Heritage Professional AssociatesHow has managed care impacted the independent practice of psychology? The present article reports on data from 2 national surveys (from 1996 and 2001) that address this question. Both surveys indicated that managed care was a source of stress, with external constraints, paperwork, and managed care reimbursement being the most highly rated stresses. These stresses had not increased in the 5 years between surveys, and the most recent survey suggested that, overall, psychologists did not report high levels of burnout. However, in contrast to respondents with low managed care involvement, respondents with high managed care caseloads worked longer hours, had more client contact, received less supervision, reported more negative client behaviors, experienced more stress, were less satisfied with their incomes, and scored higher on emotional exhaustion. Implications for burnout are discussed. PATRICIA A. RUPERT received her PhD in clinical psychology from the University of Kansas and is currently an associate professor of psychology at Loyola University of Chicago. Her research interests include professional ethics and factors related to burnout among professional psychologists. KEITH A. BAIRD received his PhD in clinical psychology from Loyola University of Chicago and is currently in private practice at Heritage Professional Associates in Chicago and the surrounding suburbs. His research interests include professional ethics and clinical decision making.

Heritage Professional AssociatesThis survey examined an array of Illinois psychologists' attitudes regarding prescription privileges. Of the licensed psychologists in the state, 25% (n ϭ 890) were randomly selected to receive the survey, and a return rate of 37.8% was obtained. A total of 61.2% of the responding psychologists endorsed prescription privileges; 25.9% planned to prescribe once trained. Years of experience, theoretical orientation, and the population density of a psychologist's county were not significant variables affecting the desire to prescribe. The sample was evenly divided over whether there were enough qualified physicians to prescribe psychotropic medication to their clients. However, regardless of their status as an urban or rural psychologist, those most likely to prescribe indicated that there were not enough qualified physicians in their locale. Compared with the general population, psychologists are overrepresented in the most urban areas and underrepresented in the nonmetro areas of Illinois. Because more psychologists endorsed prescription privileges (61.2%) than reported that there were not enough qualified physicians (40.9%), there are other variables affecting prescription privilege attitudes that warrant further investigation.

Psychologist'! in seven states were surveyed regarding their management of confidentiality in general and in specific situations that challenge confidentiality. The 188 respondents indicated a high regard for the confidentiality of the psychotherapy relationship and a reluctance to disclose information without the client's consent. In response to only two situations, consulting a colleague and dealing with a potentially dangerous client, were psychologists willing to consider disclosure of information without consent. There was considerable variability in how respondents inform their clients about confidentiality, with hall' either alluding to or mentioning specific limits of confidentiality from the outset of the psychotherapy relationship and the other half either saying nothing at all or indicating that everything is confidential. Previous experience with breaches of confidentiality appeared to influence psychologists' general approach to informing about confidentiality. In a situation relating to potential dangerousness, theoretical orientation and potential target of harm emerged as important factors in determining information given about confidentiality.Although the concept of confidentiality is central to the provision of psychological services, the client's right to privacy increasingly has been called into question as various forces in society seek access to and disclosure of confidential information. Of particular concern are pressures exerted by the legal system to reveal information in order to protect society from potentially harmful people. In this regard, probably no legal event has raised more questions about the confidentiality of the psychotherapy relationship than the Tarasoffcax in California (Tarosoff v. Board of Regents of the University of California, 1974). This case, in which a therapist was held liable for a murder committed by a former client, poses a challenge to the confidentiality of the psychotherapy relationship by establishing a legal precedent for requiring a therapist to break confidentiality if he or she assesses danger to another person.The profession of psychology does not have clear guidelines for dealing with the increasing challenges to confidentiality. The Ethical Principles of Psychologists (American Psychological Association, 198 la) states that psychologists should reveal KEITH A. BAIRD received his doctorate from Loyola University of Chicago in 1985. He is currently a staff psychologist at the Illinois Masonic Medical Center in Chicago and in private practice in La-Grange, Illinois. He provides training to interns in professional issues and ethics.

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