THE PSYCHOTHERAPY Bulletin Features In This Issue The Role of Psychology and Psychotherapy in the Treatment of the Seriously Mentally Ill Client in the Community Mental Health Center A Developmental Approach to Psychotherapy Supervision of Interns and Postdoctoral Fellows Health Care Reform: An Update The 1994 Mid-Winter Convention Highlights Individual Psychotherapy in Chronic Disease I Documentation Guidelines and Ethical Practice in Psychotherapy APA and Psychologists’ Future in Managed Care Croatian Needs Assessment Project i OFFICIAL PUBLICATION OF DIVISION 29 OF THE VOL. 28.NO. 4 AMERICAN PSYCHOLOGICAL ASSOCIATION Winter 1993Division of Psychotherapy of the American Psychological Association 1994 Officers and Committees OFFICERS, President MEMBERS-AT-LARGE Norman Abeles,Ph,D.1994-1996 epartment of Paychology 129 Peychology Research Bldg. Michigan State University MI488241020 355.8 PAX:517-353-54 Enst Boer, PhD, 1994-19 T. Segall, PhD. 7018. Acadian Taruway ge, LA 70806 Giiee bei FAX: 801-581-5841 Morris Goodman, PhD., 1992-1994 96 Millburn Ave, Ste. 208 Millburn NJ 07041 fice: 201-763 Norine G. Johnson, LOW. Squan President-Elect Stanley R. Graha John Noreross, Ph Dept of Peycholor Ui Office: 717-941 FAX: 717.94 88 Lisa M. Porche-Burks, CSPP-Los Angeles (Oregon Health Services University S181 SW Sam Jackson Park Ra Lisisonto APA Committeeon \ativetoInterdivisional Task jonal Relations in Peychology ur L Kov 359 Wilshire B Los Angeles, CA 9% Ur eai01 o 0 Salt Lake City, Ofc Representatives Employee Benefits Patricia Hannigan-Fesley, Ph 24600 Center Ridge Ra Ste. 420° Wade H. Silverman, Ph.D,1993-1995 1514San Ignacio, Suite 100 Coral Gables, FL 33146 (Ciice: 305-661-7854 FAX: 305-661-6664 Suzanne B. Sobel, PhD. 1953-1995 1680 Highoway ALA, Suite 5 Setellte Beach, FL 7-77-5844 University of Colorado Me 4200 E 9th Avenue Denver, C0 80262 (Office: 308-270-8611 Xx: 308-270-5641 REPRESENTATIVES to APA COUNCIL Donald K. Freedhoim, Ph.D, 1993-1996 ‘Mather Mem Case Western Reserve University ‘Cleveland, OH 4105 Office: 216.368.2841 AX: 216368-4891 Ellen McGrath, Ph.D.1994-1997 380 Glenneyre, fice: 714-497-4333 FAX:714-497-0913 EDITORSOFPUBLICATIONS Peychotherapy Journal Wade H.Siverman, Ph. 1514 San Ignacio, Ste. 100 Coral Gables, FL 33146 Peychotherapy Bulletin Linda F.Campbell, Ph.D. University of Georgia 2 Aderheld Ha Athens, G 30600-7142 (Office: 706542-1812 FAX: 706-542-4130 Continuing Education William Pollack, Ph.D, Chair McClean Hospital Dept. of Psychology & 115 Mil StreetPSYCHOTHERAPY BULLETIN Published by the DIVISION OF PSYCHOTHERAPY AMERICAN PSYCHOLOGICAL ASSOCIATION. 3875N. ddth Street Suite 102 Phoenix, Arizona 85018 (602) 952-8655 EDITOR ‘Linda Campbell, Ph.D. ‘CONTRIBUTING EDITORS Medical Psychology David B. Adams, Ph.D. PSYColumn Mathilda Canter, Ph.D. ‘Washington Scene Patrick DeLeon, PhD. Student Column Laura Meyers Professional Liability Leon VandeCroek, Ph.D. Finance Jack Wiggins, Ph.D. ‘Substance Abuse Harry Wexler, PhD. Gender Issues Gary Brooks, PhD. STAFF Central Office Administrator Pauline Wampler Associate Administrator ‘Norma Files PSYCHOTHERAPY BULLETIN Official Publication of Division 29 ofthe ‘American Peychological Association Volume 28, Number 4 Winter 1993 CONTENTS President's Message Editor's Column... Student Column... Krasner Award Interview Washington Scene .. Medical Psychology ... Feature: TheRole ofPsychology and Psychotherapy in the Treatment of the Seriously ‘Mentally Ill Client in the Community Mental Health Center .. Feature: A Developmental Approach to Psychotherapy Supervision of In- terns and Postdoctoral Fellows Feature: Health Care Reform: An Update... Feature: Individual Psychotherapy in Chronic Disease Feature: Documentation Guidelines and Bthical Practice in Psychotherapy ... Feature: APA and Psychologists! Future in Managed Care .. Feature: Croatian Needs Assessment Project. Professional Liability ‘Substance Abuse Task Force Update...PRESIDENT’S MESSAG Psychotherapy and Health Care Reform Tommy T. Stigall As wildfires swept across south- em California last fall, the politics of health care reform was heating upon Capitol Hill. InlateSeptem- ber, theClinton Administration un- veiled its long-awaited legislative proposal on national television. In October, the plan was “officially delivered” to Congress as another highly publicized media event. In November, a revised Health Secu- rity Act wasintroducedin the 103rd Congress. Political commentators and pun- dits are of the opinion that some form of federal health reform leg- {slation is likely to be enacted by late summer of 1994. But there are at least a half-dozen very serious legislative alternatives to the President's initiative pending in Congress, and the outcome as to final scope and shape of health care reform is far from certain. As House ‘Minority Leader Robert Michael (R-IL) stated in October, the Clinton health care reform bill has been given “a new examination and diagnosis” and the Administration has “now come to Con- gress for a second opinion. ‘The health care reform legislative landscape in- cludes a range of proposals from the Canadian-style “single payer plan” introduced by Rep. Jim McDermott (D-WA) to the far more conservative plan put forward by Sen. Phil Gra- ham (R-TX) that proposes tax credits for RA-like health savingsaccounts. McDermottisa medical doctor and psychiatrist, while Graham is an economist by training. Somewhere to the left of center is the Clinton plan, stressing universal ‘coverage and HMO-style managed care as the delivery system of choice. ‘Other reference points on the legislative spec- trum have been staked out by Sen, John Chats (R-RD, Rep. Jim Cooper (D-TN), and Sen. Don Nickles (R-OK). These bills closer to the political center, would provide increased access to health, care and greater freedom of choice for consum- ers, They also are less far-reaching in imposing, tax increases and government controloverhealth 4 care than either the Clinton or McDermottalternatives. Butonly the Health Security Act and the single-payer bill provide for true universal coverage—a principle the Administration saysitwillnot abandon. ‘There has been strong opposition from the private insurance and small business community to the Clinton plan which adds signifi- cant costs to employer payrolls and limits consumer choiceamong, insurance options. In recent ‘weeks, bigbusinessinterestshave came out against the plan, while biglabor remains supportive. Or- ganized medicine and health care providers are divided in their support or opposition. The increasing burden of ranaged care efor hes some providers thinking that national health ‘care reform may be preferable to slow torture by a thousand cuts from scores of managed care intermediaries and state reform initiatives. Political endorsement of expanded coverageand reining in of health care costs is easy; the real battlein Congress willbe overfinancingofhealth care reform.” Philosophically, the debate will tum on whether to have more orless government control of the system. Pragmatically, the issue will be where to find the money to pay for ex- panded services without bankrupting the sys- tem. Thisis the point at which mental health and psychotherapy benefits are most vulnerable. APAadvocacy efforts havebeen directed toward persuading the Clinton Administration that it makes economic sense to include more generous outpatient psychotherapy benefits in health care reform. These efforts have met with mixed re- sults. Unfortunately, there is still a widespread perception that psychotherapy isa relatively in- nocuous procedure delivered by ancillary pro- viders who do not have much responsibility for the overall care of the patient. There is also the view that, in order to constrain costs itisneces- sary to limit access to mental health care.