Spring 2017: Volume 73, Number 1
APA Council Meeting Summary
Marta Miranda, Psy.D.
WSPA Council Representative
On February 24 and 25, I attended the APA Council of Representatives meeting in Washington, D.C. This is one of two annual face-to-face meetings at which APA’s governing body discusses and sets APA policy. The second meeting occurs in August during the APA Annual Convention.
The February meeting, which was shorter than usual due to a venue glitch, consisted of a packed agenda of practice, policy, and internal APA governance issues. The following is a summary of key decisions that are likely to be of particular interest to WSPA members.
Update on NBI 23A
Prior to attending the February Council meeting, I received numerous emails and phone calls from Washington State psychologists concerned about New Business Item 23A, “Resolution in Favor of Providing Support and Assistance to Military and National Security Psychologists Striving to Abide by the APA Ethics Code and APA Policy.” My response to these requests and my position on this matter was highlighted in a previous WSPA Newsletter.
Prior to the meeting, the movers of the motion had requested that the item be withdrawn from the agenda. Council voted to approve withdrawal (89% in favor) of this item from the agenda, and it was not debated during the meeting.
Professional Practice Items
Council was asked to vote on approval of the APA’s first clinical guidelines for the treatment of PTSD. This represents the first time APA has developed clinical guidelines for treatment of any disorder, and it will likely set a precedent for future guideline development. The panel charged with guidelines development contracted a third party (RTI, in North Carolina), who used the Institute of Medicine’s standard for medical guideline development. As such, the parameters for research review were narrowly defined to include only randomized control trials that studied the outcome of treatment, as defined by symptoms reduction, for PTSD.
The resulting guidelines identified four strongly recommended and two recommended treatments. Cognitive Processing Therapy, Cognitive Behavior Therapy, Cognitive Therapy, and Prolonged Exposure Therapy were the four “strongly recommended” treatments. The two “recommended” treatments were EMDR and narrative exposure therapy. The guidelines also recommended fluoxetine, sertraline, paroxetine, or venlafaxine as pharmacotherapy interventions. All recommendations were for adult patients with PTSD only; the guidelines did not address PTSD in children.
Several Council members expressed concern over the methodology of guideline development, the narrow definition of PTSD (i.e., no inclusion of Complex PTSD or Dissociative Disorders) and the near absence of any contextual factors (e.g., race, ethnicity, gender, sexual orientation, immigration/refugee status) or common factors (e.g., therapist-patient relationship). Other Council members also expressed disappointment that the guidelines did not consider treatments, such as psychodynamic psychotherapy, for which there is evidence supporting their use in PTSD treatment, but which typically have received less research focus than cognitive therapies.
After considerable debate, Council voted 79% in favor of adopting the clinical guidelines as developed by the panel. Due to the concerns voiced by Council members, Council also voted (70% in favor) to request that APA develop Professional Practice Guidelines for PTSD, which will aim to address issues related to the treatment of PTSD that were deemed not adequately reflected in the Clinical Guidelines (e.g., treating individuals of different racial and ethnic backgrounds, therapist-client factors, and client preferences).
Council also voted overwhelmingly (94%) to adopt as APA policy a motion asserting that the principles of Applied Behavioral Analysis (ABA) are within the scope of practice of psychology. This motion was developed in response to a recent push in some states (e.g.., Texas) to define a separate scope of practice with concomitant licensure requirements that would require psychologists to meet separate training and educational requirements to practice ABA.
Educational/ training Items
Council voted to adopt as APA policy a motion encouraging graduate programs in psychology to use multiple indicators to evaluate prospective students for admission to graduate study. This motion, which had been introduced a year ago, initially called upon graduate programs to end the practice of using GRE cut-off scores as the sole indicator for admission to graduate study in psychology. After multiple revisions, the adopted motion reiterates APA’s commitment to the training and retention of ethnic and racial minority students, and calls on graduate programs to review multiple indicators when evaluating candidates for admission to graduate study in psychology.
The last APA member apportionment ballot resulted in the loss of a seat on Council for the U.S. Virgin Islands. This unintended consequence, which was based on the logarithmic formula for apportionment of seats on Council, would result in the loss of representation on Council for APA members from this U.S. territory, unless they are also members of other APA divisions. As a result, a new business item was introduced to forward a proposed Bylaws amendment to APA members that would ensure that each division and each state, provincial or territorial association has at least one seat on Council.
A vigorous debate ensued, with members of most divisions and state, provincial and territorial associations (SPTAs) urging passage of the motion. The representative from the U.S. Virgin Islands spoke about the historical marginalization of U.S. Virgin Islanders from the mainland, as well as the challenges of practicing psychology in a territory where scientific journals arrive months after their publication on the mainland. Among the minority voices of dissent was one representative from Division 29, which will likely lose a seat on Council if APA members vote in favor of the Bylaws amendment. The vote passed with strong support from Council (88% in favor).
APA members will receive a ballot asking them to vote to enact the change to the Bylaws ensuring that all divisions and SPTAs have at least one seat on Council. I strongly urge WSPA members to vote in favor of this amendment. Doing so ensures that smaller SPTAs (such as WSPA) have a voice on Council. It also ensures equity and diversity of Council representation for U.S. geographies, such as the U.S. Virgin Islands, that have been traditionally marginalized.
Council also voted on a motion to continue the trial delegation of authority to the Board of Directors for three more years. At its February 2014 meeting, Council voted to delegate certain administrative and financial decisions to the Board of Directors for three years. At the time, Council members complained that too much time was spent during Council meetings on administrative and financial decision-making, and not enough time was available for policy-making. The decision to delegate authority of these tasks to the APA Board of Directors was made, in part, to free Council to devote more time to policy-making, as well as to place some decision-making in the hands of a group of individuals with expertise in specific areas, such as finance.
Proponents of this motion argued that the three-year trial delegation period was not enough time to test this new governance structure, especially considering that during this time period, the Board also dealt with two major crises in APA: the Independent Review (aka Hoffman Report), and a class action lawsuit by APA members against APAPO. Opponents of extending the trial delegation pointed to the decision to conduct the Independent Review as a negative outcome of taking decision-making authority away from Council. The motion passed, and Council agreed to extend the trial delegation of authority for an additional three years.
Watch this space….
In December 2016, members of APA Division 39 (Psychoanalysis), section 9 (Psychoanalysis for Social Responsibility) published an apology letter to Native American, Alaska Native and Hawaiian peoples. This letter, which was also presented to members of the Society for Indian Psychologists at the National Multicultural Conference and Summit in January 2017, sparked interest among some Council members to introduce a motion at the August Council meeting which would compel APA to issue a similar apology letter, including action items to ensure APA takes steps to repair the decades of wounds resulting from APA’s and psychology’s actions (and inaction).
I have been asked to participate as a member of a work group established by the Council Leadership Team to develop, with consultation from the Society of Indian Psychologists, an apology letters that will be presented to Council, an offer that I accepted.
As always, if you have questions, comments or concerns about my participation on Council, please do not hesitate to contact me at: email@example.com.