UT's Psychology Clinic offers students a
chance to learn and patients a chance at treatment
by Carol Owen Bell
Step into the quiet facilities of the University of Tennessee's Psychology
Clinic, and you may wonder if you're in the right place. In the basement
of the Austin Peay Building, the old UT administration building on "the Hill,"
there are no cushy couches, no low-lit waiting rooms playing piped-in music.
The clinic's quarters are indistinguishable from any other campus offices.
There's the concrete block, fluorescent lights, and straight-backed '70s-era
chairs, but in the private suites which once served as faculty offices, graduate
students in psychology, social work, school psychology, and counseling psychology
(the last two in separate departments from psychology) provide therapy for
their patients.
The students are all in the second, third, or fourth year of their programs.
All are versed in the interviewing and assessment skills necessary to practicing
psychotherapy. All are closely supervised by faculty. Each session is videotaped
for evaluation later by the student and his or her supervisor.
The clinic's mission is to provide low-cost, quality treatment for the working
poor, and its fees are set on a sliding scale based on income. Fees can be
as low as $10 a session for someone who makes $15,000 a year. The low fees
are possible because of the clinic's status as a training program and because
its expenses are absorbed in the budget of the psychology department. (The
clinic does not accept insurance.) In an era when the need for mental health
care at all levels of society is increasingly recognized but access to that
care remains limited, the clinic helps fill in some of the gaps for Knoxville
families and students.
The clinic turns 50 this year. Its roots reach to the end of the Second World
War, when Dr. T. Ernest Newland was discharged from the U.S. Navy and able
to return to his first lovechild psychology.
Hired as a psychology professor at the University of Tennessee, Newland took
charge of the department's new clinical training program for Ph.D. students
and in 1948 began one of the first university-affiliated psychological clinics
in the Southeast.
Because of Newland's focus on children, they became the special emphasis
of the clinic. Within a couple of years, it was known in the community as
the place to take children for behavioral treatment and intelligence testing,
remembers Dr. Kenneth Newton, now retired but a member of the psychology
faculty when the clinic began.
From the beginning, Newland and the other faculty designed the clinic to
give Ph.D. psychology students the hands-on training they would need to practice
psychotherapy after graduation. Though the clinic's clientele emphasis switched
to adults in the early 1950s and the number of departments participating
has expanded, students, closely supervised by faculty, for a half-century
now have been providing low-cost psychological assessment and treatment to
the campus and the Knoxville community.
The profile of the patients at the clinic varies widely, as do the problems
for which they seek treatment. One person might be an uninsured minimum-wage
worker who suffers from depression symptoms and needs help but cannot afford
a private therapist. Another is a student who is having trouble adjusting
to being away from home from the first time and might have been referred
to the clinic for more extensive treatment by the free UT Student Counseling
Center. A clinic patient might be someone who has insurance and was seeing
a private therapist but who reached the limit on what their insurance company
would reimburse and still needed further therapy sessions to deal with a
relationship problem. Patients also include couples seeking affordable marriage
or family counseling.
Sitting relaxed in one of the UT Psychological Clinic's offices in suit and
tie, Dr. Leonard Handler, its director and a psychology professor, is passionate
about why he believes in it. "This is a good bargain, but the nice thing
about it is these graduate students have a tremendous amount of heart and
spirit. Since they're training, they want to do an outstanding job. They're
not worn out and tired like someone might be who's been around for a long
time and may be a little jaded...The supervisors want to do a good job because
we're interested in training. That's our life's work," Handler says.
In the 1970s, psychoanalysis became synonymous with the well-heeled urban
professional, spoofed so well by Woody Allen movies such as Annie Hall.
The truth is, clinic workers say, that the need for mental health care knows
no socioeconomic bounds. According to the National Institute of Mental Health,
one in five Americans has some form of mental illness in any given six months.
Going to a therapist has become less stigmatized in the past 50 years. At
the same time, societal changes such as downsizing, job layoffs, dual income
families with time pressures, and a fast-paced life have created stresses
for people resulting in great demand for psychological treatment, local
psychologists and social work professionals say.
At the same time, managed health care policies have diminished access. For
example, a person who had no insurance coverage used to be able to go to
a mental health clinic such as Overlook Center or Helen Ross McNabb Center,
Inc., and receive affordable treatment.
"They had funds in their budgets to include the uninsured in their practice
along with those who had private pay insurance," says Dr. Rob McDonald, the
medical director at Interfaith Health Clinic, which offers the complete range
of medical services, including mental health care, to the uninsured of Knoxville.
"With Tenncare, funds were cut drastically. Now the mental health clinics
must charge $75-$100 a session on a sliding scale. That's a lot of money
for some people. The requests for mental health care at our clinic have increased
since Tenncare was established."
Interfaith and the UT Psychological Clinic often cross refer patients, depending
on which site's services most suit the patient's needs. (For example, a patient
who needs medication would have to see a doctor at Interfaith, since students
at the UT clinic cannot write prescriptions.)
Beginning last fall, a new partnership between the psychology, social work,
school psychology, and counseling psychology programs at UT put more graduate
student therapists in the university clinic and thus expanded the number
of patients who could be treated.
Making it possible for more people to receive treatment played a role in
the merger, but economics also figured in the motivation, Handler says. Because
of the recent budget crisis at UT and drastic cuts, the clinic was left with
little operating budget. In order to generate more income, it had to be possible
to see more patients. "But the more we thought about it, the more it made
very good sense to have an interdisciplinary clinic. I think even if our
budget were to be restored, we'd still prefer to do it this way," Handler
says.
Frank Castlebury, a fourth-year doctoral student in psychology and clinic
coordinator, has the kind of soothing voice you can envision immediately
putting a patient at ease. Speaking from his pleasingly pastel-painted office
at the clinic, containing the only actual couch in evidence, he says that
UT's clinic is one of the few such in the country, that not all university
psychology programs have training clinics for their graduate students.
Castlebury says he has seen 15 clients at the clinic during his time there,
two for about two years each. He says the problems he has treated range widely
but that relationship issues are common among the clinic's patients.
Dinah Davidson, a second year master's student in social work, started working
in the clinic in late August last year as part of the new partnership. She
had been in advertising for 20 years before deciding to make a major career
change. After spending the first year learning the interviewing and assessment
skills needed for administering psychotherapy to individuals, groups, and
families, she is now treating five patients.
"The sliding scale [for fees] plus the supervision we receive makes the clinic
the best mental health care you can get at really reduced rates, even at
the top of the sliding scale. The clinic's chief benefit is that quality,"
Davidson says. The collaboration between students from four different programs
is a great strength of the clinic because most of the settings students work
in after graduation are interdisciplinary, she says. For example, most clinical
social work students go into practice with a human service agency that would
probably also have psychologists on staff.
Rob Riethmiller, a third-year psychology student whose fast-talking rhythm
quickly reveals his enthusiasm for his chosen career, is also upbeat about
his work at the clinic but honest about what may be too ideal a situation.
"My experience at the clinic is that we have a lot of luxuries we won't have
in the field. We don't have to be concerned about income so we are able to
take the time, in some circumstances, to do a full assessment of a patient's
needs. Since we're not working with insurance companies, we can do [more]."
He says insurance companies now expect psychologists to be expert enough
to understand what the patient needs without testing; traditionally, assessment
has been an important part of diagnosing a patient for psychological treatment.
Riethmiller says the feeling among many professionals, though not all, is
that the current managed care climate is turning therapists into "family
practitioners" who are expected to administer "crisis intervention" rather
than treatment.
"I'm glad to be working in the clinic and to be able to see a patient long-term
and consult a supervisor. That helps me to understand what a patient really
needs, the intricacies in patients' responsibilities," he says.
The trend in insurance coverage is to limit reimbursement for mental health
care to 50 percent (as opposed to 80 percent for medical problems) and cap
the costs insurers will pay at well below a therapist's fees, which, outside
the clinics, range from $60-90 locally for a 50-minute session. In addition,
insurance companies may limit their coverage to a certain number of outpatient
visits a year.
That's what makes the services of the UT Psychological Clinic so crucial,
its students and faculty say. For people who need help but feel priced out
of private practice because of their insurance coverage or their own limited
means, it's an avenue of help.
The UT Psychological Clinic is open Monday through Thursday from 8 a.m.
to 8 p.m. and Friday from 8 a.m. to 5 p.m. The first visit, a "get acquainted"
session," is $10 with fees for following sessions set according to the patient's
income. The clinic is located at Room 227, Austin Peay Building, on the UT
campus. The phone number is 974-2161.
The clinic is not set up to accept insurance for payment and cannot accept
people for treatment who cannot pay anything. For that reason, the clinic
seeks donations from anyone who is willing to give, in order to offer care
to people who cannot afford the lowest fee on the sliding scale. Currently,
they have to be turned away.
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