Review of “Anatomy of an Epidemic” continued from previous page)
them -- vary in patients with the same diagnosis.
than first generation ones, let alone carrying a heightened risk of metabolic syndrome. Immunological complications are common to certain antipsychotics and mood stabilizers. Neurotransmitter levels -- we can test
Relationship - Acceptance -
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cuss therapeutic nutrition. The disillusionment regarding psychopharmacology coexists with the explosion of The most eloquent, evidence-based knowledge in molecular biology, piece is Whitaker's closing story creating molecular nutrition laboratoabout a group of psychiatrists in Lap(4) the sparse, judicious use of prery assessment and nutrigenomics. land (Finland) whose observations scription drugs. The novel field of metabolic nutriand research showed that, "over the Their astonishingly good results are long term," psychotic and depressed tion illuminates pathways that can be normalized via diet and nutrition inat odds with the paucity of funding patients did better when "off drugs," terventions, producing mental/ for those programs... within a caring therapeutic commubehavioral improvements. Current It is timely to revisit Whitaker's book nity. In Great Britain, 20% of family studies of mental disorders point to physicians give depressed patients a in relation to the Rx movement resystemic factors such as inflamma"prescription" for exercise. Those gaining momentum with last year's tion, oxidative stress, mitochondrial approaches focusing on the patient's passage of a law granting prescripdysfunction, the mind/brain/gut con"health" rather than their "illness" tion privileges to properly trained nection, nutrient deficits, and envialso reduce the cost of mental illness psychologists in Illinois. We now ronmental toxic exposure as alternaknow far more about psychopharma- to the community. tive avenues to understand the physicology, its virtues and limitations, For those of us who began a mental opathology of mental conditions. than when the DOD project was health career in the pre-Prozac, pre- Some genetic polymorphisms are launched over 20 years ago. In addi- DSM era, psychotherapy and lifealso being addressed with micronution to its benefits for some patients, style recommendations were at the trients (e.g. 677C affecting the folate we continue to learn about the dark core of our work. The methods utiside of psychopharmacology, name- lized were deemed compatible with -converting enzyme MTHFR) to enly, inflated profits for certain psychi- each client's problems, preferences, hance pharmacotherapy outcomes. Nutrigenomics thus gives us invaluaatrists and iatrogenia for many paand circumstances. Drugs were not ble tools to rebuild health and practients. Whitaker's epilogue on behalf first-line treatment but an adjunct, tice prevention. However, this apof "We, the people" sends the mesoften a temporary measure until the proach does not suffice to treat "the sage to overcome a societal patient developed a therapeutic alli"delusion" that once led to label psy- ance and engaged in the psychothera- whole person." On balance, Whitaker's compelling narrative supchopharmacology a "revolutionary peutic process. For a few, this may ports an integrative model of menadvance in the treatment of mental take community re-adaptation and tal health that accesses various disorders." the use of behavioral health stratepsychotherapies, diet/molecular Still unknown is the precise biology gies over a long period of time. nutrition, exercise, and community Through the analysis of mainstream of mental disorders, assuming one resources. Prn we may also carry research reports versus those of nonexists. The monoamine theories of on safely and effectively with our conventional groups in Europe, an depression are under question. The "psychological model of prescribteratogenic effects of antidepressants unusual therapeutic community for ing" drugs as we earn prescriptive youths in Alaska, and anecdotal stoare becoming manifest. Pediatric authority throughout the country. cardiologists are seriously cautioning ries, Whitaker reaffirms classic This book is an indispensable reabout the use of stimulants with chil- premises in treating mental condisource for medical psychologists tions, regardless of severity. In my dren and adults in certain populaown summary words, those premises and the general public. tions. The atypical antipsychotics have not shown greater effectiveness are: Vision - Empathy A RAVE review so far. Whitaker falls short as he mentions the virtues of diet but does not dis-
VOL 4, ISSUE 2
AUGUST 2015
effects on the immuneinflammatory system,” McIntyre said" (end quote).
a hegemony in psychotherapy pushing relational approaches (psychodynamic, psychoanalytic and interpersonal) into relative disfavor.
The immune-inflammatory system is implicated in the translation of many psychological-to-
As the article indicates, this phenomenon of declining effectiveness is likely associated with the
(continued from pg. 8)
Page 13
“Turning fake pills into real treatments (placebo)”. Dr. Morris commentary on the article: “Many studies, including about antidepressants, show that a Drs. attention and encouragement are about as powerful as the chemical substance (which, in the case of
biological (stress) health problems placebo effect. New treatments -- antidepressants have not been and has reciprocal effects. Medi- that show some positive effect -- shown, scientifically o have cal psychologists are very familiar generate excitement which trans- much positive effect for two thirds of those taking them, and with this dynamic and of psycho- lates into the treatment relationlogical and behavioral, as well as ship and improved treatment out- only a little better than placebo for those one third that do recombined (with medical) intercomes. ventions toward addressing these The irony, is that some very effec- spond. We've got to get the price of these psych meds down and in problems. tive treatments which fell relative- line with their ‘scientific valMeanwhile, psychotherapy rely out of vogue (as described ue’ (they can cost up to $600 per search shows us that a psychoabove) because they didn't fit the month). Patients have been duped therapeutic approach – Cognitive- CBT worldview have essential by ‘marketing plans’, and many Behavior Therapy (CBT) – con- elements that make placebo such of we doctors of psychology, psyventionally accepted in academic an important force: the power of chiatry, and general medicine circles (if not amongst practition- relationship. While not explicated have mindlessly gone along. See ers) as a gold standard of treatin the article, it is likely that as we the National Psychology Practiment, for a number of disorders, continue to increase our undertioner's association publication is proving to be less effective as standing of these essential relaTruthInDrugs published years ago the modality ages and excitement tional factors in healing that some (National Alliance of Professional around it — as a “new treatment” of these relatively neglected treat- Psychology Providers, — fades. This, in fact is a phements will enjoy a renaissance, www.nappp.org).” nomenon seen amongst many new even as we find new ways to aptreatments in both medicine and ply what we are learning through These changes in our understanding of essential mechanisms in the psychology. This finding was placebo studies to medicine and healing process– including the presented by Oliver Burkeman in psychology. placebo effect – bode well for The Guardian, Health and Well Placebo was also the theme of an Being section, "Why CBT is fall- article Dr. Morris briefly re(continued on page 18) ing out of favor" . CBT once held viewed for our facebook page
THE AMP VOLUME 4 ISSUE 2
AUGUST 2015
Page 14
EMERGING PRACTICE TRENDS The Changes in the Healthcare System By; Jerry Morris, PsyD, MBA, MsPharm, ABMP, ABPP, ABBHP, NCSP, CCM Since the passage of the Affordable Care Act (ACA) in 2010 our healthcare system has been changing rapidly. Already, we have moved to more uniform benefit plan requirements so that competing insurers have a much harder time confusing consumers with complex plans that appear more affordable but are in reality much less coverage than other plans to which they are being compared. Of course critics counter with the idea that the young and healthy want to purchase cheap and catastrophic coverage to take advantage of their blessed situation. Secondly, “cherry picking”, or denying coverage to the sickest and focusing a plans admitted consumers on the young and healthy has become illegal. Both the infirm, elderly, and young and healthy benefit from this component of healthcare in America. No longer does illness devastate families and ruin inheritances of the next generation or put unnecessary burden on the nation’s hospitals and clinics and practitioners or the public (tax supported; we all pay) health systems. Further, there are early and more affordable interventions and care achieved by outlawing “cherry picking”. Third, electronic health records (EHRs) have become a requirement in most payers to be reimbursed, and soon all panels, payer
sources, and Government programs are going to require these systems as the healthcare system evolves and implements the ACA. Still, the real reasons for EHRs are just starting to be implemented. EHRs allow data mining and use of massive healthcare interventions and records to be collated and used to increase healthcare efficiency, effectiveness, fraud and abuse protection, curtailment of expensive over use of diagnostics rather than sharing them with easy access to all providers, coordination and collaboration among multi-disciplinary and multi-specialty providers (teamwork), and most importantly and for the first time in US history-the supervision of doctors and programs. EHRs have already created efficiency and efficacy gains by allowing supervising bodies to: 1. Monitor and rate doctors and programs and facilities so that the coming competition for contracts annually with Accountable Care Organizations (ACOs; the new meta insurance companies with more risk, and reward opportunities), and this for the first time introduces Capitalism into the healthcare system where doctors, facilities, and programs will have to compete on quality of product, price, and acceptability of product (the ACA required programs and facilities to submit “patient satisfaction data” under the new “Client Centered Approach to Healthcare” required by HEW and accrediting bodies. Fourth, we are moving toward “Universal Coverage”! The ACA is set up to “get coverage to (continued on next page)
THE AMP VOLUME 4 ISSUE 2
(Health Trends: ACA cont.’d from previous page) as many Americans as possible”. The idea is not just humanitarian and value based, but economic. The science is clear! If we give people coverage they will demand healthcare! This demand will lead to early diagnoses and treatment of illnesses when they can be more effectively, cost efficiently, and easily treated. This saves millions in “late disease cycle” interventions (which are the most expensive). Most health economists report that even though the Republicans have consistently opposed “Universal Healthcare Coverage” that the ACA will move us increasingly toward the point that that is accomplished because of obvious benefits and savings and because we increasingly approximate that end anyhow!
AUGUST 2015
lions by this component of the ACA. Pharmacies are routinely empowered now to refuse to fill ineffective doctor prescriptions, doctor prescriptions that use the highest priced medication when a lower priced one has proven as effective, and pharmacists in most states can give flu shots and vaccines without paying a physician middleman/woman. Hospitals are routinely denied payment for treating patient inpatient (expensive) when the science shows that outpatient techniques and interventions are safe and effective. Physicians and prescribers can no longer prescribe treatments that are patient demanded but are ineffective (this really started with things like antibiotics for the flu, but is beginning to be extended to pain pills, sedatives, and other drugs where more effective alternatives have become available and known). This trend, due to the increased supervision available in the new healthcare system is likely to increase.
Fifth, we are now refusing to pay for colloquial, traditional, and doctor preference interventions and techniques which are not proven effective by scientific validation. Sixth, the ACA will take away We have already saved mil-
Page 15
the exclusivity of the Managed Care Empaneled Doctors who have a closed system, insulated from competition in many ways, and a semi-guaranteed flow of patients. In the new and emerging healthcare system, the ACOs will rotate contracts for hospitals and primary care systems every 12 months, or at will, based on doctor or program or facility batting average! Thus, you will have to focus on being good at what you do, and helping your program and facility to be good at what they do (or, like other industries in capitalistic systemslose your contract)! I laughed when some called O’Bama Care (the ACA) “socialism”! It moves us from a semisocialistic (old) healthcare system to a very “free market and price and quality competitive system” (the core elements of capitalism). That’s what scares us doctors and facilities. We’ve never had to compete in a really capitalistic system. We’ve worked in a system where the Government and government (continued on page 16)
VOL 4, ISSUE 2
(Health Care: ACA continued from pg. 15 ) guarantees and fee systems determined how the system evolved! Now it will be price, quality of product, competition (fierce), and consumer satisfaction (consumers voting with their feet as Milton Friedman used to say). Seventh, starting January 1, 2016 HEW has now promulgated rules to take Medicare from a “fee per procedure” to a “per patient per month premium paid to the most competitive contractor”. Most insurers follow and trigger off of Medicare (and most health economists believe that Medicare will evolve into the nations “Single Payer System”. If you don’t participate in Medicare, my advice is-“Do so immediately”! We will all eventually, as the ACA evolves, be paid salaries with money flowing through ACOs (meta-insurance systems with much financial risk and many will fail; they will have to be cut throat and hard managers -the large insurers are currently purchasing and merging with the smaller ones to become big enough and well capitalized enough to become ACOs) as salaried doctors and evaluated on
AUGUST 2015
unit cost, consumer satisfaction, and diagnostic and programmatic outcome data to keep our jobs! Already, most primary care clinics and general physicians in America are being purchased or merged with hospital and healthcare systems. Psychologists who aren’t employed by or closely affiliated with Primary Care Clinics (increasingly owned and operated by hospitals and healthcare systems rather than independent doctors) had better immediately get involved with these entities! All monies will eventually flow through them! Eighth, prevention will become an important and funded service in the future of the US healthcare system. Starting in January prevention will be a supported service. Lifestyle, Medical, and Health psychologists or Clinical Psychologists with these skill sets will be increasingly in demand. HEW has identified eight target diseases that are breaking the healthcare bank and they will be used for initial ACO contracting and outcomes evaluation. HEW has the ACO based right to add other chronic diagnostic groups to this list. You should be getting expertise in treating these complex diseas-
Page 16
es (such as Obesity, CHD, Hypertension, Diabetes-especially juvenile onset with many emotional regulation components, Substance Abuse and Mental Illness, etc.)! Ninth, Primary Care Centers and hospitals will be paid differently and this will shrink hospital beds in America by as much as 50% in the next 10 years. Emergency rooms will increasingly restrict care to a much smaller group of situations, diagnoses, and patients for which they can be paid and which don’t negatively effect the maintaining their contract status. Similarly, hospitals will do the same with their very contracting opportunities and life depending on restricting admissions! This cost competition will force ERs, Hospitals, and Primary Care Centers to “dumb down” and “water down” their staffs (no disrespect meant). They will hire (as will psychologists, and psychologists need mid-level and bachelors level assistant standards and guidelines for role definition and supervision and use) mid-level, bachelors level, associate degree and certificate personnel much more often than (continued next page)
VOL 4, ISSUE 2
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Page 17
(Health Care: ACA continued
quickly culling physicians, psy-
lution, or Medicare-Public Sector
from previous page )
chologists, and mid-level provid-
Solution!)!
more physicians and psycholo-
ers in the system that: 1. Have
Position yourselves! The surviv-
gists. This trend started several
low productivity and increase our
ing systems will need specialty
years ago with many nurses be-
unit price, 2. Are unsupervisable
psychologists who are able to
ing AA (2 year degree nurses),
or uncoachable. 3. Are not flexi-
recruit, train, and supervise mid-
and states starting to license
ble, willing to learn and adapt,
level behavioral health and bach-
bachelors level behavioral spe-
and have a good attitude toward
elor’s level, and nurse educator
cialists, substance abuse coun-
change, 4. Are not good at gain-
staff. Systems won’t survive that
selors, and thousands of 18
ing high levels of outcomes with
just focus on high dollar hospital
month graduate program (called
target diagnostic groups, 5. Can’t
and medical care only or as their
fast track) LCSWs and Masers
document well to help systems
single core mission! They are
Counselors. Doctors will have to
prove their success and keep
not where you will want to work
have much greater supervision,
national certifications, 6. Who
(hitch your wagon). Find, life-
team leadership, and case man-
don’t embrace integrated care
style medicine and outpatient
agement skills in the new system
and team treatment.
specializing healthcare systems
and I recommend you start get-
I have been telling you about this
with appreciation for how much
ting these skills on your resume!
for over 5 years and it is quickly
behavioral experts can add to
Tenth, demand will rise! There
unfolding. If you think your pri-
contracting ability and the bot-
will be more jobs in psychology
vate practice is safe because
tom line! They are where the fu-
than ever. Clearly, more people
you are on panels and get regu-
ture lies!
will have coverage under the
lar referrals look at the insur-
ACA, and more systems will want
ance company mergers and fold-
non-medical but cost saving pro-
ing that is occurring rapidly.
grams and interventions. Still,
There were 22 major insurers in
the old slow paced, unitary skill
the US last year and by next year
(psychotherapy), and unsuper-
there will be less than 10, and
vised and independent (your own
the year after that less than 5.
boss) jobs will dwindle in psy-
Do you think the design is push-
chology and medicine under the
ing us toward a “single payer
new system. We are already
system” (either by one or two surviving ACOs-private sector so-
VOL 4, ISSUE 2
(Health and Science: Change, cont.’d from pg. 13 )
AUGUST 2015
Page 18
after assessing international evidence, “psychological intervene tions have a better incremental cost -effectiveness ratio and greater profitability in the long term.”
scribing paradigm shifts in modern medicine.
3:33PM EDT) -- describes health ship positions in Canada. to cost advantages of psychotherapy when compared to medication Psychological and psychiatric along multiple dimensions. health, illness and treatment were not the only focus of change in our From the article: facebook reviews. Another article "“Compared with pharmacological linked to our AMP Facebook page treatment,” the study concluded, was a review of three books de-
As Gatham notes, LeFanu also eschews social medicine, saying the statistics relating lifestyle changes (eg, cholesterol intake) to health are not as useful as once expected. Medical psychologists should
evolution of practicing psychologists including medical psychologists. We know that, at least one important mechanism in the place- A key reason, the report suggests, bo effect is relational processes. is that “the benefits of psychotherPeople’s relationship and attachapy last longer after the end of ment histories associated with treatment than those of medicahealth sickness and healing likely tion,” making it better protection have a role, along with condition- against relapse, which is common ing processes in general in our re- for depression and anxiety. sponse to treatments of all sorts. From the article: “This is now a Consistent with this nascent shift political question,” says Michael back towards relational treatments Sheehan, a former Quebec Superilike psychotherapy was an imor Court judge who lost his son to portant article and strong statement suicide and is now a spokesperson from the Quebec health institute, for the Quebec-based Coalition for The Institut National d’Excellence Access to Psychotherapy. “We are en Santé et en Services Sociaux simply not giving state-of-the-art (INESSS) on the health benefits of care – what else is there to psychotherapy versus medication. say?” (end quote) (The Globe and Mail) "Quebec The Academy of Medical Psycholhealth institute calls for psychoogy (AMP) is a USA-based profestherapy as front-line treatment sional organization but has internachoice" (ERIN ANDERSSEN up- tional membership including exdated Thursday, Jun. 25, 2015 perts and professionals in leader-
Roger Gatham in, "Surreal Science How Medicine Is Unlocking the Evolution of Disease, Accident by Accident", (The Austin Chronicle March 02, 2001), reviews Plague Time: How Stealth Infections Cause Cancers, Heart Disease, and Other Deadly Ailments by Paul W. Ewald, Cancer the Evolutionary Legacy, by Mel Greaves and The Rise and Fall of Modern Medicine by James Le Fanu -- with the theme of dissatisfaction and disgruntlement among modern medical chroniclers about trends in the meta-science of medicine which — for all our technological advance and sophistication — in some ways disappoint with regards to outcomes of overall better quality of life when compared to major advances, eg, treatment of infectious illness with antibiotics and other such quantum advances seen in the early and mid 20th century.
(continued on next page )
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(“Health & Science” continued from previous page) Medical psychologists should beware because none of the authors that the article author is reviewing is giving serious consideration to psychology, psychological factors and psychological intervention. Without inclusion of this encompassing system -- which affects all other medical systems directly through stress and recovery mechanisms and indirectly through a whole network of personal selfcare choices, treatment relationships and so forth -- a full appreciation of the dynamic of health and illness cannot be obtained. An interesting finding in empirical medicine, that was a surprise to the medical community also has implications for medical psychology due to the direct role of psychological processes (e.g., psychological stress in the immune system). In an article in Medicalexpress.com -- "Missing link found between brain, immune system" (June 1, 2015) — reviewed
on our facebook page, the presence of previously unidentified lymphatic channels connecting the CNS to the immune system have been imaged and described. Though not stated in the article, this finding has potential to increases our understanding of the relationship between psychological stress and illness
Page 19
‘No organ is an island,’ he likes to say. And if X talks to Y, then Y should talk back to X. …. insulin acts on bone, and bone should help regulate insulin. Testosterone has an influence on bone mass, and the skeleton should act on the testes. And just as the brain talks to the skeleton, he says, ‘I always knew that bone should help regulate the brain. I just didn’t know how.’” (end quote).
Another reviewed article which included a body-brain surprise describes how the skeleton deserves a possible relocation to our endocrine system and how it exerts an effect on our brains, mood and behavior via the hormone osteocalcin . From “Do Our Brains Influence Our Minds” (Amanda Schaffer, The New Yorker, November 1, 2013) states:
As AMP keeps up with societal trends in communication we are also out front in tracking and incorporating new findings on the mind-body front that have potential for con“Karsenty [a researcher of this phetributing to more effective and innomenon] also believes that we know tegrative treatments in the practice enough now to recognize that the of healthcare. body is far more networked and inter- [Clink link below to be taken to connected than most people think. our AMP Facebook page.]
Click Link Below to be Taken to Our AMP Facebook page:
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THE AMP VOLUME 4 ISSUE 2
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“Greetings,” and Services Offered, From Our Highly Trained and Credentialed Membership
~*~ Dear AMP members and ABMP diplomatEs: If you would like to have a copy of your business card included on the page please scan your card and email the scan to me, Dr. Jeff Cole, Editor “The AMP” at:
[email protected] and, your card will be included on our Business Cards page with the next issue of "The AMP"! There is a $20 fee for the service, payable to "Academy of Medical Psychology" deliverable to our Nevada, Missouri corporate office address as shown on our home page. http://www.amphome.org/ Perk!: the $20 fee is waived for all Board members and AMP governance and for editorial staff of our " Archives of Medical Psychology"peerreviewed journal!! Dr. Cole Editor, “The AMP”
THE AMP VOLUME 4 ISSUE 2
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Invitation for Contributions “The AMP” NewsleTTer -- newsletter of the Academy of Medical Psychology (AMP) – invites you to contribute short articles and brief pieces for our upcoming issue! Our theme is the integration of psychological and medical theory and practice and movements within psychology that increase psychology’s role in both mental healthcare and medicine, all falling under the rubric and specialty designation of “Medical Psychology”. Specific topics that past articles have addressed, or that would be welcomed, include but are not limited to the following: *Psychological and behavioral approaches as first-line treatments and in combination with medication and other medical treatments *Behavioral health, placebo phenomena, and psychosomatics in healthcare and mental healthcare *Interdisciplinary practice, e.g., Psychologists as part of — or leaders of — health teams in clinics and institutional medical and mental health settings *Reviews and discussions of scientific and scholarly articles and books supporting medically and psychologically- integrated understanding of psychiatric and medical illnesses, e.g., research into stress and immune response, stress and protective factors (e.g.., relationship and oxytocin phenomena), cardiovascular health, epigenetics *Commentary, on matters associated with relevant to Medical Psychology e.g.,: DSM, and other diagnostic nosologies their uses, abuses and relevance to healthcare; RDoc *Emerging Practice Trends, e.g., Articles on Telehealth and other alternative delivery modalities We have a column specifically dedicated to student writing. “Student” can include any one in the course of his or her formal learning process, e.g., undergrad, grad, post-doctoral or specialty/diplomat training If you would like to sample previous editions of “The AMP” to see what sort of entries are there, here is the link to our newsletter archives: http://www.amphome.org/newsletter.php
VOL 4, ISSUE 2
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The Academy of Medical Psychology received final approval of its trademark and logo of the Archives of Medical Psychology in November 2009. The Board of AMP and ABMP seeks your assistance in the editing and publishing of the Archives of Medical Psychology. The Academy of Medical Psychology was founded as an organization of practitioners for practitioner interests through volunteerism. Service on the Board is an unpaid duty of psychologists dedicated to the advancement of Medical Psychology. Medical Psychology's goal is to enhance access to specialty behavioral health care that is in such short supply that it has been declared an emergency in some states and recognized by military and veterans’ services as a critical shortage. State prisons have been designated as mental health shortage areas by HRSA and prisons in some states are in the hands of federal receivership. Thus, the Academy has a crucial role as practitioner organization in advocating for the health and safety of the public at large and the military and other governmental agencies designed to serve public needs. The advocacy role for public health service must be a primary mission of the Academy. The Archives of Medical Psychology, on the other hand, is a repository of information that can serve this advocacy function of the organization and collect valuable new data for continuing education of members of the Academy. Editing of the Archives must be by people that have the necessary experience in medical psychology and the skills to carry out these functions. Editing also requires electronic communication skills for the actual publication of the Archives. The variety of the skills necessary for publication in the journal are unlikely to be found even in a complete Editor. Members of the Board of the Academy are already assigned specific tasks and duties within the organization and cannot be expected to contribute routinely in the editing and publishing of the Archives. Therefore, the Board has begun a search for members of the Academy to volunteer in the editing and publishing of the Archives and ask your personal support. The Board of AMP invites you to contribute your services to the Archives. We welcome AMP members with prior publishing experience and those with computer expertise who are willing to learn the rudiments of editing and electronic publishing. For further information contact Ward Lawson at
[email protected] .
VOL 4, ISSUE 2
AUGUST 2015
Page 23
Dr. Ward M. Lawson: Editor Call for Manuscripts The Archives of Medical Psychology began its fifth having just released its Winter 2015 issue. The Archives is now accepting submissions for the next issue. We welcome original articles of interest to readers of medical psychology. For information about requirements for submission of articles go to www.amphome.org and click on Journal Archives in the left-hand column or simply type in Archives of Medical Psychology on Google. Editor at
[email protected].
THE AMP VOLUME 4 ISSUE 2
AUGUST 2015
Page 24
AMERICAN BOARD OF MEDICAL PSYCHOLOGY
©
A Psychology Specialty Encompassing Behavioral Healthcare, Psychopharmacology, and Mental Health Treatment in Multi-disciplinary and team Treatment Approaches and Healthcare SEE THE ARCHIVES AT OUR WEBSITE
S E E :
W W W . A M P H O M E . O R G
Four opportunities that involve different designations in Medical Psychology; Medical Psychologist (American Board of Medical Psychology Diplomate). Fellow of the Academy of Medical Psychology. Member of the Academy of Medical Psychology, or Student Member of the Academy of Medical Psychology, is someone interested in the area, but not qualified for diplomate status at this time. Qualifications for each of these AMP Membership categories are described on our website at www.AMPhome.org.
Manuscript submissions: Dr. Ward M. Lawson, Editor, at
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Join the Most Sought After Specialists in the Emerging Era of Integrated Care
Affirmations to Diplomates: Our society is a growing and vibrant specialty representing the highest trained and most relevant psychologists in America to the emerging healthcare system. During the next year, our specialty will appear in The National Psychologist, The Psychology Times, and in various APA Scientific and Professional Journals. We represent specialists and those interested in Medical Psychology across America. We are setting standards in our field and influencing practice standards with governmental agencies. We are becoming recognized by states and practitioner associations. We are developing integrated care and hospital practices, becoming leaders in prevention and lifestyle management, and our specialists are being asked to present at national physician societies and professional workshops. We prescribe complex psychological treatments, recommend and/or prescribe psychotropic medications, treat addictions, and establish treatment and prevention for patients with chronic illness-
You are a member of an important psychological and healthcare specialty! es such as obesity, diabetes, hypertension, asthma, etc.
ACADEMY OF MEDICAL PSYCHOLOGY
The Official Journal
of the American Board of Medical Psychology Academy of Medical Psychology 815 S. Ash, Nevada, MO 64772
E-mail:
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The AMP
AMP’s new journal needs specialty editors and authors. Help us have a great place to keep our specialists aware of emerging practice issues, science, and opportunities. Volunteer! Sign up for the Journal at http://amphome.org/.
ANNOUNCEMENTS FROM YOUR EDITOR Dear membership: existing in a complex consubsumes psychopharmacoltinuum of psychologicalogy in a comprehensive This issue’s theme could be behavioral and physicalmental healthcare framecalled: “Change and biomedical factors. work that also addresses Growth.” In a choppy sea in “the psychological aspects which psychology as an or- In this issue’s “President’s of physical disorders.” Column” Dr. Lawson’s preganized profession is in sents his “Inaugural AdDr. Morris’s Executive Ditransitional waters AMP dress” as President as he rector’s special editorial holds a steady course as the takes the helm from Dr. makes a strong and incisive primary credentialing and Morris who has moved into statement on the importance professional advocacy organization for medical psy- the new Executive Director of our practitioners increasposition of AMP and our ing our role in assessment chologists. Medical psyBoard ABMP. and treatment and decisively chology continues to evolve as the cutting edge integra- In his inaugural President’s taking our key role on integrated treatment teams. tive approach to an emerg- column Dr. Lawson reafing model of integrative firms AMP’s commitment Multiple articles in this ishealthcare that conceptual- to medical psychology as an sue celebrate “change and izes health and illness as integrative specialty that growth.” Enjoy!
Jeffrey D. Cole, PhD, ABMP Email address:
[email protected] Or By US Mail: 1121 Upper Front Street Binghamton, NY 13905
