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What Does Your Psychology Practice/Licensing Act Reveal That Can Help Your Efforts to Develop a Colleague Assistance Program?

As Chair of the Oklahoma Colleague Assistance program for the Oklahoma Psychological Association, I have been involved in helping establish a colleague assistance program over the past several years.  A critical turning point in my efforts occurred while working clinically with other health care professionals.  I began to examine the practice acts for various disciplines (i.e., medicine, nursing, pharmacy) and this led me to wonder how our psychology practice act compared.  I determined six areas in which we differed significantly from our health professional peers in Oklahoma.  I have posed these in the form of questions below.  Even if you have a formal Colleague Assistance Program (CAP) in your state, it may be useful to review your state’s practice act as it lines up with the workings of your CAP.  It may help to obtain a copy of your state’s psychology practice/licensing act as you read through the list.

  1. Does your practice act contain a reference to practicing with skill and safety that can be compromised by substance abuse and/or a psychiatric condition?  Does your state practice act go further to include medical conditions and neurocognitive conditions which can impair functioning?  Language about impairment is fairly commonplace in practice acts, but knowing how impairment is defined in your practice act is important.
  2. What does your state practice act say about reporting an impaired colleague?  In Oklahoma, there is no explicit mandate in their licensing act for psychologists to report.  Other professions in Oklahoma are explicit about a mandate to report impaired colleagues, and some professionals (e.g., physicians) are required to report across health profession lines.  In some states, like Oregon, there is a requirement to make such reports within a specific time period, 10 days (ORS 676.150, signed into law January 1, 2010).
  3. Related to reporting an impaired colleague, does your state practice act grant civil and criminal immunity if the report is made in good faith?  In our Oklahoma psychology practice act, this is not addressed.
  4. Will your colleague know that you reported her/him to the licensure board? In Oklahoma, the psychologist being reported to the licensure board will receive a copy of the Request for Inquiry (i.e., complaint form) that is sent to the board.  This complaint form contains a description of what is being alleged and the name and contact information of the person making the report.  Other boards in Oklahoma provide statutory protection of the identity of the person filing a complaint.  This of course, lowers the threshold for reporting.
  5. Does your state practice act require you to answer questions upon annual renewal of your license regarding impairment, treatment, or current suitability to practice with skill and safety?  In Oklahoma, this is not addressed in the practice act.  Other health professional boards do include a section in their practice act regarding continued suitability to practice with skill and safety. In addition, the licensee is required to complete an annual attestation about suitability or continued ability to practice with skill and safety, among other questions such as legal problems.
  6. Does your state practice act empower your state licensure board to create or affiliate with an entity that can aid in addressing impairment among psychologists?  In Oklahoma, the ability of our licensure board to affiliate with a program was not explicitly outlined in the practice act or Rules of the Board. An interpretation of the board rules by the State Attorney General’s Office determined that the licensure board had the authority to establish such an affiliation. Consequently, our licensure board moved forward with an agreement that allows psychologists to participate in the state's physician monitoring program. 

Examining our psychology practice act in Oklahoma and comparing it to the practice act of our healthcare professional peers illuminated some stark differences.  When I presented these differences at our annual state psychological association meeting several years ago it created strong momentum to make changes. 

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New Member Spotlight: Rachel Awes

1)    What is your background in psychology (e.g., education)?

I work as a psychologist, speaker, author, and art playgroundist. The common thread through out these is my colorful pursuit of the human heart: to listen deeply for the stunning beauty within, to address what may be getting in the way of seeing the beauty and fully living it out, and to reflect it back to people with spoken and published words, art, and even in my colorful clothing. My education is from the University of Minnesota’s Ed Psych/CSPP program.  I’ve counseled 22 years since then, and am currently in a solo St. Paul private practice.

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Risk Management: Who let the doggie on the airplane?

Most people enjoy dogs and find great pleasure in having them around. All of that is fine, but there is a growing trend among those who want to be with their dogs that should be of particular concern for psychologists.

Psychologists are frequently being asked by their patients to attest to their need for an Emotional Support Animal (ESA) for mental health purposes, which allows that animal to be present in what previously would have been a restricted environment.

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Meditation, Spirituality & Mental Health

Until relatively recently, yoga, meditation, and non-traditional spirituality – as opposed to classical religious practices – were widely perceived in the West as esoteric pursuits with little to offer mainstream society. Now they are highly-valued, prominent fields of endeavor with massive cultural buy-in. Having dedicated 40+ years to this “questionable arena,” it is rewarding to note the positive shift in public opinion, and, the appreciable enhancement such activities have made on so many lives. In fact, writing an article like this is challenging because there is no longer a dearth of information on the topic but, rather, an exhaustive volume of research requiring extensive time to read, process, and apply. On the up side, an abundance of scientific literature now attests to a range of psycho-social and body/mind benefits resulting from meditation and Sacred practices, (i.e., pertaining to religion or spirituality). Fortunately, these positive outcomes are no longer points of anecdotal testimony subject to academic dispute, but, matters of established fact. For psychologists then, several especially relevant questions arise regarding how to include this domain within the scope of practice. Specifically, when is it appropriate to engage patients on topics pertaining to the Sacred, meditation, and related activities? When is it viable to suggest patients explore such in adjunctive alignment with on-going therapy? And, when should these topics or practices not be addressed?

Such questions require more time and space to address than this brief article allows. Accordingly, readers may find additional value and a more comprehensive understanding of these issues in theAPA Handbook of Psychology, Religion, & Spirituality (Pargament, 2013).  However, to capsulize two key areas let me answer the last question first: Psychotic patients and those with too severe a character disorder are best served by not engaging in mystical or meditative pursuits as such activities could de-stabilize their mental coherence or trigger added psychiatric complications. However, many less severe patients confronting depression, anger, anxiety, stress, hypertension, addiction, insomnia, chronic pain, or, mild-to-moderate neuroses, defensiveness, compromised self-awareness, and self-destructive behaviors may benefit considerably from intelligently applied meditation if they are sufficiently motivated to practice. There is even related evidence suggesting that therapists who engage in meditative practices themselves, or hold to compassionate spiritual paradigms, may passively contribute to enhanced therapeutic outcomes.

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From MPA's President Robin McLeod, Ph.D., L.P.: MPA Psychologists Are Making it Happen in 2016!

When people ask me where I am from originally or where I grew up, my answer typically is that I am from the Army.  Yes, I grew up as an Army brat, which is a term of endearment in my world.  In the military, when a leader begins a new position, there is a formal change of command ceremony.  In the Minnesota Psychological Association, not so much.  We all just wake up on January 1, and a new President of our association is leading the charge.  Welcome to 2016!

This first month of 2016 has started much more calmly and slowly than we saw last year at this time.  Do not let that fool you.  The Minnesota Psychological Association has much on the horizon.  Volunteers serving on MPA’s Legislative Committee are initiating legislation designed to correct the Duty to Warn oversight in our psychology practice act.  We have retained an attorney to assist MPA in presenting an amicus brief before the Minnesota Supreme Court on this same issue.  Hopefully you will join other psychologists for Mental Health Day on the Hill (March 31, 2016) as MPA volunteers join with other professional associations including the Minnesota Medical Association to oppose efforts to rescind the upcoming sunset of the Provider Tax.  Finally, MPA psychologists have entered into talks with the Minnesota Department of Human Services to work toward modifying documentation requirements for psychologists practicing in integrated health care settings.  I hope you will make 2016 the year that you join other MPA psychologists who are volunteering to make things happen for psychologists in our state.

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From MPA's Past President Scott Palmer, Ph.D., L.P.: Ringing in the New Year with the Minnesota Psychological Association

The Minnesota Psychological Association (MPA) is in great shape and great hands.  Ringing in the New Year inspires us to look ahead to 2016 and gives us the opportunity to reflect on the events that shaped 2015.  As MPA’s President for 2015, I thank you for the opportunity to serve you and am proud to be a psychologist in Minnesota.  Our 2016 MPA President, Robin McLeod, is fantastic and I thank my mentor and friend, Steve Vincent, for serving MPA well as our 2014 President and our 2015 past president.  MPA’s Executive Committee and Governing Council members have worked hard to implement strategic initiatives for 2015.  Our strategic initiatives for 2016 move MPA forward in a way that expands the resources and support for psychologists in Minnesota.  A special thanks to MPA’s Treasurer, Pearl Barner II and to MPA’s secretary, Mimi Sa for their service to you and to MPA.

So what is happening in MPA as we start out the New Year?

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Nominations Open For Three MPA Teaching Awards

Nominations for each of three MPA Teaching Awards (Graduate Faculty in Psychology, Mink Outstanding Undergraduate Teacher Award, Outstanding Teaching of Psychology in Community/Two-Year Colleges) should be submitted to the MPA Office no later than Friday, March 4, 2016.  The criteria and nomination process for each award are outlined below.  Questions can be directed to Jack Rossmann at Macalester College ([email protected]).

MPA Award for Outstanding Graduate Faculty in Psychology

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MPA First Friday Forum - Cognitive Behavioral Therapy for Binge Eating Disorder

“Cognitive Behavioral Therapy for Binge Eating Disorder” was presented at the Minnesota Psychological Association’s First Friday Forum on January 8, 2016. Drs. Koball and Grothe focused on discussing diagnostic criteria for binge eating disorder, reviewed recent research on the efficacy of CBT for binge eating disorder, and described specific CBT skills using pertinent case examples. Finally, they offered information on behavioral weight management for individuals who are in remission from binge eating disorder, but who desire further weight-related intervention.

Binge Eating Disorder (BED) is characterized by episodes of eating in a discrete period of time (e.g., within 2 hours) a larger amount of food than what most people would eat in a similar period of time under similar circumstances (e.g., 4 bowls of cereal, 1 pint of ice cream). Additionally, individuals with BED experience a sense of lack of control over eating during the episode(s) (e.g., feeling that one cannot stop eating or control what or how much one is eating). Furthermore, to meet criteria for BED, binge eating episodes must be associated with 3 or more of the following: 1) eating much more rapidly than normal, 2) eating until feeling uncomfortable full, 3) eating large amounts of food when not feeling physically hungry, 4) eating alone because of feeling embarrassed by how much one is eating, and/or 5) feeling disgusted with oneself, depressed, or very guilty afterward. Finally, marked distress regarding binge episodes must be present to meet diagnostic criteria, binge eating must occur on average at least once a week for 3 months, and binge eating is not associated with recurrent compensatory behaviors (e.g., vomiting or laxative use; APA, 2013). Today, BED is more common in the U.S. than anorexia nervosa or bulimia nervosa, occurs in approximately 3-5 % of women and 2% of men, and is commonly associated with other mental health conditions including low self-esteem, borderline personality disorder, substance abuse, and depression (ANAD, 2012). Individuals who engage in binge eating often struggle to balance eating, and may cycle between periods of significant restrictive eating, episodes of binge eating, and severe guilt and shame.

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Health Care Coverage for Exercise-Based Programs for People with Serious Mental Illness

The Society of Behavioral Medicine (SBM) and American College of Sports Medicine (ACSM) recently released a position statement calling for health plan coverage for exercise interventions for serious mental illness (Pratt et al., 2015).  The position statement states that, “The Society of Behavioral Medicine and the American College of Sports Medicine encourage legislation and policies for Medicare, Medicaid, and private insurers to reimburse exercise programming for people with serious mental illness treated in community mental health programs.”  Currently, exercise programs designed to treat mental illness are not reimbursable through Medicaid, Medicare, or private insurers.

Research indicates that exercise is related to improvements in both physical and mental health (Lobelo et al., 2014).  Specifically, lack of exercise is related to several health issues including increased risk of heart disease, hypertension, and stroke (AHA, 2015).  Regarding mental health, exercise is effective for treating depression (Cooney et al., 2013).  Furthermore, studies have found that exercise is just as effective as antidepressant medication for treating depression (Blumenthal et al., 2007).  Despite these benefits, only 20% of individuals with serious mental health illness exercise at the recommended levels to obtain these health benefits and over 80% are overweight or obese (Bartels & Desilets, 2012; NIH, 2013).  The recommendation is that healthy individuals engage in five or more day of moderate intensity physical activity for at least 30 minutes each session or three or more days of vigorous intensity physical activity for at least 20 minutes per session (Haskell et al., 2007).  Behavioral interventions are efficacious for increasing exercise among individuals with severe mental illness (Rosenbaum et al., 2014); however, these types of interventions are typically not reimbursed by health insurers.

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New Member Spotlight: Vinzetta Williams Jackson

1)  What is your background in psychology (e.g., education)?

I’m currently a student at St. Mary’s University – Rochester. I am working on my bachelors in psychology and plan to obtain my Master’s degree in Organizational Psychology.

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From MPA's President Steve Vincent, Ph.D., L.P.: Continuing a Theme: Connection, Protection and Growth for MPA Members

As you may have recognized from previous pieces I have written for the Minnesota Psychologist Online, I have been thinking a lot about “Connection, Protection and Growth.”  This was the theme for MPA’s annual convention this year, taken from our strategic plan as the statement of what MPA offers members.  Most readers will readily see that this statement leads to a next set of important questions about how we bring these terms—connection, protection and growth—to life.  How do we operationalize them?

One Success Story

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The Zeitgeist from the Eyes of Your President-Elect

When I was an undergraduate psychology major at St. Olaf College, I clearly remember learning a strange sounding word, zeitgeist, defined by Merriam-Webster’s Dictionary as “the general beliefs, ideas, and spirit of a time and place.”  A Ph.D. and 28 years as a psychologist later, this word resonates with me once again.

Zeitgeist:  Reflecting on the spirit of the times, I have heard many psychologists describe this time as a scary yet exciting place for psychologists engaged in the science of psychology and its application.  For psychologists in a therapy or assessment practice, the times are a bit scary because psychologists have seen steady erosion in reimbursement rates over more than a decade.  The times are concerning because the decline in Medicare and Medicaid payment rates is leading psychologists to leave these programs and become highly selective in who they provide care.  Challenging because psychologists in Minnesota are faced with mandates to implement expensive electronic health records (EHR) or to submit outcome measures to a web portal so the results can be shared with the general public.  Yikes, should we all treat anxiety disorders with a more predictable treatment response?

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New Member Spotlight: Mary Garafalo

1)     What is your background in psychology (e.g., education)?

My interest in psychology began in high school when I enrolled in AP Psychology as a senior.  As I made my way through the curriculum, something just clicked and I knew that this was the field for me.  After high school, I continued to study psychology throughout college at the University of Minnesota where I enrolled in courses such as Social Psychology, Cultural Psychology, and the Psychology of Human Sexuality.  Each specific course provided the opportunity for me to expand my psychological knowledge while reinforcing my passion for the field.

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ADHD and Sleep-Related Disturbances: A General Introduction

Sleep-related disturbances are common among children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD; Mick, Biederman, Jetton, & Faraone, 2000).  Recent estimates suggest that approximately one-third of children diagnosed with ADHD experience moderate to severe sleep problems (Sung, Hiscock, Sciberras, & Efron, 2008).  These problems include difficulties initiating sleep, delayed sleep onset, bedtime resistance, maintaining sleep, restlessness during sleep, and chronic tiredness upon awakening from sleep (Corkum, 2001; Lecendreux & Córtese, 2007; Owens, et al., 2009). The causes of sleep-related disturbances range from environmental (e.g., family, neighborhood, school) to psychological (e.g., depression and anxiety) to biological (e.g., obesity and diabetes).  They also frequently result in co-morbidities such as Restless Leg Syndrome, Sleep Disordered Breathing, and/or Periodic Limb Movement Disorder (Chervin, et al., 2002; Córtese, et al., 2005; Konofal, 2008).

Although there appears to be a fairly clear connection between sleep-related disturbances and ADHD, the reasons for this co-morbidity is largely unknown. Research has shown that even subtle changes in the sleep patterns of children diagnosed with ADHD potentially impacts cognitive and psychological development in children (Kirov et al., 2012). Hence, understanding the nature of the co-morbidity between sleep problems and ADHD and the adoption of interventions based on this understanding may improve these children’s quality of life. For example, when it is possible to create a connection between disordered sleep and the effects of stimulant medication used to treat ADHD, medical professionals, educators, and family members may be able to intervene more quickly and more effectively (Cortese et al., 2012).

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In Memoriam: Dorothy Loeffler, Ph.D., ABPP

Dr. Dorothy Loeffler, a past president of the Minnesota Psychological Association (1979-1981), passed away on June 16, 2013.  She earned her Ph.D. in educational psychology (1965) at the University of Minnesota and was employed there at University Counseling and Consulting Services where she worked as a psychologist and Director of Training until her retirement in 1995.  Dr. Loeffler was an adjunct professor in the Department of Educational Psychology.  A highly respected professional, she mentored many young psychologists and modeled how to share energy and expertise.  Dr. Loeffler generously gave her time and energy to make sure that students received the best counseling training and developed excellent research skills.  She demonstrated the responsibility of the profession to support women in their development when she was the founding “mother” of Minnesota Women in Psychology and the creator of the course, “Women a Sense of Identity.”  Dr. Loeffler, an ABPP in psychology, actively served on the national level as a member and fellow in the American Psychological Association (Divisions 37, 31, & 35) and member of Division 20 – Student Personnel Psychology Program.

From MPA's President Steve Vincent, Ph.D., L.P.: A Celebratory Round Trip

A Psychology Celebration in Washington, D.C.

Having recently returned from APA’s State Leadership Conference (SLC) in Washington, D.C., I am again proud of both psychology and Minnesota.  Each year at SLC there are two awards ceremonies which honor, respectively, 1) winners of Psychology Healthy Workplace Awards [PHWA], and 2) individuals and state associations that have made significant contributions to advancing psychology through advocacy.  Minnesota produced winners for each of these ceremonies.

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New Member Spotlight: Justin King

1)      What is your background in psychology (e.g., education)?

I did my undergraduate studies at Gustavus Adolphus College in which I received my B.A. in Psychology.  Afterwards, I attended the Minnesota School of Professional Psychology.  I graduated in 2012 with my doctorate in clinical psychology and became licensed in October of 2013.

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Communities Invested in African American Youth: Strengthening Relationships among Children, Caregivers, and Teachers

On Friday, February 7, 2014, Dr. Willie Winston III and Dr. Sonya S. Brady co-presented at the Minnesota Psychological Association’s First Friday Forum. The title of their presentation was Communities Invested in African American Youth: Strengthening Relationships among Children, Caregivers, and Teachers. The presentation described results from a five-year research partnership between the Minnesota Association of Black Psychologists (ABPsi) and the University of Minnesota School of Public Health, funded by the University of Minnesota Medical School, Program in Health Disparities Research. Minnesota’s ABPsi chapter is a non-profit organization focused on enhancing the well-being of African Americans through social change programs and positive approaches to research. Formative research was conducted in two stages with a partnering elementary school in St. Paul, Minnesota including: (1) Focus groups of 16 African American children and their caregivers to discuss the most important issues affecting the well-being and future success of young people in the African American community; and (2) structured interviews of 46 African American children and caregivers to begin testing a conceptual model informed by empirical literature and clinical experiences of Minnesota ABPsi members. The model posits that externalizing behavior among disadvantaged African American youth may be a response to stressors within the home, school, and community. Inadequate resources may lead professionals to focus solely on children’s behavior, without also addressing underlying affective symptoms, such as depression, related attitudes, and low academic investment. Youth assets and resources for resilience fostered by parents, teachers, and community members may protect youth from negative outcomes. Further, advocacy on the part of caring adults may reduce the likelihood that mental health referrals, diagnoses, and treatments are exclusively focused on behavior.

Dr. Winston and Dr. Brady presented data in support of their conceptual model. Key interview findings discussed with the First Friday Forum audience included the following: (1) When children experience many stressors or have poor relationship quality with their caregiver, children report more symptoms of depression, anxiety, anger, aggression, and rule breaking; (2) When caregivers feel more supported by others in their social networks, children feel more supported by their caregiver; (3) When children feel more supported by teachers, they exhibit fewer externalizing symptoms, are more academically invested, and perform better academically; (4) When African American boys engage in greater levels of problem-focused coping, they perform better academically and have higher standardized test scores; and (5) Different facets of African American identity are associated with academic investment and performance among boys and girls. Key focus group findings discussed with the First Friday Forum audience included the following: (1) It is sometimes difficult for caregivers to acknowledge information suggesting that children are struggling with behavior because this may reflect poorly on the caregiver; (2) children hesitate to trust professionals with their problems, particularly those involving events at home; (3) words such as “depression” and “anxiety” are not used in the African American community, despite the need for help in coping with feelings; (4) teachers and parents need to work together to help children reach their full potential; (5) African American families address racism and discrimination in different ways. Collectively, findings demonstrate a need to strengthen relationships among African American children, caregivers, and teachers. In addition, it is essential that mental health practitioners and other professionals improve the conceptualization and treatment of behavioral problems among youth who experience adversity.

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Creative Minds - Fascinating Journeys

When many of us think of the contributions of Minnesota psychology, the MMPI immediately comes to mind, as it well should — dating back to 1943.  The personal journey of MMPI expert, and now Professor Emeritus, James Butcher exploring Watercolors as a late-life adventure, and the extraordinarily impressive APA governance service of his University of Minnesota colleagues Bruce Overmier and Jo-Ida Hansen, seem equally significant however.  As editor of Psychological Services, I had the pleasure of working closely with Shelia Brandt on behalf of the profession’s public service members.  Having worked on Capitol Hill for nearly four decades, I was very pleased to learn of her growing interest in becoming involved in the public policy process.  This year she is serving as a Humphrey School of Public Affairs Fellow.  Those fortunate to attend the annual Practice Directorate State Leadership Conferences (SLC), which in my judgment are one of the highlights of the APA year, have recently been exposed to the vision and dedication of another explorer, Art Evans, Commissioner of the Department of Behavioral Health and Intellectual Disability Services for the City of Philadelphia.

Arthur C. Evans, Jr. is a psychologist and frontline policymaker who oversees a one billion dollar behavioral healthcare system in Philadelphia.  Growing up in Florida in the 1970s, the unlikely journey that brought the son of a school teacher and an Air Force electronics technician to his current position was somewhat circuitous.  After graduating as a music major at a local community college, his psychology teacher asked him what he planned to do next.  He admitted he didn’t know, but, while he enjoyed the field a great deal, he did not want to major in psychology, because he thought it would take him too long to complete school through to a doctorate.  That brief conversation altered the course of his life as his teacher encouraged him to pursue his real interest and identified a couple of colleges that he could attend, including Florida Atlantic University (FAU) where he would matriculate with a bachelors and master’s degree in experimental psychology.  At FAU he received rigorous training in research, including a year of full time work experience through a co-op at the United States Army Aeromedical Research Laboratory.  He credits this strong scientific foundation to a core belief; that the answers to many of the complex problems that society faces may lie in psychological research.  But, he has observed, the dots between the researchers and those trying to resolve the problems often remain unconnected.

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In Memoriam: Donald H. Blocher, Ph.D.

On November 9, 2013, Donald H. Blocher of Hugo, MN, a highly influential psychologist and my former graduate program advisor, passed away. Don died at the age of 85; he is survived by his wife, Betty, his three children, John (Carolyn), Susan and Mark, and a grandson, Matthew.

A 1959 doctoral graduate of the University of Minnesota, Don had a distinguished career as a scholar and educator in counseling psychology.  Upon the completion of his graduate degree (which was done under the guidance of Dr. Gilbert Wrenn), he took a position at the university where he stayed until 1975—leaving to take a position at the University of Western Ontario.  In 1977 he joined the faculty at the University of Albany where he stayed until he retired in 1991.  He then returned to Minnesota.

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