Psychotherapy Articles

Psychotherapy Articles

I was reminiscing just the other day. While having coffee all alone.

At the end of 2023, Alex Siegel, Director of Professional Affairs, Association of State and Provincial Psychology Boards, reported that there were 40 jurisdictions (39 effective), out of a total of 55 states and territories, which had adopted and were part of the PSYPACT Commission.  The Psychological Interjurisdictional Compact (PSYPACT) allows for increased access of care and continuity of care for providing psychological services across state lines.  Successful applicants are awarded Authority to Practice Interjurisdictional Telepsychology (APIT) and temporary Authorization to Practice (TAP) credentials.  The APIT authorizes psychologists to practice interjurisdictional from their home state into the receiving state (where the patient is located).  The TAP credential authorizes psychologists to temporarily physically provide face-to-face psychological services in the distant PSYPACT state.  Alex has further noted that an increasing number of the health professions have embraced a compact approach, similar to psychology’s.

During the previous Congress, licensure mobility received attention from several Congressional committees.  For example, the U.S. House of Representatives included report language in the Fiscal Year 2024 Department of Health and Human Services Appropriations legislation for the Bureau of Health Workforce: “Interstate Licensure. The Committee recognizes that almost 100 million Americans live in a primary care health professional shortage area and over 156 million – almost half of the U.S. population – live in a mental health care health professional shortage area.  While efforts continue to support the recruitment and retention of the health care workforce, optimizing the existing workforce is critical.  The Interstate Medical Licensure Compact, created under the Licensure Portability Grant Program, is a voluntary, expedited pathway to licensure for qualified healthcare professionals, including psychologists, to practice in multiple states….  The Committee encourages HRSA to expand public awareness of these compacts to encourage provider participation.”

On December 22, 2023, President Joe Biden signed H.R. 2670, the National Defense Authorization Act for Fiscal Year 2024, into public law for the 63rd consecutive year.  Included in the legislative conference report was language addressing the portability of professional licenses of servicemembers and their spouses.  “Portability of professional licenses of servicemembers and their spouses: The House bill contained a provision (sec. 640) that would require the Secretary of Defense, acting through the Defense State Liaison Office, to consult with licensing authorities of States to increase awareness of section 705A of the Servicemembers Civil Relief Act (Public Law 117-333) not later than September 30, 2024.  The Senate amendment contained no similar provision.  The House recedes.  The conferees note that the Department of Justice is working on implementing the requirements of section 705A of the Servicemembers Civil Relief Act, and the Department of Defense continues to raise awareness of this statutory provision among servicemembers and their spouses.”

In reviewing the provisions of the Servicemembers Civil Relief Act (SCRA), the Congressional Research Service (CRS) reported in June, 2023: “Portability of professional licenses of servicemembers and their spouses – Section 705A (50 U.S.C. Section 4025a).  Added in 2023, this section provides for the recognition of professional licenses and certificates (not including law licenses) issued by other jurisdictions to servicemembers or spouses of servicemembers who have relocated to a new jurisdiction pursuant to military orders, providing the license remains in good standing with the issuing authority and any other issuing authority that has issued a similar license to the licensee.  The licensee must meet standards of practice for the relevant profession in the new jurisdiction, including fulfilling any continuing education requirements, and is subject to the relevant disciplinary authority there.  The licensee must have actively used the license during the two years preceding relocation to the new jurisdiction.  If the licensee is able to practice in multiple jurisdictions through an interstate licensure compact, the provisions of that compact apply.”

CRS further pointed out that the U.S. Attorney General is authorized to commence a civil action in U.S. district court for violations of the underlying statute.  In essence — “In any case in which a servicemember or the spouse of a servicemember has a covered license and such servicemember or spouse relocates his or her residency because of military orders for military service to a location that is not in the jurisdiction of the licensing authority that issued the covered license, such covered license shall be considered valid at a similar scope of practice and in the discipline applied for in the jurisdiction of such new residency for the duration of such military orders….”

To put this development in perspective, in November, 2023, the web site Military.com reported: “A federal judge has ruled that the state of Texas violated a new provision of the Servicemembers Civil Relief Act in refusing to recognize an Air Force wife’s out-of-state school counselor credentials – a rejection that prevented her from getting a permanent job in the state.  As the first-ever decision on a law that required states to recognize occupational licenses issued elsewhere, the case has widespread implications for the estimated 255,000 active-duty military spouses who require professional credentials to work in education, medicine, real estate, the beauty industry and more.”  Professional licensure had once been considered the primary, if not exclusive, responsibility of the individual states.  However, the federal government, both administratively and legislatively, would appear to have become increasingly concerned with its impact upon its employees and the nation.  With the ever-increasing sophistication of telehealth technology, we would hope that the remaining 15 jurisdictions would seriously consider enacting PSYPACT this coming legislative year.

Personal Reflections Of A Dedicated Visionary

This past November, our nation and particularly the mental health community lost a compassionate and visionary leader, the former First Lady Rosalynn Carter.  She was a passionate champion of mental health, caregiving, and women’s rights.  She served as a member of the Governor’s Commission to Improve Services to the Mentally and Emotionally Handicapped when her husband was Governor of Georgia.  And, she was the active honorary chair of his President’s landmark Commission on Mental Health, helping to bring about the passage of the Mental Health Systems Act of 1980.

Rod Baker, VA psychology historian extraordinaire: “I’ve always seen her as one of the few public officials who took talking about mental health out of the closet.  During her remarks before the American Psychiatric Association in May of 1979, she noted: ‘Since I have been working in this field, I have been told time and time again that the subject (of mental health) is boring, that the public doesn’t care about or indeed is even repelled by those who suffer from mental and emotional disorders, and that the press doesn’t find mental health a ‘sexy’ or important national issue.  I do not believe we have the luxury of giving in to these views.’”

Former APA President Frank Farley initiated a moving “Broom Closet” discussion among our former Presidential colleagues on their personal experiences with the former First Lady: “We have lost an amazing person who dedicated much of her life to concern for mental health – Rosalynn Carter, former First Lady, who died November 19 at age 98.  I met Rosalynn when she invited me to participate with her in a special event on mental health issues at The Carter Center in Atlanta.  It was a thrill to participate at that fine Center, created by President Jimmy Carter and First Lady Rosalynn, that has contributed so much to a range of public matters.  Rosalynn had as her #1 issue the STIGMA of mental illness.  No First Lady has contributed more to raising awareness of the problems of mental health.  She was a gracious, giving person.  (I note her founding of her Institute for Caregivers, and more).  BOTH Jimmy and Rosalynn were amazing, including their 77 year marriage!

“A few years before the foregoing event I had spent much of a day with Jimmy at the White House when he invited me to join him in celebrating his creation of the U.S. Department of Education as a Cabinet Level Department.  The nation had never had an Education seat on the President’s Cabinet so Jimmy rightfully created it!!  It was important to have education represented on the Cabinet, seated along with Defense, Labor, Commerce, etc.  I was then President of the American Educational Research Association, the world’s largest society of scholars in education, and he wanted me to represent at the White House celebration the nation’s scholars and researchers in the field of education, teaching and learning.  He had a large cubist-style poster in the White House in celebration of the event, titled ‘Learning Never Ends’.  He and I at one point were chatting while looking at the poster and I said as a hard-working professor ‘Mr. President.  It’s gotta end sometime!’  He laughed and said as a hard-working world leader ‘I know what you mean!’  At the end of the day-long celebration as I was about to leave the White House he brought me that poster!  I still have it.  All the best, Frank.”

Nadine Kaslow: “It has truly been an honor and a privilege to serve on Mrs. Carter’s Mental Health Task Force since 2000.  For me, Mrs. Carter was a role model par excellence as a mental health advocate.  During the past 2 plus decades, I have developed a special bond with the Carter family.  It meant a lot to me that Amy Carter wore my pearls today, a small reflection of my deep connection to the family.

“Today, I attended Mrs. Carter’s funeral, which was sad, inspiring, funny, poignant, and powerful.  I never expected to be moved to tears in a group singing America the Beautiful, but somehow being in the same room with 3 Presidents and 5 First Ladies along with our Governor, 2 Senators, multiple Congress people, and former Surgeon Generals with Mrs. Carter’s beautiful coffin prominently displayed can do just that.  We heard so much about Mrs. Carter as a steadfast and tireless mental health leader and champion, one honored by multiple APA Presidents including Carol and Tony as examples.  I know many of you had relationships with President and Mrs. Carter over the years and for each of you whose paths they crossed, I offer my heartfelt condolences.

“But I hope that we can all take a moment to celebrate a long life incredibly well lived.  And more importantly, I hope that each of us and APA more generally will dedicate ourselves to ongoing mental health activism and humanitarian efforts.  I know that for me doing so is one small way to honor her amazing legacy.  With gratitude to Mrs. Carter, Nadine.”

Dorothy Cantor: “Well said, Nadine.  I had the privilege of serving for many years on the Board of the Rosalynn Carter Institute for Caregivers, as did Ray Fowler, at Georgia Southwestern in America’s GA (which is as far from NY as you can get!)  Mrs. Carter never missed a meeting and the depth of her concern for caregivers was palpable.  She will always be an inspiration for me.  Dorothy.”

And, Susan McDaniel: “I was invited to one of Mrs. Carter’s Family Caregiving seminars at the Carter Center with 9 colleagues from across the country.  (Each seminar had a focus and was turned into a book.)  Each of the 10 of us gave a talk.  Mrs. Carter sat through all of them for the first day, along with her Secret Service, and was warm, knowledgeable, and interested in the content.  At a reception that first day, she spoke to each of us independently for a fair amount of time.  Mysteriously, the next morning she wasn’t present.  She had been so involved the day before that it was peculiar.  Around 10 AM during our presentations, there was a knock on the door.  We opened it and a staff person from the Carter Center said, to our utter shock collectively: ‘We just learned last night that President Carter won the Nobel Peace Prize.  The family is going to have a celebration, and would like to invite you to it.’  So there we were – President and Mrs. Carter, their children, their grandchildren, two Carter Center staff, and the 10 of us.  It was truly amazing.  We had champagne and delicious food.  I spoke to President Carter for what seemed like 30 min; I don’t know how long it actually was.  He was warm, accessible, and real.  A peak experience all around….  Thank you to Mrs. Carter for her work fighting mental health stigma, advocating for family caregivers, and for serving with her husband as a role model of service leaders for all of us.  Susan.”

Tony Puente presented her with an APA  Presidential Citation at the Carter Center in 2017 when he was able to spend time with her: “It was her humble, simple spirit that made the greatest impression.  Carol Goodheart served on Mrs. Carter’s cancer expert panel focused on the impact on caregivers, which resulted in a book.  “Our group thoroughly enjoyed the project and enjoyed our time with her and former President Jimmy Carter in Atlanta.  During my APA Presidency in 2010, she came in person to our convention to receive the APA Presidential Citation for her remarkable advocacy at the Opening Session.  It now hangs in the Presidential Library and Museum.  She graciously stayed after the session to sign her latest book for attendees.”

An Intriguing Opportunity Two Decades Ago

February 23, 2003, Dean Given: “Prescribing in California – Our new Executive Director, CF, was approached by the California Medical Association’s chief lobbyist ST about prescribing.  He told her that if CPA was willing to discuss ‘collaborative prescribing’, CMA may be able to support this.  I talked to a friend who is a past president of CMA about this.  He said something like ‘If ST were to tell CMA leadership that psychologist prescribing seems inevitable and CMA would do well to cut a deal and focus on more pressing matters, like getting physician reimbursement out of the toilet, the leadership would probably agree.  We trust ST to make the calls for us about the political environment.  We usually try to circle the wagons on prescribing but there certainly are some leaks and it does seem that elsewhere in the country states are rolling over.’

“I talked to some of our CPA leadership about this.  Of course, the definition of ‘collaborative’ is crucial.  There is concern for many that we ought not to put our advocacy energies toward prescribing at this point.  However, if the possibility of such a bill were to reap a deal with CMA, all I spoke with would support this.  Among our concerns about pursuing this further is that we do not wish to undermine the success of APA and other states in obtaining prescribing rights for psychologists.  This is all at an informal discussion level at this stage and I would like to know your thoughts….”  “But I don’t wanna dance.  If I’m not dancing with you” (Holy Ground, Taylor Swift).  Aloha,

Pat DeLeon, former APA President – Division 29 – January, 2024

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Pat DeLeon is the Distinguished Professor at the Uniformed Services University of the Health Sciences (DoD) in the School of Nursing and School of Medicine. He was elected to the Institute of Medicine of the National Academies of Science in 2008 and served as President of the American Psychological Association (APA) in 2000. For over 38 years he was on the staff of U.S. Senator Daniel K. Inouye (D-Hawaii) retiring as his Chief of Staff. He has received numerous national awards including the Order of Military Medical Merit; Distinguished Service Medal, USUHS; National League for Nursing Council for Nursing Centers, First Public Policy Award; Sigma Theta Tau, Inc., International Honor Society of Nursing, First Public Service Award; Ruth Knee/Milton Wittman Award for Outstanding Achievement in Health/Mental Health Policy, NASW; Delta Omega Honor Society Award for Outstanding Alumnus from a School of Public Health; APA Outstanding Lifetime Contributions to Psychology Award; American Psychological Foundation Gold Medal for Lifetime Achievement in the Practice of Psychology; and Distinguished Alumni Award, University of Hawaii. He has been awarded three honorary degrees. He is currently the editor of Psychological Services. He has over 200 publications.

Cite This Article

DeLeon, P. (2024, January). I was reminiscing just the other day. While having coffee all alone. Psychotherapy Bulletin, 59(1) 45-49.

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