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 love—child 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.