Monday, October 12, 2015

“NEW APA POLICY BANS PSYCHOLOGIST PARTICIPATION ….”

The APA State Leadership Conference (SLC):  One of the highlights of my year has always been the annual Practice Directorate/Practice Organization State Leadership Conference (SLC), where Katherine Nordal exposes approximately 550+ state association leaders from around the country to the changes evolving within the nation's health care system, as well as the world of national politics.  One of her subtle reoccurring themes is the importance of the attendees getting to know their local media on a personal basis, in order to educate them about the field of psychology and our collective potential for having a positive impact upon society's most pressing needs.  Dan Ullman, for example, recently shared with us an article from the Star-Heraldgraphically describing the compelling need for quality mental health care throughout the rural areas of Nebraska.  This will undoubtedly be used by the Nebraska Psychological Association in furtherance of their contemplated RxP legislation.  Earlier this year, I was invited by President Lori Butts to participate in the Florida Psychological Association annual meeting where their ongoing efforts to collaborate with the media were highlighted.  And, I am well aware that the Hawaii Psychological Association hosts an annual media award.  There can be no question that the media has a major impact upon society's appreciation of psychology.  During our Toronto convention, the impact of the New York Times coverage (as well as that of other major news organizations) of the Hoffman Report was quite evident.

            The Hoffman Report:  I have had the extremely good fortune to have been involved in the APA governance for approximately a quarter of a century.  It was a wonderful experience – addressing important agendas; working with fantastic colleagues; and a real chance to "make a difference."  Having been interviewed for the Hoffman Report at the invitation of Past President Nadine Kaslow, I read it carefully several times.  As the Report indicated, the specific question the APA Board of Directors asked the authors to address was: "whether APA officials colluded with DoD, CIA, or other government officials 'to support torture.'"

In my judgment, the discussion regarding the Department of Defense (DoD) psychopharmacology (RxP) training program was very accurate.  "The demonstration project thus served a crucial unlocking function for psychology and APA, since it established the legitimacy of a prescription-training program outside of traditional medical school, thus providing a strong answer to the traditional critique from psychiatrists that the only way to be trained in prescribing psychiatric medication was to graduate from a traditional four-year medical school.  We do not believe that by 2005, APA officials were realistically seeking or expecting anything further from DoD on the topic of prescription privileges.  Nor do we believe that APA officials actually worried that a failure to curry favor with DoD would cause DoD to reverse course on prescription privileges by, for instance, disallowing previously-certified psychologists from continuing to prescribe medication when they treated DoD personnel."

            The convention Town Hall meeting focusing upon the Report, chaired by Nadine and President-Elect Susan McDaniel, was most impressive.  More colleagues passionately participated than I had anticipated and they were definitely engaged.  My sincerest appreciation and congratulations to Steven Reisner and his colleagues Stephen Soldz and Jean Maria Arrigo for their personal commitment to having APA address this important issue.  And yet, as I listened to the audience and reviewed the comments being made on various list-serves, I must conclude that if I had been President in 2015, rather than 2000, there is little question that the same individuals would be demanding my resignation.  That realization fosters an entirely different perspective.

            Over the years, I have served in various capacities within the APA governance.  As an elected (or appointed) member of various boards and committees, including three terms on the APA Board of Directors and President in 2000, I relied heavily upon the good judgment of staff and volunteers.  I worked closely with a number of the individuals mentioned in the Hoffman Report and have the highest respect for them and their professional integrity.  For example, during my Presidential year APA CEO Ray Fowler unfortunately suffered serious health problems and Mike Honaker did an outstanding job in his absence.  Similarly, no one has contributed more to APA's smooth functioning than Judy Strassburger during her 40 years of service.  I will never forget how helpful Rhea Farberman was to then-President Norine Johnson during the chaos surrounding 9/11 and her efforts to address the psychological needs of our nation's children and their families.  Similarly, I will remember Norman Anderson as the CEO who succeeded in having our Association named by the national media as a wonderful place to work.  To see these individuals being sharply criticized today for doing their jobs is simply unfair and not right!

            Having worked on the staff of the U.S. Senate for 38+ years, I have come to appreciate the unique (and at times delicate) role that senior staff must play in order to keep an organization functioning smoothly and goal oriented.  Psychology's elected officials (on Council and Boards and Committees) set overall policy.  Within that framework, senior staff work tirelessly to implement mutually agreed upon goals and objectives, often consulting extensively with their committee chairperson.  It is frequently the responsibility of staff to draft correspondence, formal statements such as language for proposed resolutions, and even speeches for the elected ones to cogently present.  One should never forget that staff, no matter how senior or knowledgeable about a given content area, do notvote.  That is solely the responsibility of those elected to office.  If during the process there are any questions about documents presented to the committee, it is the obligation of the elected members to raise questions and respond to the proffered answers.  On the PENS report, for example, I understand that multiple governance groups had the opportunity to respond at different times during the process.

The Hoffman Report was to address the issue of whether APA officials (including staff) "colluded with" the Department of Defense.  The Report stated: "The collusion here was, at the least, to adopt and maintain APA ethics policies that were not more restrictive than the guidelines that key DoD officials wanted, and that were as closely aligned as possible with DoD policies, guidelines, practices, or preferences, as articulated to APA by these DoD officials."  From my perspective, more appropriate terminology might be the less value-drive term "collaborated with."  APA is fundamentally a membership organization and whenever its policies could potentially have a direct impact upon any segment of the membership, the organization has a long history of reaching out to those who might be affected to explore how to most effectively accomplish mutually agreed upon objectives.  For example, during the early discussions surrounding the CHAPUS peer review efforts, the voices of independent practitioners were affirmatively solicited and responded to.  Certainly, in working on the specialty forensic guidelines, staff worked closely with forensic psychologists.  These collaborations seem most reasonable to me.

During my years working for the legislative arm of the federal government, I learned that almost all levels of executive staff within every federal agency were extraordinarily hesitant to be identified as talking with outside entities (such as Congressional staff), especially outside of their formal "chain of command."  This orientation might provide an alternative explanation for the Hoffman Report's finding that many of the APA staff-agency discussions (e-mails or phone) were labeled "confidential."  Perhaps this approach was intended not to keep governance members uninformed; but instead, to provide a level of protection to colleagues working within the federal agencies.  I will not pretend to know the answer; however, I would suggest that there are many possible alternative explanations for the behaviors that were the focus of the Toronto Town Hall meeting.

Personally, I have never heard any of my colleagues or APA staff expressing support for torture and I seriously doubt that I ever will, notwithstanding impressions that may have been conveyed by the media.  This reflects a fundamental personal value system which, growing up as an altar boy in a Russian Orthodox church, I am very proud of.  It seems to me that much of the ongoing discussion has wondered away from the fundamental question of whether APA policy has had the effect of facilitating torture on any detainee and instead addresses other agendas, which although they may be meritorious are, in my judgment, tangential.  For example, some have called for increasing the voice of early career and ethnic minority psychologists within the APA governance.  These are objectives which I would strongly support – and reflect one of the underlying reasons why I have not run for any APA elected office since the end of my Presidential term.  However, I do not feel that this directly addresses the underlying issue of whether APA has acted in a manner which condones torture.  Monitor on Psychology.  Aloha,

Pat DeLeon, former APA President – Division One – September, 2015