3rd Quarter 2014 - Michigan Psychological Association

12 Pages·2014·2.31 MB·English

by  Emily Arents

Understanding the Future
of Integrated Services for Psychologists
James Windell, Editor

The afternoon session will be devoted to how all that
T he way care will be delivered in the very

was discussed in the morning session is playing out
near future, and the way providers will be
in Michigan. The initial afternoon presentation will
reimbursed for their work, is changing --
be given by Lynda Zeller, Deputy Director of the
whether we like it or not,” declares Louis Post, Ph.D.,
Michigan Department of Community Health. Ms.
Chair of MPA’s Insurance Committee.
Zeller will share her thoughts regarding the ACA and
With that in mind, MPA has scheduled a conference the delivery of mental health and substance abuse
on Friday, November 7, 2014 entitled The Future of treatment in Michigan.
Psychological Services in the Era of Integrated Care.
Following Ms. Zeller will be Dr. Thomas Simmer,
An all-day conference beginning at 8:30 am, the
M.D., Senior VP for Health Care Value & Provider
conference will be held at The Henry Center,
Affiliation, Chief Medical Officer, Blue Cross Blue
Michigan State University, 3535 Forest Rd, Lansing,
Shield of Michigan. Dr. Simmer’s presentation will
Michigan.
address these issues from a private sector perspective,
Dr. Katherine Nordal, the Executive Director for including how the Physician Group Incentive
Professional Practice of the American Psychological program has evolved, the nature of the integrated care
Association will be the first morning speaker. She models which have evolved within the PGIP, the
will address how the impact of the Affordable Care role of psychologists within the PGIP, and his vision
Act (ACA) and the movement toward the integration as to where the provision of treatment and of
of health care services is playing out in terms of psychological services is heading.
policy and application at the national level. She will
“This conference is a must for any psychologist in
also discuss how the delivery of mental health
private practice who participates with insurers and for
services will be affected by the ACA and the
those psychologists working in the public sectors,”
different models for the delivery of integrated care.
Dr. Post emphasizes.
Dr. Nordal’s presentation will focus on Health Care
“Our intent is to provide attendees with an
Reform in 2014 and the implications for professional
understanding of what is going on, how it might
practice.
affect their livelihood, and the opportunities that are
The second morning speaker will be Dr. Benjamin present for them,” Post said. “For psychologists who
Miller, Director of the office of Integrated Healthcare are in private practice, a lack of clear understanding
Research & Policy at the Department of Family as to what is occurring, and how to respond, can end
Medicine, University of Colorado, Denver. Dr. Miller up literally taking money out of their pockets.”
will talk about the integration of behavioral health
CE credits will be available upon completion of the
and primary care, and he will particularly focus on all
workshop, and registration can be handled online at
the reasons why we must integrate to get to better
the MPA website through November 5, 2014.
health outcomes, decrease cost, and enhance our

patient’s experience.
To comment on this article, email James Windell at
[email protected]

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The Michigan Psychologist – 3rd Quarter 2014
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The Michigan Psychologist – 3rd Quarter 2014
FROM THE OFFICE OF THE PRESIDENT
Multiculturalism in a Changing Practice Environment

Tamara McKay, Ph.D.

In September, 2014, the Committee for Diversity, nuances in meaning stemming from unique histories
Inclusion, and Social Responsibility co-sponsored a based on ethnicity, gender, and religion, the
workshop with Wayne State University on Ethnic consistent thread appears to be an issue of SES. A
Identity and Treatment Implications. The speakers of multitude of organizations, foundations, and non-
this day-long workshop were immensely profits have addressed this issue for decades, but for
knowledgeable and engaging. The morning speaker, the first time in this country there may be an
Dr. Jessica Henderson Daniel, provided an historical, opportunity to make significant strides in alleviating
social, political, and economic exploration into this injustice with the Affordable Care Act (ACA).
African-American ethnic identity, with special The ACA mandates parity which requires insurance
emphasis on adolescent development. Dr. Julie
plans in the Marketplace to cover mental health and
Hakim-Larsen took attendees through a rich journey substance use disorders on par with other health
into Arab-American cultural diversity and provided
concerns. Additionally, most plans are prevented
tangible treatment recommendations for working from denying benefits due to pre-existing conditions.
with this population. Those attending the workshop
Preventive care, such as screening for depression and
were as diverse as the material shared. For those anxiety, are incorporated in plan benefits. The ACA
interested, the resources provided by the speakers
is incredibly young in its inception which makes it
will be available on the Committee web page.
difficult to anticipate the long term effects of this
As is the case for most workshops, the audience was policy. However, for some time, psychologists and
a self-selected group. Due to professional interests other mental health professionals have been informed
and/or practice matters, attendees take special interest that the nature of health care is forever changing in
in establishing and maintaining multicultural this country. Combine this reality with the data on
competence. Clearly, multicultural competency increasing diversity in this country, and it is clear that
evolved far beyond a simplistic understanding of the work of psychologists is being reshaped by new
mutually exclusive diversity categories some time practice environments.
ago. Practicing clinicians are now challenged with
Even the nature of supervision is being affected.
assessing, understanding, and applying data regarding With each generation, the beliefs around race,
the patient’s intersecting identities into their practice,
ethnicity, gender, sexual orientation, class, etc. have
regardless of theoretical orientation. This is no small taken on new meaning. Training relationships require
task given the rapid increase and complexity of
that the supervisor and supervisee find a common
“diversity” within the U.S.
language to meaningful engage in dialogue around
Another issue of diversity that permeates throughout client needs. Therefore, it is just as imperative to
the U.S. is mental health disparity. These disparities stay abreast of findings related to culture/diversity as
have always existed because of the differential access it is to follow developments in neuroscience as it
to health care, which is an artifact of class in this applies to the treatment of trauma. Members are
country. Interestingly, during the workshop Dr. encouraged to read the October, 2014 issue of
Larsen shared that a number of Arab-American American Psychologist. Articles include “Critical
adolescents must sacrifice their education in order to Cultural Awareness: Contributions to a Globalizing
help provide income for the family. This practice is Psychology”, “The Cultural Lens Approach to
also quite common in the African-, Hispanic-, and Evaluating Cultural Validity of Psychological
European-American communities based on this Theory,” and Feminism and Psychology: Critiques of
author’s own clinical caseload. While there are likely Methods and Epistemology.” Psychologists would
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The Michigan Psychologist – 3rd Quarter 2014
do well to not overestimate their levels of Lastly, MPA is pleased to bring another important
multicultural competence. The human species is far workshop to its members. On November 7, 2014, Dr.
too complex to take this stance. Katherine Nordal, along with several other experts,
will discuss the Affordable Care Act and Integrated
MPA continuously works to make sure that
psychologists have a seat at the table. Let us work Care. Although the practice settings and
environments are changing for psychologists, we
together to make sure that the following important
message is shared with policy makers. Psychologists continue to provide excellent, comprehensive care for
the clients that rely on us for their well-being. Let’s
are uniquely qualified to incorporate multiculturalism
into our assessment and treatment practices relying honor the trust they have placed in us and do all that
we can to remain on the cutting edge of theory and
on psychological science to inform the field
practice in mental health.
regarding the implications of individual and group
differences and similarities. This is one of the most To comment on this column, contact
important aspects of our training and practice that set Tamara McKay, Ph.D. at [email protected]
us apart from other mental health disciplines.

EXECUTIVE DIRECTOR’S REPORT
Executive Director Leaving with
Confidence in MPA’s Future

Cheval Breggins, MBA – Executive Director

Many of you have heard that I am resigning as the MPA Executive Director and will serve as the Executive
Director for the Florida Psychological Association. I truly am humbled to have had the opportunity to be the MPA
Executive Director and the opportunity to work with such outstanding association members. I want to thank the
Board of Directors, Committee volunteers, Association members and staff for their support and dedication.
Many of the accomplishments during my tenure were highlighted in prior newsletters. You should know that the
MPA Board members have worked tirelessly, and their efforts and contributions have been outstanding. The Board
is embarking on an important, thought-provoking, and challenging facilitated strategic planning process. As a
result, I continued to learn and try new ideas for a profession that is evolving, and hopefully for the better. To those
of you that I had the opportunity to work with closely, I commend you for your achievements and hope that you
continue to succeed through your life journeys. I could mention individuals by name and groups, but in the end the
message would still be: I have truly enjoyed my time as the MPA Executive Director, and have been well
supported with the work and outcomes we have achieved. I hope that you give the next Executive Director just as
much, and even more, support to him or her.
I leave with great confidence knowing that MPA is capable of overcoming any hurdles that will come up. MPA
has managed to assemble a very competent and practical Board and staff that will continue to provide excellent
support to the membership. This provides me with a sense of pride and gratitude that is indescribable.
As I continue in my career as an Executive Director, I would like to leave you with an anonymous quote: “Do not
follow where the path may lead. Go instead where there is no path and leave a trail.”
I wish you all the very best.

I welcome your input, questions and concerns about MPA;
you can contact me at [email protected] or call me at 517-391-0182.

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The Michigan Psychologist – 3rd Quarter 2014
Stacey Gedeon, Psy.D. is Honored
with Award for Exemplary Services
by James Windell, Editor

Stacey Gedeon, Psy.D., was one of two staff MidMichigan Community Health Services provides
members from the MidMichigan Community Health quality, comprehensive, affordable health care to
Services honored for exemplary services at the residents of Roscommon and Gladwin counties. It is
Michigan Primary Care Association’s (MPCA) 35th one of Michigan’s 38 Health Center organizations
annual awards ceremony held August 5, 2014. that together operate 240 sites across the state,
providing care to more than 600,000 patients each
The MPCA. the non-profit
year regardless of insurance status or income.
association representing
Michigan Health Centers are part of a nationwide
Michigan Health Centers,
network of Health Centers that serve the primary
recognized Dr. Gedeon,
medical, dental, and behavioral health care needs of
Director of Behavioral
more than 22 million individuals in over 9,000
Health & Integrated Primary
locations across the U.S.
Care at MidMichigan
Community Health Services, The award is given to a Michigan Health Center
as the 2014 Clinician of the clinician who exemplifies leadership, dedication, and
Year. MidMichigan Community Health Services in commitment to providing quality health care to
located in Houghten Lake, Michigan. Michigan residents, however, the award has never
been given to a psychologist previously.
Each year MPCA honors a Michigan Health Center
clinician for commitment to providing quality health “I felt incredibly honored and appreciative to have
care to Michigan residents. received such an award,” Gedeon said. “Being the
first psychologist to receive this award holds special
“Dr. Gedeon is most deserving of the 2014 Clinician
significance to me, as it emphasizes the importance
of the Year Award,” said Kim Sibilsky, CEO of
of having psychologists embedded in the primary
Michigan Primary Care Association, in presenting the
care team."
award. “She has been a catalyst for integrating
primary and behavioral care at MidMichigan To comment on this article:
Community Health Services and across the state with
Contact James Windell: [email protected]
the goal of improving patient health.”
To contact Stacey Gedeon, email her at
Sibilsky went on to say that integration increases
[email protected]
access to health care, improves the quality and cost
effectiveness of care, and effects health outcomes.
“We honor Dr. Gedeon for her dedication to
implementing this model of care that is impacting the
lives of so many,” Sibilsky concluded.
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The Michigan Psychologist – 3rd Quarter 2014
Appropriate Behavioral Health Care and Communication Between Providers
Contributes to Better Overall Patient Health

By Carol Ellstein, Ph.D.

Increasing emphasis on behavioral health has health and psychological functioning of two patients
prompted many primary care physicians to ask how with complex presentations.
collaboration with mental health specialists and other • Annie (pseudonym) is a woman in her mid-50s with
allied health professionals benefits their patients. I’m Type 2 diabetes, obesity, migraine headaches,
a licensed psychologist in northern Michigan who has medication-resistant depression, generalized pain,
collaborated onsite for almost six years with primary
sleep disturbance, energy deficits, and a rare
care providers (PCPs) in an independent family autoimmune disease.
medicine practice.
My first contribution was to discover a history of
The collaboration begins when a PCP refers a patient hypomanic episodes in addition to depression. After
to me for mental health treatment, behavioral health consulting with me, the PCP referred her to a
consultation, and/or psychodiagnostic assistance.
psychiatrist, who prescribed a mood stabilizer, with
Sometimes I’m asked to provide a second opinion. good results.
Other times, a patient self-refers. Once in a while,
Next, Annie and I developed a three-tier activity
I’m asked to conduct a same-day consultation, which
routine that corresponds to her energy level on any
leads to a discussion between the patient, provider,
given day. We also located an online food tracking
and me for planning purposes.
system and created a behavioral health regimen for
My psychological interventions range from sleep hygiene.
behavioral health consultations for specific medical
Annie’s chiropractor introduced her to essential oils
issues (e.g., techniques for pain management) to a
that, according to Annie, eliminated her migraine
full course of specialty mental health treatment (e.g.,
headaches and substantially decreased her overall
anxiety or trauma). The patient gives consent for the
physical pain. She now works closely with an
medical provider and me to share information.
aromatherapy practitioner.
I maintain two sets of records: a complete set of
Annie’s medication use has decreased substantially;
written notes that is stored in a locked file cabinet,
most notably, she reports that she is now completely
and a brief session summary and plan that is written
free of pain medications. Annie manages her sleep
into the electronic health record. Unless the PCP and
disturbance with behavioral strategies and sleep-
I catch each other for impromptu consultations, the
inducing essential oils. Although Annie suffers an
EHR is the primary mechanism through which we
occasional setback, she generally reports significant
communicate. My notes are omitted from outside
improvements in mood, energy and overall sense of
record requests unless the patient specifically
wellbeing.
consents to include them. Office staff schedules my
• Barbara (pseudonym) is a woman in her late 60s
appointments, obtain treatment authorizations and
with uncontrolled type 2 diabetes, congestive heart
bill insurers and patients for my services.
failure, pain, occasional suicidal ideation, numerous
Here are two examples of how specialty mental
medical hospitalizations, routinely missed office
health and behavioral health services, in concert with
other providers, have helped to improve the physical
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The Michigan Psychologist – 3rd Quarter 2014
appointments, a long-standing diagnosis of bipolar along with a decrease in hospitalizations overall, and
disorder, and an unhappy marriage. no hospitalizations for diabetic crises.
Her PCP referred Barbara to me as a last resort My inclusion in the treatment team has contributed to
before dismissing her from the practice due to each woman gaining a level of physical comfort and
noncompliance with medical treatment. Based on psychological wellbeing within a one to two-year
conversations with Barbara and her PCP, our initial period that would likely have been impossible to
goals were to increase Barbara’s compliance with achieve otherwise.
treatment protocols and to elicit active involvement
in her own health care.
Carol Ellstein, Ph.D., maintains a psychology
After almost two years of intense teamwork between practice in Indian River, MI. She also serves as the
Barbara, her PCP, the practice unit’s diabetes on-site clinical psychologist and behavioral health
educator, and me, along with routine follow-ups with specialist for Little Traverse Primary Care, a BCBSM
outside medical specialists, we have seen significant Patient-Centered Medical Home with offices in
Harbor Springs, Alanson and Cheboygan MI. You can
improvement in treatment compliance, mood,
reach Dr. Ellstein with questions or comments at
responsibility for self care, and marital satisfaction,
[email protected]

MPA President Tamara McKay with recent Conference speaker Jessica Henderson Daniel with
conference speaker Jessica Henderson Daniel. MPA Board Member Josephine Johnson.

Position Available: Neuropsychologist
Full time position available for Neuropsychologist to join thriving private practice in Bingham Farms, MI. Position
requires primarily neuropsychological evaluation, although there is some opportunity for provision of individual
psychotherapy with adults with traumatic brain injury, dementia, vascular disorders, movement disorders and other
neurological conditions. Candidates should have substantial experience in neuropsychological evaluation and
should be fully licensed or eligible for full license in the State of Michigan. Competitive salary and benefits.
Qualified individuals are welcome to submit a CV, letter of interest and at least one sample report with all
identifying information deleted to Renee Applebaum, Ph.D. at the following email address:
[email protected]. Any potential candidates would also be asked to provide 3 letters of recommendation.

7
The Michigan Psychologist – 3rd Quarter 2014
BOOK REVIEW: ALSO FOR PSYCHOLOGISTS
Review of Blood Will Out
Walter Kirn - Liverwright, 2014.

Reviewed by Jack P. Haynes, Ph.D.

As a psychologist particularly interested in murderer, a person who misled the author about
personality disorders, and of that group being almost everything.
particularly interested in antisocial personalities,
The dynamics of this psychopath are described, and
often labeled psychopaths, Walter Kirn’s recent book the author eventually realized that he had been taken
Blood Will Out was a title of interest. It did not
in and manipulated over about ten years. Kirn talks
disappoint. It was much more than good summer about how their relationship was established, how he
reading.
essentially bonded with Gerhartsreiter, how the con
The book has a noir-ish title and the cover does have man was able to manipulate him and others, and how
a blood stain. But the book is more than a well- the real person was revealed, including his major
written true crime story. It also is about fraudulent crime.
identity, improbable friendship, and about conflicts in Some of the most interesting passages reference the
a friendship with perceived striking social class
inquiry by Kirn of the unmasked “Rockefeller” while
differences. The book is the true story of the the con man was incarcerated awaiting trial in 2013
friendship of the author with Clark Rockefeller, a
for a 1985 murder. How the author came to be duped
scion of the Rockefeller family and a huge and how their relationship was maintained make for
namedropper, except that the subject of the book
fascinating and at times harsh and uncomfortable
turned out to be no Rockefeller at all, but was reading.
revealed to be a fraud, a con man named Christian
To comment on this article, contact Jack P. Haynes,
Gerhartsreiter, who also was discovered to be a
Ph.D. at [email protected]

Recent MPA conference speaker Jessica Henderson Conference speakers Julie Hakim-Larson and
Daniel with WSU Professor Christopher Trentacosta Jessica Henderson Daniel.
(who also helped co-sponsor the event).
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The Michigan Psychologist – 3rd Quarter 2014
Charles Clark, Ph.D.: A Remembrance

Jack P. Haynes, Ph.D.

Dr. Charles Robert Clark, known to many as Charlie, concise, and direct. But things never were the same
was a long time friend of mine, a fellow forensic after Beth died so early, about ten years ago.
psychologist, and a highly respected colleague.
Charlie and Beth had been a team -- both bright and
Charlie, age 66, died suddenly and unexpectedly, in
articulate, but with Beth more outgoing, expressive,
Ann Arbor on September 22, 2014.
energetic and warm, while Charlie was more
Charlie and I met in 1982, when each of us was a cerebral, witty, and imposing. The team had been
relatively newly minted psychologist. Charlie, Larry broken up. Charlie withdrew, and several of us took
Cowan, and Rod Howard were the founding him out to dinner monthly. He was appreciative, but
members of the Michigan Society of Forensic Charlie was not the same -- less intense, less
Psychology. I became member number 6, and we all enthusiastic, more contemplative.
took turns as president of MSFP during the next ten
However, after years of mourning the loss of Beth,
years.
Charlie recently allowed himself to develop a
Charlie’s training and experience were impressive, to meaningful relationship with a woman in Ann Arbor.
be sure. First, there was his work with John Exner of Also, in the last years -- who knew these would be
Rorschach fame at Long Island University, and after the last years -- Charlie enjoyed spending time with
that, experience and connections at St. Elizabeth’s his grandchildren through his son, Peter, who had
Hospital in Washington, D.C. recently moved to his house in Ann Arbor, as had
Beth’s mother.
Charlie was head of the Psychology Department at
the Center for Forensic Psychiatry, then went into Charlie was proud of both his children, Peter and
private practice. He was a President of MPA and Laura. He spoke of them with strong commitment
active in leadership of the American Board of and clear appreciation. In some ways Beth lived on
Forensic Psychology, as well as being the APA through them. That was important to Charlie, and it is
Ethics Chair. important and offers some consolation to those of us
who knew and appreciated Charlie and Beth.
We at MPA were fortunate that he was involved with
the MPA Ethics Committee. Charlie and Beth, his Contributions in memory of Charlie can be made to
wife who was also an outstanding psychologist, The Nichols Arboretum in Ann Arbor.
together wrote a handbook of relevant laws for

Michigan psychologists.
To comment, contact Jack P. Haynes, Ph.D. at
Later in his career, Charlie and I occasionally worked
[email protected].
together on cases, and we referred cases to each
other. He loved working in his home library,
especially in later years, and especially on reports.
Charlie was a low key fellow, very bright, erudite,
and articulate, and his reports often were
parsimonious because Charlie himself was strong,
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The Michigan Psychologist – 3rd Quarter 2014
Notes of a Psychology Watcher
What Killed Robin Williams? Not Depression, Manic-Depression

Steven J. Ceresnie, Ph.D.

The comedic genius Robin Williams put a belt youngsters and adults, while lining the pockets of
around his neck and took his life on August 11, 2014 pharmaceutical companies and boosting the incomes
at age 63. Most media reports concluded that of quick-fix 15-minute appointment docs who pass
depression, alcohol, and drugs were the lethal mix out medication before they understand the patient.
that killed him.
Mental life is always complicated and can be altered
But depression is a set of symptoms that can occur in from each of these four perspectives (McHugh &
a variety of diseases. The disease that most likely Slavney, 1998). For example, Robin William’s life
killed Robin Williams was bipolar disorder (manic- was altered by what he “had” -- the mental disease
depressive illness), an “episodic recurrent of bipolar disorder; what he "was" -- personality traits
pathological mood disturbance that ranges from such as hyperthymia; what he “did " -- behaviors
extreme elation or mania to severe depression, and is such as drug and alcohol abuse; and what he
usually accompanied by disturbances in thinking and “encountered" -- an often absent father, three
behavior, and often by psychotic features such as marriages, and the recent cancellation of a new TV
delusions and hallucinations” (Craddock and Sklar, series.
2013).
Some people have mild to moderate manic symptoms
There are no diagnostic tests for this disorder that has all the time. Williams had that kind of mind --- his
two subtypes: bipolar l (have at least one full manic associations were faster than a speeding bullet, his
episode), and bipolar II (have only milder hypomanic wit had no equal, his personality was “hyperthymic”
episodes). Bipolar disorder type I and II affect about – extroverted, funny, high-energy, hard-working and
2% of the world population (Geddes and Miklowitz, successful. He had access to the stuff of dreams,
2013). doing jazz improvisations with words to create visual
images, tickling the depths of our unconscious minds.
The mean delay between the illness onset of bipolar
disorder and diagnosis is 5 – 10 years (Phillips & Williams was described by those who knew him as
Groucho on steroids -- a man fueled by a high
Kupfer, 2013). The major reason for this surprising
voltage mind that was always going.
delay is the difficulty differentiating bipolar I and II
from unipolar depression. Misdiagnosis of the illness Some clinicians have claimed that bipolar disorder is
as recurrent unipolar depression occurs in 60% of a gift. They draw connections between bipolar
patients seeking treatment for depression (Phillips & disorder and creativity. Nancy Andreasen, who first
Kupfer, 2013). obtained a Ph.D. in English Literature and then
No doubt Williams’ years of cocaine and alcohol became a psychiatrist, is the author of “The Creative
Brain: The Neuroscience of Genius.” Andreasen
abuse contributed to his death. Even cocaine use did
not escape Williams’ ability to turn tragedy into uses the case-study method and introspective
descriptions of creative individuals to study the
comedy. He once quipped that cocaine is God’s way
of telling you you’re making too much money. creative process (Andreasen, 2005). Kay Jamison, a
psychologist who talks about her own bipolar
Depression is the most acceptable diagnosis for
disorder, has outlined connections between creativity
Williams based on media reports. Clinicians and
and madness in famous artists, musicians, and so on
consumers often downplay, dismiss, and trivialize
in her book “Touched with Fire: Manic-Depressive
bipolar disorder. Many clinicians say we are over-
Illness and the Artistic Temperament” (Jamison,
diagnosing bipolar disorder, especially in children
1993).
and adolescents, leading to dangerously drugging
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The Michigan Psychologist – 3rd Quarter 2014