Cognitive and Behavioral Psychology
Robert Vanacek, Ph.D., ABPP
Cognitive & Behavioral Psychology
Q. What motivated you to seek board certification in Cognitive-Behavioral Psychology?
Motivation for seeking board certification was driven by two primary factors. First was frustration with the usual continuing education (CE) process. Completing on-line courses met the state's CE requirement but added nominally to my knowledge. Conference attendance represented an obvious improvement over the on-line option. However, following years of this same old routine, I wanted something a bit more challenging and gratifying. The process of listening to several recorded psychotherapy sessions, something I had not done in years, while trying to choose one for submission as a practice sample was eye-opening. I noticed things about my style of interaction with patients that had previously gone unrecognized and was able to make some refinements. The usefulness of the oral exam cannot be underestimated. Talking with seasoned experts about theory, therapy and ethics was far more enriching than any on-line course, or even conference, has ever been. In short, certification far exceeded my expectations as a quality continuing education experience.
A second motivation was to increase my usefulness as a mentor to junior psychologists. One of the most positive aspects of my postdoctoral fellowship has been supervising interns and helping them develop as clinicians and officers. A strong desire to continue in this role led me to consider the experiences I might need to offer useful advice beyond the internship year. Board certification seemed to be a logical step. Since my initial certification, I have conducted didactics on the topic of board certification in hopes of creating the expectation that meeting the board is a natural and reasonable step in any psychologist’s professional development. My hope is to become active in the organization in order to gain further experience to assist others who choose to seek diplomat status.
Q. Having attained board certification, looking back, what was your greatest misconception about the ABPP or the credentialing process?
My initial expectation that the board process, particularly the oral examination, would be adversarial in nature or that certification required an intense, unpleasant interrogation designed to expose my flaws could not have been further from the truth. Persons associated with ABPP were generous and collegial in nature at every turn. I was given a contact/mentor who answered numerous questions about requirements for the practice sample and what to expect during the oral exam. Despite my own unwarranted anxiety, the oral exam was very pleasant and interesting. Though the purpose was to ensure that I had an explicit and coherent rationale for my work, the examination was conducted in a manner the conveyed respect and a sincere desire that I do well. In retrospect, it was a rare opportunity to talk with distinguished psychologists about the common work that we do.
Q. What advice would you give to a candidate for board certification in Cognitive-Behavioral psychology?
My first piece of general advice is that all eligible psychologists should consider certification. It is a great experience for professional development. Secondly, do not be reluctant to contact a board representative and ask questions at any point during the process.
In terms of more focused recommendations, applicants should consider a few points while preparing their practice sample, which can represent the greatest barrier to final certification. Difficulties encountered during this step could be based on uncertainty about what examiners would want to see or hear in a recorded session and unrealistic expectations that any submission must be perfect. Regarding the first issue, choose a session in which you do good, solid clinical work. There is no need to submit an “amazing” session or one in which you address a very unusual situation. The board’s goal is to ensure that applicants can deliver therapy with a high degree of competence and quality. This includes having a thoughtful, reasoned rationale for what is done with the patient. The content of work samples does not have to be something that is rare or exotic and should reflect the applicant’s customary practice. Likewise, perfection is not a requirement. Examiners are aware that few sessions are conducted perfectly and that work can be very good without being perfect. My approach was to record a handful of sessions and submit the one that I felt most confident about. Lastly, be certain that the practice sample contains no identifying information and have a peer review the material prior to submission.
Q. What did you learn about yourself and your practice while doing the board certification?
I would have to say that I have obtained a greater degree of self-confidence following certification. There was never any doubt that I had been blessed with talented teachers and mentors. However, I have not been immune to cognitive distortions. The patients who did not do well stood out in my mind and probably exerted undue influence on my self-critique. I wondered, “Did I learn everything I was supposed to have learned? Did I drift from the example set by my instructors?” What I learned during certification is that I have not drifted from my training. I have learned that you do not have to have all of the answers all the time and do not have to be perfect (because the practice sample I submitted certainly was not perfect) in order to be doing well. My approach to uncertainty in a case, including research, consultation with trusted peers and hypothesis testing, was confirmed as appropriate. I learned that my capacity for self-evaluation, while representing a strength in support of continued professional development, may have been applied too inflexibly and without appropriate recognition of successes. In summary, the detailed examination of my work by others has led to a more balanced and accepting self-perception.
Q. What is your practice like?
Currently, I am completing the last few months of the Air Force’s 2-year Clinical Health Psychology postdoctoral fellowship at Lackland Air Force Base in San Antonio, Texas, and the diverse nature of my practice reflects the fellowship goals. The first year included rotations in cardiac/pulmonary rehabilitation, diabetes management, tobacco cessation, treatment of chronic pain and insomnia, primary care behavioral health, pre-surgical evaluations, biofeedback and weight/fitness management. Most of these rotations involved working closely with physicians to deliver interdisciplinary care. The second year has been more flexible, allowing me to pursue personal interests in developing groups for mindfulness-based stress management and behavioral management of chemotherapy side effects. I have also been able to establish a memory screening clinic that provides basic neuropsychological testing and manage the Air Force’s Behavioral Health Optimization Program (BHOP), which supports 84 military and contract providers at 51 bases who deliver behavioral health services in primary care clinics. The fellowship allowed pursuit of two personal research projects and work on two federally-funded grants. Close collaboration with nationally known experts in tobacco cessation research and behavioral health in primary care were unexpected bonuses. Careful mentoring was provided by highly experienced psychologists to expand my skills in research and supervision of residents as well as clinical work with active duty personnel, their family members and retirees.
Though the fellowship has offered a diversity of rich experiences that is not duplicated anywhere else, it faithfully reflects the variety of opportunities that characterize work in the Air Force. Ten years as an Air Force psychologist has afforded many opportunities that would not have been available elsewhere. During that time I have been lucky enough to serve at 3 overseas locations including Korea, Guam and Okinawa. Travel and participating in other cultures has been incredibly rewarding. More importantly, the richness of my clinical experiences has been enhanced in those locations. I have been able to manage two outpatient mental health clinics where a lack of community resources meant that any issues that arose were mine to manage. Involvement in a wide range of community psychology efforts, in addition to the usual patient care that is so characteristic of small mental health clinics, ensured that there were always plenty of new opportunities. An exciting balance of patient care (in individual and group formats), research, organizational consultation and project management has always prevented boredom and kept me pushing forward into new things.
Q. What is the most interesting/challenging/rewarding/fulfilling aspect of your work as a psychologist?
As may be true for many psychologists, the most rewarding and interesting aspect of my work is helping others overcome barriers to achieve a better quality of life. The basics of this work, the application of fundamental research and clinical skills, are probably no different from those of someone practicing in non-military settings. The details of that work can be thrilling. I have coached a patient in management of motion sickness while flying a night mission in the back of a C-130 cargo plane. Talk about in-vivo! On many occasions, particularly in places where I was the only psychologist and having few resources, I have been asked to address specific problems for the base community or individual units. Examples include developing programs to treat gas mask claustrophobia, improving the mental health response to disasters, reestablishing outpatient substance abuse treatment or implementing an island evacuation plan for over 200 families. Recent questions from a General Officer about the utility of screening for PTSD symptoms in dental clinics led to research examining the relationships between symptoms of PTSD, orofacial pain and deployment history. Essentially, working in the military provides exposure to a wide range of issues that may not be encountered elsewhere. While that can be intimidating, it keeps one on their toes, promotes learning and expansion of skills, and is extremely gratifying when your efforts result in improvements for individuals and communities. Luckily, the Air Force includes a network of experienced clinicians who willingly provide supervision and assistance when novel situations arise.
Most importantly, my work serves a courageous and deserving group of people. Among them are active duty members who work long, hard hours and endure the sacrifice of extended separation from their families in order to protect a nation that I love and champion the ideals of freedom. Likewise, I am able to help retired service members who met the challenges of their day in heroic fashion that has deservedly earned them the title of "the greatest generation." Lastly, I have the honor of serving the family members of retired and active duty persons. These are the often unrecognized heroes who trade careers and friendships in favor of frequent moves to support the work of their spouses. These are the laudable people who manage home and children alone while their wives and husbands spend months, in some cases 18 months at a time, in foreign lands serving their country. I have no doubt that there are many other places to find wonderful, rewarding work in psychology. However, I am certain that none could ever be as personally fulfilling or provide the variety of opportunity as service in the Air Force.